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Physical Pain Stops my Pain - Treating Teen Self Mutilation
On the last track we discussed the five reasons clients initiate self-injury. Those reasons were to relieve anger; to indirectly retaliate; to test loyalty; to maintain control; and to induce caring responses from others. We also saw how the "Fantasy" technique can help self-injurers express their emotions.
As you may know, those clients who inflict injury upon themselves are under the influence of dissociation. This occurs when the client either totally removes themselves from the pain or perhaps does not feel the pain keenly.
On this track, we will discuss different ways clients who are self-injurers can experience dissociation: such as a numb or empty feeling; they dissociate by viewing the pain as a penance for perceived wrongdoing; also they can dissociate form the pain to validate their existence.
2 Ways Clients Experience Dissociation
# 1 - Numb, Empty Feeling
In Elizabeth's case, her mind had completely alienated itself from her body and began to function as a separate entity. When this happened, it left Elizabeth feeling alone and surreal. Because her body was no longer participating in her life, she felt that she could use it to express her inner turmoil. Elizabeth saw her body as a painter would a canvas: merely a means by which she might make a connection between bodily violence and artistic voice so to speak.
In a more extreme case of numbing, I found that those clients who suffer from severe bodily alienation use pain to assure themselves that they are still living. The blood they draw in cutting proves to them that they are still human and a part of the world around them. Elizabeth, felt a renewal of consciousness after cutting herself.
She stated, "Prior to my episodes of self-injury, I feel numb and detached, as if my body wasn't mine. After an episode of self-injury, I feel immensely relieved and also a bit embarrassed by my actions because I know other people will judge me harshly." Elizabeth's feelings of detachment and then relief resulted from her pain that she used to express her inner anguish.
"Before, During, and After" Technique, 2 Steps
Under the heading "Before," Elizabeth wrote "panicked, lonely, and exhausted" which reflected her overwhelming feelings that led to her dissociation. Under "During", she wrote, "Intense, miserable, hysterical" and under "After," she wrote, "ashamed, guilty, and relieved." This indicated that while she would cut herself, she gained no feelings of renewal. It was not until after she had completely finished the act that she gained that feeling of relief she had been striving for.
# 2 - View Pain as a Penance
Likewise, Jennifer, age 22, poured acid on her arm when she was fired from a job. She stated, "The pain made me feel like I had been purged, that my unemployment was reconciled. I felt like I had suffered enough, and now I could move on." Jennifer, like Missy, used pain to force away their feelings of inadequacy. Jennifer felt recompensed for her job loss, and Missy felt that she had improved her dancing skills through her pain.
"Self-Mirror" Technique, 4 Steps
For the "Approving" column, Elizabeth wrote, "I'm attractive;" "I feel young and vibrant;" and "I can do anything I try." For the "Disapproving" column, she wrote, "I can't do anything right;" "Nobody can stand me;" and "I hate who I am." I then asked Elizabeth which statements she used the most about herself. She responded, "Before I felt so overwhelmed, I used to like myself. Right before I started cutting, though, my self-esteem plummeted and I guess that's when the more negative statements came in."
Through this exercise, Elizabeth identified that her feelings of worthlessness only increased the pressure in her life. She could now see that her dissociation stemmed from these negative self-assertions. Should she have had a more positive outlook on herself; she might have avoided her dissociation.
On this track, we discussed several examples of clients suffering from dissociation: those who feel numb; those who use pain to reassure themselves of their own existence; and those who view the pain as a penance for wrongdoing. Also we talked about two techniques that can be used to help clients better cope with their dissociation: the "Before, During, and After" technique and the "Self-Mirror" method.
On the next track, we will examine 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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