A Safe Place for Cutters Blog

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.

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