Self-Harm Before Therapy Sessions?

[JBug]

Hi -

I am currently seeing a psychologist twice a week for therapy. I've been seeing my therapist for over a year now, although it started out as a very prolonged assessment due to a unique situation that I'm dealing with. But for at least the last six months or so, it has definitely progressed into what feels like therapy. That said, my therapist feels like we can't really begin serious therapy until I get into a position where I can sustain a conversation without dissociating or shutting down. He's afraid that I will leave a session and not be able to function or put myself in harm in some way. So, although we approach many topics that will need to be addressed in more detail later, I feel like my symptoms are inhibiting our progress in some way, which I feel very responsible for. I know that this is the right therapist for me and I feel a certain guilt when I feel like I'm wasting his time in sessions where I can't stay present.

I have found that if I engage in some relatively minor self-harm before I go to a session, I can stay more focused and really start to do the work that I need to do. But I feel horribly guilty about this, because I am doing something that I know is damaging to me, just so that I can participate in therapy and not feel like I'm a failure. It kind of seems like I'm negating the benefit that comes from therapy by hurting myself before the session. I've tried it both ways and it does work for me; the pain allows me to focus and I feel more in control. I am on medication right now, but don't feel like it is helping me. We are searching for a new psychiatrist who can shed some light on the medication issue. My therapist's goal for medication is simply to reduce my anxiety to a level that therapy is possible. That, ironically, is my goal when I self-harm before a session. My therapist knows that I self-harm, but does not know that I do so before a session in order to function. I have a trusting relationship with him, and will bring this up soon, but wanted to know if anyone else has a similar experience with this.

 

[Iam]

Hi Jbug,

I am glad that you are going to tell your therapist about self harming before your sessions and the reasoning for it. He does need to know that. Like you, I have been in therapy for a year now and while I don't self harm, I do know that my anxiety before a session, sometimes for days before (and I see him weekly) is so great that I can barely function. It has taken me the better part of the year to really open up. I have found that my symptoms have gotten a lot worse since starting to really dig into the tough stuff, to the point of suicidal ideation at times. We have to back off during those times and work more on coping skills.

Going thru therapy is hard. Sounds like you have a really good T who understands that you need to be stablized more before you address the deep issues. Getting on the right meds will hopefully help. Hang in there & be honest with your T.

One other thought. You are paying your T, he works for you. You are NOT wasting his time. In fact you aren't wasting your time either, this is all part of the process and it sounds as if you are making progress. I know it doesn't "feel" that way, but you obvioulsy are!

 

[JBug]

Thanks, Iam. I know that I need to bring this up with him, and I will. The dissociation thing is hard for me. Either I dissociate by self-harming or dissociate in sessions. Neither option is good. I also feel like by hurting myself before a session, I can give him the illusion that I am doing better that day, am more able to attend, and really can participate in therapy. But that's not a truthful picture to paint and I do know that.