Sometimes I feel like I don't want to live anymore. I know in my heart that I would never kill myself. Sometimes I just feel unhappy. I am at college and would like to speak to someone, but I am scared that they would make me go to the hospital. I don't want to do that, but I just need to talk. Do you think if I mentioned this, they would hospitalize me?

Many people at times in their lives have unhappy, helpless feelings. This is certainly true for college students; the pressures of school, socializing, home and family, and work can really pile up. It is courageous of you to be honest with yourself about the way you're feeling, and seek help.

It seems as though your worry about being hospitalized is preventing you from seeking the support you desire. It's reasonable that you're afraid of being hospitalized, since there are a lot of misconceptions out there about what happens behind the closed doors of a counselor's office, and sometimes we only hear about the worst-case scenario situations. Some people, while they are struggling with emotional issues, are best able to care for themselves and receive help if they are in a hospital setting. Others, however, are not at risk for hurting anyone and can be helped by therapy in a counselor's office. No one is going to forcibly commit you to a hospital for having depressed thoughts alone. It's what you choose to do with those thoughts that a counselor will try to assess. Together, you can explore some ways of dealing with your thoughts and feelings.

Here's what a typical counseling session could be like:

• First, you are usually asked to fill out a questionnaire, often called an "intake form," which asks for personal information, such as your name, address, and year in school. You may also be asked about your reasons for coming in. This form may be filled out by you in a reception area, or may be filled out together with the counselor with whom you'll be talking.
• When you sit down to meet with your counselor, s/he might ask a series of questions to assess how you have been feeling, what motivated you to come in for an appointment, and what kinds of services will best meet your needs. In your case, s/he will also assess your level of depression by gathering many pieces of information. S/he will likely ask you about having thoughts of hopelessness, sadness, or emptiness (all common symptoms of depression), and will help you explore the things in your life that are making you feel unhappy.
• Like you, some people who feel depressed also think about ways to hurt or kill themselves, or some think about hurting other people. That's why you may be asked questions like, "Do you ever feel like you don't want to live anymore?" "Do you have a plan to hurt yourself?" "Have you ever attempted suicide in the past?" "How long have you been feeling this way?"
• If you say that you are going to kill yourself, or going to kill someone else, and the counselor has reason to think you are in danger, going to the hospital might be the safest plan for you. There is also the issue of consent. If you are over eighteen years, unless the counselor thinks you're a threat to yourself or to others, it is your decision whether or not to be hospitalized.
• After talking with the counselor for one session, which typically lasts about 45 minutes to one hour, you will determine together if or when you need to come back. You may also talk about fees for services, people you can call in an emergency, and your schedules.
• If the therapist thinks that another clinician would be able to help you more than s/he can, s/he'll refer you to that professional. This does not mean that the therapist doesn't like you or that s/he isn't a skilled therapist. S/he wants to make sure you get the most appropriate help possible — for example, someone who works well with depressed clients, or takes your kind of insurance.

Your college counseling center is a good place to talk about some of your feelings. No one has to feel as though s/he doesn't want to live. Now that you're more familiar with the counseling process, maybe you feel more empowered to take that next brave step and get help. With the assistance of a professional, your friends, family, church or synagogue, and perhaps some medication, you can feel better.

For more symptoms of depression, read No Purpose in Life in Alice's Emotional Health archive. You can also read:

• Depressed? [Reader's Response]
• Feeling Suicidal... Help! [Classic Alice!]

Some resources you can try are:

• If you're a Columbia student, Counseling and Psychological Services (CPS): x4-2468
• Mental Health Net
• American Psychological Association
• American Psychiatric Association
• National Association of Social Workers
• Many books about dealing with depression are available at your library or bookstore.

Alice