One of the many confessions I made to J when everything came flooding out last week was that I see self-harm as a way of communicating pain. As in, when I’m feeling really really awful, one of the reasons I feel desire quelling within me to hurt myself is that I feel it clearly shows to her just how much hell it has been to live in my own mind that week.
I’ve nearly removed self-harm from my list of habits in about the last 2.5 months. There have been some slips, and what might be categorized as an “almost” harming event, but on the whole I’m not grabbing for my razor every other day (mostly because I threw it out). I’m working really hard at making better choices.
As such, I’ve noticed that when I am really fighting the urge, one of my recurrent thoughts is that I have to cut myself because if I don’t, how else will J understand just how deep and intense my pain was over the week? It’s like I believe words will not be enough to truly tell the story.
I’m not sure exactly where this need comes from. It’s not like J does anything over the top when I admit to her I’ve hurt myself. Typically, she’ll ask when and what triggered the incident. She may ask where I’ve cut. Often, we talk about replacement behaviors. Sometimes, we discuss safety. These are all run of the mill and none of them feel particularly validating. Not that they’re bad strategies, just that they don’t support me in a way that would encourage me to keep cutting to receive the attention.
When I wrote about this before, a fellow blogger who I really respect left me a comment that stated she was in a similar situation. What she and her therapist decided was to replace self-harm as a means of expressing severe pain with the urge to self-harm as an indicator of the same level of pain.
This idea seemed remarkably simple, but effective. I shared it with J. That strategy had been her first recommendation too. However, she wondered if I would truly be able to feel like my pain was understood or if the distinction between cutting and wanting to cut would still feel obvious to me. Would cutting still rank highest no matter what?
She’s probably right, I’m sure it would be a process to make the shift. But obviously continuing to hurt myself isn’t an option, so I think that I’m willing to try using “tempted to hurt myself” as the high point on a continuum of describing emotional pain.
J obviously doesn’t want me to relapse back into self harm. She doesn’t want this to be another factor contributing to that behavior. So she asked me how she can receive the information from me that I wanted to cut in a way that feels as validating as if I told her I did cut?
I’m having so much trouble developing a response. Since I don’t know the source of the need, I don’t know what she can do to help me suppress it.
So what can she do? How can she make me feel supported and understood? I’m still not entirely sure. I don’t have an end-all, be-all solution.
Validation is the golden rule of working with people like me. When in doubt, find some way to legitimize my feelings. Make sure I know that you’re supporting me amidst them. Say it 10 different ways. Say it again and again and again until it sticks.
“I believe you when you tell me how intense your emotions are.”
“I hear that you are in a very difficult place right now.”
“I understand how much you feel you need to hurt yourself. I’m glad you’ve chosen to be safe, despite all that pain.”
“What do you need? How can I help you right now?”
“Tell me more about what’s going on. Let’s work through these challenging feelings together.”
“I’m still here.”
I need to hear the validation. I need to hear it 100 times, using the same calm patience and empathy with each repetition. I need to hear it from J, and I probably need to say things like this to myself. To believe myself when I’m tempted to dismiss my own pain, as if not cutting means that I’m somehow healed and not allowed to feel negative feelings.
I need to hear that she’s still there, because maybe there’s a part of me that thinks not hurting myself means I’m on a path to being better – but does being better mean an end to therapy?
Will this work? Once, I’m sure it will not be sufficient. Over time? I’m hopeful.
Because what’s the alternative? Hospitalize me? Refer me to an IOP? We’re in agreement that I don’t need a higher level of care. What I really want when the pain has been that bad is to be held, but that is unfortunately beyond the therapy relationship. So in lieu of that, I just want to know that she believes me, that she has as much of an understanding as she can without living the experience.
That’s so, so hard when I can’t know for sure what she’s thinking.
Has anyone else been in a similar situation? How does your therapist convey to you that they recognize the depths of your struggles in a way that makes you feel like they really get it? I’ll take any suggestions.