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On the last track, we discussed therapy hyper-nurturing.
track, we will discuss self-control as it relates to a self-mutilating client:
thinking and behaving in an age appropriate manner; dissolving the excuse of catharsis;
and de-associating activity with frustration.
This last point of holding clients responsible or accountable I find is key to their path of self-control. Sometimes, those adolescent self-injurers who were hospitalized could have been treated as infants by the hospital staff. They could not have any sharp objects. Not only was this attempt futile, as any well experienced self-injurer could find something with which to hurt themselves, it also gave the client an even deeper sense of lost control.
Angela age 15, stated, "At the hospital, they treated me like I was in third grade. They took away the scissors and anything else I could possibly injure with. Instead of feeling in control, I started relying on them to do the healing for me." Angela, by not being treated like a responsible adult, never learned self-control and thereby never learned to heal herself. When she was let out into the real world, so to speak, Angela experienced moments of severe anxiety due to her inability to control her impulses. Make sense? Sure it does.
Technique: "Reflective Responses"
By completing this exercise, Angela could focus on her strengths, such as hard work and devotion, and try to diffuse her weaknesses, such as hypersensitivity. Think of your Angela. Does he or she need an exercise in examining their strengths and weaknesses to increase their self-control?
Dissolving the Excuse of Catharsis
However, in practice, I feel this sort of treatment actually leads to an escalation in the self-injury. Angela was directed by a staff member during her hospitalization to dip her arm into a bucket of ice water. In doing this, she developed a treatment-resistant case of frostbite. When she was referred to me, I explained to Angela how this seemingly harmless act can be used to only further her preoccupation with self-injury.
Sometimes clients are asked by their therapist to use exercise as a form of dispelling negative emotions. Many of these clients told me that when they used physical activity, they felt overanxious and their feelings of frustration actually increased afterwards, causing them to intensify their self-injury. Sylvia, age 19, would punch a bag to release her emotional stress. I explained to Sylvia that the only real effective way to keep herself from self-injuring is to stop associating emotions with an action.
Self-control, I told her, is going to keep you from cutting yourself, not constantly bringing yourself back to a violent action when you need to vent. Let me repeat that. I explained to Sylvia that the only real effective way to keep herself from self-injuring is to stop associating emotions with an action. Self-control, I told her, is going to keep you from cutting yourself, not constantly bringing yourself back to a violent action when you need to vent.
Technique: "Anger Inside Me"
I asked Sylvia to answer these questions:
In response, Sylvia
answered, "I get frustrated when things don't go my way. My mom yells at
me, my grade was bad on a test or something someone said to me just won't stop
replaying in my head. When I'm under these stresses, I tend to be very sensitive
By identifying the specific triggers to her anger, Sylvia could better understand how these lead to her self-injury. Viewing her angry feelings with sympathy and acceptance helped contribute to Sylvia's self-esteem and her control over impulses.
On this track, we discussed how self-control is essential in treating a self-mutilating client: thinking and behaving in an age appropriate manner; dissolving the excuse of catharsis; and de-associating activity with frustration.
the next track, we will discuss the various mental disorders with which adolescent
self-mutilators are diagnosed. These include Axis I disorders such as depression,
thought disorders, anxiety disorders, and post traumatic stress disorder, and
the Axis II disorder of borderline personality disorder.
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