A Safe Place for Cutters Blog


Turning Darkness into Light
March 8, 2010, 10:11
Filed under: Tools | Tags:

The silver lining in the painfulness and loneliness of human plight is the awe inspiring creativity that it brings out in people.  This in turn brings hope and inspiration to others.

The following photo was taken by one of the members of my Facebook group, “The Safe Place for Cutters.” The caption is hers.


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A blood- red sky. A delight for those who know the darkness brings worry and strife. A bother who know that the Light will be gone only for a short time. But the colors are always to remind us that life is a blend of color and picture. We are to cherish it, whether you are afraid of the impending darkness, or take joy in the Light to come.

*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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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!



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!