the last track we discussed several examples of clients suffering from dissociation.
The examples discussed were: 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.
track, we will examine the consequences of badly executed hospitalizations such as: a feeling of isolation; a discharge without being truly cured of the
dilemma; and belittling the self-injurer.
3 Consequences of Badly Executed Hospitalizations
# 1 - Feeling of Isolation
As you know, many
people view self-mutilation as an oddity and view the population as untreatable.
The innate human instinct toward self-preservation makes self-injury seem inexplicable
and even terrifying. Seventeen year old John, after staying in a psychiatric hospital
for over four months, felt that the attitude of the staff was one of detachment
John stated, "The feeling I elicited from them, though not intended,
was horror. 'Oh my goodness-why would he do that?' They didn't say it to my face,
but their indirectness told me that they didn't want to have too much to do with
me." Because of his vulnerable stage in adolescence, John's experience in
the hospital left him with a feeling of isolation from the rest of the world.
Instead of better adapting to it, he fell even further into depression and anxiety
until he sought more therapeutic aid.
# 2 - Discharge Without being Truly Cured
Some of those doctors
in the medical field who have even attempted to work with self-mutilating patients
have taken the position that self-injury is an unchangeable disease, much like
alcoholism. Many times this is a result of abhorrence of the condition. Sometimes
hospital treatment only focuses on the act of self-injury itself: how dangerous
it is to harm one's body, what a toll it takes on the client and the people around
them, how aberrant or bad it is to take arms against one's skin.
In John's case,
he was trying to convey a message through his self-mutilation. He stated, "I've
thought, 'I'll show them just how worthless I am, and how much I hurt.' A lot
of people thought it was a suicide attempt, which it really was not." John's
disease was much more mentally internalized and by merely treating the symptoms,
his cuts and bruises, he was never really cured of the incentive to self-mutilate,
of course you can guess.
Technique: "Feelings Awareness" Exercise
To help John become more aware of
the emotional dynamics involved in his self-injurious behavior, I found the "Feelings
Awareness" exercise to be beneficial.
I asked John to answer the following
questions about his self-injuring behavior:
1. What feelings and fantasies
do I typically have prior to, during, and after an episode of self-injury?
2. What feelings have I wanted to create in others through this?
feelings do I elicit from others, even if I don't intend to?
"I want to leave a mark on myself in some way. I like having the scars. They
tell people, 'Look at me, I'm hurting.' I wanted them to want to help me. Usually,
they just think I'm incredibly sick and deranged." The ability to identify
the feelings and thoughts that lead up to an episode of self-injury helped him
conquer the behavior by placing its origins in the proper context.
# 3 - Belittling the Self-Injurer
your self-mutilating clients have probably related to you, hospital doctors
may tend to misunderstand self-injury. Some see it as a random or chaotic
type of behavioral expression, not, as I believe it to be, a condition with complex
and hidden meanings that can be clarified during therapy. Cynthia, age 19, related
a situation in which her self-mutilation during her hospitalization reached such
a frenetic peak her doctor ordered she be put into four-point restraints.
told me, "Sure it prevented me from hurting myself, but I felt so humiliated.
I mean, they had me spread eagle on the bed. It put me in a very vulnerable position and made me even more anxious than I was before." By immobilizing her, Cynthia
describes herself as regressing into a state of total dependency on the hospital
staff. Cynthia's grueling trial in fact worsened her tendency to self-injure and
she soon was trapped in a vicious cycle common to repeated hospitalizations.
her anxiety from being in a psychiatric hospital increased, so did the frequency
of her self-mutilation and thus lengthening her hospital stays. When Cynthia finally
was referred to me, she had had a cumulative hospitalization period of a year
and a half in the last three years.
Technique: "Impulse Control"
Often, the desire to
self-injure comes so quickly and unpredictably, the only way to keep from
relapsing to self-harm is to deal with that impulse almost immediately. To keep
clients on a controlled path towards healing but at the same time giving them
free reign to orchestrate this healing themselves, I find the "Impulse Control"
Log beneficial. To aid John and Cynthia in regaining control of themselves after
their damaging stays in a hospital, I asked them to make a grid on a blank sheet
I asked them to place the following 9 categories running across the top of their grid:
2. Time and Date
6. What would be the result of self-injury?
7. What would I be trying to communicate with my self-injury?
One of Cynthia's Impulse Control
Log's looked like this:
1. Self-injury thoughts: Cutting, burning
and date: July 20th, 5:30 p.m.
3. Location: Living room of my friend and her family
4. Situation: I was watching my friend's family get along so well.
5. Feeling: Disappointed,
alone, upset, angry
6. What would self-injury accomplish? Scars,
7. What would
I be trying to communicate through my self-injury? That I wish my family was close,
and that I felt alone.
8. Outcome: I started talking to people and challenged
thoughts to hurt myself
9. Comments: I noticed a decrease in my desire to act
As you can see, by writing out and communicating to herself
about her impulses, Cynthia was more ably ready to combat her urges. Think of
your John or Cynthia. Could they benefit from an "Impulse Control" Log?
On this track, we have discussed 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.
the next track, we will examine why adolescents are so vulnerable to the guiles
of self-mutilation. These reasons include: a drive for perfection; triggers from
childhood; and the construction of identity.
Peer-Reviewed Journal Article References:
Lee, S. C., & Hanson, R. K. (2016). Recidivism risk factors are correlated with a history of psychiatric hospitalization among sex offenders. Psychological Services, 13(3), 261–271.
Miret, M., Nuevo, R., Morant, C., Sainz-Cortón, E., Jiménez-Arriero, M. Á., López-Ibor, J. J., Reneses, B., Saiz-Ruiz, J., Baca-García, E., & Ayuso-Mateos, J. L. (2011). The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 32(2), 65–73.
Tepper, M., Berger, R., Byrne, S., Smiley, J., Mooney, M., Lindner, E., Hinde, J. L., & Korn, P. (2013). Older adults’ perceptions of recovery from mental illness: Impact of psychiatric hospitalization prior to 1990. Psychiatric Rehabilitation Journal, 36(2), 93–98.
What are the three ways in which hospital tactics can worsen a self-injurer's
condition? To select and enter your answer go to .