Category Archives: Self-Harm

Seminar on Addiction

Addiction seminarRonnie Aaronson provided the seminar group with a well of her knowledge and experience on addiction, in particular focusing on the issues of alcohol addiction.   Ronnie explained how she works with clients using the Cycle of Change (Prochaska & DiClemente) system which helps both therapist and client to see quite clearly at what position they take in their process of tackling their addiction.   Moving along the cycle is helpful in motivating clients and the “lapse” stage is also an important part of the process of change and is not seen as a failure, but a chance to re-evaluate and to encourage a continuation of the work.

Supporting clients with addiction is complex and Ronnie believes that it is important for therapists to always work with the client’s needs, whilst at the same time being aware of the therapist’s own needs for rescuing and “fixing” which can often be unhelpful.   Ronnie uses the “Drama Triangle” (Karpman: Persecutor, Rescuer, Victim) to help explain the behaviour involved in addictive client relationships.  An understanding of Dependent Personality Disorder is helpful to asses for likelihood of addictive tendencies.

An important part of the therapeutic work with clients involves helping the client to manage their feelings of shame, which are often feelings associated with addiction issues.

Role playing and discussing scenarios helped the seminar group to understand in more depth how to think about working with addiction clients.

Participants rated this seminar in terms of overall assessment, on average, 4.03 out of 5.  Average ratings for the speaker were 4.11 out of 5.

By: Jo Turner
Edited by: Wendy Bramham
19 November 2015

Feedback from participants:

  • “All perfect”
  • “excellent organisation”
  • “great venue, very central”
  • “speaker very knowledgeable on the topic”
  • “gave a good insight into the complexity of treating addiction and the pitfalls of dismantling defences too quickly”.

Suggested reading:

  • AARONSON R. (2013) Addiction – this being human Bloomington: Authorhouse
  • BERNE E (1970) The Games People Play. London: Penguin Books
  • GERHARDT S. (2004) Why Love Matters –How affection shapes a baby’s brain. London: Routledge
  • KAUFMANN (1985) Shame: the power of caring. Cambridge, Mass: Schenkman Books.
    MILLER W.R. &
    S. ROLLNICK (1991) Motivational Interviewing. NY: Guildford Press
  • NATHANSON D.L. (1992) Shame and Pride. Affect, Sex and the Birth of the Self. New York: W.W. Norton & Co. Ltd
  • SCHORE A. (1994) Affect regulation and the origin of the self: the neurobiology of emotional development. Hillsdale: Erlbaum.
  • TURP M. (2003) Hidden self-harm. Narratives from Psychotherapy. London: Jessica Kingsley Publishers Ltd.
    WINNICOTT D.W. (1960) ‘The Theory of the Parent-Infant Relationship.’ In The Maturational Processes and the Facilitating Environment. London: Hogarth, 1965.

Self-harm: ‘When I hurt, I cut…’

self-harmSelf-harm accounts for over 24,000 hospital admissions every year¹ and it is estimated that 1 in 12 children self-harm². Rates in the UK are some of the highest in Europe³ but – because self-harm is, by its very nature, a private activity and is often kept secret and thus remains unreported – these statistics may be just the tip of the iceberg.

Self-harm is generally thought of to include violent acts to the self – specifically deliberately cutting, hitting, burning, injecting or imbibing potentially dangerous objects or substances, hair pulling, eating disorders etc. Smoking and drinking, over or under-exercising, engaging in risky sporting/driving/sexual behaviour, cosmetic surgery, tattooing and piercing may also be added to the list – although some may not consider many of behaviours in the second list to be harmful. Is eating a doughnut after a difficult meeting at work an act of self-harm or of self-care?

Self-harm is on the increase, and many wonder at the “contagious” aspect of the behavior – is it a way of crying out for help or attention; an act to externally express inner rage; a form of self-punishment; or just a way of “belonging” to a particular group?

Whilst working with a self-harming client can be very distressing, Lynn Martin references many examples of clients who, she feels, were kept alive by their self-harm(4). She refers to “anti-suicide” element of the behaviour, and explains that, for some, self-harm actually allows them to feel that they are in control of their lives. The endorphins, which are released into the blood stream after a puncture to the skin, can serve to somehow “re-boot” the depressed, withdrawn client who has lost touch with her world. Similarly, the pain of the wound can highlight that it hurts “here” rather than just “inside”.

As therapists, it is important that we do not allow any personal shock to spill out when working with a self-harming client. Showing concern for the wounds, and making sure that they are kept clean; ensuring, too, that the client is secure in the fact that you see them behind their pain; communicating that it is alright to talk about the self-harm; respecting the fact that the client is, more often than not, trying to survive and not to die; and reassuring the client that you will not try to steal from them their coping mechanism until they themselves feel safe enough to live without it – all these sort of responses are seen as being the most helpful to the truly distressed and pained client.

Whatever the reasons or the resolutions for the self-harming individual, as therapists we need to be aware of the width and prevalence of this behavior. We need, too, to look after ourselves whilst working with self-harming clients by exploring, in supervision, the myriad of reactions that this particularly violent representation of pain can produce in us.

By: Annabel Murray, Counsellor, June 2015

1 Samaritans & Centre for Suicide, 2002
2 Talking Taboos, 2012
3 NICE 2002
(4) Lynn Martin, Therapy Today, July 2013


Self-help Information about self-harm

What leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  •  developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.


Thoughts from the front-line
We asked a few teenagers to tell us in their own words how they would have liked their parents to support or help them.   The purpose of this exercise was to inform and assist parents/guardians who may be unsure of how to help their child.  Comments remain anonymous to protect identity.
 
Girls aged 14 and 15 told us:
“Further criticism is definitely something NOT to do, because most likely that is what caused the person to self-harm in the first place.”
“Parents shouldn’t pretend they understand, that is one of the most frustrating things for people in this situation. Perhaps saying they are trying to understand would be a better way.”
“Friends can play a large part in preventing further harm… I would get the parents to talk to their child’s friends to see if they have noticed anything.. make it subtle though!”

Girls aged 17 told us:

“For me, my parents couldn’t have really done anything to help me, my mum made me keep my door open at night and took away my razors, making me use hair removal cream instead.  But that didn’t stop me and it wouldn’t stop anyone from doing it.  There’s no way parents can stop it physically in all honesty.   For me it was my own personal feelings of guilt and these weren’t gonna stop no matter how much my mum and dad tried to help.  But the situation would’ve been a lot better if my mum had understood when I told her.  She didn’t say anything and I feel like she didn’t understand why I did it.  Maybe she thought it was some sort of cry for attention, but it wasn’t (I’d been hiding it for one and a half years). If she was more aware of the reasons why people do it, and maybe just gave me a hug, told me I would be okay, comforted me when I was upset about anything, then maybe it would have stopped me doing it sooner.  But instead she never mentioned it to me, only tried to physically prevent me from doing it, not mentally”.  FW

“What might have helped would be if I was not made to feel it was my fault or that I was a drama queen. Guilt is a key contributor to my issues and I was made to feel guilty for self-harming.  I wanted my parents to understand that I wasn’t doing it because I hated them.  I knew they would be heartbroken if I died, but when you’re mentally ‘effed up’ you don’t see it that way, and the selfishness that depression produces isn’t controllable.  Self-harm isn’t always slitting your wrists.  It can be pinching yourself under the table all lesson, or forcing your mind through horrible thoughts (emotional self-harm is a huge thing).  Yes, we know we shouldn’t do it, we know it is bad for us, we know it’s selfish.  Telling us this just makes us feel guilty, which makes us feel crapper which makes us more likely to lose control and do it again.  When you get a cold or even cancer you don’t blame yourself or anyone else; you just look for a way to fix it.  Sometimes we self-harm because it is the only way to feel alive.  Yet, blaming the child for feeling so low is not healthy and will not make them forthcoming with reasons why.”  MA
 
From the above stories, it is clear that it is helpful if parents/carers/relatives can try to understand the emotional distress underlying any self-harm behaviour in their child.    It may be important for the parent to seek their own support, such as counselling, to cope better with this alarming situation.  Wendy Bramham Therapy offers a range of therapists in Newbury & Marlborough who are qualified and experienced in helping with these issues, so please don’t hesitate to contact us.  
Wendy Bramham
July 2015

Self-harm – BBC Wilts, by Wendy Bramham

SELF HARM

What a leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  • developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013
for BBC Radio Wiltshire

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.

Helplines:

Domestic violence 0808 2000247
Bullying 020 8554 9004
Chidline 0800 1111
Homeless: Shelter 0808 800 4444
Samaritans 08457 909090
Drugs: Frank 0800 776600
B-eat (eating) 0845 6341414
Consumer Credit counselling services 0800 1381111
Mind 0300 123 3393