*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.