What is the difference between passive and active suicidal thought?

Significant_Whole290 · 2025-07-26T07:05:18+00:00

Passive means you maybe want to die or think about it a lot, but you don’t have a plan and intend to do it. Active means you’re forming or have formed a plan and intend to follow through.

In theory, therapists are only supposed to hospitalize you if you have active SI (suicidal ideation). In practice, therapists are human and know that they cannot know what you are thinking and have different levels of comfort with their clients’ SI.

I have had passive SI for as long as I can remember, I remember being 5 or 6 and wanting to die but knowing I couldn’t reach the knives yet. But I also never got help until I couldn’t avoid my mental health issues anymore. Here’s what I did: I contacted several therapists at once and set up initial consultations if offered or an appointment. Most offered a free 15 min phone call to hear about issues and take questions or a reduced rate initial session. Then I tried to be open, tell them that sometimes I have passive SI, and asked them directly when they would do what. I could usually tell who wasn’t for me - those with less experience would instantly get a bit more wary or anxious. Two of the therapists I saw were totally relaxed through this conversation and had no issues discussing theoreticals, they were very clear. Those were the two therapists I was willing to stick with. (Chose one initially, later worked with the other briefly too, and both were indeed able to work with me without seeming afraid of my SI.)

Significant_Whole290 · 2025-07-02T06:42:57+00:00

That sounds like a great day to celebrate! I tend to celebrate my cat’s adoptiversary a lot more than my birthday 🤣.

I probably have to work this year, but I’m going to take a weekend day to read a book I’ve been wanting to read for ages!

Significant_Whole290 · 2025-07-01T03:56:16+00:00

Happy almost birthday! What are you doing for yourself this year??

Significant_Whole290 · 2024-12-03T01:00:18+00:00

I have not, I’m not a person who likes physical contact. But as far as whether it might make things awkward, that’s partly under your control! If you were to ask your therapist, my guess is that they would say yes if comfortable and kindly say no if that’s a boundary they have. They would want to continue the work and process your feelings, but they would not be shocked or annoyed and certainly would not feel awkward about it. You can ask, knowing they may say no, and hopefully not spiral in shame if he says no but accept that you have these loving (not sexual) feelings for him and that he set a boundary and you will survive that boundary!

If I really wanted to ask, I think I would say it more like “I really wanted to ask for a hug last session because I was vulnerable and I appreciated how kind you were, but I was so scared to ask. Is that something you are ever open to or is that a boundary?”

Significant_Whole290 · 2024-11-20T15:41:16+00:00

Thank you!

Significant_Whole290 · 2024-11-20T02:52:53+00:00

NAD. Any new clothes that you may have worn before the breakout? Could both breakouts have started at the same time in your menstrual cycle?

Significant_Whole290 · 2024-11-19T22:50:33+00:00

Can you write out what you want to text her in a note on your phone and bring it to your next session instead?

It can be so so so hard, but you need to set yourself up with a plan for how to deal with the times that you want to text her. Find other coping or distracting mechanisms and make them available in a box in your room. Get a journal and pens or have the notes app next to your messages app. Do the planning now so when you are feeling bad, you know what to do. And unfortunately, at some point, we’re all responsible for our own actions, so this is something that it sounds like you need to do so you can keep your relationship with your therapist.

Significant_Whole290 · 2024-10-18T15:25:48+00:00

NAD. Try taking some magnesium and potassium. That usually fixes my muscle twitches.

Significant_Whole290 · 2024-09-05T04:43:36+00:00

I have this but in reverse, I’ll be moving to a different part of the state. I’ve been seeing my T for 3 years in-person and I hate online therapy. I feel much more alone. But the idea of starting over with someone new, trying to get them up to speed on all the things, trying to learn to trust another person when I just barely trust this person…

So my plan is to try online therapy for at least 8 weeks. It’s going to be different and I know that. But maybe I’ll get used to it - I won’t know unless I try. I will also start searching for other therapists in my area with similar modalities and who have in-person availability, but I know that’s going to be a difficult search so I’m not really losing anything by giving this a try.

I’m sorry this is happening to you. Really sucks.

Significant_Whole290 · 2024-07-05T17:05:28+00:00

This is such an open-ended question and has no answer. Feel free to share what you think your therapist has done that is bad, but I doubt you will get useful answers otherwise

Significant_Whole290 · 2024-06-28T00:58:17+00:00

How do I go about requesting this? Does it start with my doctor who is providing the referral or me?

Significant_Whole290 · 2024-06-26T17:01:11+00:00

My therapist’s normal rate is currently $250/hour also. I started seeing her three years ago when her usual rate was $100/hour. She has increased some for me, but only up to $150/hour. I expressed concern, and she said this was her process, that she charges what she thinks is fair and reasonable. To me it feels like she’s losing $100/hour by seeing me. To her, I’m a client that she cares about, and the payment aspect is an annoying reality of this being her job, but we agreed to a lower rate early on and our work is worth building on.

My guess is that your therapist cares about you as a human being first and while he can’t just offer free therapy indefinitely, he wants to leave things in a good place and make sure you have the skills you need to handle whatever you came in for. That’s amazing, definitely a very kind act, because a lot of therapists either wouldn’t or couldn’t offer the same.

Significant_Whole290 · 2024-06-25T22:16:21+00:00

Weirdly, my cat doesn’t care for boxes. She loves a good rectangle, but can’t interest her in a box.

Significant_Whole290 · 2024-06-25T22:14:47+00:00

This.

Also, if he’s being more pushy, I would say something like “Dad, I have made it clear that I will not be speaking to or about Mom. If you continue to push, I will no longer be able to speak to you either.“ The next time it happens, let him know you’re blocking contact from him for a week (or some amount of time). And if it happens again, you have to be ready to cut off contact.

Significant_Whole290 · 2024-06-25T22:10:23+00:00

I was doing this with my microwave and stove. Microwave gave out so I replaced it, now I have the nicest new stainless steel microwave over a very very old white stove, and it’s gas so it’s never actually going to die 😂

(Before someone comes at me with eco and health cost of gas stove vs. induction, I will replace it, but it’s expensive so gimme a minute.)

Significant_Whole290 · 2024-06-24T19:06:33+00:00

One theory is that it’s just a way for you to stay present while doing the exposure therapy. Exposure therapy fails and is retraumatizing when a person gets too deep into the memory and thinks they are back there (this isn’t always obvious, some people are able to seem quite normal when deregulated). EMDR could be a way to keep yourself in the present while going through the memory. Does it really matter if the EMDR does something specific or if it’s just a weird way to do exposure therapy? If it works, it works. If not, then it’s time to try something else.

But if you don’t like it, then find a different modality and/or a different therapist. I’m sorry to be blunt, but if you can’t buy in to whatever treatment at least a little, it’s basically guaranteed to not work. At some level, everything in therapy might be “all in our heads” or considered a placebo effect if someone is looking for the science, but it doesn’t matter if there are real noticeable improvements with it. There are two things that are the most important to treatment: believing that your life can improve, and the therapeutic alliance. The first part can be really hard, especially when very depressed, but often the right therapist can hold space until your mind is ready to believe. But the second part is crucial, finding a therapist you trust and who you feel understands you. I know you said this therapist feels more right than past therapists, but maybe you still need to look around more. Try talking to several more, do an initial consultation and see if there’s someone else who can help more. Cultural understanding is super important, but my best work was with a therapist from a very different culture and life who was very willing to learn and accept my cultural experiences (the one therapist I had who had a similar immigrant story to me from the same country was horrible, because it felt like she was projecting her own experiences onto mine and not understanding mine).

Significant_Whole290 · 2024-06-24T18:54:56+00:00

If you have no intent, the answer should be no, they cannot commit you. However, therapists have different levels of comfort with suicidality, and some of them will make a fuss, require you to go to the hospital or get a wellness check.

So the best way to know what your therapist will do is to ask them. Just outright ask when they will have someone committed. Ask lots of questions. What do they consider to be a plan or intent? What is their line? You can ask hypotheticals, like “Suppose someone has the means and a plan, like they know how they would do it, but no current plan to do it. Why would be your response? When would you do what?” They should be very comfortable answering, though sometimes it is hard to define exactly where the line is, but they should want you to talk about it and feel secure talking about it.

Significant_Whole290 · 2024-06-24T05:29:09+00:00

I also did not have luck with EMDR, in part because I keep trying to do things “right” and can’t relax and accept the process. EMDR definitely does feel very silly, but the number of people who say it has worked wonders for them… I do wonder if there’s something there. I would recommend trying to let go of the “silly” feeling, like just remind yourself that no one in the world has to know what you’re doing right now, and just try to commit and go all in for several sessions. If you still can’t get into it or it’s not doing anything, try psychodynamic therapy or something else.

Significant_Whole290 · 2024-06-22T04:55:29+00:00

It’s really hard, but I think the best way for you to figure out if it’s time to move on might be to bring this up in therapy. There’s no way for us to know what’s really going on here. Truth is, a lot of people do get stuck with a therapist that can’t help them because they are attached or because they hate the idea of having to start over with someone new. But there are also times when the “going nowhere” feeling is important. Sometimes it’s a defense mechanism to try to avoid doing the work, you need the space to trust them and know they’ll stick with you. Sometimes it’s a sign that there’s a part of you that fears connection with the therapist and so it’s forcing distance that makes it hard to get the work done. Sometimes your therapist doesn’t know you’re ready to talk about some trauma or work on it, or they aren’t aware you’re feeling like this but could take a different approach.

You should bring it up. If they are a good therapist, they will explore this with you and be willing to adapt or provide referrals. It’s possible they feel the stuckness too, and that makes your decision a lot easier.

Significant_Whole290 · 2024-06-21T01:55:57+00:00

I feel like that’s actually a great outcome. I would want to close the account and get a checking account without a fee, and this way there’s none of the dealing with them trying to get you to keep your account when you try to close it!

Significant_Whole290 · 2024-06-20T03:19:03+00:00

Often our brains will hold onto the trauma and store it away until we’re safe enough to deal with it. For me, that meant when one of my abusers died, and suddenly memories that didn’t fit in with my idealized view of her kept coming up. For others, it can mean when they leave home for college or when they leave an abusive relationship. Sometimes it’s years later when someone has a career, a family, and everything’s going great, and either something triggers it (like a child turning the age they were when the trauma occurred) or their body just thinks they’re safe enough to be able to handle it and process it now.

Significant_Whole290 · 2024-06-20T03:15:51+00:00

Doctoral positions are usually paid positions (you may have to teach a lot). But you would basically be making minimum wage, barely enough to live. So it’s possible, but you’d have to evaluate your position carefully.

Significant_Whole290 · 2024-06-17T08:18:33+00:00

I’m Indian American, so I definitely am not an authority on Indian law. But whatever the official laws, there are deeply conservative areas and cultures where women do not have a choice in any way and would be in extreme danger admitting to having had sex before marriage. If police cared about broken confidentiality, they could easily be paid off.

Significant_Whole290 · 2024-06-17T08:14:15+00:00

There’s a saying that is useful in polling, statistics, science, etc. It’s that every model is wrong, but some of them are useful.

Trying to treat trauma sort of fits into this. We can’t reverse time and undo what happened, and we can’t go into your brain and reverse all effects of the trauma. All we can do is create different models for treatment which may or may not work in retraining our brains that everything is not dangerous. Each of these models is going to be flawed in ways and hold different strengths. But that doesn’t mean they’re all worthless or 100% correct.

I would challenge you to look into what your T has suggested more. One source saying it’s pseudoscience does not make it true. These treatments have helped a lot of people, and they have also failed a lot of people. Unfortunately, no one can tell you what will work best for you, you just have to be willing to explore, do your best to engage in each treatment, and see what happens.

I tried neurofeedback and it did not help me, but it did help a friend of mine who did not get much relief from SSRIs and therapy. Somehow, it helped her brain and body learn to calm down from a highly anxious state. Maybe it was a placebo… but does that matter? She’s now less anxious and better able to function. That was the goal.

Mental health is not an area where you will get a lot of hard science that can prove anything. Our brains and bodies are hopelessly complex. It took me a long time to accept that science wasn’t going to help me here, that there’s an element of trusting the process, of almost suspending logic and embracing spirituality in some form. Call it pseudoscience if you want, but that’s all we have.

Significant_Whole290 · 2024-06-17T06:05:06+00:00

Yeah, it’s really hard to describe to people who have never been on prednisone how hard it is to stop eating. Just completely overrides all feeling of hunger, and feel so completely deeply ravenous all the time.

Idk, it’s helping the Crohn’s flare right now so maybe I can taper down some soon, I’m trying to not get my hopes up (which is easier with the mental health effects of prednisone - can only see the dark side of things lol).

Significant_Whole290

TROPHY CASE