What are the challenges that face a psychotherapist working with self harm or eating disorders.
“She cuts herself. Never too deep, never enough to die. But enough to feel the pain. Enough to feel the scream inside. The lines I wear around my wrist are there to prove that I exist. A broken mirror, a bleeding fist, a silver blade against a wrist, tears falling down to lips unkissed, she's not the kind you'll come to miss.” (http://xxdailydreamxx.tripod.com/id16.html)
I took this poem from an internet site that encourages people who self harm to express themselves creatively or make themselves heard. It helped me to understand the emotions and thoughts behind self harm.
Self harm is considered to be a deliberate attempt at causing
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This perhaps would be something that could be worked on in therapy.
It was also suggested that some people self harm as a way of communicating or expressing things they cannot speak. It is suggested when self abuse is used in this mannor it is considered manipulative an attempt at getting a need met or to influence another. If this is the case it is important for the therapist to listen to what that need is and to help the individual satisfy that need in a constructive and effective manner
I imagine the therapists first challenge when presented with an individual who self harms is creating a space where the client can trust the therapist. I can imagine an individual who self harms will carry a large level of guilt and shame at the behaviour and it is as always vital to move at a pace the client is comfortable with. If I am aware of marks or cuts before the client has disclosed to me I will wait until the client feels safe or I feel is ready to talk about the behaviour.
Often the client will not have appropriate support systems for whatever reason which puts them in a very vulnerable position. I would never suggest a no self harm contract as I feel that would create too much pressure. It is important to remember that the behaviour is the adapted coping strategy for this individual and on some level it provides some release or comfort and the idea of
Be aware of the diagnosis, but do not treat the individual as the diagnosis. Respect and appreciation for each person's unique career and life journey is essential. (P.1) The client needs to seek additional counseling to receive a diagnosis and treatment for her self-mutilation. Nevertheless, as her career counselor, there are effective techniques that can be implemented so she does not feel ostracized or singled out during career counseling and in the workplace due to her mental illness. The more a career counselor knows about the client’s diagnosis, the easier it is to tailor their approach to suit the client’s needs. Rubin (2007) also discusses how important is it to provide your clients with hope, hope that they will succeed in the workplace despite their mental illness. During this time, it is best to help the client feel empowered about their capabilities as well as being honest about their limitations. The client self mutilates as a coping mechanism so it is important to identify which career positions may be too overwhelming and daunting that may possibly force her to surrender to cutting
By describing to us what Callie was doing, feeling and thinking we are able to gain insight into the psychology of self cutting. We see exactly how Callie cuts herself as she describes how the metal “…sinks in deeply.”(50) as well as how she feels when she cuts: “A sudden liquid heat floods my body.”(51). Callie’s first hand accounts of her self cutting is not clouded by the prior experiences, cultural values or beliefs and we are able to see exactly why and how she does it and how it makes her feel.
This week has been a short and busy week for me. I had an interesting case where one of my in-home therapy clients (5-year-old) mentioned that he wanted to “cut his head off”. While I have heard things like this from clients before, It was difficult for the grandmother and legal guardian of the client to hear these statements. He slapped himself and started to bang his head onto walls and the ground. His behavior started right after grandmother set a limit of not using her cellphone to play games during therapy. His grandmother, mentioned that this behavior is relatively new and it scares her every time he slaps himself. when the client started the self harming behavior, the grandmother could not stand it and even walked out of the room. She
A client could be a harm the themself if they mention that they have been participating in self harm and suicide attempts. Another major warning sign in a case with this situation is if the client is expressing that they plan on continuing this behavior. Identification of the ethical standards that impact the case can help to determine whether the breach or maintain confidentiality. The client would require emergency medical attention if there is risk for suicide. Clarifying questions to ask before determining whether or not to break confidentiality including questioning the motive behind client's actions and if they intend in acting on their thoughts. Acknowledging that the client may just have thoughts and not a plan to carry out these actions can guide a counselor in determining how to handle this situation. It is important to gather information of the client's thoughts and inquire if there is a plan in place for hurting themself or committed suicide. It is also important to come to decision if they are likely to fall through with these desires. Consulting is important especially in the case of a possible end of life
If I was interested in learning more about eating disorders in order to better help a client, I would utilize reliable sources on the Internet as well as “reading books, professional journals, government documents and publications, encyclopedias, monographs, published by private agencies and organizations....” (Reamer, 2006, p. 195). It would also be beneficial to look up and see if there would be any continuing education sessions that are about eating disorders. Contacting other professionals who have experience working with eating disorders would also be beneficial. These individuals might be social workers and they might even be doctors. Looking up evidence based practice for eating disorders would be
Through methods of self-mutilation, abuse victims often fall within another vicious cycle. At first, “the individual may be plagued by intrusive or unacceptable thoughts, images, flashbacks... of traumatic events, or burdened by negative self-beliefs” (Sutton). These burdens grow strong within the mind, which causes the individual to have feelings of panic, which eventually leads them to action. In “Healing the Hurt Within,” Jan Sutton further examines self-harm and its destructive cycle:
Patients find help with problem solving extremely valuable and can help them feel able to cope (McLaughlin 1999). Generally, after most assessments, I learnt that listening, giving emotional support and problem solving helped restore enough hope in the previously suicidal patient enable them to feel safe from future self harm. In only a handful of cases did my mentor and I need to admit patients to any inpatient facility under the Mental Health Act (1983). This was because they still felt at risk of future self-harm.
You would need to look into this to see if the client has a maybe a family related history of mental illness that could not of been diagnosed in the client, if the client has self harmed, harmed others, or has a pattern of behaviour. You would need to know if they have previously seen other professionals so you can get a clear picture if you are the correct person to treat client.
This incident presents several demands for works and is complex as a result of what was disclosed by F4. The expression of thoughts of self-harm by F4 put the facilitators in the very difficult position of having to not focus on an individual and to stay focused on the group as a whole. Though it is assumed that this is a difficult task for social workers in a general sense, I am of the opinion that when a potentially serious and/or a complex issue arise that it increases the difficulty. The group member that disclosed the thought of self-harm felt safe and connected, which is why she was able to disclose such intimate thoughts with the group. The fact that F4 was able to share such information is a positive reflection on the mutual aid of this group, though it may have been too much too soon or not appropriate, because of the nature of the disclosure. This is not to imply that it was easy for her to disclose what she did and it clearly was not easy for the group to hear this information.
-My client clearly had difficulty functioning on their own, and were in denial about their disorder. They tended to avoid questions, and make excuses for questions they didn't have an explanation for. They were very unresponsive and when I tried to get them to open up they got angry and recoiled, probably because they were scared to talk about their problems.
Suicide is the third leading causes of death; and a Major social problem. Suicide is an example of the initial attempt to cause harm to yourself. There are many issues that lead individuals to want to commit suicide such as loss of a loved one, not feeling wanted or accepted, childhood abuse, trauma event, socially neglected, bullied in school, abusive relationship or loss of a job. Regardless, Suicide should never be an excuse or result to deal with problems in life. Knowing what solutions to the social problem can help save an individual who is battling the thought of suicide. There are methods to the solution such as referrals for treatment, Medications, will show effective signs that are observed over time.
While her situation is difficult, my client does not appear to be in crisis at this time. She seems to have an active and extended support system through her family and friends. She denied any thoughts or feelings related to self-harm and denied any past history of self-harm. Client could benefit from regularly scheduled psychotherapy and case management, including resource referrals.
The Bradley, Whisenhunt, Adamson, and Kress, (2013) study suggest that utilizing taking care of the self or self-sufficiencies approaches that encourage therapist physical and psychological wellbeing and averts burnout and damage. When therapists are compromised, they have a weaker capability to deliver the proper attention to their patients (Bradley et al, 2013). Therapists perform at their best when their mental and physical health is met; furthermore, they are capable of giving valuable healing amenities (Bradley et al, 2013). Additionally, there is a chance of acquiring a breakdown and diminished capacities, and there is further significances of not participating in self-repair comprise of secondhand distress, empathy exhaustion, and second-hand distressing anxiety (Bradley et al, 2013). The significances associated to a deprivation of self-maintenance and injury are the concern acknowledged and lectured in the American Counseling Association Code of Ethics, and it occurs when therapist’s private matters control their capability to positively interrelate with patients (Bradley et al, 2013). Diminishing capacities could be attributed to psychological disorder, individual problems (in theory burnout), physical disease or incapacity, or drug misuse (Bradley et al, 2013).
Self-harm is considered a major public health issue at present (Mental Health Foundation, 2006. Cleaver, 2007). The National Institute of Clinical Excellence (NICE) describes self-harm as ‘self-poisoning or self-injury, irrespective of the apparent purpose of the act’ (2004:16). The incidence of self-harm in young people appears to be increasing and there is a strong link between self-harm and increased risk of completed suicide (Cleaver, 2007). McDougall and Brophy (2006) produced a summary of the Mental Health Foundation publication, Truth Hurts, examining the implications for nurses and mental health professionals. They report that the incidence of self harm has risen by 30% since the 1980’s and that children are self-harming at
Deliberate self-harm is a term that covers a wide range of behaviours some of which are directly related to suicide and some are not. This is a relatively common behaviour that is little understood. This essay provides an overview of the nature and extent of those most at risk of self-harm, including causes and risk factors. Examining some of the stereotyping that surrounds self -harm, and looking at ways in which self-harm can be prevented.