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Self Injury: Common Mistakes Made When Trying to Help

Common mistakes are made when Working with Self-Injury

Angie is a 17-year-old ballerina. Her dance teacher tells her that she needs to get help or stop dancing, if Angie will continue to scratch her arm. When she was 18 years old, Angie decided to break through the painful part of her body. That week in therapy, he finally agreed to talk about the resulting infection and why he was hurting himself.

Belle is a 14 year old, bright, talented, social, and high school student. Her parents take her to psychotherapy when her grades start to fall and Belle's separation from her friends becomes clearer. In a few sessions, Belle raised her longer arm to reveal a horizontal wound along her wrist made with dirty scissors.

These two teenage girls don't want to kill themselves. They did not need hospitalization at that time. Both are trying to continue to hurt themselves. Both come from upper middle-class families, in good schools, academically and socially successful. Angie and Belle each convey a picture of perfection to the outside world, including their families; so that they cannot do so. The most common mistake made by mental health professionals and families is to respond and believe that suicide will occur. Self-injury or self-harm is a suspension mechanism used to prevent suicide. "If I let that feeling go, I wouldn't be so shocked, hurt, hurt, and alive."

Charlene is a 35-year-old mother from New York who moved to the West Coast to be with her true love at 17. As she grows older, has children, has no job and finds herself overwhelmed by her husband's money and emotional needs, Charlene begins to move between drinking alcohol, not eating, cutting herself and running to New York. Her husband calls her "crazy" and always tells her daughter that she is just looking for attention.

Daisy is the only 23-year-old woman in the banking career she hates. He was lonely but, due to his early abuse, did not trust enough people to forge friendships or more intimate relationships. After a period of psychotherapy to find out how her history affected her current social situation, Daisy began a meaningful relationship with a non-threatening man. As the relationship progressed, Daisy became frightened and began cutting off her thighs and wrists. When his fiancée is identified, he becomes angry over his attention seeking behavior.

Another major mistake made by self-harm behavior is to think that teens or adults are "just trying to get attention." In fact, self-aggrandizers often master their secrets. They are helping others and describing their lives as if they were good. They "act" rather than "act out." Therefore, a major mistake made in the field of mental health is to ignore personal injury as an attempt to get attention. Most of your privacy is done in full privacy. So when statistics say that 1% of Americans are self-harming, (mostly women), we can be sure that it's a big budget. Cutters, sellers, burners, breakers, scratches and painters, find places in their bodies that no one else sees. They will cut their bikini strips, brand above or below their breasts, rub their thighs or bite the cuticle and then wear gloves. When the behavior is discovered, there is a great deal of shame and guilt; usually not enough to stop the behavior, but bullying can escalate or become worse and even more hidden, if the reaction of a loved one or a mental health professional is one of disgust, anger or helplessness. "I'm a terrible person, I have to punish myself."

Evelyn is seeing a Family Therapist (MFTI) because of her extreme cuts and knees and her ankles. In her supervision, MFTI was positive that Evelyn had been sexually assaulted as a teenager due to personal injury. After looking at all the other factors involved in Evelyn's history and current life circumstances, it is clear that no such trauma exists. In contrast, Evelyn's parents split up when she was younger and her mother had a long string of couples who received more attention than her daughters. Evelyn's father was completely out of the picture and quickly landed in a life sentence for murder. Evelyn feels completely abandoned.

Fran was admitted to the hospital for a straight cut on her inner arm and thigh. Cutters know that horizontal means "help," while vertical means "I'm serious and can kill myself." Mental and social workers pressure Fran and her family about who, when and how she was sexually abused. Fran and her family insist that no one hurt her. When he got into individual psychotherapy, his story of an early emotional emergency by a crazy working dad and an alcoholic mother emerged. Fran believes that she does not deserve love and that her body is a place for self-esteem. All that matters is leaving her, why not leave her alone?

A third mistake made by many who assist professionals in working with self-aggrandizers is to believe that the etiology of shameful acts is from early sexual abuse. In 1998, Steven Levenkron wrote a beautiful, helpful and honest book called CUTTING: Understanding and Relating SELF-MUTILATION. He describes the major element of self-injury as the initial neglect; real or perceived. Since its seminal work, researchers and other physicians have agreed with the premise that self-mutilation is embedded in one or three thought processes, whether conscious or not:

  1. "I was shocked by my feelings, I had to divert my attention or I would explode, I would cut, I could focus on physical pain, not emotional pain."

  2. "I don't understand, I can't feel anything and wonder if I'm still human, I'm going to cut it.

  3. "I hate myself, I must be punished."

All of this is based on the feeling of being left behind by the person or person who should be there when the child needs it. Often, parents will swear that they give their children everything they need. From their perspective, the child was "too poor," or "getting what all the other kids were getting." From a child's perspective, however, he does not get what he needs, when and how he needs it. Therefore, the inner sense is, "I feel too much or too much," "I need to close my feelings to realize and serve others." or "I shouldn't like it the way I need it: I don't deserve it."

Gwen is a 14 year old girl with lots of potential. She's smart, pretty, friendly and liked. Her mother is in an unhappy marriage and spends a lot of time in the toxic battle, praising Gwen's little brother for her success and humiliating Gwen for starting Gwen. He started scratching at his arm to distract himself. When Gwen starts running away from home, using drugs and prostitution, she discovers that a glass knife and straight edge will do a better job; causing more pain, which he believes he deserves. After years of working on the problems that Gwen left behind and blaming herself, she was able to stop hurting herself and find other healthier ways to deal with issues like art, music, nature and rubbing ice on her arm to feel some pain. She realizes that she doesn't have to leave her alone even though her parents did; he should be better.

Until mental health professionals, parents, teachers and doctors are aware of the frequent mistakes made, too many women and men, men and women will be diagnosed wrongly and wrongly in the health and mental health system. First and foremost is not to be disgusted or angry at bullying. Does a professional show anger toward alcohol? anorexic? Self-harm is another way of dealing with trauma, such as substance use or eating disorders.

Next, taking an interest in real wounds is important. Ask them what tools they use. Is it clean? Did they clean the wound? Where and when do they endanger themselves? Each answer will provide invaluable information about how clients treat themselves, triggers and respond to trauma. Ordering about thoughts and feelings immediately before they do is also helpful when looking at ways to change or inhibit behavior. Self-awareness is very useful for intruders. Working with self-aggrandizers to understand why and when they are in danger will give them the power to respond to stress such as stress; if they understand why and when, they have a choice. Finally giving them an alternative suspension mechanism, so that when they are triggered, they can choose, going a long way in reducing or stopping self-injury.

With more seriously injured patients appearing in therapeutic settings, whether hospital, home care, nursing home or sometimes school, helping professionals need to be clear about who, how, when and why people are harming themselves. Much of the fear surrounding self-abuse is due to a lack of knowledge and aiding the response to physical pain. Of course not all mental health professionals should work with this particular population. Just as it is important to be aware of personal limitations with substance, eating disorders or personality disorders, it is important to be aware of personal / professional limitations with personal injury. At the same time, having a basic knowledge of what is and is not suicide behavior, what is and what is not being sought, what is and what is not associated with early sexual abuse will only help the appropriate diagnosis and planning by parents and professionals alike. .

(c) Lisa Cohen Bennett, PhD



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