People resort to self-harm when underlying emotions are overwhelming. Feeling so utterly alone and out of control, they’ll do anything to stop the torment of their feelings. Inflicting pain on the Self sometimes becomes the only reliable way to deal with unbearable experiences.
When we are babies, our mother’s soothe us and implicitly teach us how to soothe ourselves. When a parent, because of his or her own limits and traumas, is unable to soothe an infant, the infant becomes an adult who may lack the capacity to modulate emotions.
Experiencing childhood abuse or neglect of any kind, can also make it difficult for someone to soothe and calm themselves in the face of stress.
I teach my patients to eventually become their own good mothers learning to be compassionate to themselves while they take care of their feelings in a healthy way.
Renee’s problems began in childhood. When I met her, she told me she was nervous all of the time. She told me a part of her mind was constantly yelling at her, just like her father had yelled at her throughout her childhood.
“You’re a stupid little shit,” the male voice in her head would say.
She feared her emotions, feared others’ emotions, feared asserting, and feared feeling strong.
In the presence of people, her mind was completely preoccupied with their needs, as opposed to her own needs. She could not “hold on” to her Self. In fact, Renee found it almost impossible to know her own needs and wants.
Renee was extremely hard on herself. When I first met her, she resorted to self-harming behaviors such as cutting, burning and head banging to deal with her feelings.
She also felt she was a “bad person.”
The real and imagined anger of other people was a huge trigger and connected her back to earlier memories of her father’s rages. She could easily spiral into feelings of terror, rage, despair, and massive amounts of anxiety.
These feelings would come up quickly and were so excruciating that the only resource she had was to inflict pain on her own body to stop them.
The self-harming behaviors seemed to satisfy two purposes:
1) Self-punishment for her perceived badness; and
2) To stop overwhelming emotions from intensifying any further.
Attempting to Self-Soothe
Symptoms like cutting can be thought of as a person’s best attempt to self-sooth in the face of utter aloneness. Despite the fact that it is ultimately hurtful, the intention of the self-harming behavior is to help in some way.
Symptoms need to be appreciated for their good and adaptive intention—even when they are self-destructive and maladaptive.
Judging or stigmatizing anyone for their suffering only adds shame and makes people feel worse.
Time and time again, my patients are relieved when I share this positive understanding of their self-harming behaviors. I invite them to approach their behavior with a stance of curiosity and compassion for themselves.
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