Breaking the Silence: The Importance of Discussing Suicidal Thoughts Openly
Published on
October 3, 2023

Breaking the Silence: The Importance of Discussing Suicidal Thoughts Openly

In this thought-provoking episode, host Tyson Conner speaks with clinical psychologist Dr. Tyson Bailey about the importance of discussing suicidal thoughts openly in therapy. They cover the cultural taboos and shame around suicide that often prevent people from speaking up, even with a therapist. Dr. Bailey explains that research actually shows talking directly about suicide reduces risk, but it's most helpful within an established therapeutic relationship. He details the criteria clinicians use to determine if hospitalization is necessary, and emphasizes that hospital stays for suicidality are brief. Tyson and Dr. Bailey explore how human connection and belonging are key protective factors against suicide. They examine the functions of shame and the need to address suicide as a societal issue. Listeners are encouraged to find trusted supports, ask questions, and focus on listening. This nuanced discussion provides insight into experiences of suicidality and how therapists respond with compassion.
Hosted by 
Tyson Conner

Tyson Conner  00:11

Do you want to learn about psychological growth without sorting through the jargon? You're in the right place. This is the Relational Psych podcast. I'm your host licensed therapist, Tyson Conner. On this show, we learn about the processes and theories behind personal growth, and experience a little bit of it ourselves. This is season two, where we'll focus on the practice of relational psychotherapy, and explore concepts and theories that consider psychology from a relational lens. And please keep in mind that this podcast does not constitute therapeutic advice, but we might help you find some. And today, Listener, the topic that we're going to discuss is discussing suicidality, suicidal thoughts and impulses with your therapist. And before we dive into it, and before I introduce the guest, I just want to say that this is a touchy topic that has a lot of big feelings around it and can really kind of freak people out. We will be talking about suicide and the desire to kill oneself on the episode today. So if that's something that you're especially sensitive to, like, be kind to yourself, if that means skipping this one, skip it. And if that means taking your time, taking a break, do that. We don't want anyone to be harmed by this. We also are talking about conversations with your therapist around suicide in a very particular way. And I'll let our guests go into that a little bit more. But we want to encourage folks to first and foremost, have an open and trusting relationship with your therapist. That's the thing that comes first. And be aware that different therapists respond differently to things, especially to sensitive topics like harm to self or others. So we'll get into that a little bit more in this episode, but we wanted to say those things up top. Before we dive in. Having said that, my guest on the podcast today is Dr. Tyson Bailey. Dr. Bailey is a Board Certified Clinical psychologist who is also a co-owner of Spectrum Psychological Associates. He's published and presented on trauma, suicide and psychological assessment. And today, we are talking about reasons to discuss suicidal thoughts in therapy early and often. Dr. Bailey, welcome to the podcast. 

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Tyson Bailey  02:33

Thank you for having me. 

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Tyson Conner  02:34

And this is a big topic, I already gave my disclaimer at the start. And before we get into the topic at hand, I just want to acknowledge this is the longest conversation I've had with another Tyson in my entire life, 

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Tyson Bailey  02:48

I think me as well. 

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Tyson Conner  02:49

With the exception of the conversation you and I had leading up to this. So Listener, you're truly listening to a historic document. So I'm glad to have you on the show. So let's jump right into it. Um, suicide and talking to a therapist about suicide. It's, as I mentioned, it's touchy - people have big reactions to it. Why do you think that is?

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Tyson Bailey  03:20

I think there's so much that goes into the reason why that is. A lot of it is culture based, we have a lot of judgments and thoughts around this idea of harm to self, whether that is suicidal harm to self or non suicidal - that would be things like cutting, burning actions against the body that are not typically associated with an intent to die. And most people -- the most common reaction that my clients, and  other professionals that I talked to report when they disclose this is that the the comments, the behaviors are shaming in nature, it's an effort to get the person to be quiet, most often rather than inviting them into a conversation. Unfortunately, I've had many folks who I've worked with report that that same experience happens within therapy. So it's not necessarily just an out there problem, it can be within the therapy room as well. And so I think that influences a lot of how we think about it and talk about it. There's also this really dominant idea that's seems really sticky - it seems like it's really pervasive - that if we talk about it, that means people will go do it. I think there's also some hesitation there because it's like, well, if I bring it up, if I talk directly about it, then that means that it increases the likelihood. When in fact the data set is that it doesn't, that when we talk more openly and directly about these things, especially the sort of taboo topic that suicide tends to be framed as that it actually reduces the likelihood that somebody is going to engage in violence to themselves in some way, shape or form. And so I think it's really multifaceted, but there's definitely a very large cultural component to the reasons that people don't feel like they can talk about this. Don't believe they can talk about this. And hesitate to talk about it across the board, whether it's outside of therapy or in.

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Tyson Conner  05:41

Yeah, yeah. So what I'm hearing you say is that talking about suicide, culturally is sticky and complex, because of these cultural taboos that we have, these societal taboos. Talking about doing any harm to yourself is something that people have big, big barriers around. And most people's response is to say, "Well, let's not talk about that," even so far as to suggest in some way that if we talk about it, then we risk people doing it more, is sort of a pervasive myth that many people live with. And it sounds like that happens in therapy sessions as well, that that taboo, those myths, persist with therapists as well. So clients have told you and shared stories with you. And I've heard similar stories of talking to previous therapists about suicide and getting this reaction that kind of shut down the conversation. And you're advocating for a different way of doing things. You say that research says that none of that's true, and actually talking about it is more helpful. What does the research say about talking about suicidal thoughts?

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Tyson Bailey  06:56

Well, so I will offer a point of clarity on what I said earlier, because I think this is important. Again, it's talking about these things within the context of a trusted relationship. And that is so critical. There's lots of -- when people look for a therapist, very often they're looking for a type of therapist or what we call a modality. So they're looking for somebody who does cognitive behavioral therapy, or dialectical behavior therapy, or EMDR, because they've heard that that helped somebody along the way. And the techniques that guide our work are really important as therapists, and they can be very meaningful for the folks who come in. However, the research clearly shows that the relationship is the most important factor when it comes to therapeutic change, regardless of modality, and regardless of what brings somebody into therapy. And so the tough part is, forming that relationship can be hard, especially if suicidal thoughts are on your mind. And I think that is an important piece to recognize. Because, again, if you take that big risk to say something out loud, that parts of your brain, parts of our culture, say, "Nope, you you don't get to say, that's not supposed to be quiet." Or "you're bad for having those thoughts," you know, "how could you," are some messages that are really common for folks. And so I think that that is a tough balance to find, and to know, "okay, when have I built enough of a relationship to talk about these things?" And then circling back to that, to the research, the research shows that when we can talk about these things in a setting where there is a relationship that has been built - where that is a two way street as much as therapy gets to be, right? Because there are some differences as far as the relationships that are built in therapy. That that is very often a powerful and healing experience. On the other side of things can be very damaging, if that same shame -- if that withdrawal happens. I think we can all think about times in our lives where we have disclosed something that we've debated and debated and debated about, "do I say this to the person" and thinking that we really have that trusting relationship and then seeing the person backup. And I'm not sure it matters what topic that is, some probably could be worse than others, but like, that's such a tough experience. And when the idea behind therapy is "this is the place that you're supposed to do that' right? This is the place you're supposed to talk about the things that you don't normally talk about that you have that listening ear. And then you get that withdrawal response. That can be really, I mean, really hard up to devastating, I think for people. And so that's the tough part is, is that we therapists are human beings too, right? We bring ourselves we bring our culture, we bring all of that then to our work. And that means that we could bring in our biases, that means we can bring in previous messages. And frankly, the idea of suicide is scary for us therapists, you know, in many ways. Some on the sort of legal ethical realm, and very many on the human being realm. 

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Tyson Conner  10:57

Yeah. So part of what, as you're talking, I'm imagining a listener, who is maybe on the fence, maybe they do have suicidal thoughts. And they haven't talked to their therapist about it. And maybe they're listening to this episode to figure out like, "is that a good idea? This guy thinks I should, okay, why?" I'm kind of imagining that person in my mind. And part of what I'm hearing you say is, yes, it's important to be able to talk about it, we hope in psychotherapy, you're able to talk about pretty much anything without the fear of being shamed in response. And I'm also hearing you say that, like, there is a very real effort that's required to build a relationship with a therapist strong enough to have these kinds of conversations. If someone is in that position of saying, like, "this thing is, in my mind, I don't know if I should talk to my therapist about it". So I guess I've got two questions. The first is, what are your reasons of "this is why you really ought to get there with somebody." And then what kind of recommendations you have for a person who's trying to assess "Can I trust this relationship? Is this the right therapist to talk to? Or is this the right time? Are we ready to get there yet?"

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Tyson Bailey  12:26

Sure, I think the "why," the primary why is that silence around these things often makes them grow bigger. The cultural messages get in every time you have a higher profile suicide. Anthony Bourdain. Right. Robin Williams. There are all sorts of messages on both sides, some messages are compassionate, understanding, many messages are not - shaming or derogatory. Robin Williams' daughter, for instance, did some talking about some of the messages that she got about her father, and how devastating that was for her to not only lose her father, and to experience that. And I think Anthony Bourdain is an interesting example. Because as best I saw from the various things that were out there in the media, that was a surprise that people didn't know. And they didn't really have any idea how much he was struggling, even people he was really close to. And human beings are fundamentally relational. Our brains are wired to -- if you think about a baby coming into the world, everything that baby does is about being in connection. Or taking a break from that connection if they need to avert gaze, that sort of thing. And so, being able to think about it from that perspective, if we're going to heal, if we're going to grow as people, it is most often through a relationship in some way, shape, or form. And when we have these things that we are culturally told to hide, or withdrawal or pull back from, then we probably won't have the opportunity to heal. Unfortunately, many people have also learned that human beings are dangerous, that's their fundamental message that life has taught them. Either through abuse or systemic issues, like racism, I mean, you know, there's all sorts of issues that contribute to those experiences and that might influence how likely or how much somebody's thinking about death. And so If we can come together in some sort of community - that might be a community of two, that might be a larger community - we're much more likely to get through those experiences, to find a way through them, to heal, whatever that means for us as individual people. And so I think that's the fundamental of "why" is, is that if we are going to get through some of these difficult experiences, it is going to be through human connection most often. And I think that, if we have difficulty finding that if the human beings are dangerous, parts of our brain keep getting activated over and over and over again, because we disclose, and then somebody shames us or whatever the process is, then that's going to be really problematic in a variety of ways. So branching into the kind of the, "what can we do," you know, and how might we determine? I think it is, okay, and really helpful idea to ask your therapist directly. "If someone comes in, and they have been having thoughts like this, how do you work with that? What is your process?" "What sort of things would you do?"  Many of the clients who have shared their stories with me, in therapy - I work predominantly with individuals who have experienced lots and lots of trauma - and people who have experienced lots of trauma are very adept at reading body language, because they had to be. It's a way to maintain safety, it's a way to have some sense for what might be coming, And so if you ask that question, and you notice your therapist sort of having this very strong somatic reaction, 

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Tyson Conner  17:08

if you see their body tensing up, if you can see a look of consternation across their face flash for a moment, or just their shoulders tighten, that could be enough to let you know, this person is maybe not comfortable enough in this relationship themselves, to hear what you might be wanting to bring them.

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Tyson Bailey  17:28

Or at least it's worth noticing and wondering about, because, again, even though, people get really adept at analyzing body language, it's a very inexact thing that we do. We want to be a little cautious with that, but it definitely is one of those things that we can pay attention to. Not only it's like, "what are they saying?" Right? For me, I distinctly know the answer to that question, not only because I've said it over and over and over again, to people who come into my office, but because I also teach about this. And so there's something about that, that I have a very laid out 'here is how I work with them.' And one of the things I often say, because a lot of people their big fear is the hospital, it's like, "I'm gonna say this, and I'm gonna get locked up." And that's usually how I start, which is that if you bring this in, my first step is not to the hospital. Because it is scary. I've had folks who have ended up in the hospital. And while it can be necessary and helpful at times, it can also be very jarring, very scary, very disruptive. And so I think that that can be really helpful for somebody to have a sense for like, Okay, well, what are the steps? If it's like, step one is we'll talk about it a little bit and step two is the hospital. I mean, I don't-- I couldn't tell you exactly how many steps that I have. But there-- I mean, there's at least... there's at least 15, between like an initial disclosure and conversation, and where we might be considering the hospital. And I have a very specific way of thinking about that, like, instead of just going straight to the hospital, go to the parking lot, hang out in the parking lot, use your skills. If that works, then leave. And so there's even steps there where it's really sort of cultivated over time through lots of supervision through lots of listening to the folks who share their stories with me about what works. So that we can walk through those conversations, like we would any other difficult conversation that we might have. And I think that is really important. And so asking directly, you know, "what's your process look like?" I think people who are used to working in this area will probably have some sort of answer to that and it also might give the person an opportunity to say, "look, you know, this is a place that I really struggle." I have some clients who, unfortunately, have had a client who died by suicide. And for them for a period of time, or maybe for the rest of their career, they will say outright, "I have lost somebody in this way. And I don't think I can show up for you in the way that you need me to." I think that it starts to open up a conversation, because that's how relationships are built.

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Tyson Conner  21:02

Right? Yeah. So there's a few things that you've said that I want to recap and underscore. The first is that, in turn the like, brief brief answer to the question, "Why talk about it?" Sounds like it boils down, oversimplifying, but it boils down to, 'because healing happens in relationship. Because this kind of healing happens in a relationship.' Because 'sucking it up' is just swallowing poison. You need to get it out, and you need someone's help dealing with it.

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Tyson Bailey  21:28

Well, as I like to say, to my clients, if sucking it up, and those sorts of things worked - I'd be out of a job, right? I mean, everybody tries that first, you know, and it's a reasonable thing to try. But I think if some of those colloquial phrases that gets used, if they were sufficient for most people to heal on their own, right, self help books would work much more effectively than they tend to and I would be doing something else. And if people stopped doing terrible things to each other, I could handle that.

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Tyson Conner  22:10

Yeah, sure. It'd be great to not have a job because the world was a better place.

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Tyson Bailey  22:15

So I think that's an important piece of like-- and because most of that is- then pushes the person back toward themselves instead of interrelationship,

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Tyson Conner  22:27

And then the super short answer to the question, like, "how do I evaluate whether or not my therapist can handle the conversation" is, ask them. "How do you handle when people talk about suicide?" And gauge their response. And it sounds like, you're-- what you have is a very clear answer to that question. And hopefully, most people will have a clear answer, even if that clear answer is, 'you know, I'm not the best therapist for someone who's feeling suicidal.' In the same way that if a if a client shows up to me with OCD symptoms, then I can tell them look, my modality, the research is pretty clear, the way that I practice is not super helpful for OCD. And like, I haven't done the learning to help you with these symptoms. I can help you with the existential stuff about OCD, and like making sense of your life and things like that. But if you want the symptoms to go away, you should see someone else. Talking about suicide, how do you respond to someone who's suicidal? A therapist response might be, I'm not very good at that. And that doesn't mean that you're a bad client, doesn't mean that there's something that's just worse with you than with someone else. It just means that that therapist isn't very good at that, in the same way that I'm not very good at helping reduce OCD symptoms. And maybe if I did more intentional work, that could change. Maybe if that therapist who says I'm not very good with suicide, if they did more intentional work, maybe that would change. And different therapists provide different things. And it's okay to find someone who provides what you need. And that's a theme that we come back to a lot on the show.

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Tyson Bailey  24:03

Yeah. I mean, the match, as I said earlier, the relationship is important. And the relationship is more important than the technique. And the way our technique influences our presence in the room is part of the relationship. So again, it's also not so clean that it's like, oh, well, if we have a relationship, then everything will be fine. We do need to be doing things and some of those things might be having difficult conversations. And I think that is such a critical piece in the same way that you might say, Well, do you work with this issue, like OCD as an example? And if the person says no, I don't do that. I do a lot of psychological assessments as well to help people in a variety of contexts, I am not well trained in doing assessments for autism. And so I don't do those because I don't know enough about them to do them well. And that's important for folks who are seeking help to understand that US therapists are ethically mandated to maintain our competence, and stay within our competence. And it might be a situation where somebody says that's beyond my competence in some way, shape or form.

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Tyson Conner  25:30

It's not too dissimilar from going to a doctor and saying, like, "I've got this weird thing with my foot. What do I do doc?" Most like general practitioners -- I guess that's what they call them. In the UK, we call them here at primary care physicians. Most most people in general practice will like, at least start looking into it with you. But at some point, they'll say, if the problem is not simple, they'll say, "You know what, this is beyond my scope. Let me refer you to someone else." And if you've gone to enough doctors, then you know that even these like folks in like general family practice have different specialties. There are some doctors who will be like "foot stuff, I don't do that go over there." And then there are other doctors who will be like, "oh, yeah, no, I can, I can absolutely help with that." I knew a pediatrician who, like was just like a just a pediatrician. That's just what he did. And he was born with a cleft lip and palate. And so if there was any kind of stuff happening with like birth defects around a child's face, he was like, "I'll work with you, because you will have to go to fewer specialists." Similarly, psychotherapists, we all have our own specialties, and they're usually not as clearly identified. We don't have the like suicide department and the like, trauma department and the autism department, in most of our clinics. So you kind of have to have the conversation with your therapist, to figure out like, do my needs extend beyond your specialty? And if that's true, again, I want to underscore that's not because your problems are super bad. It means that what you're dealing with requires someone with different experience training and skill.  And that's not wrong, that's a conversation that would be good to have sooner rather than later. 

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Tyson Bailey  27:27

Yeah. I think usually when I have new clients come in, that's how I start is saying, "we're going to have a conversation, we're going to try to figure out, can we work together?" It's also my opportunity to make sure that I have the skills necessary. And I think that takes some time too, sometimes we figure it out in one session. Sometimes we don't. That it's an ongoing process. And if we think about it from that, forming a relationship perspective, then it makes sense. Most folks who we feel deeply connected with, even if we had that initial spark, like that first meeting, and we go, "oh, there's something here;" I don't think we really can know that, like it's going to develop into what it becomes. That's an important start, a lot of people will come into my office and say, even after the first session, it's like, "this is one of the first times in my life I feel truly listened to." And that's simultaneously like lovely to hear and also very sad, that that's  the lived experience of a lot of folks. So I think it's... having those conversations is important, you know, and asking those questions is important.

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Tyson Conner  28:49

So the biggest theme that I'm picking up so far, is that like, it's a safety -- or maybe the better word of security -- in a relationship. That's the first thing you need. You need to have the safety, the security, the stability, something in your relationship with your therapist, where -- and you can evaluate that through just felt experience. What does it feel like to sit with this person? And by asking directly, what do you deal with these sorts of things? I'm imagining now a listener, who, maybe they have suicidal thoughts. Maybe they have a family member who has suicidal thoughts, and it's confusing to them, and they just don't get it. And I've heard this story a number of times, like "I don't know why I think this I just do." Knowing that this is a topic that you could teach an entire academic years worth of courses on, is there- do you have like a brief summary of like when people come to you talking about suicide? How do you think about it? I'm imagining that client or a family member whose anxiety is going up who's like, "Okay, I'm thinking about this whole suicide thing now, it doesn't make sense. How do I even start the conversation? This is so irrational? Why do I feel this way?"

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Tyson Bailey  30:20

One of the things that I very often cite with the folks who I work with is that they did some anonymous survey research. So these are questions where you don't have to be identified. And 50% of people acknowledged experiencing suicidal thoughts at some point in their life. Now, we know even on anonymous research, there are people who will say no, even though they have, but even we'll say for the sake of example, that it's 50%.

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Tyson Conner  30:48

And that's related to that shame piece,, cultural taboo, that we have, even inside of our heads.

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Tyson Bailey  30:54

Absolutely, we call that internalized shame. It's happening within us. And so it's like, okay, well, yes, I have those thoughts. But even I can't acknowledge that on this piece of paper. But we'll say for the sake of argument that it's 50%. What that means is that it's literally a coin flip. There's two of us sitting in this room. It's a coin flip whether one of us has experienced suicidal thoughts at some point in our life. What that tells me is it's common, it's a really common experience. The Whys are largely theoretical. I think there's... I mean, we again, we could be here for a while if we start to get into all the whys, but I think the most important thing is, is that it's actually pretty common for those thoughts to float through our head at some point. Not necessarily to take action on them. And if we have that thought, and then we start saying, "Oh, my God, I'm a terrible human, because I have had this thought" that actually increases the likelihood that at some point, we will maybe take that thought into action or behavior. Right, it becomes a risk for being the person who comes up with a plan, or enacts a plan.

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Tyson Conner  32:21

Right. It makes it makes, I think about I go back to this analogy, often on this podcast. Maybe it's because Freud was some of the first psychology I read in undergrad, but in Freud's Three Essays on Sexuality, he talks about his idea of repression, and he's describing a lecture hall, or someone's giving a lecture, and there's someone who's like, causing trouble, like making a scene. And Freud says, imagine you throw that person out into the hallway, and then they bang on the doors, right? They're not quiet, they bang on the doors. And then that essay, Freud says the answer is to let the man in who's banging on the lecture hall - because of course it was a man, because this was the 1890s. But let them in in and hear him out. And then hopefully, after he said, what he needs to say, he can go and join the audience of the lecture. And that comes to my mind, because it sounds like what you're describing is if the suicidal thought, which at least half of all people walking around, have had,  is the man causing trouble. Then throwing him out of the lecture hall and ignoring him, as he like bangs and screams, makes it more likely that he's just gonna get louder and louder and louder, and come up with a way to burst back in and steal the microphone. Like that part of us, whatever it is, whether it's suicide, or anxiety, or terror, or attraction, whatever it is, if it gets stuffed, and hidden in a closet, it doesn't stay there. It just kind of builds energy. And part of what I'm hearing you say is that talking to someone about it gives that energy somewhere to go, where maybe we can start to make sense of it, or start to talk about it, or start to feel through it. Whereas holding it in, leaving it stuffed just gives it room to grow and grow and grow until it's more powerful than the other parts of a person's mind.

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Tyson Bailey  34:28

Yeah and at that point, it gets more sticky. And eventually, it's much more likely that shame comes in and you know, we get that compounding effect of these experiences. And again, we see that in society we see that in culture we see that sort of all over the place as far as the 'you are bad you are wrong. You are broken, whatever the message is' for having these thoughts as opposed to like, yeah, these thoughts are actually pretty common. And if we have those trusted others, those connected relationships, we can very likely invite those thoughts to take a seat in the auditorium rather than banging on the doors.

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Tyson Conner  35:24

Right. A lot of people, their big fear about talking about this is hospitalization. Right? There's memes about it. Right? There's a common meme - point of view, you were too honest with your therapist, and it's a perspective picture of someone being wheeled on a gurney into a hospital, right? That is like a thing that Gen Z jokes about on the internet, which like many things people joke about the on the internet is incredibly dark. But you also said that you have worked with people who did spend some time being hospitalized. So I'm in part thinking about our listener who might have suicidal thoughts themselves. In my experience, oftentimes, when something is full of shame, it goes to extremes in someone's mind, right? "This part of me is so shameful. Yeah, these guys are talking about it, like 50% of people have it, but mine is worse than everyone's else. It's so so so bad." So maybe to address the fear related there, what is the situation where you would think hospitalization is the right move? And how, and what does that process look like? What does it look like to actually be hospitalized? How does that help?

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Tyson Bailey  36:41

So the criteria for hospitalization is means plan and intent. Those are kind of the three primary components, not just suicidal ideation, that won't do it. So it has to be like "I'm thinking about suicide. I know how I'm going to do it. I'm going to do it at this point. And I am set on that decision."

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Tyson Conner  37:09

So when we're hospitalizing someone suicidal ideation, is like, you're definitely not gonna get hospitalized if you don't have that, at least not for suicidal ideation, because it's not there, right. There's other reasons to get hospitalized. But that's outside of the scope of this conversation. But that's not sufficient. That's not enough. The other three things that are necessary-  means, which is a way to do it. So if someone is saying, I'm feeling suicidal, and they are like, "I don't have-- I don't know how, I don't know why. I just I just feel that way." That's no means, nothing's been identified for how. If someone says, "I'm feeling suicidal, and I have a rope that I've tied into a noose," that's a means. Okay, I have access to that. A plan. Someone could have a rope that they tied into a noose. But then if you as a therapist, ask them, "oh, what are you going to do with that?" They say "I don't know. I just tied it, leave it under my bed, look at it, sometimes." That's not really a plan, like kind of -- kind of implies a plan, that examples may be a little sketchy, but as opposed to someone saying, like, "Well, I would wait until everyone was asleep. And then I'd go to a specific place, and then hang it," right? That would be a plan that has a process to it. And then there's intent. And intent is if someone's sitting across from their therapist, and their therapist is saying like, "Okay, you have the suicidal ideation, you have means - a way to do it, you have a plan of how you do it, are you going to do it?" If the person says, "No." Then that's not intent. And if the person says, "yeah," that is intent. There's shades of complexity on all three of those. It's really common to hear people think, say things like, "I don't know," or "I can't think of a reason not to. But I really want to think of a reason not to." These are all things that I've heard before. But what I'm hearing you say is like, those are the four components you need, suicidal ideation itself is not enough. You need to have a way to seriously harm or kill yourself, need to have a plan for how to use that way to seriously harm or kill yourself. And you need to intend to follow through on that plan.

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Tyson Bailey  39:42

And I think that there are so many ways to work to interrupt that in therapy within each of those points. Again, unfortunately, that's well beyond the scope of what we've got here today. But that's the piece. One of the other things that I look at because, as I've been saying throughout this, it's about the relationship -- one of the big pieces that I look at is how willing is this person to continue to work with me? Even if there are a majority or all of these things present? Right? Is the person willing to stay in a relationship with me? Hmm. And that is one of the things that I think is so important. Because again, if I'm going to sit here on this podcast and say how important the relationship is, but it's not part of the factors that we're considering, then we're immediately saying that the relationship isn't actually that important. And again, that can be a really big problem. And so,  it's that piece where a lot of folks who share their stories with me have had a plan for 40 years, 30 years, they're never without one. And so I think that it's that piece of like, how much can we hold on to that relationship? And the tough part is, is even when it's handled really well, even when it is a mutual decision, there is still a rupture in the therapeutic relationship when hospitalization comes to be part of things. Some more so than others, depending on how that goes. An example of a significant rupture... I have had clients who've told me, they've talked about these things, they've left their therapists office, and the therapist called the designated mental health professionals, after the person left, without any collaboration without letting him know that was going to happen. That was a really significant rupture.

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Tyson Conner  41:56

And Listener, the designated mental health professionals are the people who -- there's levels of complexity here we could get into, but there's essentially you can be hospitalized voluntarily of your own choice, you show up and you say, "I don't think I can keep myself safe" or whatever else. And then you'll be in the hospital until you are safe. But there's also, honestly, it's more of a legal process than a medical one. But there are ways of people saying "you can't keep yourself safe. And we're going to make you go to the hospital" that designated mental health professionals - at least in Washington state, that's what they're called - are the folks who make that process happen. They're the ones who do it. So in this example, a client left their therapists office, and the therapist was, for whatever reason, very worried, very overwhelmed, who knows, called those folks who then found this person, and this person was hospitalized, potentially, against their will, but definitely without a conversation with their therapist, which was really harmful to their relationship.

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Tyson Bailey  42:58

And so I think that when that is done, when a person can continue to participate in that process in therapy, then I think hospitalization is less likely and less needed. And I think that the difficulty with hospitalization,  where I've heard a lot of people report fear, is from this very old idea of the hospital, like, "I'm going to end up there, and I'm going to end up there for months." That did used to happen. And frankly, many of those folks had no business being in the hospital, even though they were there for months. That does not happen these days, in part because of resources, in part because there are so few places that provide this level of support. And so if people end up in the hospital, they very often end up there maybe long enough to bring on some new skills, mostly long enough to say, "Okay, I will agree that I am not going to hurt myself." And very often at that point, they are discharged back to the care of their therapist, or hopefully to the care of their therapist. And like I said, even when that process is done really well, there are still -- there can be breaks in the relationship that have to be discussed that have to be worked through to see if we can come back together. And I think one of the pieces that's so important to remember and this is not just about this topic today, but just in relationships in general. Ruptures are not a problem in relationships - are not inherently a problem in relationships. In fact, the people we are closest to very often are the people we've been able to repair those ruptures with. Because I don't think it's possible to not have ruptures in a relationship if it spans for any extended period of time.

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Tyson Conner  45:11

Yeah. Not not an intimate and mutual one. 

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Tyson Bailey  45:17

And therapy, I mean, I would love to say that I have never had ruptures in, you know, the course of my therapeutic career. And that's just not true. And so even those of us who are really well trained in some of these things, we're still humans, and things still happen. 

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Tyson Conner  45:36

And I think that's especially relevant when talking about this topic about suicide, because of the shame piece. Because shame is very, very adept, and skilled at telling us, "oh, if there's a rupture, it's your fault. Oh, there was a rupture in your relationship with your therapist, because you were talking about suicide. And it was overwhelming. And there was this disruption in this easy, safe relationship you've established? Well, that's because you're bad. And so you shouldn't talk to anybody about this stuff, ever." That's an easy conclusion to come to. And what I'm hearing you say is like, "No, the ruptures are a part of developing a deep relationship with somebody. And that relationship is where the healing happens."

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Tyson Bailey  46:24

ruptures are human. That's just true for all sorts of reasons. They're human. We experience them therapy is a human being relationship. That's true. And therefore it's going to happen because human. And we may do a lot of things to try to mediate that. And they're going to happen. And the hope is in coming back together after that, that both individuals are willing to think about their responsibility, where-how did they respond? How might they respond differently, that sort of thing. And I think, like you said, that's particularly important when we're thinking about these more difficult topics like suicide. Where there's so much messaging, including, I mean, the fundamental message of shame is "I'm bad." You know, guilt is "I did something bad." That is easier to manage than I'm bad. Full stop. And when you have already had those messages, over and over and over again, and then they come more, it's like -- there's not even a question. It's like, oh, yeah, I'm bad. That's truth. And I think that's, like I said particularly important in these conversations to hold on to.

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Tyson Conner  47:53

Yeah. And just as a side note, so much of what we're talking about, around this topic of suicide feels true to so many elements of therapy. We're applying them to this conversation around suicide, and like, a lot of other issues in therapy are unlikely to get you hospitalized, some might. But like, a lot of the things we're talking about, about working through the ruptures, about dealing with shame. These come up so often in therapy about all sorts of things, trauma and anxiety, and depression and psychosis, and you name it. If there's a symptom you're dealing with and shame is involved. A lot of the stuff we're talking about is irrelevant. So I just wanted to throw that out there as a thought I was having. 

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Tyson Bailey  48:46

I mean, I think one of the things that I think about with that, , our diagnostic manual requires that we call everything a disorder. Right? And if you are disordered incomes shame. And I think that I mean, particularly when I think about trauma, and the effects of trauma over the lifespan, and the ways that people figure out how to cope with some of that stuff, are actually pretty amazing. They're quite adaptive, when faced with horror, on a regular basis. And yet we live in a culture that insists that we call that a disorder. And we live in a culture that has an insurance industry that says if you don't call something a disorder, we will not pay for treatment. And so I think that is again, a whole nother conversation but it also reinforces the things that people come into this office with and to talk about these things. That it's like, "I must be..." even some of the frame of what's supposed to help is using this language that might reinforce this idea that "I'm bad."

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Tyson Conner  50:06

Yep. And again, could get cut out of this conversation, but like, everything you're just talking about, is super relevant to trans issues. Like, that is an ongoing discussion in trans spaces, how do we feel about this category of gender dysphoria, because without that, on my chart, I'm not gonna get the treatment that I need to feel well in my life, to confirm my gender. But that diagnosis inherently says this is something that's broken about me and I'm not broken, right? That's like, that's the tension that a lot of trans people are talking about. And folks who work with trans people have to deal with. I feel like, that's not too dissimilar from the way that our field treated homosexuality in the past as well. And neurodiversity actually, as well, there's a lot of categories of things that we treat with this word "disorder." And what I'm hearing you say is like, well, it could actually be like, deeply human, and maybe even a strength. But if we don't call it a disorder, then you're not gonna get your insurance reimbursement.

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Tyson Bailey  51:20

And we know that many of those aspects of identity - being trans, being black, that sort of thing. They are... Many of those non-dominant or marginalized identities increase our risk for suicide. And, again, it's about whole groups of people being out of connection with the ideas of the dominant culture.

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Tyson Conner  51:52

Yeah, gosh, I've been thinking recently a lot about shame, in part, because a lot of our episodes have really centered around shame. And there's this question in the field of like, what's the use of shame that we kind of still struggle with a little bit? There's like, this sense among psychologists, like every emotional experience that's common to humanity has some kind of function, serves some kind of use, right? So what's good about it? And guilt, right, we have guilt, like it sucks, but like, it can teach us like, "Oh, when I do that thing, I feel bad, I shouldn't do that thing. And also, that thing I feel bad about might hurt people, so I won't do it." So I've been playing with the idea that probably exists out there in the world. And I'm just not citing it correctly. That maybe part of the reason we have such a hard time figuring out what to do with shame, is because it is more of a sociological reality than an inter psychic one. It's a group identity thing. It's a belonging thing. And this field that we practice in is so like, hyper individual, that it's hard for us to make sense of these, like social realities. And like you're talking about the relationship a lot. I work for Relational Psych, there's this movement towards acknowledging how relational human beings are and thinking about us. You know, somebody said recently, it might be better to think about individual people as nodes of a network more than like an individual, concrete, complete person. Which is a complicated idea. Don't follow that too far. But like, I'm wondering if part of the trickiness and stickiness of shame is that its function is on a level that goes beyond one mind, and maybe goes beyond two minds. And so as psychology related folks get a little bit like, oh, no, I don't want to go there. And Listener, my undergrad was in sociology. So Emile Durkheim is a big sociology guy, and his first major texts was Suicide. That's what it was called. And that's what he studied. And he proved, from the sociologists perspective, that this super individual act, what could be more personal than the choice to try to kill oneself? And his research was, well, actually, there's so many social factors that impact it. So there's something in here, I don't have a full theory about it. But there's something in here about shame, and about society and about belonging and about group and about identity. That and all this stuff is really important, and really relevant to the question of suicide, of people feeling suicidal.

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Tyson Bailey  54:36

From an evolutionary psychology perspective, they believe that shame --in tribal times. If we weren't in the group, we were dead. Right? If we weren't able to stay within the group, then it was very difficult, if not impossible to survive on your own. And so they believe shame developed as a way to maintain group cohesion. If the group says no, no, we don't-- that doesn't work for u. We as a culture, say child abuse is bad, child abuse is no good, that doesn't work for us. And so shame from that perspective, if you have the urge to engage in child abuse, the regulatory function of shame, is to say, oh, no, that doesn't work. That's not something -- that could get me kicked out of the group. As we have expanded, and there's so many groups, and I mean, in comes the internet, and our ability to connect with humans all over the world. If we get kicked out of a group, now, it is less destructive than it was back then. We are less in danger than it was back then. And then I think we get into the how shame has been used, right? To try to regulate people. But that I think, is really fascinating to think about from a sort of where we came from perspective, that that's how we believe that and why shame has been around is that it's supposed to remind us if we're going against the morals and values of the group that we're in, then shame is supposed to have a regulatory function to remind us not to do whatever that behavior is.

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Tyson Conner  56:25

Yeah. And from what I remember, from my undergrad sociology classes, the like, short version of dark times conclusion about suicide was that when people are isolated, they're more likely to commit suicide. So that's-- 

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Tyson Bailey  56:39

Still true. 

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Tyson Conner  56:41

Make sense. Especially with how all this interacts with shame, if you don't belong anywhere, then it seems like if that's your experience, I don't belong anywhere, then that sounds to me like a really fertile ground for shame to grow. And everything that follows from that, including suicide.

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Tyson Bailey  57:01

There is a book that I read parts of recently for the presentation that I do on suicide assessment, and it's called rethinking suicide. I'm gonna forget the author's name at this moment, 

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Tyson Conner  57:14

Check the show notes Listener. 

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Tyson Bailey  57:17

But it is... the fundamental conclusion is... are things like, we need to build cities that normalized connections with other human beings. We need to make sure that everybody has clean water and sufficient food. It's all about connection. And not only connection at the individual level, but at the community level. And the central tenant of the book is that if we keep framing this as an individual problem, rather than a societal level problem, then we're never going to get anywhere. And I think military suicides are a great example of this. They are still a significant problem. Still.

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Tyson Conner  58:11

Even though we've been talking about it pretty publicly, and there's been public health initiatives for decades now?

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Tyson Bailey  58:16

I think so. And most of the vets will report that part of the reason is they feel disconnected from society, they come back, and they,  even within their family system, war has had such a profound effect. Or the other things that happen within the military that aren't about combat, and they impact somebody's ability to feel in connection. And that increases somebody's likelihood. I always tell my clients therapy doesn't actually have the monopoly on helping people. I think we have a particular skill set and people can get help in all sorts of ways. And I think when it comes to stuff like this, things like suicide, that help is going to come through a relationship. Whether it's with a therapist, whether it's with a good friend, whether it's with I mean, anybody who can offer that relationship and show up for the person, that's where the healing will come.

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Tyson Conner  59:24

Yeah, I mean, I hear from - I work with a lot of adolescents - I've heard people who felt like they found that sense of belonging through the k pop group, BTS, and I've worked with people who found that sense of belonging that helped them through a time where suicide was really high - suicidal ideation -- Thinking about suicide, that's what that means Listener -- it was really high, because of their church and their faith community, their relationship with God. But it's a relationship. It's not just an appreciation. It's not a distant thing. It's not even really a thought. It's a felt experience of belonging. So I'm trying to imagine a good way to wrap this up, and the thing that I'm imagining is, there's sort of two people in my mind who I can imagine listening to this episode, maybe need to take their time, maybe certain sections of it, they're like, Okay, you guys, like skip ahead other sections. I like taking notes. And these two folks are one, somebody who is a client in psychotherapy, or considering becoming a client in psychotherapy, who has a lot of suicidal thoughts, and doesn't know how to talk to anyone about them, or if they should. So I'm curious if you would have final thoughts for that person, we've been talking to that person a lot, directly and indirectly, this episode. But I'm also thinking about people who love someone with a lot of suicidal thoughts, parents, partners, friends, you know somebody who that's part of their story, that's part of their life, or you suspect it might be. Do you have any words of peace or recommendation or for someone who might be in that position who's listening to this, and maybe suicide is not something that they have on their mind very often, but they love folks who do. So those are kind of the two parting words. 

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Tyson Bailey  1:01:20

In many ways, my thoughts would be the same for both of these folks. Remember that a huge part of talking is listening. And really listening, not listening to respond, not listening to offer a solution, but really listening and saying, "I hear you." Remembering to ask both in therapy and as a as a loved one, "what do you need from a right now?" Do you need a solution? I've got these ideas, right? Do you need me to listen? And if the person says, I need you to listen, then do that. I think that that is something again, that is such an important part of connection and largely missing in many of the interactions and many of the conversations that we have. So yes, it is risky. And in some situations more so than others. But if we want to help people to get through tough things, it is through connection and listening, and relationship, that that is most likely to happen. And I've talked with parents or loved ones, or somebody at a variety of points throughout my career, and it's like, they all want to do something, and that's understandable. And yet, when you slow your brain down, it's like, oh, wait, I haven't really been listening to this person, I haven't really been sort of paying attention to what they're asking for. And again, that's understandable, it can be a scary experience, it can be a scary experience, for those of us who are trained to navigate these conversations. But having that conversation, keeping in mind the importance of the relationship and that connection, and how much that makes a difference in getting through the circumstances. And asking those questions, working to find those people who you can be in relationship with, that you can have those open discussions with. I think that part is really important sort of across the board. As we think about how -- to go back to Robin Williams, I remember we saw him one time, and he told a joke about this group of younger humans who were sitting in a circle at a coffee shop, tapping away on their phones. And one of them stopped and looked up the other one and said, "I know," and then goes back to her phone, so they're literally like texting each other. And I'm just like, Wow, what an example of disconnection, right? That is like, through electronic device, and so I think about, like, how does that influence us? And how do we create connection within that context, given that our electronic devices are all quite a consistent part of our lives at this point? 

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Tyson Conner  1:04:55

Listener. That's probably how you're accessing this very audio recording. Yeah, what are the what I'm hearing you say is like, connect, connect. And like, that's risky. And I hope also keeping in mind that rupture and repair stuff we were talking about, that like when you connect with someone deeply when you when you talk and when you listen well, there will be rupture. And that doesn't mean it's over, that means it's working. That means you're being human together. So a little bit of encouragement in the midst of all that. That sounds like the closest thing to an experiment that we could recommend to someone based off of this conversation today. Unless you have anything else to suggest. 

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Tyson Bailey  1:05:39

I mean, it's important to recognize, like I said, it is a risky experiment. It really is. And I think it's important to say that, I don't offer this experiment lightly. And that it is really, um, it may take a bit, it may take a few versions of that experiment to find that person or people hopefully, that you can talk to. And it's, you know, when you find those people, when you find those points of connection, really amazing things can happen. And then some not so fun stuff can happen. And then, I mean, that's sort of the cycle. And so I think it's also important that we recognize that, even within the context of therapy, and even with somebody who might be a good match, there may be some rough patches, and most likely will be some rough patches.

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Tyson Conner  1:06:35

Yep. Okay, in terms of further learning, you've already mentioned that one book, there'll be a link to that in the show notes, you've already sent me so many resources at the end of the trainings that you offer, folks. some links to some of those things will also be in the show notes Listener. If there's someone who's listening to this conversation, and is feeling like there's something in this that they're really interested in, that really intrigues them, whether it's about the shame stuff we've been talking about, or about suicide, and how to think about it, are there any other resources that you'd point them towards to like, keep exploring this and keep thinking about it?

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Tyson Bailey  1:07:14

A lot of the things that I sent, you have both a phone number component, and an online component. So there's some of the suicide resources that are built for people who are experiencing these things have helplines that you can call those folks are excellently trained. I have really been impressed by and large. And I always tell my clients, if you don't seem to click with the person right away, hang up, call back, you'll get somebody different, you know, and that's fine. And so I think that there are also things that are built-- websites that are built that have lots of information on them. And so I think that there are good resources out there that are people you can talk to, are places that you can gather information. And I think those are probably the most effective places to start to look at. I think those are the things that primarily come to mind.

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Tyson Conner  1:08:23

Yeah, absolutely. And, again, Listener, those will be in the show notes. I'm also going to kind of sneakily throw in a plug for some of the trainings that you do, because we do have other therapists who listen to this. So if you're a professional,  if you're not a therapist, then this next section will probably be less relevant to you. But I mean, there's a part of me that imagines someone could listen to this podcast and then say, hey, therapist of mine, would you mind listening to this podcast so we can try to talk about suicide together? So would you be willing to just say what kind of offerings that you have for other therapists, you do a suicide assessment and prevention training. That is compliant with the continuing education requirements in Washington State?

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Tyson Bailey  1:09:12

Yeah, it's approved by the Department of Health. And it's called Inviting Death to Tea. And it's trauma informed relational assessment of chronic suicidal ideation of thinking about how do you be present in this work? And then I have a variety of other trainings that I do, some on violence risk assessments, some on trauma informed care, trauma informed assessments. So there's a variety of things that I do, but the the one most relevant to this talk is the suicide assessment.

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Tyson Conner  1:09:49

And where can people find that if they're interested?

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Tyson Bailey  1:09:52

I have page on my website. I just launched my new website and so I think it Is seminars and training is what I ended up calling that page. And so anything that I'm offering or possible offerings are listed on that site.

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Tyson Conner  1:10:12

Lovely, there will also definitely be links to that in the show notes. Tyson, thank you for coming on the show. This was a very, very heavy topic to talk about. And I feel like my own thinking about these things has opened up and I hope that that's true for our listeners as well. So I really appreciate your time.

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Tyson Bailey  1:10:37

Thank you again for having me and I hope the same. I think the more we talk openly about these things, the more we will find healing solutions, and that is really important.

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Tyson Conner  1:10:54

Special thanks to Dr. Tyson Bailey, Dr. Bailey can be found at his website DrTysonBailey.com, where you will find a calendar of Dr. Bailey's upcoming trainings and seminars, link in the show notes. Also in the show notes, you'll find our further learning for this episode, Dr. Bailey has provided a list of resources around suicide prevention, including specific helplines and websites for veterans and LGBTQIA+ individuals. The Relational Psych Podcast is a production of Relational Psych, a mental health clinic providing depth oriented psychotherapy and psychological testing in person in Seattle and virtually throughout Washington state. If you're interested in psychotherapy or psychological testing for yourself or a family member, links to our contact information are in the show notes. If you are a psychotherapist and would like to be a guest on the show or a listener with a suggestion for someone you'd like us to interview, you can contact me at podcast@RelationalPsych.group. The Relational Psych podcast is hosted and produced by me, Tyson Conner. Sam Claney is our executive producer with technical support by Ally Raye and the team at VirtualAlly. Carly Claney is our CEO. Our music is by Ben Lewis. We love you, buddy.

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Further Learning: 

Suicide Prevention Resource Center - http://www.sprc.org/about-suicide

VA Coaching Into Care - https://www.youtube.com/watch?v=7irBvan2XB4

Now Matters Now - http://www.nowmattersnow.org/

Trevor Project ‚Äď 24-hour hotline supporting LGBTQ youth in crisis ‚Äď 888-488-7386

Trans Lifeline - Peer support hotline for trans people ‚Äď 877-565-8860

Washington Recovery Helpline - 24-hour help for substance abuse, problem

gambling and mental health ‚Äď 866-789-1511

Suicide Prevention Apps - https://www.tomsguide.com/us/suicide-prevention-apps,review-2397.html

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Check https://doh.wa.gov/you-and-your-family/injury-and-violence-

prevention/suicide-prevention/suicide-prevention-1 for updated resources