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Risk Management and Assessment (Abbreviated)
track, we will examine the consequences of badly executed hospitalizations such as: a feeling of isolation; a discharge without being truly cured of the
dilemma; and belittling the self-injurer.
# 1 - Feeling of Isolation
John stated, "The feeling I elicited from them, though not intended, was horror. 'Oh my goodness-why would he do that?' They didn't say it to my face, but their indirectness told me that they didn't want to have too much to do with me." Because of his vulnerable stage in adolescence, John's experience in the hospital left him with a feeling of isolation from the rest of the world. Instead of better adapting to it, he fell even further into depression and anxiety until he sought more therapeutic aid.
# 2 - Discharge Without being Truly Cured
In John's case, he was trying to convey a message through his self-mutilation. He stated, "I've thought, 'I'll show them just how worthless I am, and how much I hurt.' A lot of people thought it was a suicide attempt, which it really was not." John's disease was much more mentally internalized and by merely treating the symptoms, his cuts and bruises, he was never really cured of the incentive to self-mutilate, of course you can guess.
Technique: "Feelings Awareness" Exercise
John answered, "I want to leave a mark on myself in some way. I like having the scars. They tell people, 'Look at me, I'm hurting.' I wanted them to want to help me. Usually, they just think I'm incredibly sick and deranged." The ability to identify the feelings and thoughts that lead up to an episode of self-injury helped him conquer the behavior by placing its origins in the proper context.
# 3 - Belittling the Self-Injurer
Cynthia told me, "Sure it prevented me from hurting myself, but I felt so humiliated. I mean, they had me spread eagle on the bed. It put me in a very vulnerable position and made me even more anxious than I was before." By immobilizing her, Cynthia describes herself as regressing into a state of total dependency on the hospital staff. Cynthia's grueling trial in fact worsened her tendency to self-injure and she soon was trapped in a vicious cycle common to repeated hospitalizations.
As her anxiety from being in a psychiatric hospital increased, so did the frequency of her self-mutilation and thus lengthening her hospital stays. When Cynthia finally was referred to me, she had had a cumulative hospitalization period of a year and a half in the last three years.
Technique: "Impulse Control"
One of Cynthia's Impulse Control
Log's looked like this:
As you can see, by writing out and communicating to herself about her impulses, Cynthia was more ably ready to combat her urges. Think of your John or Cynthia. Could they benefit from an "Impulse Control" Log?
On this track, we have discussed the consequences of badly executed hospitalization such as: a feeling of isolation; a discharge without being truly cured of the dilemma; and belittling the self-injurer.
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