the last track, we discussed three methods by which self-mutilators avoid discussion
in therapy: a blank slate; deflecting; and a false self. With the blank slate
or unresponsive client I used short statements. With the deflecting or evasive
client and with the client exhibiting the false self, I used direct focused questions.
On this track, we will examine the different challenges teen
self-mutilators face when going through the final stages of recovery. These
challenges are self-blame; the fear of incomplete analysis; the danger of over-analysis;
explaining scars to peers; and regret.
5 Challenges in the Final Stages of Recovery
Challenge # 1 - Self-Blame
As you probably
have observed, like I, many self-mutilators blame themselves for their illness.
Self-blame stems from the client's belief that he or she does not deserve to recover
or be treated as a success. Many clients feel a great deal of shame for having
a mental disorder in the first place. They feel that they are behind others their
own age as a result of this sickness and worry that they will never emotionally
and socially mature.
This issue of self-blame can cause regression and
shame. Sylvia, age 17, stated, "If they really know who I have been and who
I may be, they would lose all respect for me." This low self-esteem that
Sylvia was experiencing inhibited her final stages of recovery. I notified Sylvia's
parents and asked them to take a more active role in Sylvia's confidence building.
Once her family acknowledged her great achievement, Sylvia's confidence grew and
her self-blame began to diminish.
Challenge # 2 - Fear of Incomplete Analysis
Sylvia also suffered
from a fear of incomplete analysis. She believed that there were many more
issues that still needed to be uncovered. Sylvia was afraid that if any problems
were not addressed immediately, she would be left vulnerable and would regress
to her old behaviors.
Challenge # 3 - Danger of Over-Analysis
However, over-analysis was also a large danger. The intense
experience of self-exploration in therapy can lead a client to become so preoccupied
that the search becomes an endless obsession. I soon realized that Sylvia was
becoming too involved with her therapy and not enough in her recovery. She did
not want to leave therapy and was beginning to adopt a style of self-absorption
and narcissism. I reminded Sylvia that the goal of therapy was to make her independent
and not reliant on self-analysis.
Challenge # 4 - Explaining Scars
A unique challenge posed
to recovering self-mutilators is the presence of scars. Scars, as you know,
are an everyday reminder of the challenge and an inherent weakness. Adolescents
tend to lie about their scars instead of telling the truth about their illness.
Sonia used the excuse of a roller-blading accident. I told Sonia that if the person
became a trusted friend she might evaluate if it was appropriate to tell the truth,
but limit the details.
I also reminded her that if they begin to ask personal
questions such as, "Did it hurt?" or "Did you know what you were
doing to yourself?" that she was not obligated to answer them. Such questions
could leave Sonia humiliated and create old tensions and thus resurrecting old
feelings. However, in cases such as close friends, family, or spouses sharing
is natural process, conducive to building intimate relationships.
Technique: "Response" Exercise
help Sonia become more comfortable with telling the truth about her scars, I used the "Response" exercise. I asked Sonia to make a list of responses
to questions about her scars that told the truth, but didn't reveal any information
that Sonia did not want to share.
Some of Sonia's responses
to questions about her scars included:
scars are from a very painful time in my life;"
"They are a reminder
of something I did that I now regret;" and
"I once had problems when
I was young, but I'm just grateful that it's in the past."
By making this
list, Sonia would not have to think of lies to account for her scars. This way,
she acknowledges her struggle but also recognizes the achievement she has accomplished.
Challenge # 5 - Regret
Regret, while similar to blame, is rooted more in frustration.
Beth, age 19, was disgusted by her scars and the memories they brought on. Beth
stated, "How could I have done this to myself? I must have been crazy. Look
at these scars! I'll have to get plastic surgery to remove some of them. I used
to be so proud of them-they showed I could take pain. Now I want to throw up when
I look at them. I hate taking baths. At least in the shower, I don't have to really
look at my skin."
Beth could now see how her behavior, which she saw as a
solution, destroyed her mental and physical health. In Beth's case, her family
and close friends became vital in helping Beth forgive herself for what she had
Technique: "Stop, Reflect, and Reward" Exercise
To address Sylvia's feelings of self-blame and Beth's
feelings of regret, I found the "Stop, Reflect, and Reward" exercise
beneficial. I asked both of them to answer a few questions relating to their
change in their health over the past year.
Sylvia wrote, "I
feel like I'm a totally new person. I still feel stressed and everything, but
now I can handle the stress in constructive ways without harming myself. I don't
look at everything as a weapon now and I understand myself so much better. I realize
now that my cutting and burning was a way for me to handle the pressure of school
and mom and dad's divorce.
"I now wish I hadn't done what I did because it hurt
them so much. But as a result of my healing, I'm much closer to my mom. We ate
lunch together yesterday and had a long conversation about life and how I was
handling everything. I think she'll be much more involved in my life now, because
we understand each other a lot better."
By writing down
these thoughts, Sylvia recognized the great leaps she had made in her life. Even
though the scars are still there, she now knows that without the urge to self-mutilate,
Sylvia has completely turned her life around.
On this track, we discussed the five challenges teen self-mutilators face when going through
the final stages of recovery: self-blame; the fear of incomplete analysis; the
danger of over-analysis; explaining scars to peers; and regret.
What are five challenges teens face when going through the final stages
of recovery? To select and enter your answer go to .