A Safe Place for Cutters Blog


Did You Know that Exercise Can Reduce the Urge to Cut?
July 24, 2009, 11:00
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools

ExerciseOne of my assignments at the State Hospital where I work is running an exercise group. I used to take the individuals to the park on the hospital grounds and have them walk around it at least twice which is about a mile. Oh, the moans and groans I would have to endure as I insisted they get up off the grass, where they were spread out like fleshy mushrooms, and get moving. I felt like a cruel taskmaster.

Today, an individual told me that she remembered how she had hated it when I persisted in my efforts to get her to walk around the commons. However, over time she began to enjoy the walks and noticed some delightful benefits that included: weight loss, increased energy, motivation, and self-esteem and much to her surprise in a decrease in her urges to cut herself.

Exercise, does have an antidepressant effect making it another important tool for your toolbox.

To A Life Worth Living,
Foresteen Forbes, Psy. D.

*If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend.  Click here!

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July 22, 2009, 05:00
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools

Nia Misses from Toronto, ON and a member of my Facebook group The Cutters Safe Place* says that she often feels like she is drowning in the seductive urge to cut hrself. She claims that she finds the 15 Minute Rule helpful for such torrid moments.
She explains, “You tell yourself that you can cut, only if you wait fifteen minutes.
If you wait fifteen minutes, you have to wait another fifteen, just to see how long you can suppress the urge”. She finds that typically, after the first 15 minutes, the urge is gone and adds, “The things that you do to distract yourself from cutting in that 15 minutes tend to also help you get rid of the drowning feeling”.

Nia illustrates her use of 15 Minute Rule by explaining that she had gotten herself addicted to reality TV and using this to occupy herself during the !5 minutes. She has her favorite reality show on her Ipod as well as on DVD so that any time that she wants to cut, she is close by to something that will play an episode for her. She then stops feeling like she drowning, and stops wanting to cut, and then starts YELLING at the Survivors.

Yelling at TV

This is a good use of the Distraction technique that I discussed in an earlier blog.

To A Life Worth Living,

Foresteen Forbes, Psy. D.

*If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend. Click here!



Steps in the Chain to Self-Harm
July 20, 2009, 05:00
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools

Chain AnalysisIn my last blog I explained what a Chain Analysis was and how to use it. In today’s blog, I am going to offer an illustration of what a Chain Analysis might look like when completed. The following is an example of a Chain Analysis I did with one of my individuals at the state hospital where I work. I will call her Shaneesh.

Problem Behavior: Shaneesh broke a toilet in order to have some porcelain shards to cut herself with. The staff caught her before she was able to harm herself.  She put up quite a fight as the staff removed her from the bathroom. She was placed  under close watch with a staff who assigned to stay with her (1:1) until Shaneesh felt safe from hurting herself. She screamed at me her psychologist whenever I tried to talk to her.

Precipitating Event in the Environment: Sheneesh had observed a favorite female staff being chased by a male peer the day before and it brought up memories of her drug addicted mother being chased by boyfriends. This made her feel so angry she wanted to kill the peer.

Vulnerability Factors: Shaneesh was already feeling some anger building up inside for the past few days. She wasn’t sure where it was coming from but felt that she was about to “cycle” meaning that she was struggling to control her urges to cut herself after having been free from cutting for two months. Shaneesh also realized that she saw her psychologist as a mother figure and had projected the feelings of rage she had toward mother onto her psychologist.

Consequence in the Environment and Yourself: Shaneesh felt very ashamed of herself for her violent behavior. She was reminded of the poor opinion she had of peers who had done similar behavior with breaking toilets and cutting themselves. Whenever such incidents occur the staff have to take time out to do paperwork to document the incident. This not only adds a burden to the staff who she cares about but angers her peers who now find it harder to get staff attention. In addition, Shaneesh felt alienated from staff members she had felt close to and knew it would take a while to repair the relationships.

The toilet costs $125 dollars to replace which impacts the department budget which results in outings and  activities not taking place as well as other reduced benefits. The department was threatening to put in steel toilets which give an institutional appearance and not nearly as attractive as the porcelain ones. The broken toilet meant that the bathroom would be closed off for a while which would inconvenience her peers as there were now less bathrooms available.

It also meant that she lost her grounds pass for seven days. A grounds pass means that you can wander around on the 162 park like acres of the hospital property and enjoy the peace of being outdoors instead of being on the unit listening to all the chaos that often reminded her of the domestic violence in her home while growing up. Being able to be outside also meant that she could order food such as pizza or Chinese food with her peers instead of having to be subjected to eating the tasteless hospital food.  She was also doomed because she wouldn’t be available for any fun outings with the staff such as attending the Angels game or the Orange County Fair.

Different Solutions: Instead of acting on her feelings to cut herself she could have talked to a staff member that she trusted. She also could have distracted herself by listening to her favorite music.

Prevention Strategies for the Future: Shaneesh realized that she was feeling vulnerable since she had been allowing her feelings to build up because she had been refusing to be open about them by talking to trusted staff, attending group therapy or journaling.

Plan for Repair: Shaneesh agreed to spend the next five days helping staff out by doing cleaning jobs on the unit.

Chain of Behavior:

Thoughts/beliefs: Shaneesh has a love hate relationship with her mother who is currently in jail.

Feelings: The part of her that loves her mother was enraged when memories of her mother were triggered by seeing a favorite staff in danger.

Actions: Ran to attack male peer.

Thoughts/beliefs: Family secrets are not to be shared therefore she believed that she had to keep her feelings to herself.

Feelings: Felt bottled up and angry. Strong desire to cut self.

Actions: Broke toilet

Thoughts/beliefs: If she fought with staff, the pain from having to be taken down by them and forcibly removed from the bathroom would provide needed relief from her painful feelings.

Feelings: Volcanic anger.

Actions: Fought with staff

Lessons learned: Shaneesh realized that a volcano had been building up inside of her and it was related to her that it was wrong to share family secrets. This caused her to avoid talking about feelings to staff and using humor to deflect others and keep them from knowing how bad she was feeling inside. It also kept her from going to group therapy where she might be in danger of having to share intimate parts of herself. As a result, Shaneesh resolved to be more open about her feelings with staff and start attending group therapy. She has been as good as her word and has been more open and honest about herself and attending group therapy. She is a whole new Shaneesh.

Click link for a copy of the Chain Analysis form.

Next: How to Stop Feeling Like You Are Drowning

To A Life Worth Living,

Foresteen Forbes, Psy. D.

If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend. Click here!



Do You Hate Yourself After Cutting?
July 18, 2009, 22:46
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools | Tags: ,

Do You Hate Yourself After Cutting?

Hate YourselfI hear from many cutters* that they loathe themselves after they succumbed to cutting after struggling to fight off the urge. This is true of my patients at the state hospital as well. They complain of feeling like a failure and figure they might as well go all the way and make it big.

Rather than beat yourself up for this setback look at it something to learn from. So much of the time you don’t really know where your urges came from or why you are feeling the way you do. This makes it easier to cut once you get the urge. Instead, take a close look at the steps that led up to your cutting. This is called a Chain Analysis or Backward Chaining. By practicing this method you will come to better understand yourself and help you to better manage your urges and put controls in place.

A Chain Analysis can help you identify why you are engaging in certain problem behaviors. It will help you figure out all the things that can contribute to cutting, and in doing so, a chain analysis can give you insight into how to stop cutting.

  • The first step is to describe the cutting incident that you just engaged in. Rather than berate yourself over having cut again, stand back from the situation and examine the behavior as if you were an indifferent bystander. Describe it in enough detail that an actor in a play or movie could recreate the behavior closely. Describe exactly what you did, said, thought and felt and the intensity surrounding the problem behavior.
  • Next, think about what happened prior to your cutting. What were you doing? What was going on around you? Were you in an argument? Did you have a memory of a traumatic event triggered? Basically, you want to identify the event or situation that served as the starting point for the cutting.
  • Now, identify what kinds of thoughts were brought up by the situation or event you came up with in Step 2. How did you evaluate the situation or yourself in that situation?  It might also be helpful to identify what things might have made you more susceptible to responding to the situation as you did. What was making you feel particularly vulnerable? On another day, those things that were going on in your environment would not have triggered you. Why this time? For example, when people do not eat well or do not get enough sleep, they may be more susceptible to experiencing negative moods or having more reactive emotional experiences.
  • Think about what emotions you were having as a result of that situation. Try your best to list as many emotions as you possibly can, such as worry, fear, sadness, anger, shame, guilt, embarrassment, and feeling isolated.
  • Pay attention to what you felt in your body. Try to recognize and label all the sensations that came up. For example, did you experience shortness of breath? Muscle tension? An increased heart rate? Think about how your body reacted to the situation you identified in Step 2.
  • Next, list off what your thoughts, emotions, and bodily sensations made you want to do. That is, did they make you want to escape the situation or do something to make those feelings stop? Did you feel a need to engage in your problem behavior?
  • Finally, think about consequences of engaging in your cutting. Did you feel better afterwards? Did you feel disappointed in yourself? Ashamed? What was the impact on others? Was there any property damage? Did someone have to take time out of their schedule to drive you somewhere? Was a relationship damaged? Try to list off as many consequences (both positive and negative) as you can.
  • What can you do to repair the situation or make amends? This can include fixing something that broke, doing something for someone else to make up for the situation and even apologizing.
  • This final step is the most important of all; what did you learn about yourself after completing the Chain Analysis? What can you do differently next time?  Did yuo have any deep thoughts or insights?

Tips:

  • It can be helpful to go through a chain analysis soon after you engage in a cutting. This way, your experience is fresh in your mind and you will likely be able to remember more information about the factors that led up to your cutting.
  • Behaviors can serve multiple functions. Therefore, go through a chain analysis for a number of different situations that led to a problem behavior and try to identify all the functions a problem behavior serves for you.
  • After you go through the chain analysis, come up with different coping strategies that you could use at each stage. In addition to identifying the function a problem behavior serves, it is also incredibly important to figure out how to “break the chain” with healthier coping strategies.
  • Click this link for a Chain Analysis form that you can download to help guide you through the process as well as an MP3 of a recent teleconference I did on the subject.

Next: A real life example at the state hospital.

To A Life Worth Living,

Foresteen Forbes, Psy. D.

*If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend. Click here!



Managing Urges that Come at 03:00 Part 8
July 13, 2009, 07:00
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools

0300 AM So far in my “Managing Urges” series, we have covered the following ways of coping: helping others, distraction, releasing anger, channeling emotion, changing the moment, spirituality, facing the problem head on.

But what works at 03:00 when you have a strong urge to cut yourself?

I asked Paige S* this question, ” since she provided most of the material for my previous blog posts for the series I figured that she might have an answer.

Paige replied, “For the person with urges that happen at 3 am I suggest maybe listening to some happy music maybe reading a book to get their mind off the feeling or really anything that can distract them”. I would add that you get completely out of bed and don’t even try to sleep, as  focusing on the urge and/or the insomnia will only make the situation worse. Just expend your energy on distracting yourself.

For more ideas on the use of distraction, see my earlier post on the subject.

To A Life Worth Living,
Foresteen Forbes, Psy. D.

*If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend. Click here!

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Managing Urges Part 7: If All Else Fails…Take the Bull by the Horns
July 11, 2009, 12:50
Filed under: Borderline Personality Disorder, Coping Skills, self-harm, Tools

FearSometimes it’s just better to dive in and face a problem head on. What stops us is the fear of it. But ironically, when you face a fear head on you actually make it smaller.

It’s like when I did a fire walk once. The very thought of it was terrifying. But when I walked fast with my focus on my waiting friend at the end I made it without a singe. The people that burned their feet were the ones who hesitated and did not keep their eyes on the goal. Now when I picture a fire walk I am reminded of the fun I had doing it and no longer feel any fear at the thought of it.

The point I am trying to make is that the fears you harbor grow but when you take measures to deal with them directly they become smaller because they lose their power and dominion over you.

The following list of fear fighters by Paige S* are an excellent start for managing the siren call to cut. Much of what she suggests has to with journaling, a practice that I highly recommend.
Feeling: Upset, Lonely, Depressed, Frustrated
Method: Mirror Time
Description: Sit down in the bathroom and look at yourself and start talking. Who can understand what you’re going through better than you? Talk through the problem and do a little self-counseling!

Feeling: Upset, Depressed, Frustrated, Creative
Method: Journal
Description: Keep a journal? Either on VF, another website, or just a notebook under your bed? Then whip it out (or sit down on the comp) and write about what’s going on. It doesn’t have to be Hemingway material, but focus on getting your point across.

Feeling: Upset, Angry, Frustrated, Depressed, Lonely
Method: Write It Out
Description: Take out your notebook and get ready to be honest. If you could say anything in the world to someone, what would you say? Now say it. Write it all down. There are no limits here, no restraints. Tell your mom how she makes you feel insecure, or ask your dad why he never said he was proud of you. Let your friend know that she acts like a jerk around other people. Everything you’ve been holding in or thinking about–let it out. When you’re finished, rip that thing up into a zillion (yes, one zillion) pieces and throw them away.

Feeling: Upset, Angry, Frustrated, Depressed
Method: Self-Medication
Description: We all have someone in our life that we truly love. Think about them. Now imagine that they were in your situation. What would you tell them? Sometimes we have to follow our own advice.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry
Method: Strike A Match
Description: This is a long-term activity and one that you can do every week. Whenever you get upset or frustrated or hurt–write it down on a slip of paper. Then fold it up and put it in a box or container or envelope; it doesn’t matter what it is as long as you can keep them all together. You can also write down your insecurities or fears. At the end of the week, get your slips together and head outside. Don’t forget to grab a book of matches or a lighter, too. Find a quiet place and sit down. Now, clear off a spot where you can start a small fire (safety first!). Then take out your slips. Read them, say them aloud, or just burn them. Either way, don’t stop until there’s nothing but ashes left. Let this symbolize letting go. You don’t have to worry about it anymore.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry
Method: Pros and Cons
Description: This is where you actually sit down and think about what you’re doing. Get out a notebook and divide a sheet of paper into two columns. One is for the pros (good things) and one is for the cons (bad things). Now, think about what you want to do. If it’s self-harm, smacking your sister up side the head, sneaking out, whatever. Now write down the benefits of doing this, the good things. Now, write down the consequences. Sit back and reread what you’ve written. I guarantee that 99% of the time, you’ll find that a negative behavior will have far too many negative consequences to be a healthy choice.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry
Method: Projection
Description: This is something that I do quite often when making a decision. Before you act, think about what you would want your hypothetical child to do. Would you want your son/daughter to stay with their cheating mate? Would you want him/her to self-harm? Would you want them to scream at you and then slam the door and stay out all night? If it’s something you wouldn’t want for them, you shouldn’t allow it in your own life.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry
Method: To Be Free
Description: Take out a sheet of paper and a pen. Now, write down all the things you can do without SI that you can’t do right now. Wearing a tank top to school without feeling self-conscious. Being honest to your parents when they ask what’s wrong. No worrying about infection. Write it all down. Now, keep it somewhere close by. The next time you have an urge, pull it out and look at it. Do you want to sacrifice those things? Is it worth it?

Feeling: Upset, Frustrated, Depressed, Lonely, Angry, Aggressive
Method: Therapy / Counseling
Description: You cannot win every battle on your own. And part of being strong is knowing when to ask for help. So talk to your parents about going into therapy or counseling. Call and make the appointment yourself if you can. Start changing your life right now.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry, Aggressive
Method: Breaking The Cycle
Description: Right now, this moment, get rid of your blades. Throw them into the nearest stream or trash bin. Let them go. If you can remove the temptation from your life, you can get one step closer to recovery. And a happy, healthy new life.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry, Aggressive
Method: Time Capsule
Description: This is something I did when I was in 6th grade with a couple of my best friends. And it’s something YOU can do every year. Get a shoe box or plastic container (it doesn’t have to be huge) and sit down in your room. Write a letter to yourself. Write about the point you are right now in your life. Everything. And write about where you would like to be in six months or one year. Put in a picture of yourself. Add whatever else you’d like. Then find a spot in your yard and get to digging. Put that baby in there and leave it. In three, six, or twelve months, make a date with that shovel and dig it up. Think about how much you’ve changed. Then fill the box back up (or use another) to do the same thing. Continue that tradition.

Feeling: Upset, Frustrated, Depressed, Lonely, Angry, Aggressive
Method: I Overcame
Description: Keep a journal or log of every time you have overcome an urge to do something negative, whether it’s SI or something else. Now, when you have another urge, get that book out. Read what’s worked for you in the past and remind yourself that you CAN make it.

Feeling: Upset, Angry, Frustrated, Depressed
Method: Impulse Control Log
Description: Taken from Bodily Harm: The Breakthrough Healing Program For Self-injurers, this method is used to help you analyze the situation instead of just brushing it off. It will help you get to the root of your feelings. Just write this down on a sheet of paper. Or you can even start your own Impulse Control Log Journal. Then you can look back on how far you’ve come and perhaps notice some patterns in your behavior.

Next: Managing Urges at 3:00 AM.

To A Life Worth Living,

Foresteen Forbes, Psy. D.

*If you would like to be a member of my Facebook group “The Safe Place for Cutters,” please find me on Facebook and invite me to be your friend. Click here!