Life in a Bind – BPD and me

Borderline Personality Disorder, Generalized Anxiety Disorder, and my therapy journey. Listed in Top Ten Resources for BPD in 2016 by goodtherapy.org. I write for welldoing.org under the name Clara Bridges.

My ally against self-harm

18 Comments

*TRIGGER WARNING: SELF-HARM*

Five minutes before the end of my last therapy session before the summer break, I asked my therapist if she would be disappointed in me if I self-harmed that evening. I think I took her by surprise – I hadn’t mentioned self-harm for quite some time. She didn’t say ‘no’ – but then, she rarely gives a direct answer to my requests for reassurance! Instead, she encouraged me to think about why I wanted to self-harm, and why I wanted to punish myself. She said that I had other coping mechanisms – for example, I had talked about communicating more with friends, and about learning to play a particular piece on the piano. She would never tell me not to self-harm, and in the past our conversations about it have focused on trying to understand why I do it and what it means. So I think this was the first time she had actually gone as far as to try and encourage me to resist. It was a risky strategy – I’m incredibly sensitive to control and she couldn’t be sure I wouldn’t react against it.

But the strategy (if it was one – she hardly had time to think!) paid off. I saw her encouragement as caring – it felt good that she trusted me and our relationship enough, to tell me something that might be hard to hear and that I could so easily misinterpret. It felt good that she thought I might have come far enough to be able to consider the possibility of resisting the impulse to self-harm, without simply feeling panic at the thought of a vital coping strategy being taken away. Not that it was physically being removed as an option; but I would find it very difficult to do anything that I knew would disappoint her.

As well as encouraging me to think about why I wanted to hurt myself, and pointing out I could use other strategies to deal with my intense feelings, she did acknowledge that I may, despite those things, feel that I needed to do it. But she didn’t ‘let me off the hook’ of having to really think about it if I were tempted, by simply telling me she wouldn’t be disappointed. And perhaps she knows that in many ways, she has already done all that she needs to do, to reassure me in that regard.

Strangely, though I sometimes doubt her acceptance in other ways, I am confident that she does not judge my self-harming. I cannot doubt it, after I asked her many months ago if I could show her some recent cuts, and she said that I could. I was shocked, and completely unprepared for the fact that she might say yes. It was an incredibly important, personal, and emotionally intimate moment. I had shown her something no one else had seen, and however she might have felt about it, she was prepared to see what I had to show her and to share that with me. For me, it was a very bonding experience, and it spoke of her acceptance. I am sure she feels it would be better if I did not hurt myself in that way – but I have never felt any pressure from her to stop, and her comment at the start of the therapy break, did not change that.

I emailed her during the break to let her know that I was happy she had responded in the way that she did. I said that I had felt that she trusted me and that she’d taken a risk in encouraging me to refrain, when I might have reacted negatively. She turned my email on its head, and said that I had taken a big risk in asking her to support the part of me that wanted to stop. And until she wrote that, I hadn’t realised that it was true.

I think that ultimately, the only way to deal effectively with self-harm is to deal with the underlying issues that give rise to the urge to harm, and at the same time to learn to try and sit with those feelings until their intensity diminishes. But the very very first step, I think, is that some part of you must want to stop. I’m not sure how that happens – for me, there was a realisation at the start of the Easter therapy break, that part of me wanted to stop for her (my therapist). Although lasting change would need to be based on internal motivating factors, I’m not convinced there is any harm in taking motivation, initially, where one finds it! And then waiting for that motivation to shift, and for it to become something that you want for yourself, and not ‘only’ for another.

I had wanted to discuss these feelings with my therapist a few months ago, but somehow never got round to it, and they faded. And so when I asked her in late July, if she would be disappointed in me if I self-harmed, those feelings were the furthest things from my (conscious) mind, and I genuinely believed I was asking for reassurance and ‘permission’ to self-harm. But her interpretation was exactly right. Part of me did want to stop – and unlike a few months ago, I think it may even have been more for my sake than hers. I was asking for her support – even if I hadn’t realised it. But I’m so grateful that she did; and that she provided it.

Did I let her down? Yes and no. ‘No’ because she accepts me and that acceptance doesn’t depend on whether or not I turn my pain in upon myself, or express it in a less self-destructive way. And ‘no’ because this is not a question of ‘balancing’ the harming acts against the non-harming acts, and nothing can negate the fact that for the vast majority of the therapy break, the way in which I approached the desire to self-harm was different to how I have approached it in the past. In the last couple of months I have played the piano more than I have in the last few years. As well as giving me an insight into how significant it must have been in helping me to deal with my emotions and circumstances when I was growing up (even though I didn’t realise it at the time); it also gave me an immediate and concrete way of both seeking and expressing connection with my therapist, while also putting a distance of time between my desire to self-harm, and the possibility of acting on that desire.

But eventually I did self-harm, a few days before the end of the therapy break. And so although I know that she is not disappointed, it’s still difficult to completely eradicate the sense that I let my therapist (and myself) down. The incident was not directly connected to her – it was related to an argument I had had with my husband. However, it may be that my feelings of being alone (and possibly of being abandoned) during the last few days of the break, contributed to the fact that I did not even try and resist. I realised afterwards that it had felt as though there was absolutely no part of me left that wanted to stop, or refrain. And that was what was different at the start of September, compared to the start of August.

Earlier in the summer, a few mental health charities put out through social media a number of strategies or alternatives for dealing with the desire to self-harm (for example, holding an ice cube, ‘pinging’ an elastic band against the skin). For me, there has been no better strategy for trying to resist self-harm, than postponement, although I can appreciate that this won’t necessarily work for those whose self-harm is very ‘immediate’ and ‘of the moment’. For me, it’s often the case that I cannot self-harm when the feelings are most intense (for example, because my children or my husband are around), and the passage of time, even sometimes of short duration, allows the intensity of the feelings to subside a little, and with it, the intensity of the desire to harm. Although I know they work for many people, the difficulty I have with a number of suggested strategies is that they are essentially seen as ‘alternatives’ – and yet self-harm is such a very complex thing, that it feels very difficult to simply try and substitute something else in its place. Whereas ‘postponement’ does not try and replace it or forbid it – it very much leaves the option open, but it simply says ‘later, in a little while, in a few minutes – you can do it later’. And that, particularly in the absence of other motivating factors, has often been my biggest ally.

But what this therapy break has taught me is this: with my therapist’s support, I have an even more powerful ally in my struggle against self-harm; and that ally is, quite literally, a part of me.

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18 thoughts on “My ally against self-harm

  1. I’ve had a similar experience with my therapist and saw things like you do too – that a part of me gradually wanted to stop self harm.

    However I couldn’t find the words, which you have expressed so eloquently! 🙂

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  2. One time, when I had noted some cutting on my diary card, my therapist asked if she could see. It was the first time I felt like she really cared whether I did it or not. I didn’t feel like she was judging me negatively for having done it, but the fact that she asked to see made it seem like I actually mattered to her. She has never asked to see again, although I was doing really good at refraining from hurting myself for almost four months. In my latest appointment, my diary card noted that a cut I made was deeper than usual. She didn’t ask to see it, but did ask me if it needed medical attention that I wasn’t getting.

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    • I can completely understand the feeling of mattering, that this can engender – it can definitely feel very caring when someone is willing to discuss self-harm without being judgmental, but only with a view to keeping you safe, and being there for you. I think her question about medical attention served the same function as her asking to see the cuts – it was a way of showing her caring, and wanting you to be as safe as possible. I think it’s likely she will find different ways to show you that, if a similar situation re-occurs. Thank you very much for reading and for commenting….

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  3. Self harm for me is a way for me to see it, no one can see the hurt and I can’t see it either so to be able to see it somehow helps.

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    • I can very much relate to that, though I have found that my reasons and motivations for self-harming changed over time, and depending on the situation. Having a visible manifestation of what I was going through was a big part of the experience in the first year or so of my self-harm and my diagnosis, which was also the time when it was happening most frequently. So much so, that I would feel nervous and invalidated and unreal once the cuts started to fade. This was also connected with the sense that I had that ‘I was a fraud’ and ‘making it all up’, and once I started to feel more accepted by my therapist, and more validated and secure in therapy, both that sense of ‘making it up’ and also that sense of needing self-harm in order to ‘make things visible’, started to fade. I hope that the same might be true for you as well, in time, and thank you for reading and for your comment…

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  4. Wow. Beautifully written too. Thank you for sharing such a personal reflection. Xoxox

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  5. You and your therapist are impressive — really. While I can’t comment on the complexities of your own behavior as you described it, you might want to know what would have gone through my head (back before I retired) if my patient suggested the possibility of self-harm just before I took off on holiday. Well, I won’t say it. I think you are your readers already know it.

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    • Thank you…I never thought I would be anything other than on the receiving end of this particular line, but – I don’t know what you’re thinking! 😉 And I have a talent for missing the obvious and failing to navigate ambiguity! Your comment is very thought provoking, and because I can’t be sure what would have gone through your mind, I can only speculate on what might have gone through my own. There are two aspects of your comment that have really made me think. The first is this: “while I can’t comment on the complexities of your own behaviour as your described it…”. It occurs to me that neither can I – in the sense that what I said/did may well have been more complex than I suspected, and I haven’t paused to examine the possible ‘hidden’ motivations (if there were any), once my therapist pointed out what I hadn’t seen – my plea for support. But as with dreams, there could be multiple layers of interpretation, and perhaps looking at what else might have been going on, could be helpful. One of those interpretations is one that arises when I think about how I might have responded if I had been in my therapist’s place.

      I think I would have been taken-aback (which may explain my sense that she was more than a little surprised and perhaps a bit shocked!). And I think I might have felt got-at. And possibly a little responsible. And maybe as though I was being punished or being made to feel guilty for going on holiday. I can honestly say that it never occurred to me, until today, that my therapist might have felt that way, or, even if she didn’t, that those were the possible feelings that my question could elicit in someone else. And I was never aware of any such ‘motivations’ behind my question – but then, we are talking about what might be going on subconsciously, and so by definition I wouldn’t have been aware of any such motivations. Do they make sense as an interpretation? They make logical sense – but not, at the moment, emotional sense, though of course I could be in denial! The thought that I might have wanted to hurt my therapist in any way, is abhorrent, and had I realised at the time, how my question might have been taken, I would have been appalled (so it’s perhaps a good thing that I didn’t, given that I had no opportunity to talk it through face to face!). I felt differently leading up to this break, compared to previous breaks when I did indeed start to feel disconnected from her, abandoned, and wanted to pull back. This time I was prepared for the upcoming ‘loss’ and I think I was much more in tune with it and I don’t think it affected our relationship in the same way (which by that point was much stronger).

      Why didn’t it occurred to see these other possibilities in what I was saying? On the one hand, I didn’t think- the question just came out, in the moment, with no fore-thought. I always find the last few minutes of any session awkward, not knowing how to use them or what to say. So I didn’t stop to think what it might mean, though I was conscious it felt like needing reassurance – not wanting a massive feeling of guilt to be hanging over me during the break if I felt as though I had let her down. Perhaps another reason was trust, and the strength of the relationship. Funnily enough, I often tell her that her interpretations are too generous and positive – they paint me in the best light possible, whereas all too often that is not the case. And so perhaps I had a sense that she would take the question as I thought it was meant – that she would always know that I would never want to say something to annoy or upset her, or to make her feel responsible for something that was my decision. I’m coming more and more to trust in the unconditional positive regard. But I’m also conscious of your writing and your encouragement to see one’s therapist as human (though at the same time partly-idealised, in order to facilitate the work). Perhaps she did have these feelings – if so, she hid them extremely well and moved through them incredibly quickly to a therapeutically positive response. She is certainly impressive – you will get no arguments from me there. I feel incredibly lucky, and thankful for her.

      Perhaps this is a really helpful illustration of the way in which our quest for reassurance – whether overt or less obvious – can sometimes come across as something very different. In much the same way as silence and withdrawal when one is hurting deeply, can come across as passive-aggressive. Thank you again for your very thought-provoking comment….

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      • What might have gone through my mind (mine, not your therapist’s or anyone else including you) was exactly what you just mentioned: “And maybe as though I was being punished or being made to feel guilty for going on holiday.” My “take” on this might well say more about me than either of you. Your words certainly on that occasion don’t make you a war criminal even it that had been your intent.;) I trust your statement that you had no ill intent. As I said earlier you are impressive and as sincere as can be. Perhaps best to just leave it at that.

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      • Thank you 🙂 I really am glad that you take the time to read and comment – you always, without fail, make me think, and it is always, without fail, helpful 🙂

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  6. Reading this shows me how thoughtful and deep you are, and how strong you are. I really admire your strength. Thank you for sharing such a personal post with the world, it was brave of you! Take care x

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    • Thank you so much – it helps to hear that, particularly when I’m not feeling very strong at all! Sometimes I don’t realise how ‘brave’ I’m being until I have actually written and published – perhaps it’s better that way! 😉 Take care too, it’s lovely to hear from you x

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  7. Your words really connect with me, and I appreciate so much your bravery in sharing this battle. It took me years to even bring up the subject with my therapist, who, by the way never shames me and listens and hears patiently and nonjudgmentally despite my own shame and head hanging, but I understand the fight and the infinite variations on all the internal arguments. Which sometimes are less arguments than impulses, or drives to release. Your writing and your openness is a gift for which I am very grateful. Someday, when I am as brave as you, maybe I can contribute to this sort of a conversation.

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    • Thank you so so much for your comment, which really means a lot. I am so glad you did bring up your self-harm in therapy – it doesn’t matter how long it takes to mention it, I think it all comes out at the right time. And I’m also glad your therapist responds so well and non-judgmentally – that’s so important. Thank you so much for your kind words about my writing – I hope to be open in order to be able to help, but at the same time I’m not sure it’s so much bravery, as it is that drive to release that you spoke about. My writing now feels like a part of therapy – it feels like a way of processing, of sorting through things, of releasing feelings and thoughts…..it _is_ a conversation, with others(which is a privilege and a comfort), but in some ways, most importantly with oneself.Sometimes it helps to sort through those infinite variations on all the internal arguments that you mentioned 🙂 Take care, and thank you again 🙂

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  8. Thank you for writing so honestly, i really feel that i empathise with what you write. I don’t have much time at the moment but i will follow your blog and i look forward to reading more. I don’t know why but i never want to talk about self harm, even with my therapist. Its such a personal experience that is so hard to rationalise and justify when you’re not in the moment. I have tried many suggested ways to deal with self harm, however i have never found any of them helpful. In a way i feel like it is an addiction that i have to decide to give up, while also finding new coping mechanisms to manage the feelings that lead me to hurt myself. Thank you for your brave and honest post.

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  9. Whenever I bring up that I “indulged” in some self harm, my therapist asks me what I did, and my reasons behind it. I find myself telling her very briefly, as fast as I can and then tell her I don’t want to talk about it. She doesn’t push. But maybe I should be more open. I’m apparently in the habit of bringing things up, in an effort to pull her closer to me, then in the very next moment, push her away by telling her “I don’t want to talk about it”. I hate doing that. But I find it difficult to let go completely sometimes.

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