How Does Your Therapist Handle Self-harm?

[sun seeker]

Awkward question for me. Right now, I'm questioning a lot of things.

For those who struggle with serious self-harm and/or chronic suicidal ideation, what is your therapist's attitude towards these things and what specifically do they do to help you? Not so much what do you do for yourself, but what does your therapist do?

I'm beginning to wonder about how this issue has been handled in my own life, but I'm not really sure what "normal" is supposed to look like.

 

[Eagle3]

My therapist is a former Suicidal Ideation sufferer as well, so if I'm struggling with it, we can talk very openly about this and he knows I'm just talking (won't actually go through with anything yet). Basically, we talk about stuff a lot, but it always comes down to my choices. When it comes to self-harm, I don't know how he handles it, but I think he understands that my love of getting new ink, practicing extremely brutal Martial Arts with Fibro, and generally not paying any attention to pain is a form of SH for me. He complements the new ink, encourages me to take time off from training if I need to, but he just lets me do my thing since its not too harmful yet. We both use alcohol as a coping mechanism (him previously, myself currently), so he understands that one too. Again, my levels of use don't require intervention yet, so he just lets it go.

 

[Sideways]

My SI and SH have been treated differently, which I think has been appropriate, because they are 2 very different issues for me, and I'm usually one or the other, rather than deeply into both at the same time. But in bothh cases, I'll be honest, the way it was handled has been ultimately helpful, but very difficult for me to get my head around.

The SH got to a point where it was SH or they weren't going to help me any longer. 2 different pdocs and a T all ended up with the same approach. It was too hard for them to cope with on a personal level knowing what I was doing to myself at home. I should caveat that by saying that I typically got into SH that was different from cutting or burning. It felt a lot like I was being abandoned, but I've been SH-sober for 5 months, so I guess it's working. Still not easy though, and I wish there was a way for my T's to be a bit more supportive. I don't know what that would look like though, because I can get pretty obsessed with SHing when I start.

SI in my context is being managed on the tail end of several attempts that each landed me in ICU on a ventilator. While I've always been supported through my depression and with meds to assist, ultimately the way it's now managed is it's my choice. If I can't keep myself alive, it's up to me to get myself to the ED and check myself in. That has worked a lot better, because I've actually come to terms with not just being solely responsible for whether I'm alive tomorrow, I've also gotten pretty good at keeping myself alive without needing hospital. It hasn't gone away - I haven't "chosen life" yet, but I'm not ready to quit yet either.

Both of those stragies put me in complete control of how I treat myself, and the outcome of that. It's a lonely way to deal with it, and a pretty damn big risk. But I've had a lot of respect for the T's in each situation and as painful and isolating and "unsupportive" as their approach has been, ultimately I did need to take control of my life myself. Hard and risky way to learn that lesson, could've had a really really bad outcome. But so far, their risk has paid off.

Does that help? I may be totally projecting, but it sounds like you're not sure you're comfortable with the way your T is handling these issues for you?

 

[sun seeker]

I may be totally projecting, but it sounds like you're not sure you're comfortable with the way your T is handling these issues for you?

Yes. More that there is no real strategy for dealing with it at all, leaving it up to me to figure out. (There have been strategies suggested for when it isn't at its worst, that can work. It's when it is at its worst that I'm at a loss and haven't found the help I need.) I'm trying to get a sense of how normal that is.

I wouldn't want it dealt with the way you are describing, but we are different people in different situations. It may be what you need, but it wouldn't work for me. I'd be terrified of not being able to live up to it.

 

[sun seeker]

f I'm struggling with it, we can talk very openly about this and he knows I'm just talking (won't actually go through with anything yet

Yes, that is actually something I have appreciated, that my therapist can go into those dark places with me.

my levels of use don't require intervention yet, so he just lets it go

Yes, see, mine has reached a level that requires... well, something. And I'm not getting that "something." Just trying to get a handle on what other people's "somethings" look like.

 

[Naoru]

I do not struggle with self harm, but I do with S/I. My therapist is very supportive, calm, and really doesn't dwell on it too much. She focuses on helping me figure out what causes it and how I cope with it... we have brainstormed ways to ensure my safety... but really, we don't discuss it very much at all. She feels comfortable with my stability as long as I'm honest and open with her about it each week, and she's pretty confident in my ability to handle it on my own. I think so long as I'm talking about it to show it hasn't turned into a crisis, she's cool. I'm not sure what she would do if this changed. An official safety plan? Check-ins? I don't know.

 

[Blurred]

With previous T's their solution was put me in hospital where I was dosed up with seroquel till sufficiently dazed and compliant then I was released. That was repeated many times and didn't help one bit. My current T has been completely different. We've worked at it from different angles simultaneously. 1. Preparation before a crisi hits - things like distraction, grounding, mindfulness etc, 2. During a crisis - attempting to do those things (mostly distraction initially), I was also able to call her (or her workplace crisis line) if those things weren't helping where she would talk me through it, 3. Working on underlying issues - really working through them.

My T is really supportive if I tell her I have self harmed/suicidal or am thinking about either. She pretty much talks with me (distraction, grounding type stuff) until I calm down a bit and am able to make an agreement with her to defer any self harm/suicide. After that she calls (or her work crisis line calls) at regular intervals until they/I are confident I can manage. Initially it was all about the preparation and crisis stuff but as we've been working more on the underlying issues, the frequency of SH and SI has been decreasing. My T also helped me reduce some of the regular life stressors by helping me find supports for those things - like childcare (which is hard to get into here) and other things like occupational therapy for my son.

 

[Blurred]

Oh I should add that there have been a couple of times when she didn't think I could make an agreement and I was taken to hospital for assessment but was not admitted. I went from pretty regular hospitalisation with previous T's but none in the 3 years I've been with my current one

 

[Deleted member 36624]

Awkward question for me. Right now, I'm questioning a lot of things.

For those who struggle with s...

Sun seeker, as a hynotherapist that deals with PTSD, I understand that people's cognitive part of the brain plays the backseat to the EMOTIONAL brain. I deal with the painful emotions FIRST, not the thoughts which require logic to deal with. People dealing with the thought of suicide are not logical, they are emotional, so I start and end there. Find a hypnotherapist in your area that specializes in severe depression. Also google Rewind Technique Treatment for your area. The technique is astounding! If no one in your area does the technique, Google someone who will do it via Skype. Do it today. I wish you well, my friend.

 

[sun seeker]

Thank you Ease Trauma, but you know, that wasn't actually what I was asking about.

 

[sun seeker]

Thank you @Blurred, that is helpful.

 

[pixel]

People dealing with the thought of suicide are not logical, they are emotional

Wanting to clarify that this is utter rubbish.