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Talking To Therapist About Self Harm

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ellienad

Confident
(Possible self harm trigger warning)
I'm new to discussing self harm with my therapist, as I just recently started talking about it with her. For those of you who have experience discussing it with your therapist, I was wondering if anyone could clarify from experience some reasoning behind her questions.

She first asked the location. This is one pretty self explanatory I guess. She then asked how often/how frequently. Again, this is pretty self explanatory, and I would assume to also assess my safety? The question that confused me a bit though was when she asked about the direction/way in which I cut (ie, straight lines, all over, across each other, etc). I guess the direction and way I cut could give some meaning to my mindset behind it? For example, straight lines in a row would be a need for gaining control and order, etc. I'm not sure...

Since, again, I'm new to discussing SH with my T, I would just like some input I guess from anyone else who has discussed it with their T. I've heard about therapists asking to see self harm as well...mine hasn't, but I'm afraid she's going to and I wouldn't know what to do! Thanks in advance.
 
My T doesn't ask to see anything.

She probably is just asking a question to get motivation or what you get from it. She also probably wants to know if you are getting what you need from it - I.e. You'd be at greater risk for continuing the behavior because it's being reinforced.

For instance scratching haphazardly in the moment because it's all you have access to May not be as effective for you as cutting in straight lines.

Just a thought... You get to say no or pause on conversations you aren't ready for. And you can decline to show her if she asks.

Talking helps. Don't shut down the lines. But be patient with yourself and the process though it's scary
 
Whoa. I wouldn't show a therapist my cutting. Much too personal for me. Considering where I cut I would have to remove major pieces of clothing and... I don't like any of my shrinks that much. ;)

I've never had anyone ask about the specifics of cutting. I would find that kind of odd.
 
I suggest asking her why she asked the questions that she did - she is really theoy person to know for sure.

I have told two therapists about my self harm and they both handled it pretty differently - and it was related to what info they wanted to know to beat understand the severity and impulsivity or ritualization of the behavior and how unsafe I was with it.
 
When I went to a Partial Hospital program, they asked me so many questions about my cutting. Some of the questions made no sense at all.
What do I cut with...knife,razor, glass,etc?
Where do I cut, on my body?
How often?
Where do I cut, my room,car,bathroom,etc?
This one really confused me...which hand do I use to cut? I asked my therapist why they asked that and he didn't even know.
How deep do I cut?

I'm not really sure why they ask these questions, but I suspect to find out how severe a problem this is, although I would think any frequency is severe because it only takes one time...to go too far.
Maybe, the questions also help to get people to open up about it.
 
You don't ever have to show your therapist your sh, they may ask but you are well within your rights to refuse - this will not (or should never) be immediately turned against you as a potential reason for hospitalisation. The only exceptions might be where you're under-age, but I still think you don't have to show them.

Most of the questions that can be asked are to try and assess whether you're self-harming with suicidal intent - and if you're at risk of suicide despite not having intent. Other questions can be about the risk of infection, or another complication (like a glass shard in your blood stream), in an attempt to assess your mental state (now or for future reference - if you get worse), in an attempt to diagnose (or rule out diagnosis) of another condition like bipolar or borderline personality, whether you are at risk of psychologically harming others by sh'ing directly in front of (for example) minors, whether you are at risk of lashing out and harming anyone else, whether or not you have are at risk of drawing in further abuse to yourself and so on.
 
My therapist has never asked me to show him but he always asks me where and if I needed or need medical attention.

He asks my what I was feeling during it.

For instance if you do it and you feel a wave of relief and calmness rush over your body it can be a signal that your seratonin is low. If you are doing it and your feel anger and rage that is being fueled your adrenaline could be as mess. Most of ours is anyway. But those answers are clues to someone who understands what cutting is actually about.

I read that there in some insight to how people cut. For instance is it where people can see or can it be easily shown. Is it a cry for help or is it hidden and kept secret and used as a punishment towards yourself?

Are you trying let emotions out or trying to get connected back to your body because of dissociation? I have done it for both reasons.

Where are you when you cut? If it is in your bathroom or bedroom is it because you are more triggered there?

What do you cut with and where do you keep those utensils. Is it a spur of the moment thing and you are fueling with rage so you break a bottle and use a shard or glass...,or is it a slow simmering thing?

I think a lot of information can be gleaned from the mere facts of it that could be used to help put tools in place that could help prevent self harm.

I only cut with a certain thing. I don't keep them at my house anymore. I used to keep it in my bedside table. Then I hid it from myself. Then I threw it away.....then I had a hiccup and got another one and had to go through the whole process again but simply moving it away from the place I felt most triggered was very helpful.
 
My regular therapist never asked to see, but she asked where and with what. I am enrolled in a Partial Hospitalization Program and the nurse practitioner did ask to see and I did show her but only because I felt comfortable doing so. When she asked what I cut with, her answer surprised me. I always assumed therapists asked about it to see how harmful the item was. She asked if my tetanus shot was up to date and that caught me off guard. I went slow at first when talking to my therapist about it, but eventually it helped and now I am working on recognizing early warning signs that I am headed to that kind of place and try to avoid it. It was a coping skill, it did help, but I'd rather find better ways now. That's a new journey for me. I would also agree with asking your therapist why she asked the third question.
 
Actually, in my opinion, I think knowing whether the cuts are straight across, all over, etc can give a good indicator of a person's stability & a better indication of suicidal intent. If cuts are straight across where veins/arteries are, it demonstrates methodical work, less haphazard, so a system is in place. If the cuts are diagonal, that's closer to damaging veins. And if it's haphazard, all over, no method or rhyme, that could indicate that it's more dangerous. I think it's a good way of knowing how much control a client is in when he/she is engaging in self-harm.

My T did ask me to show him (so did the other T back in the day). It made me a little uncomfortable, but I knew he only wanted to help me. Shortly after that, I stopped cutting altogether (and it'll be 4 years this May!)
 
Mine told me that he did not want to make any assumptions about how I was hurting myself, and so he was going to ask some detailed questions. I remember the process of answering being even more important to me than the answers themselves probably were to him; it can feel like such a shameful act, and just talking about it in factual terms helped me "see" what I was doing to myself in a way I hadn't before.
 
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