New Content Added: To update the content we have added Self-Mutilation information found at the end of the Table of Contents.
seems that a logical place to start is with the obvious. Why the teens become
On this track, we will examine the five reasons I have found why clients self-injure. These reasons are: to relieve anger; to indirectly retaliate;
to test loyalty; to maintain control; and to induce caring responses from others.
5 Reasons Why Clients
# 1 - Relieve Anger
you probably have observed, self-mutilating clients tend to live with the myth
that when someone gets mad, somebody has to get hurt. Usually, this stems
from a childhood home that valued repressing angry emotions.
Crystal, age 16 stated "My family almost never showed any anger, but when they did, it sure
got bad. My fantasies are that I want self-injury to the point of death. Sometimes
I feel like if I self-injure, maybe someone will notice me." Crystal's emotionally
repressive family left little room for self-expression. I felt Crystal's need
for someone to notice her is a way for her suppressed emotions to make themselves
known. Many times, Crystal believed that it was better for her to hurt herself
than to hurt someone else, or to let someone else hurt her first.
# 2 - Indirect Means of Retaliation
second reason for self-mutilation in addition to a "notice me" kind
of anger is it can serve as an indirect means of retaliation. In this case, self-injurers
who have been abused as children think that mutilation of themselves will cause
pain to their aggressor. Unable to express their feelings of wrongdoing coupled
with their belief that those feelings would be ignored, clients like Sylvia repress
their emotions until they're released through self-injury.
Sylvia, age 19... was
abused by her father when she was 7. She stated, "My parents never publicly
recognized the abuse. Every time I confronted them, they denied the whole thing.
They really never addressed my feelings of betrayal or loss of trust. I thought
'I'll show them' and that's when I started cutting." At the end of this track,
I will discuss how I how I utilized a "Fantasy" exercise with Sylvia's
feeling of indirect retaliation.
# 3 - Means of Control
A third reason for self-mutilation
in addition to a "notice-me" kind of anger and indirect retaliation,
I have found clients sometimes use self-mutilation as a means of control. Generally,
this is a result of an abusive or traumatic childhood.
As you know, clients who
experienced sexual manipulation have lost a sense of control of their environment
and self-mutilation is a way to regain it. They decide when and how long the pain
will endure, not their aggressor. Sylvia stated, "I felt that when I inflicted
pain on myself, I was reclaiming what I had lost." Sylvia described her pain
as a way of forcibly establishing a line between herself and her aggressor, in
this case mainly her father.
# 4 - Test Loyalty
A fourth reason for self-mutilation:
Sylvia also used her self-injuries to test a person's loyalty to her. She would
be very open about her self-mutilation. She stated, "One pattern in my life
that I'd like to change is my need to sort of poke at people in order to see how
much I can trust them and whether or not they'll leave me." Her loss of trust
as a result of her childhood abuse caused her to feel alone and helpless.
# 5 - Engage Caring Responses
Cutting herself and talking openly about it was her way of protecting herself from a second
loss should someone she trusted betray her. As you are aware, many times, clients
who reveal their self-mutilation in public also want to assert a personal declaration. Tony, age 17, stated, "I liked the attention I got from people. I felt like
I was different or tough. I told myself that I was strong enough to take it and
everyone else was impressed with my strength." In addition
to relieving anger, maintaining control, indirect retaliation, and a test of loyalty,
clients use self-mutilation to engage people's caring responses.
age 18, stated, "When I knew someone would be seeing the cuts, I was hoping
they would feel compassion and want to help me." There's a fantasy behind
Kristen's line of thinking, that if the other person cared enough, he or she would
prevent the mutilation from happening. In reality, her dramatic actions drive
her loved ones away in understandable fear.
This only strengthens Kristen's view
that the world is uncaring and apathetic to her needs. Also, clients like Kristen
tend to rely on the therapist to rescue them from themselves. Ultimately, though,
only Kristen can save herself. Eventually, when all human relationship disintegrated,
Kristen looked to her scars and the instruments she used to self-injure as her
friends. One way I helped Sylvia... to begin to overcome the
abuse by her father was to help her express in words what her self-mutilation
was trying to communicate.
To do this, I used a "Fantasy" technique.
I had Sylvia who was abused by her father write down and identify the people she
felt who wronged her, create a fantasy of revenge, and then imagine what actual
apologies, punishments, or retribution might reasonably occur. In this way, Sylvia
could express the things she needed in order to put her traumatic childhood behind
"Fantasy" Technique, 2 Steps
Step 1: Identify People who have Wronged You
Sylvia wrote... "I feel that my mom hurt me as a child
by ignoring my needs and focusing on my brother's needs. She heard my brother's
cries but not mine. My dad abused me emotionally and sexually. I don't feel that
any of my mom's actions have ever been talked about. I still feel that she loves
me, but I still have problems believing that she loved me when I was younger and
dad was going what he did."
Step 2: Create a Fantasy of Revenge
After expressing her feelings of wrongdoing,
Sylvia went on to explain a necessary retribution for her reconciliation with
her past. "I would like to see my dad go to jail for the crimes he did to
me when I was younger. I would also like to see a confession from him, but that
won't happen. I guess a confession from both of my parents would make me feel
better." In articulating her emotions through the fantasy and words but not
self-injury, Sylvia began to learn how the abuse was leading to her cutting.
On this 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. Think for
a moment of you self-injuring client do any of these reasons apply to them? If
so which one? Would the fantasy technique I used with Sylvia be beneficial? We
also saw how the "Fantasy" technique can help self-injurers express
On the next track, we will discuss 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.
Peer-Reviewed Journal Article References:
Bloom, C. M., Holly, S., & Miller, A. M. P. (2012). Self-injurious behavior vs. nonsuicidal self-injury: The CNS stimulant pemoline as a model of self-destructive behavior. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(2), 106–112.
Courtemanche, A. B., Piersma, D. E., & Valdovinos, M. G. (2019). Evaluating the relationship between the rate and temporal distribution of self-injurious behavior. Behavior Analysis: Research and Practice, 19(1), 72–80.
Schoenleber, M., Berenbaum, Hs., & Motl, R. (2014). Shame-related functions of and motivations for self-injurious behavior. Personality Disorders: Theory, Research, and Treatment, 5(2), 204–211.
What are five reasons why your client may self-mutilate? To select and
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