I was watching Dr. Drew the other night and they were talking about teens that self-harm.  I was reminded of a girl that I worked with in a residential treatment centre who had an affliction for inflicting pain on herself by cutting.  One night the night shift staff did such a good job searching her room that they had taken all the sharp objects out of her room.  When I came in on the morning shift, they had had such a rough night with her; not sleeping, acting up.  They were really worried about her (let alone frustrated after a long night).  When I talked with her I tried to understand why she was so agitated.  She pointed out to me that I smoked.  I said yeah (this was a long time ago – when smoking was still cool).  She asked how I felt when I ran out of cigarettes, even though I knew I could still get more.  I had to admit that I felt a little panicked.  She indicated that that is how she felt when they cleaned her out.  She didn’t feel safe;  she felt anxious.  From that point on – for the next few days – it was sufficient for her to bring out of her room one or two sharp objects at bed time.  She wasn’t suicidal and it seemed that by bringing out the one or two items she was saying, “I could have, but didn’t.”  In other words “I’m safe tonight.”  That wasn’t to say she stopped altogether though.  When I asked her what she got out of cutting in other discussions with her, she indicated that she got a rush out of it.  When she was feeling bad, or, in her case a lot of the time, guilty, she would cut to feel better.  One night she came back to the centre from an unsupervised outing visibly stoned.  She tried to hide it and tried to go straight to her room; head hung low.  Rather than scolding her and making her feel guilty (which would have likely resulted in more cutting), I thought I’d throw her for a loop and congratulate her.  She was surprised and asked what I was congratulating her for.  I said that it was obvious that she was feeling bad and was looking for a different way to get a rush to feel better.  I was congratulating her for trying something different than cutting to get the rush.  She was a little stunned, but I think I was successful in planting a seed in her brain; not a seed that drugs are good, but a seed that she was looking for something different.  Looking for something different was the first step in reaching her goal of feeling better.  Conversations from that point on were around exploring other – non-harmful – ways to get that same rush (i.e. exercising until you puke was one of the suggestions we came up with) and to set goals around that.

A good counselor doesn’t tell the client what their goals are.  They find them from the stories the clients tell.  Her cutting was an attempt at feeling better.  Her goal was to feel better, not hurt herself.  Once she realized that there were other options, she was more open to exploring other; less harmful options. Only by truly listening do we find the gems that we can then turn around to help a client find ambiguity.  Once they find ambiguity, they start to search for alternative solutions to clear up the ambiguity.  She didn’t know she was looking for other ways to feel better, but I was able to help her think she was.  Or maybe I’m just manipulative 😉