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Her previous therapist had just retired from analytic practice and referred Mona to me. She warned me that Mona could be a difficult patient and that treatment would proceed slowly, since she was granted a “fortress existence” by her father that supported her resistance to change. The analyst also diplomatically informed me that Mona could be “quite independent at times.”
Mona entered the room with a pleasant smile, shook my hand, then became preoccupied with taking off her backpack, scarf, and coat. She placed them at the end of the couch, turned around to face me, and sat down. Her focus on the rituals involving in folding and placing her clothes and backpack, in blatant disregard of my presence, indicated her comfort with detachment from others. As she sat down, she resumed smiling, as if to say, “Now I have time for you.” It was all very natural and devoid of hostility.
Part of the referral information received from her previous therapist indicated a history of physical (not sexual) abuse and of neglect by her mother (divorced from her father for fifteen years and now remarried). The abuse had begun when Mona was a child and had continued through her young adulthood. Mona never received a birthday card, or any other greeting card, from her mother, even though she had sent her mother cards on Mother’s Day, Christmas, Easter, and her birthday without fail for the past fifteen years.
At our initial session, Mona sat there with a friendly smile, saying nothing. I was aware that her previous therapist was comfortable with silences of up to ten minutes, so Mona didn’t expect me to speak for a while.
“I have been told by Dr. N. that you haven’t had much experience with having your feelings of warmth reciprocated by those closest and most important to you.”
She brushed my comment off with a frown and a shake of the head. “Whatever you grow up with, you think is normal. You just take it as it comes.”
For the first three weeks, Mona was pleasantly light in response to questions about her discomfort and loneliness. She told me stories of punishment, assaults, and not being let into the house after coming home from school on cold winter days. She seemed to regard me as sympathetic, which I had been, and easy for her to talk to. We appeared to have gotten off to a good start.
Mona came in for her seventh session with a frown
on her face.
Her face still maintained its hard look.
“You will have to go next door to my dermatologist
colleague to see if it needs stitches or other treatment after
our session is over. What is this about?”
She answered me in a tone that suggested I should
have known the answer.
Mona had come into her session angry, dissatisfied, acting as if she wanted to end the relationship. She did not have the relationship skills or the ability to reflect upon what was really bothering her. At the age of twenty-eight, she was doing what an early adolescent does: she yells at her mother or father for a grievance that belongs somewhere else. Ironically, Mona was snapping at me over a grievance she had with her own mother. Another birthday passing without hearing from her mother had been a painful reminder of her mother’s neglect.
Therapy offered Mona a new opportunity to learn that she could depend on another person. By dressing her wound, I did what a parent would do. This would deepen her trust and attachment to me and would provide me with more leverage to help Mona.
My goal was to develop her verbal expressiveness,
which would in turn give her more insight into her own feelings,
especially her anger and sadness. I knew from her symptoms she
had no healthy outlet for emotional pain. I would continually
push her to clarify the reason behind every self-harming act until
the act itself became unnecessary.
Information Brief Non-Suicidal Self-Injury:
- Ohio Department of Education, What is non-Suicidal Self- injury?, Miami University, Center for School Based Health Programs, 2017
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