Symptoms like self-harm won’t go away until the sufferer has other ways to calm and soothe their emotional overwhelm. To ask someone to stop cutting without offering alternative ways to achieve comfort and calm is akin to asking a trapeze artist to give up a safety net.
So the cutting is not, in fact, crazy but wise in some way and must be appreciated as such in the beginning of a treatment.
Ultimately, for someone like Renee, a successful psychotherapy has the following three components:
- Figure out together by a process of trial and error alternative strategies for calming and comforting that are not destructive to the Self. Dialectical Behavior Therapy (DBT) teaches many useful skills and strategies that help a person manage overwhelming emotions. Plus, having a list of people to reach out to for support is helpful. In sessions, Renee and I experimented with many ways to help her sooth herself and calm her emotions such as: grounding her feet on the floor, breathing, talking about light-hearted things like her favorite television shows, wrapping a blanket around her, trying to parse out the overwhelm into bite-sized pieces, sharing with her what I thought she was experiencing in the moment when she didn’t know, and extending a hand for her to hold if she wanted.
- Help the patient understand, label, and validate the underlying emotions that have been overwhelming—helping to notice them and work with them before cutting becomes the only option. Renee had a lot of anger towards her father, which she learned to suppress when she was a child. She learned to recognize and validate her own anger when she felt it and this helped.
- Eventually, the long-term work of therapy entails healing old traumatic wounds and processing old and current emotions as they arise in the present moment of the therapy. This involves regulating or calming anxiety when it comes up in the session. Then, we return back to the core emotions underneath and aid them in safe expression. As trauma is healed and people have the experience of safely having emotions, overwhelming emotional experiences diminish. More specifically, Renee’s treatment focused on helping her calm anxiety by learning what emotions were triggering them; accessing and processing the anger at her father for his abusive behavior; teaching her how to tolerate and channel anger at others in a healthy way by asserting; and building her tolerance to the full spectrum of emotions and their accompanying experiences including their inherent body sensations and impulses.
After about six months of treatment, Renee stopped any self-harming behaviors. She still had painful and powerful feelings like we all do. But, she learned how to soothe herself and manage them in adaptive ways.
Slowly, she grew more compassionate to herself and came to understand how her traumas affected her. Her self-harming behaviors were no longer needed. She appreciated them for how they helped at one time. Now, however, Renee was relieved and proud of herself that she had new and better ways to cope with her emotions.
*Patient details have been changed to protect confidentiality.
Woman in pain photo available from Shutterstock