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Permission? Has my therapist lost it?


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(I'm putting this in the Cutting Board instead of Therapy because it's more about how my therapist responds to my SI than about the therapy itself. Sorry if I'm wrong, mods)

I've only been in therapy since about March, but it's the same woman and after all this time and after many, many sessions being entirely about my SI, a few sessions back we had an interesting breakthrough.

She's been slowly gaining understanding of why I do what I do, what sorts of situations prompt it, what coping methods I've tried in order to replace the injury.. She finally asked why I chose SI instead of something else. I explained that it was the least of all the typical evils: I could do drugs(if I could find them) and completely destroy my life; I could drink, and destroy braincells and my liver; I could smoke, and kill my lungs and risk cancer in several locations. :Trigger: Or, I told her, I could bleed a little, which actually forces me to take care of myself while it heals, and know that within a few days my body would replenish what was lost. :Trigger:

She nodded a little, took a few notes, then looked up at me and said 'OK.' She explained how the SI had become a tool for so many aspects of my life, that she feared that if I were to stop entirely, that day, never to harm again, that the next session we had together would be in the hospital after I fell apart for being unable to cope with anything.

This is definitely not to say that we don't still discuss other ways of coping. I had another session yesterday and she smiled to see that I had a fading pink line on my arm, from trying the red marker approach. She has a promise from me, on pain of losing her as a therapist, to do my best to avoid serious injury. Still nearly every session has a portion where we discuss the SI and, if I've done it, what caused me to step over that line and what did I try before I reached that point. And if I do slip, and she doesn't see it, I'm under obligation to inform her of it, show her if it's on my arms so that she can see I'm not lying about how serious it is.

I was shocked when she gave me permission to use this 'tool.' Has anyone else ever had a therapist do this while trying to also guide them away from the habit? I admit, I felt, and feel, a little like she's giving up on helping me with this aspect of my therapy.

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Until you can replace the cutting with new, more healthy coping skills what do you think you are to do ? Just stop it ? I doubt that is going to work. I think she is accepting the reality of the situation,

provided you are making progress toward new, healthy skills.

nf

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Actually, I don't think it has anything to do with giving up on you at all. See.. a major part of therapy is trust. It's also about protecting you. She knows that you're going to cut. She knows that you're putting in effort not to. It's a process. I believe that she wants to keep the lines of communication open so that she can figure out how to go about helping you find alternatives to SI. She's trusting you to let her know where you are at and how serious it is. If it got to a certain severity point, I am 100% sure she would step in and do something to stop you.

It's not as easy as someone just telling you to stop and you stop. You could keep a promise not to and fall apart like you said... or you could try and fail and then feel forced to hide it. If you hide it - she can't help you with it.

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To add to Cetkat, if you hide it then you are not trusting her. She's letting you trust her by acknowledging that, right now, it is the lesser of all the evil options.

Giving up (or losing it) would be if she didn't also (eventually) try to help you find better habits.

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I've had 'permission' in a way. I was told not to view it as a shameful negative thing as it is only a coping mechanism. The only problem is if you go too far one day. Try to work on healthy coping mechanisms.

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Guest Vapourware

I think what this therapist might be doing isn't giving up on you, but rather doing harm minimisation - i.e. if that's the best coping mechanism for you at the moment, then at least do it as safely as possible. In some situations, it is more harmful to say to someone to completely stop engaging in their best coping mechanism, because what are you going to do instead? I suspect she would also gradually move you away from engaging in SI as a coping mechanism as you become more emotionally able to deal with new coping mechanisms. It sounds like that, at the moment, you're not quite ready at this stage.

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I wouldn't say that your therapist is giving up on you at all. On the contrary, she is acknowledging the realisy: you can't "just stop". Stopping is a process that takes time, as well as the fact that you probably have to deal with many of your issues before you can even think of being able to make that step. I think you're lucky... none of my therapists ever saw things that way. They expected me to just be able to stop immediately just like that.

N

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my therapist actually does a similar thing. he recognizes that cutting is my most useful coping mechanism at the present moment, and has accepted that. While making sure i dont go overboard, and discussing reasoning and the such like he says that his "number one goal for our time together" is not to stop me from cutting, but to help me through the emotional responses etc that lead to SI. Does he hope that by "fixing" that, the cutting will stop? yes. but "allowing" cutting for now is an indirect approach to stopping it. its stopping the cause not the effect, which you shouldn't see as giving up on you!

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Actually, therapists who are experienced with cutting often do this, in various ways. They don't ignore it. They don't say "just stop" (like the rest of the world, we know how THAT works, right?), they work on new coping skills with the understanding that cutting happens and is a hard habit to break, and may take some time. I think this is a good approach, not a bad one. She's not giving you "permission to cut" she is understanding that you do it, and that it's an issue to be worked on.

The reality is that in some cases, the ability to stop cutting and replace it with healthier coping skills takes time. Adding the pressure of the "just stop" approach often might divert energy from that.

Anna

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