A Safe Place for Cutters Blog

Trying to be Perfect Makes for Imperfect

A high school girl in my Facebook group, The Safe Place for Cutters, wrote:

“i haven’t cut in a really long time…for me, i was feeling so lost in life and the pain from cutting helped center me. i’ve finally learned that you have to love yourself or else nobody will ever be able to love you. i’m such a perfectionist and it has been so hard to let go of the perfect image that i had of my self, and to accept that i am not always going to be able to live up to my ridiculous expectations of myself, but now that i have, i feel liberated. i hope that all of you are able to find that place of acceptance within yourself…we’re all here for you, because we all are going through or have gone through something similar if not exactly the same as what you’re going through.
much love to all of you!”

Sometimes the members in my group say it so much better than I could ever say myself.

To A Life Worth Living,

Foresteen Forbes, Psy. D.


Bill of Rights for People Who Self-Harm
February 22, 2010, 10:36
Filed under: self-harm | Tags: , ,

Sometimes health professionals can stand to be more sensitive to people with self-harm behavior. I came across the following that I thought I would share.

Bill of Rights for People Who Self-Harm

An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike. Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).
Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

The right to caring, humane medical treatment.
Self-injurers should receive the same level and quality of care that a person presenting with an identical but accidental injury would receive. Procedures should be done as gently as they would be for others. If stitches are required, local anesthesia should be used. Treatment of accidental injury and self-inflicted injury should be identical.

The right to participate fully in decisions about emergency psychiatric treatment (so long as no one’s life is in immediate danger).
When a person presents at the emergency room with a self-inflicted injury, his or her opinion about the need for a psychological assessment should be considered. If the person is not in obvious distress and is not suicidal, he or she should not be subjected to an arduous psych evaluation. Doctors should be trained to assess suicidality/homicidality and should realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted.

The right to body privacy.
Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient’s dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks.

The right to have the feelings behind the SI validated.
Self-injury doesn’t occur in a vacuum. The person who self-injures usually does so in response to distressing feelings, and those feelings should be recognized and validated. Although the care provider might not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurer’s right to be upset about it.

The right to disclose to whom they choose only what they choose.
No care provider should disclose to others that injuries are self-inflicted without obtaining the permission of the person involved. Exceptions can be made in the case of team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional.

The right to choose what coping mechanisms they will use.
No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SI or be kicked out of outpatient therapy. Exceptions to this may be made in hospital or ER treatment, when a contract may be required by hospital legal policies.

The right to have care providers who do not allow their feelings about SI to distort the therapy.
Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety out of the therapeutic setting. This is crucial for basic medical care of self-inflicted wounds but holds for therapists as well. A person who is struggling with self-injury has enough baggage without taking on the prejudices and biases of their care providers.

The right to have the role SI has played as a coping mechanism validated.
No one should be shamed, admonished, or chastised for having self-injured. Self-injury works as a coping mechanism, sometimes for people who have no other way to cope. They may use SI as a last-ditch effort to avoid suicide. The self-injurer should be taught to honor the positive things that self-injury has done for him/her as well as to recognize that the negatives of SI far outweigh those positives and that it is possible to learn methods of coping that aren’t as destructive and life-interfering.

The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
No one should be put in restraints or locked in a treatment room in an emergency room solely because his or her injuries are self-inflicted. No one should ever be involuntarily committed simply because of SI; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality.

The right to have self-injury regarded as an attempt to communicate, not manipulate.
Most people who hurt themselves are trying to express things they can say in no other way. Although sometimes these attempts to communicate seem manipulative, treating them as manipulation only makes the situation worse. Providers should respect the communicative function of SI and assume it is not manipulative behavior until there is clear evidence to the contrary.

© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.

*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!

Avoid Toxic People

Toxic People 2Now that you are practicing gratefulness in your life and have made a list of 200 things in your life that you are thankful for you have found that not everyone shares your new attitude that there is always something to be thankful for. You’ll say something pleasant like, “Isn’t the sky a pretty blue?” and they will sneeringly retort, “No it isn’t. It’s a sickly hue of gray.” So what do you do?

Please heed this important advice: avoid toxic people! Unfortunately, there are a few people out there who see the world as one big problem, and in their eyes you’re part of it. No matter how well things are going, they focus on the nitpicking little negative details. And they do it constantly. It’s a habit that totally destroys relationships.

You may be thinking at this point, “Easier said than done. Do you mean if a friend I’ve known for years talks like this, should I just turn and walk away?” No, RUN! His or her constant negativity will drain the life out of you. Now please understand, I am not talking about someone who has a genuine challenge and needs real help. I am referring to those chronic whiners who take great pleasure in dumping all their negative garbage on your plate at every opportunity. It’s the highlight of their day. Don’t put up with it anymore.

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!

How Can I Be Grateful When Nothing is Going Right?

In my last post I discussed the importance of being grateful. Have you ever noticed how pleasant it is to be around people who are grateful for you or what you have done for them? That’s how you will know the following exercise works.


Something that will help you in practicing gratitude in your life and thus being present and in the moment (also known as mindfulness) is to make a list of 200 things that you are thankful for. Take 20 3×5 index cards and write 10 things from your list on each card. Carry these around with you and focus on one card each day.

You’ll be pleasantly surprised to find out how much is really going right in your life.

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!

When Everything Seems to be Going Wrong

The economy is in the toilet, your so called friends have disappointed you, your family doesn’t understand you, you’re worried about finding a job. Your grades are suffering- and God knows what else. Sometimes life is like that. We feel overworked and underpaid, and the stress takes a toll on our health and happiness.

Take a notice that all of your problems keep you focused on the past by dwelling by what went wrong and beating yourself up over it or worried about what may or may not happen in the future. All of this keeps you from being in the present. You cannot grow or move forward unless you are living in the moment. One of the most essential ways to stay present is to live with an attitude of gratitude.

When you arise in the morning, be grateful to be alive, be grateful for your health, for your job, and children. Be grateful for the country you live in, for the friends you have, and the family you enjoy. Literally, count your blessings every day. Sometimes a patient may tell me, “I have nothing to be thankful for. I hate this place.” I will then work with them to come up with something no matter how small. I will say something like, “Look at what a nice day it is!. It is not too hot or too cold. The sky is blue and clear” or “Hey, you’re talking to me right now. I could be off doing something else instead.” Then I get a response like, “Oh, yeah…I didn’t think about that.”


Three amazing things will happen when you are grateful. The first is that you will actually become more grateful. You will start to realize that, despite the trials of everyday life, you are, in fact, blessed. The irony is that the more things you realize you have to be grateful for, the more grateful you become for other things. It is like a snowball rolling down a hill. The gratitude becomes overwhelming.

The second thing that will happen is that more good fortune and opportunities will begin to come your way. I don’t pretend to understand why this happens, I just know it does. Those who are grateful just seem to attract more and more good things.

And the third thing that will happen is that you will feel great – healthier and more energetic than you have in years!

The stressors in our life are not likely to go away. What we need to do is learn to control our response to them by living with an attitude of gratitude. As motivational speaker Jim Rohn has often said, “The same wind blows on us all; it is the set of our sail that makes us who we are.” 


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. facebook.com/foresteen.forbes

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!

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!