How Does Your Therapist Handle Self-harm?

[joeylittle]

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?

I specifically sought out a therapist who would be able to engage with me on my suicidality, without believing that it was better to resort to emergency intervention by default.

I don't think it's easy to combine self-harm and suicidal ideation into the same basket - they are each fairly multi-dimensional problems. Ultimately, a therapist should always take them seriously, but what that looks like is very different depending on the individual, their diagnosis, their impulse control, and the therapist's experience and comfort level.

There's very little connection between the kinds of self-harm I've engaged in and the suicidal ideation I experience. In other words, self-harm is a separate symptom for me, and not necessarily tied to suicidal thinking. But for others, it is.

So, one thing you might need to parse out for yourself is, how related are your actions in these two areas? Are they entirely separate, or does one escalate to the other?

The suicidality is the more dangerous issue of the two for me, so I'll write about that. The first time the rubber met the road, so to speak (the first time I was really having a hard time with it) we developed a safety contract. Not all therapists use them, and there is some debate in the therapeutic community about whether they help or hurt. It's been productive for me, because it's very hard for me to go back on any guarantee I make. So, I have guaranteed that I will call him under certain circumstances (it's evolved over time, but basically, before I take an initial step in actualizing a suicide plan) - and that I'll allow him to intervene. He's guaranteed to me that the intervention will rely first on talking, not hospitalizing.

He would absolutely send me to the hospital if his assessment was that I needed to be there.

So, what he does to help me is: he holds me accountable to an agreement, but trusts me to maintain my end of it. In other words, he's not hovering. I rely on the fact that he's done a lot of time in crisis intervention, and he knows what he's doing - it lets me feel comfortable fully revealing my mental state to him, which is a necessary part of crisis management.

There have been a few times where he didn't read me right. I consider it my responsibility to disclose about stuff like that.

Mine actually does stem from overwhelming emotion. The thought process that keeps me here, though, has a lot of logic in it.

Me too, actually. Or - I'd say that it's the overwhelming emotion that creates the crisis where my impulse control gets challenged. So, I'm pretty rigid about what I'll allow myself to be in proximity to, and also, pretty rigid/logical about the realities of suicide.

 

[sun seeker]

So, one thing you might need to parse out for yourself is, how related are your actions in these two areas? Are they entirely separate, or does one escalate to the other?

True. I'd have to divide my suicidal ideation into two parts. One is a sort of dream about finally giving up the struggle and the pain. I go there in my mind a lot. But then I get to the point where someone would have to find me, and I really, really don't want to do that to anyone, or hurt the people left behind. Also due to my spiritual beliefs, I don't really believe suicide would get me to anyplace better. It's just a dream, a temporary release.

The part that is a worry does overlap some with the self-harm, which is always impulsive, never planned. When very badly triggered by certain things, I have sometimes self-harmed in a way that if it escalated just a bit more, could cause me serious injury. I don't know what to do about that. And that grew in my mind into thinking about one particular scenario that could happen and how it would be the last straw for me, how it would be too much to bear and I would be in too much pain and out of any hope at all, and I know what I could do to end it and how easy it would be. It would be more of an impulse in a time of enormous stress.

That part scares me. A lot. And I haven't told anyone the details because I really can't think of anything helpful that anyone could do. I'd be afraid of any combination of being given up on/shamed/locked up/not taken seriously.

What I need is to work on stabilization without any more trauma getting in the way for a while... but life has a way of happening anyway.

 

[Tinyflame]

It would be more of an impulse in a time of enormous stress.

I think this is really big. It's often said it comes from emotional disregulation, but when it doesn't (as in my case, ie it's not my go-to then), I think this is more accurate, that is extreme stress, extreme sorrow, extremely feeling like a burden etc. is connected, & I breakdown. In sorrow, & fear, mostly.

In your case then, how can you reduce stress @sun seeker?

(PS, I am pulling for you. Candle tonight. :hug: :hug: )

 

[sun seeker]

Aww, Junebug, you are great with your candles! What colour is it this time? :hug:

I wish I knew the answer to your question. There is an ongoing situation I've been writing about in a few other threads that is retraumatizing me... took me a while to come to that word, but it's not an exaggeration. I'm reliving so much from my past, and trying to find new and better ways to deal this time around to it doesn't end in disaster but in peace and growth. But the only part of it I have any control over is my response to what others do, and I'm at a loss there as well. I guess maybe I need to practice taking one moment at a time and when things seem desperate, remembering that they can change. Easier said than done though.

Unfortunately my therapist is not a whole lot of help at the moment, and I've been trying to come up with what might tide me over and not coming up with much. Today at work I was observing how little it takes to tip the scale one way or the other. I was sitting with a bunch of nice, welcoming people having coffee, and that was enough to make me feel kind of human at least. Then they started discussing their families, and the pain started... it's almost a physical pain, that deep aching loneliness that separates me from other people. That was all it took for me to lose that sense of connection, and the feeling of disconnection is a big part of what leads to my self-harm.

There is nothing to keep me going off the deep end, and that scares me. I've come up with a few things but when I've needed to use them, they have mainly failed. It's scary to be this close to losing it and not know how to put the brakes on.

I guess it's grace that I need... and my faith is at an all-time low, but what I mean is that third way that can sometimes open up when it feels like you are stuck between a rock and a hard place and then all of a sudden, the sun comes out and shines its light on a peaceful path.

 

[Tinyflame]

What colour

Oh! It's a beautiful Our Lady of Guadalupe candle so mostly blue & gold. :inlove: (I'm bringing out the Big Guns. :) )

Then they started discussing their families, and the pain started... it's almost a physical pain, that deep aching loneliness that separates me from other people. That was all it took for me to lose that sense of connection, and the feeling of disconnection

I'm reliving so much from my past,

To me, the 2 are related, triggers in there. If you can figure out , or it can come to you, or when it happens it will help so much. It's so hard to be patient. :( :hug:

all of a sudden, the sun comes out and shines its light on a peaceful path

Isn't that a wonderful feeling @sun seeker . I remember even how a tiny flame from a candle could light a whole dark room.

Mostly I too had nothing much to conceptualize as brakes. But being vulnerable it does become a bit my-life-is-in-your-hands. well actually, entirely. Though it felt (often) like being dragged behind a car down a gravel road, I'm still 'here'. :notworthy: Really not due to 'myself'/ own abilities.

Are you sleeping? How about pain management?

:hug: :hug: :hug:

 

[sun seeker]

mostly blue & gold

Sounds lovely.

But being vulnerable it does become a bit my-life-is-in-your-hands.

I'm in a very tricky spot right now where my therapist, who has been my main support person for a long time, is going through some big issues of his own that I seem to be triggering in him. He's working on it, fortunately, but it will take some time. Meanwhile, he's being less than reliable or consistent. A lot less. Which brings up my feelings of rejection by an attachment figure, which is overwhelming. So right now, he is not someone I can go to for help with this problem, because he is the one triggering it. Not causing, I hasten to clarify, but triggering. If I were completely honest with him about it, it would put pressure on him, and that would not be helpful. So my safe person is not currently safe, and that in itself is making me feel less safe.

So I guess I need to find someone else to help me with this, at least temporarily. But I don't know who that would be. I'm kind of stuck here.

Are you sleeping? How about pain management?

They're okay. It's the emotional pain that is so bad.

You are so kind @Junebug. I'm glad you are here.

 

[joeylittle]

There is nothing to keep me going off the deep end, and that scares me. I've come up with a few things but when I've needed to use them, they have mainly failed. It's scary to be this close to losing it and not know how to put the brakes on.

I understand this feeling, and have been here before. Not knowing detail, I'll just throw some things out there:

Is there a way you can build in speed bumps, in terms of the thing(s) you go to, when it's impulsive self-harm that could escalate? Sometimes these are just really simple, like making sure you don't have any access to what you'd use. Sometimes, a little more complicated, like keeping things locked in separate areas. It depends on the situation. If you want to brainstorm about this, feel free to PM me.

You said that your coping mechanisms have mainly failed. Has anything worked just a little? Sometimes, identifying the thing that worked a tiny, tiny bit can give you insight into what you might be able to do to strengthen it.

I'm having some problems with my own therapist right now - not the same as yours, but kind of related. I just really feel where your'e at, and encourage you to keep posting here.

 

[sun seeker]

Has anything worked just a little?

Well, the one time I did make it to the E.R., I came up with whom to call for a ride, and it worked. And now I know what the E.R. offers, which is not much, but it was enough to get me through that day. On the other hand, now I know the limitations of the system in the area, and the choices are very limited. So going to the E.R. has now turned into just a stop-gap measure in my mind, not a way to keep myself safe more long-term.

If you want to brainstorm about this, feel free to PM me.

I think I'll do that. This gets a little uncomfortable.