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

Preamble:
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!



Do You Feel Like a Failure?
September 28, 2009, 22:03
Filed under: Coping Skills | Tags: , ,

Michael JordenEvery once in a while someone in my group, A Safe Place for Cutters,* will complain that after so many years they cut again.  As one cutter said after such an episode, “it’s gonna be hard to keep it on the straight and narrow now.” I disagree.

Failure is not a bad thing. Failure is actually a good thing, so long as it doesn’t become a self-fulfilling prophecy. Failure is, in fact, the Supreme Teacher, and action is the matriculation fee that allows you to enroll in the Supreme Teacher’s class.

To develop any complex skill such as managing urges to cut, you must be willing to make mistakes and endure failures. The faster you can make those mistakes and suffer those failures, the quicker you will master the skill.”

That reminds me of something basketball great Michael Jordan once said: “I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life and that is why I succeed.”

“Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.”

-John Dewey

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!



Five Little Senses
August 21, 2009, 05:00
Filed under: Coping Skills | Tags: , ,

In my last few blogs I have been discussing the importance of focusing what is going on with your five senses in order to aid you being present and thus mindful which goes a long way in helping you to relax and reduce anxiety. The following is a little child’s poem that reminds us how important it is to get back to basics.

Five little senses are what I need,
To use when things are near.

I use my eyes to look and see.

Eye
I use my ears to hear.

ear

I use my nose to smell things.

Smell

I use my hands to touch.

Touch

I use my mouth to taste
The things I love to eat so much.

Taste

Five little senses standing in a row,
To see, hear, smell, touch and taste
The things I need to know.

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 To Practice Being Mindful
August 17, 2009, 05:00
Filed under: Tools | Tags: , ,

FiveSensesI run a group therapy for individuals diagnosed with Borderline Personality Disorder. We always start the group off with a mindfulness exercise that I will elaborate on later on in this post. Many of these individuals have also been diagnosed with Post Traumatic Stress Disorder (PTSD) related to early childhood trauma such as physical or sexual abuse. .Using mindfulness for PTSD may be a good way of coping. Mindfulness has been around for ages. Mindfulness benefits for people suffering from difficulties such as anxiety and depression.

In a nutshell, mindfulness is about being completely in-touch with the present moment. So often in our lives, we are stuck in our heads, caught up in the anxiety and worries of daily life. This exercise will introduce you to mindfulness and may be helpful getting you “out of your head” and in touch with the present moment. The following story will highlight how powerful this exercise is.

A couple of weeks ago, I had missed a group session when I was on vacation. In my absence my co-providers, a psychiatrist and a social worker were left in charge. At the next group meeting, I was informed that the group had erupted in chaos. That stuff doesn’t happen when I am there so what took place? I found that they hadn’t started with the mindfulness exercise. I start the group off by telling them to focus on their five senses: taste, touch, smell, hearing and vision. When you are centered on your senses you are in the present.  Your five senses will tell you what is happening right now, not in the future, not in the past but in the moment. After the exercise, which lasts for about one to two minutes, everyone shares what they experienced during the exercise. It is amazing how this exercise calms everyone down and prepares them for participating in the group process.

Here’s How You Can Do This at Home:

1. Find a comfortable position either lying on your back or sitting. If you are sitting down, make sure that you keep your back straight and release the tension in your shoulders. Let them drop.

  1. Close your eyes.
  2. Focus your attention on your breathing. Simply pay attention to what it feels like in your body to slowly breathe in and out.
  3. Now bring your attention to your belly. Feel your belly rise and expand everytime you breathe in. Feel your belly fall everytime you breathe out.
  4. Continue to focus your attention on the full experience of breathing. Immerse yourself completely in this experience. Imagine you are “riding the waves” of your own breathing.
  5. Anytime that you notice your mind has wandered away from your breath (it likely will and this is completely normal!), simply notice what it was that took your attention away and then gently bring your attention back to the present moment – your breathing.
  6. As you experience the awareness of your breathing, start to notice what you are experiencing with your five senses. You probably have your eyes close so you won’t to notice what you are seeing. What do you hear? Are there people chatting nearby? Traffice sounds? Birds singing? Do you notice any smells? Perhaps you smell someone cooking or a person’s  perfume. What does the couch you are sitting on feel like? Notice the texture of the leather or nappiness of the upholstery. Are both your feet on the floor so that you feel grounded? Do you discern a taste in your mouth? Sometimes people can taste their breakfast or their morning medication.
  7. Continue for as short or as long as you would like!

Tips:

  1. Before you try this exercise, it may be useful to first simply practice breathing. This may sound silly, but many people don’t breathe properly, which can fuel stress and anxiety (more on this later).
  2. Make this a habit. Practice this exercise at least once a day.
  3. At first, it may be important to practice this exercise at times when you are not overly stressed-out or anxious. When you were first learning to drive a car, you likely didn’t start out on the highway during a thunderstorm. The same goes for mindfulness.
  4. Remember, it is normal for your mind to wander during this exercise. That’s what it does. Don’t get discouraged. Instead, at times like this, it may be useful to think of mindfulness in this way: If your mind wanders away from the breath a thousand times, mindfulness is about bringing your attention back to the present moment a thousand and one times.

Next: How to Breath Properly

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!



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.

gratitude2

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!