Should I Tell My New Therapist That I Self-harmed In The Past, And I Have The Urges Again?

[rhaven]

I am meeting with a new therapist next Wednesday morning. I have been involved in self-harm in the past and as of last I have been having the urges again for over 3 weeks. I did self-harm 3 times last week, but have not since then. I have these urges almost hourly when I'm awake. I am seeing this new therapist the day before I see my medication nurse since she didn't have any cancellations in the last 3 weeks. Needless to say, I am not happy with her office staff as I feel that they did not give her my messages. I have called almost everyday for the last 3 weeks trying to get in to see her until I can meet with the therapist.

I also don't know what else I should tell the new therapist in the first session? Anyone have suggestions of things that I should definitely bring up in the first session

 

[Silent one]

Absolutely! You should tell your new therapist everything. But I think the first session is more about seeing if you get along with him/her. There is nothing worse than having a therapist who you cannot relate to. Opening up to a stranger is difficult enough. I wish you well and hope you get better. Good job for not self harming lately!! One step at a time.

 

[Sideways]

I definitely think it would be helpful for you and your T if your T was aware that self-harm is a recurring issue. It's so common with ptsd that your T is unlikely to be surprised, but it will allow your T to help you with strategies to deal with it when it comes up.

Thing is in your case, this sounds like something that you can be proud of. You've self-harmed in the past, and the urges are back. But despite how frequently those urges are popping into your head, overwhelmingly you're actually managing to not act on the urges. Every time you feel the need to self-harm, but don't, you're coping with your emotions in a healthier way, and that's a huge win. Basically the self-harm conversation is going to be you telling your new T that even though it's still an issue, you're working your @rse off and making huge progress as a result. That's something you should be proud of.

If you have that conversation now, and worst case scenario things do slide backwards, you won't be in the position where you're breaking the news to your T for the first time when you're in the midst of a crisis:)

 

[hodge]

Yes, definitely tell your therapist about the self-harming. Even if you don't stay with her, you've gotten it out and it will be then easier to tell another therapist you might feel closer with.

 

[EveHarrington]

I'd err on the side of caution.

You don't know this person. She may go overboard and literally try to force hospitalization on you against your will. Sadly, if she believes you're a danger to yourself, the law is on her side.

I think the best plan of action is to feel her out. In the first session tell her you have thoughts of self harm. Ask her how she treats patients with self harm thoughts. If she asks you if you self harm, I'd be vague and just say you don't feel comfortable saying more at this time. Her answers should be enough to get an initial impression of how she approaches self harm issues.

I'm not saying to lie-----this isn't a lie. It's a matter of protecting yourself while getting to know a new therapist.

 

[The Albatross]

I think the key point would be "almost hourly" (you said, " I have these urges almost hourly when I'm awake.")and yeah. I'd tell. Sounds pretty serious to me... no fudge room for error there really.

 

[Whyteferret]

I am meeting with a new therapist next Wednesday morning. I have been involved in self-harm in the past...

When you find a therapist you click with and trust, then yes, tell.
It's a balance. On one hand, you have to tell so you can get help. On the other hand, it can be very hard when you don't know the person yet. It's all pacing.
You can also opt to tell to see how the therapist responds and if you're comfortable with it. It may be easier to see if the relationship clicks depending on the reactions...

 

[Whyteferret]

I'd err on the side of caution.

You don't know this person. She may go overboard and literally...

If the therapist knows the difference between self harm and suicidal actions, the two will be handled differently. Some therapists aren't comfortable with the concept of self harming.

 

[EveHarrington]

Very true @Whyteferret I just say it's good for one to feel out a new therapist as forced hospitalization does happen which could compound existing trauma. Not every therapist/psychiatrist is "new school" in this sense. There are many professionals who were schooled in the days before this behavior was well understood and unfortunately they hold on to old school beliefs.

 

[recoveringfromptsd]

A lot of depends on how you present yourself, if you go into a session and tell about it and your behavior or effect gives one the sense you might not be able to control yourself, then most T's will error on the side of caution. Some will feel you out, but not all do.

In one way, if you go in, appear in control, and tell your T and say your managing it, and when it gets to much that you need help you will let him or her know. that usual would help build a two way trust relationship, where the expectation is you will be honest, and and also communicate your needs.

I have this very situation right now, I am into intensive abuse therapy, and I have a constant urge to cut to get relief but I don't because that would stop me from getting better as the therapy would end. My regular T knows about these urges, in fact I have to fill out a DBT diary card with any urges on it daily.

So a lot of it really depends on you, and how you begin this new T relationship.

For my, my T's expect me to speak up when I need help because I can't manage it on my own, but they also expect me to use my skills to manage it otherwise. So with my T it's ok to have S/H and even S/I, as long as I don't hide it, and don't act on it., and ask for help otherwise. Even when I was in crisis and they were trying to get me into Sheppard Pratt TDU a process that took a month or more. They had mobile crisis check on me daily, but they still expected me to speak up if I could no longer control myself. They could have stuck me in a regular psych ward for my safety, but they did not, they left it to me to dictate what would happen.