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Physical Pain Stops my Pain - Treating Teen Self Mutilation
On the last track, we discussed 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.
As you know, many times clients do not recognize that they have a problem with self-mutilation. They delude themselves with assertions such as the injury is not serious, that it doesn't affect them, and that it heals them.
On this track,
we will examine various arguments that clients use to persuade themselves that
they do not have a problem with self-mutilation. These include arguments of a
personal event, of necessary emotional cleansing, and of communication. We will
also include ways to address these arguments via the exploration of ramifications and analogies.
# 1 - Personal Event
For her first claim, that of "Self-injury doesn't hurt anyone", I asked Elsa how her mother and father felt about her self-injury. I then pointed out to Elsa how her older brother had not spoken to her since she told her immediate family about the self-injury. Even though she was not physically hurting anyone, her behavior was destroying her very valuable familial relationships.
For Elsa's second statement, that of "It's my body and I can do whatever I want," I told her that yes, she could do whatever she wanted to do, but I then put these questions to her. I asked her, "Is it really what you want to do? Do you honestly understand why you want to do it? What are some the ramifications of the behavior?" In this way, I was able to help Elsa break down her illusions about self-injury and aid her in her recovery.
With the first category of delusional arguments, I used exploration of ramifications.
# 2 - Necessary Emotional Cleansing
I posed this analogy to Lindsey in order to point out the flaw in her argument.
"Suppose you are diagnosed with a cancerous tumor and your doctor recommends
chemotherapy. You don't feel sick, you're still functioning, but the symptoms
of the tumor are interfering with daily routines.
This analogy demonstrated to Lindsey the errors inherent in her argument, that although the recovery process is more painful than the self-mutilation itself, the reward of good mental health is far greater.
# 3 - Inability to Communicate
As you can see, each of these statements
stems from an inability to convey any kind of desire for contact and affection.
Kara, age 17, used the argument of "It's the only way to know if people really
care about me" to justify her self-mutilation. Kara had been sexually abused when she was 6 by her uncle. When Kara reported the abuse, her parents denied
it, labeling Kara a liar and an attention seeker. Since then, Kara has had trouble
relaying any emotional distress to close friends because she feels that nothing
will come of it.
"Comfortable Presence" Exercise
In her response, Kara talked about her grandmother, who had always been understanding and kind to her. She wrote, "Grandma and I would always watch old movies together and she would tell me things about her childhood. Whenever I spent time with her, we made popcorn and she fixed me sundaes. She really spoiled me. I felt really safe with her. I never felt the urge to self-injure when I was around her.
"She gave me the care that my parents were incapable of giving because they didn't trust me anymore. I guess we got along well because her husband died when I was young and I didn't have anybody either. We both became each other's companion. Right after she died, I started cutting. It was like my lifeline was gone and I had to replace her, but I couldn't find anyone I trusted."
Kara's grandmother had been essential to her stability as a person. Without the warmth and comfort of a sympathetic loved one, Kara's world collapsed and her issues with trust soon resurfaced.
On this track, we discussed three arguments that clients use to persuade themselves that they do not have a problem with self-mutilation via the use of exploration of ramifications and analogies. These included arguments of personal event, of necessary emotional cleansing, and of communication. We also included ways exploration of ramifications and "Comfortable Presence" to address these arguments.
On the next track, we will examine
the ways in which cultural pressures have a direct effect on the adolescent self-injurer:
the idea that pain is achievement; and the "tough guy" stereotype.
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