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By: Suzanne Maiden, M.A.
I was pleasantly surprised to see the Today Show with Dr. Nancy Snyderman and the Editor in Chief, Ann Shoket, of Seventeen Magazine, discuss cutting behaviors in young women. ‘Cutting’ is the layperson word for Self -Injurious Behaviors (SIB). Why would I be happy to hear this touchy topic be talked about on mainstream T.V? Because cutters and why they cut are grossly misunderstood. I wrote my graduate thesis on SIB. Many medical personnel and mental health professionals find cutters’ behaviors troubling, treatment-resistant, and plain disgusting. As a practicing Family Therapist I have successfully treated many cutters. I appreciate your bringing awareness to this issue. I would like to offer just a bit more insight based on my experience.
Katie Stewart bravely shared her painfully private struggle with the Today Show . In many ways, she represents the various women with whom I have worked – bright, beautiful, and the seemingly a “great kid”. Unless one would see their scars, cutters do not fit an easily identifiable profile. Outwardly, they present as very together. Inwardly, they battle demons. Most want to quit. Many report extreme shame and guilt over their irresistible urge to self-injure and go to great lengths to hide their scars. But why? Why does anyone self-injure? There are multiple hypothesis as to why people self injure to include: 1) non-validating environment, 2) poor attachment in childhood, 3) addicted to their own opiate release system, and 4) history of sexual abuse.
The data strongly support the positive correlation between sexual abuse and future SIB. Not every person who has been sexually abused will end up self-injuring. Conversely, not every person who engages in self-injury has a positive history for sexual abuse. However, in my personal experience, the majority of my clients who self-injure do report a positive history of prior sexual abuse.
What’s sexual abuse have to do with self-injury? The cutters who do have a positive history for sexual abuse frequently report that self-injury is the only way they know to access their pain – or express it. Ironically, many self-injurers do not feel pain while actively self-injuring. Why? Because sexual abuse survivors tend to be very adept at the ability to dissociate. That is, when sexual abuse occurs, the victim often mentally “checks out”. This ability helps the victim endure the abuse when they cannot physically escape. Many cutters report they are in a dissociative state when they self-injure and many do not realize the extent of tissue trauma until they “come back” mentally.
Cutters are often the modern day lepers of emergency rooms and therapists’ office. Nobody wants to deal with them and their self destructive acts. However, their wounds are the physical manifestation of their internal suffering. If they knew how to access their pain in a healthier way – many would. Thank you TODAY Show and Seventeen Magazine for bringing this dark phenomenon into the light.
By: Suzanne Maiden
As a Family Therapist one question frequently asked is: “How do I find a good therapist?” Below are 5 basic components to consider:
I. Word of Mouth is still one of the best ways to find a skilled therapist. If you’re resistant to asking a friend, consider calling the following to ask for referrals:
* Primary Care Physician/Doctor’s Office
* Local church (call several)
* Hospice or Funeral Home (if grief related)
* Local Hospital Mental Health Unit
* School Guidance Counselor (s)
* Community Mental Health Center (often listed in the front of your phone book)
* EAP (employee assisstance program)
II. The First Call – What to Ask?
* What are your clinical specialties?
* What population do you enjoy working with most?
* Do you accept insurance? Will you consider a sliding scale?
* Do you have access to a competent psychiatrist if medications may be needed?
* Average length of treatment?
* Are you in therapy? Have you ever been?
Most therapists have the academic training to treat the full spectrum of mental health issues. However, as therapists we have our clinical strengths. For example, one of my areas of expertise is SIB (self-injurious behavior) or ‘cutters.’ Many therapists dislike working with this population for various reasons. I can work with cutters all day long. Don’t be afraid to ask. The last question surprises people. You want your therapist to have actively spent time working on their issues before they help you work on yours. I stay in therapy because I need a great therapist for me to be a good therapist. It’s like Tiger Woods continuing to take golf lessons – it keeps him on top of his game.
III. The First Appointment – What to Expect:
* You want the therapist to take a thorough history. Yes, I know, you or your loved one may be in crisis and you finally make it to the therapist’s office; you’ve got a lot to say. You don’t want to spend part of your 50 minutes by answering a lot of questions. But a thorough history potentially eliminates big future ‘uh oh’s’ and errors. It’s imperative to your best treatment. Nearly every time I compromise on initial history taking - I regret it because I inevitably miss a big piece of information that perhaps my client did not think was a big deal - but was key for correct diagnosis and treatment.
* Be honest about all medication use, especially recreational drugs to include alcohol.
* Make sure you understand confidentiality policies. Therapists are mandated reporters. Loosely, a mandated reporter is legally obliged to report suicidal/homicidal threats and physical/sexual abuse. This does NOT mean that if the client mentions suicidal/homicidal thoughts that they will be reported. Only, if the client presents imminent danger to self or others, then therapist must take appropriate action.
IV. Trust Your Gut – But Don’t Quit Prematurely
* Trust your gut whether the therapist is a good fit; BUT, give a new therapist 6 sessions before you bail. Rapport takes some time.
* It’s important that you like the therapist as a person; this doesn’t mean that you agree with everything they say, I guarantee you won’t, that’s OK
* It’s important that you feel confident in their ability
* It’s important that you experience the therapist as genuine, compassionate, sensitive, and non-judgmental of whatever you bring into the session
V. A Good Therapist Can Change Your Life:
The therapeutic relationship is one of the most intimate relationships you will ever know because it is supposed to be a safe haven to explore your inner world and deepest thoughts. It is completely about you - the client. Reciprocity does not, nor should it, exist. That is, the therapist is always in service of the client.
Lastly, the therapeutic role is to assist the client in exploring healthy life choices and identify barriers which may inhibit that process. Therapy can be one of the most growth-enhancing and healing events anyone can ever experience. Make that call.
