Smilla

Smilla

Visionary
Apr 30, 2018
2,549
A friend has recently been made to sign a suicide contract—that he will not ctb prior to a specific date, as outlined by his therapist.

I've heard of these but can anyone tell me the point of them from a psychological perspective?

As he said "it's a contract without any contractual penalties"—do these contracts really help patients in therapy?

I'm just curious.
 
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Miss clefable

Enlightened
Aug 23, 2018
1,577
Wtf
 
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Buddyluv19

Experienced
Dec 13, 2018
272
A friend has recently been made to sign a suicide contract—that he will not ctb prior to a specific date, as outlined by his therapist.

I've heard of these but can anyone tell me the point of them from a psychological perspective?

As he said "it's a contract without any contractual penalties"—do these contracts really help patients in therapy?

I'm just curious.

I've had to do a similar thing in the past. I'm sure you know this - but it's just a reminder that a 'therapist' is required by law (talking US here so it may be different in other countries) to report a person if there is a threat of suicide. So I'm guessing that the reason the therapist is asking for a contract is to 'cover his or her ass'.

I don't mean to be sarcastic, but I can't think of any other reason that such a 'non-enforceable' contract would be presented.

As @Miss clefable says- "WTF"
 
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Shewaitsforme

Arcanist
Sep 23, 2018
493
Also from a patients side it can be used to deter the patient from suicide for now. There was a member on here that respected their therapist to the point they couldnt CTB around the date of the their therapists sons wedding. Could by the therapist more time ie think the patient has signed that they wont untill a date months away, thats months more treatment availability
 
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Smilla

Smilla

Visionary
Apr 30, 2018
2,549
Also from a patients side it can be used to deter the patient from suicide for now. There was a member on here that respected their therapist to the point they couldnt CTB around the date of the their therapists sons wedding. Could by the therapist more time ie think the patient has signed that they wont untill a date months away, thats months more treatment availability

This is clever—it's a way of buying more time, hadn't thought of that. Thanks.
 
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Buddyluv19

Experienced
Dec 13, 2018
272
Also from a patients side it can be used to deter the patient from suicide for now. There was a member on here that respected their therapist to the point they couldnt CTB around the date of the their therapists sons wedding. Could by the therapist more time ie think the patient has signed that they wont untill a date months away, thats months more treatment availability

Thank you for the additional perspective. This is a very important perspective. Just because I've run out of faith in therapy, does not mean it isn't useful for others. Also, it was 'unskillful communication' for me to project my experience onto others. I'm sure there are many therapists that really have the best of intentions for their clients and that this is a means of helping the client seek out all options for help.

Thank you again, @Shewaitsforme, for the post.
 
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Jen Erik

Jen Erik

-
Oct 12, 2018
637
I've seen some clinicians use them coercively, i.e. no contract, no therapy.

but it's just a reminder that a 'therapist' is required by law (talking US here so it may be different in other countries)
Even so, it really is sad how so many clinicians take this to absurd levels of seriousness, with no regard for the difference between suicidal ideation and active suicidality.
 
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Severen

Severen

Enlightened
Jun 30, 2018
1,819
A friend has recently been made to sign a suicide contract—that he will not ctb prior to a specific date, as outlined by his therapist.

I've heard of these but can anyone tell me the point of them from a psychological perspective?

As he said "it's a contract without any contractual penalties"—do these contracts really help patients in therapy?

I'm just curious.

More like so the therapists take less backlash from the suicides...
 
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Justanotherconsumer

Justanotherconsumer

Paragon
Jul 9, 2018
974
Been in that position before they threaten too hospitalize you if do not sign. So it covers there ass and gets you off the hook for being gullible enough to admit your suicidal, at the time it was done nearly with a nod and a wink. Therapy is really quite useless if your reasons for going are outside forces outside of your control, like being held down because of a record ect.
 
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Empty Smile

Empty Smile

The final Bell has rung. Goodbye to all.
Jul 13, 2018
1,785
Wow. These pro-lifers are going to extremes aren't they?
 
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NotWorthLiving

Enlightened
Dec 8, 2018
1,264
Yep. I don't understand why they would want to make someone live against their will though. Like human cruelty??
 
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Xerxes

Xerxes

Invisible
Nov 8, 2018
936
Had to sign one years ago when I was in HS, and then sign another one when I was 25 via court-ordered therapist. It basically just absolves all responsibility and prevents your family from suing the therapist in case you CTB.
 
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AveryConure

AveryConure

Some idiot
May 11, 2018
437
I get a "safety contract" if I'm thinking of suicide and basically if I don't sign it or add anything I get sent to the funny farm. So I do it cause all it is a piece of paper and it's not going to suddenly revive me after I've been dead for several hours or anything.
 
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NotWorthLiving

Enlightened
Dec 8, 2018
1,264
My parents wanted me to sign an anti suicide contract. They said it would just mean that if I was thinking about suicide I'd have to see them first. I said no. I'm not even sure if it actually does exist or what the point of it would be since the one with therapists is to cover their own asses.
 
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Eden2k

Eden2k

Experienced
Nov 20, 2018
228
I think I did something similar, with an offender I was supervising when in my last job. He was a young man, about 21-22. He would tell me over the phone that he took an overdose, after an argument with his mother or he was going to take an overdose, Or if I didn't rearrange my other supervision sessions with other offenders, to fit him in he would threaten to harm himself. He did this often. You would think I didn't have a case load of 60+ high risk offenders to supervise, but anyway.

Although this was mainly for my attention, i didn't want to take the chance that he would actually harm himself or worst. I spoke to my senior manager, who told me to "create" a contract of sorts, that stipulated that if this person phoned the office and informed me that he had taken an overdose or threatened to harm himself again, I was obligated to contact the emergency services, police, his doctor. Of course the offender had to agree to this by signing this stupid contract that I created as a word document, within 10-mins.

After signing made up contract, offender contacted me to say he took all his mothers medication. I immediately contacted emergency services and the police. I received a phone call from the police, shortly after, saying that the offender was alive and well and having a beer with his mother.
 
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TAW122

TAW122

Emissary of the right to die.
Aug 30, 2018
6,849
I've never had to sign one, but when I was at uni and the topic of resentment and what not came up and the therapist suspected that something bad might happen, she asked if I planned to harm myself or others, and of course I answered no. She then said that if I had answered yes, then she would have to make a safety contract. I have never insinuated that I wanted to harm others or myself and when she did that, I stopped going to her. This was several years ago when I was a graduate student.
 
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Nanami

Nanami

Global Mod
Nov 20, 2018
110
I've had to sign one of these before. Was told the therapist would refuse to see me if I didn't sign it, so I did.

In all honesty it was as meaningless as websites asking you if you are over 18.
 
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Smilla

Smilla

Visionary
Apr 30, 2018
2,549
Thanks for all of your responses.

When I was in therapy I wasn't even asked about suicidal ideation or intent so this is a topic I am unfamiliar with (therapy contracts etc), and I hope your responses help my friend because he actually likes his therapist, or so it seems—so I hope he can take in these perspectives and make his own informed judgement about his own treatment.
 
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peachesNpoison

peachesNpoison

Student
Dec 25, 2018
115
that sounds like typical dumb therapist horseshit to me. Like someone pointed out, it's just a psychological play to "buy more time" but I bet it's counterproductive in reality because tricking someone doesn't help with trust. I think it's really about the therapist trying too hard to be clever and make themselves feel smart. Whoever came up with it and put it on the internet for other misguided therapists probably has a picture on his wall of robin williams and matt damon cry-hugging from Good Will Hunting.

The issue with therapists when dealing with people who are suicidal is that, ideally, they should be allowed to speak openly without being forced by law to report anything. If they changed the laws, they could get an honest discussion and either address problems and solutions or accept that the person doesn't want to or can't. Either way, there's already a trust barrier there that no one can help because of the law.

So when I experience something like a therapist wanting me to promise XX time or whatever I just want to be like "this isn't helping, it's counterproductive, there's already an inherent trust issue, and you're only making it worse. Speak to me like another adult, with respect and validation for my thoughts and feelings, or stop wasting both our time."
 
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AveryConure

AveryConure

Some idiot
May 11, 2018
437
Those are just my personal experiences and thoughts about the contracts though. YMMV as usual, but if it helps your friend out and he likes his therapist all the more power to him.
 
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Misanthrope

Misanthrope

Mage
Oct 23, 2018
557
From an insider perspective. Although I wasn't a therapist.

If you are asked to sign a contract of safety it is not really about helping you. It really is just a way for that service to disentangle itself from any blowback if the client does go on to injure or kill themselves. It has no evidentiary value in preventing suicide, but I only know that because I looked into it. There are not many studies on it at all. I think there is an associated view it is helpful though. In some cases it seemed to just piss my clients off further. I can't blame them, it does seem kind of absurd to me.

If a client would not sign it, it would trigger a red flag with the assumption they are in potential danger and I was obligated by internal policy to maybe need to trigger the mental health act at that point or at the very least do a secondary risk assessment. However, it was a judgement call based on if they had also presented with other red flags and what their risk assessment already consisted of. It pretty much came down to if you don't sign this our service maybe can't help you because you are considered to be too much at potential risk.

Something I would explain. Often being told how stupid that is considering the service. I would just nod, mumble something about the joys of bureaucracy and then focus on more practical things once they had signed it.

I also had clients though not sign it because they wanted to provoke the mental health act in the first place, because they already felt entirely ignored and viewed it as a shortcut to inpatient care. That resulted in an entirely different conversation of being informative without telling them what they should or should not do. So I was often supporting what I considered unwise decisions. However, you just get on with it. As we ran a client led service, my personal view on things was irrelevant. Although it was frustrating to be blamed later when I had already outlined the potential outcome and associated risks.
 
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therhydler

therhydler

Enlightened
Dec 7, 2018
1,196
I can't believe this actually exists
 
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TAW122

TAW122

Emissary of the right to die.
Aug 30, 2018
6,849
@Misanthrope This makes a lot of sense. I believe that most therapists, counselors, mental health professionals, healthcare workers, etc. just want to protect themselves from liabilities (legal action, social action, and what not), contrary to what they preach or what society would have one think. Therefore, it is always easier for them and society to blame the patient, victim, or person for not getting better since there is no concrete way of treatment or solving any real issues that a person may have. That was a different point, but back onto the main point, yes they don't care if the patient recovers or not, as long as they can earn money, advance their career while receiving the praises of society and their peers, and not get into trouble, that's all that matters to them. It doesn't matter if the person doesn't get better, but God forbid, if the person wants to die, they would do everything they can to prevent that person from succeeding in their suicide attempt, regardless of the consequences of fallout that the suicidal person has to deal with afterwards.
 
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Pulpit2018

Pulpit2018

Experienced
Oct 8, 2018
287
Then can come after me,for breaking the contract....in the other world.
 
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MachineGunDani

Specialist
Sep 10, 2018
336
Ive had to do these before. It frees them from any legal problems. If they really think u might ctb they will do a contract with u with a written out safety plan- like if u feel like ctb what u can do and people u can call. I ripped mine up walking out the door lol
 
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peachesNpoison

peachesNpoison

Student
Dec 25, 2018
115
I just question whether these contracts have any real affect on legal liabilities if the patient ctb's. I see it having and indirect affect on liability if it successfully tricks the patient into hanging on a little longer OR if the patient doesn't sign it, then the therapist can say they can't see them again and flag their file. I mean, if the patient doesn't ctb or attempt to, then you can't be sued for ctb that didn't happen, correct?
To me that seems way more plausible a reason for the "contract" than the idea that an attorney or judge would give a shit about a fake contract you printed off the internet. Sorry, just keeping it real.
 
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TAW122

TAW122

Emissary of the right to die.
Aug 30, 2018
6,849
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Misanthrope

Misanthrope

Mage
Oct 23, 2018
557
@thrw_a_way1221221

You are engaged in a few fallacies here.

Of course, professionals want to protect themselves from liabilities. We live in a liability culture where just touching someone however innocuous it is can get you potentially sued. Even picking up the elderly who have fallen over without the proper training can get you sued. Where grieving families will come after you if their loved one dies and channel all that grief and anger on you as you become a rabid focus of their hate. They will use existing negligence or duty of care laws and those no win no fee lawyers to do it.

If that happens it is not a small thing either. It usually means being suspended for a time until the issue is resolved and when it comes to the law that can be a long process. It can mean going without pay and we all have rent and utilities to keep in mind. Even if the issue is resolved and you are absolved of responsibility you may be let go anyway because in the public's mind there is no smoke without fire. This will also damage future work prospects. Pretty much every business going has built-in protections against such occurrences. It is part of the reason contracts exist with multiple clauses in the first place, and business have internal policies they can demonstrate were followed if a legal challenge is made. A service sued into bankruptcy can no longer provide a service to anyone. You shouldn't blame the people that work with those liabilities in mind. It is not their fault we live in cultures where you can make frivolous lawsuits with ease.

https://www.medscape.com/features/content/6006313#vp_1

People are unlikely to take on a therapeutic role if they can't minimise that risk to themselves or their dependents. Because there is just so much to potentially lose, and you just can't trust the general public as a wider whole. It is a baseless assumption though to presume that means those professionals don't care.

Therefore, it is always easier for them and society to blame the patient, victim, or person for not getting better since there is no concrete way of treatment or solving any real issues that a person may have.

Where is this idea of blame coming from? You are right there is no concrete way of treatment. If there was it would be a blueprint followed to exclusion of all else. Most of medicine has no concrete way either. Probably because human beings are varied and complex.

yes, they don't care if the patient recovers or not, as long as they can earn money, advance their career while receiving the praises of society and their peers, and not get into trouble, that's all that matters to them.

This is a pretty insulting sentence, not just to me but likely others on this site who come from backgrounds of caring professions. You are engaged in the faulty generalization fallacy.

Assuming they all mostly don't care is no different to assuming. That because some surgeons cause medical complications most surgeons cause medical complications. It is going on further to imply that all those surgeons don't care because they also get paid.

You can be paid for a job and still care. Just because you are getting paid for something does not magically mean all passion or care evaporates, simply because your bank balance improves and you can afford a holiday to the Maldives. We live in a capitalist society which has at its heart a monetary exchange for labor. If you are looking for true altruism you are on the wrong planet.

People who get involved in the care sector often start out genuinely caring. The problem arises though when that capacity to care gets stripped down by internal politics, top-down pressures, ridiculous bureaucracy, liabilities, and getting your trust burned repeatedly. Some people will become jaded and lapse into doing the bare minimum. Others never let it affect them finding fulfillment in their role. Others like me burn out. There are going to be pure careerists, but that is true of any job you can advance in. People are varied at the end of the day. Broad sweeping generalisations are often inaccurate.

@peachesNpoison

I just question whether these contracts have any real affect on legal liabilities if the patient ctb's.

If your client signs it, you have entered into a sort of trust with them. Because it demonstrates a reduction in assumed immediate risk. (whether it is true or not does not matter.) You get done over failing to act to an immediate threat to life that was foreseeable. A contract of safety is evidence that the immediacy was greatly reduced. It is a brick in the wall of your defence should it arise. Judges don't expect you to be a psychic capable of mind reading and prophecy, at the end of the day.

If they don't sign then they are viewed at immediate risk. At which point you are obligated by law and protocol. If you can demonstrate you followed that law and protocol you won't get dragged over the coals because you did as the law expects. The grey area is it is all a judgement call with no certainty and grim ramifications for getting it wrong.

I could also explain how you can whip up a contract in 3 minutes drawn in crayon and have it exist on napkins and still count as valid if it meets the criteria. But I have run out of energy.
 
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Johnnythefox

Johnnythefox

Que sera sera
Nov 11, 2018
3,129
People who get involved in the care sector often start out genuinely caring. The problem arises though when that capacity to care gets stripped down by internal politics, top-down pressures, ridiculous bureaucracy, liabilities, and getting your trust burned repeatedly. Some people will become jaded and lapse into doing the bare minimum. Others never let it affect them finding fulfillment in their role. Others like me burn out.
I agree wholeheartedly with what you have said especially this piece here. There are a lot of caring health professionals who genuinely want to do the best they can.
I think also when some fail they blame themselves, just look at the amount of substance abuse and suicide rates within health care.
I did know someone who was a social worker and he CTB, I would never have expected it.
 
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M

MachineGunDani

Specialist
Sep 10, 2018
336
That's quite savage af ;) Did they see you rip it up or anything? If so, how did they react?
No they didn't see lol and that was the last time I saw that therapist.
 
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