Self Harm Sucks, So Why Am I Doing It?

It’s easy to identify the reasons why I hurt myself – even when I was a teenager with the self-reflective skills of a lower form of sea slug, I could probably have told you that I have low self-esteem, and I self-harm to punish myself and to make myself feel better. But in some ways, that’s the wrong question, because the answer isn’t to find a new way to punish myself. The better question is what needs the self-harm is meeting, and how else I can meet those needs. (Thanks Sirena.)

Needs are not a thing I am good at identifying. The sea slug could probably finish his dissertation on Maslow’s hierarchy before I managed to work out that people need food to survive. But I thought I would try, and hope my little WordPress community can fill in the rest.

Need #1: To escape emotions that feel intolerable; essentially, self-soothing. 

My distress tolerance is low, and so is my patience. When I’m triggered, I feel like I can’t endure it. My thoughts are fuzzy, I can’t breathe, my body feels heavy and there’s too much happening inside me to contain it, I’m going to explode, I’m going to keep winding tighter and tighter until I explode. I’m losing my mind, I can’t chat to the checkout operator about the wind warning for the eastern suburbs, how can I talk to people and walk around and be polite and normal when there is a volcano in my chest? I’m frozen and stuck and I can’t move and that’s so incongruous with the hailstorm in my brain that I’m frustrated and angry, I need to kick and scream and thrash like a wild thing but it’s not enough to get it out, and I need to get it out.

There are voices in my head, an older male saying I’m going to kill you in a deep, threatening tone, a hysterical teenager screaming I HATE YOU, YOU STUPID BITCH, I HATE YOU, or a coldly furious voice telling me I’m a such a stupid fucking cunt. Sometimes there’s a kinder voice bribing me, telling me I’m going to feel so much better, and I can have an icecream after it’s over.

If I sit with it for a while maybe the intensity will decrease, maybe it will go away, but I know how to make it go away right now and I don’t want to feel it any more.

(It’s interesting to me that different voices use different language – the younger teenage doesn’t say ‘fucking’, because I didn’t at that age, and the older teenager doesn’t say ‘cunt’, because I didn’t until I was in my 20s.)

When I’m having compulsive thoughts of setting myself on fire, I can’t think, it takes over my whole brain and I just keep picturing it over and over again, walking through the steps; wetting the towel, unscrewing the container, pouring the accelerant, lighting the match and seeing the flames. I feel like I’m going crazy, not because of the nature of the thoughts but because they’re stuck in my head and just cycling and cycling and I’m so frustrated I’m going to burst.

*Trigger warning for burning. Seriously.*  My ability to tolerate emotion is even worse when it’s stemming from a particular memory, and burning is the most effective way I’ve ever found for decreasing the emotion associated with painful memories. Last year, I had an encounter with an ex-boyfriend that was maybe kind of a little bit sexual assault, but most definitely unwanted and awful, and I couldn’t stop reliving it afterwards. Especially in bed at night, but over and over throughout the day, I’d have a sudden flash of him on top of me, and my whole body would flinch – my eyes would close, I’d tense and my thighs would clench together. It made me feel sick and trapped and I hated it.

So I brought the memory consciously to mind, and I brought a lighter flame close to my arm, near but not touching. To start off with, the pain is extreme, and it matches the intensity of the emotions. And then my skin starts to turn white, and harden, and the intensity lessens, the pain travelling deeper into my body, still strong but duller somehow. Once my skin turns from white to black, the burn site is completely numb, and the emotions that were intolerable a few minutes ago are calmer, my body less panicked. And then I bring the memory to mind again, and I start again in a new spot. And I keep going, until I can bring the memory to mind and feel nothing but numb emptiness.

(In a side note, I feel so much rage over Marsha Lineham’s famous quote about people with BPD being like people with third degree burns who feel agony at the slightest touch – I get the metaphor, but by definition a third degree burn has no sensation. A stupid thing to feel angry about, but I do.)

Need #1.1: To regain self-esteem by splitting off the ‘bad’ parts of me?

I’m not sure what the need is here, exactly, but I do feel better about myself after I’ve been ‘punished’. If I accidentally send the CEO the wrong spreadsheet, or I feel guilty because I haven’t been in touch with my younger cousin or my uncle in a while, I feel calmer and more okay about myself after I’ve hurt myself. It’s a very childish view of solving a problem – hurting myself doesn’t fix anything. It doesn’t help my uncle feel less lonely, or guide my cousin through teenage conflicts. But still, I feel better. Because I endured pain and so I’m strong, and being strong is part of being good. And because I did something, so I feel less impotent, even though the thing I did wasn’t helpful. Maybe it’s exactly the same as #1, but it feels a little different.

And sometimes, I want to punish the younger versions of me, to make them stronger. I guess I’ve projected qualities that I hate about myself onto them (like having needs), and I think I can change things by visualising hurting my younger selves while I hurt myself. Which any sea slug with half a brain knows I can’t.

The worst is this pathetic little attention-seeking bitch; it’s her fifth birthday, and she’s not even pretending to smile. I want to hit her in the face, and keep hitting her until she hardens up and stops looking vulnerable.

Sept '95

And this ten-year-old at the playground; I want to knock her to the ground, kneel on her back, grab her ponytail and smash her face into the asphalt. I don’t even know why I hate her so much. That photo was taken around the time I first started self-harming, so I should be proud of her, right? Or am I angry at her for starting this cycle that I’m still whirling around in 15 years later?

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(I feel the need to make it clear that I have zero violent urges towards any children that aren’t me.)

Need #2: To control my body, and to distance myself from it.

I hate my body, and I want to destroy it. I don’t mean that I wish I had a more toned butt, or eyes like Angelina Jolie’s – I hate that I’m trapped inside a disgusting hunk of flesh that eats and defecates, and rarely, when it’s coerced, has sex. My body repulses me and terrifies me, and hurting it is a way to control it. The first time I cut myself, I still had bunk beds, and I draped a sheet from the top bunk to create a private little fort. When I drew the blade across my skin for the first time, I felt this awed sense of peace; I can make myself bleed. That power is mysteriously reassuring. In therapy, any time I’m asked to focus on my breathing, feel my feet on the floor, observe the sensation of the material of the couch, I feel immediate panic at being reminded of my body and asked to pay attention to it, and I automatically want to hurt it. Paradoxically, hurting it makes it go away.

Need #3: To be functional and independent.

Some days, most days, there is something that I have to do that feels too hard. Make a phone call; send an email; go to the post office; vacuum the growing mounds of kitty litter off the floor. Sometimes I’m anxious and my mind is racing and I can’t think, and hurting myself is like wiping a cloth across the mirror after a shower; the fog disappears. Sometimes I just feel like there’s a block, like I know I’m capable of doing the things I need to do but I can’t do them, I feel heavy and inert and my mind is thinking but I can’t make my body move, and I’m angry – you stupid fucking bitch, what the hell is wrong with you? – or despairing – I can’t do this any more. Hurting myself helps me move into a different state, one where I can function – maybe because of the endorphins, maybe because it helps me feel calm, maybe because once it’s done I’ve ‘accomplished’ something and I feel more capable.

If I don’t work then I can’t pay rent. But beyond the practicalities, I feel the need to be productive. If I’m not working, not studying, then I’m a useless waste of space and I might as well be dead. (I absolutely don’t think this about other people – my uncle with schizophrenia hasn’t worked in 30 years, and he is a beautiful, necessary part of the world.)

Need #4: To receive empathy.

Before I hurt myself, I am bad. I am a stupid fucking bitch, or a disgusting piece of shit. Afterwards, if I have cut deep enough, burnt enough times, I am a good girl. I have suffered, and now I deserve to curl up in a warm bed and watch TV, or drink chocolate milk and read a book. Sometimes the process of self-harming brings out my nurturing side; when I’m struggling with the pain of burning, I will coax myself gently. Good girl, you’re doing such a good job, that’s it, just take a deep breath. I know that I am allowed to nurture myself without hurting myself first, and sometimes I try, but it doesn’t feel soothing until I’ve earned it.

A few months ago, I identified for the first time that when I’m anxious or distressed but not angry about something I’ve fucked up, the urge to self-harm is actually a desire to be held. It was pretty upsetting, to realise that I couldn’t tell the difference between a need for pain and a need for comfort.

Sometimes I’m also looking for empathy from others, for affirmation that others care about me, but rarely; most of my self-harm is hidden. Mostly, I need it as validation for being in therapy. If a therapist asks me whether I’ve self-harmed in the last week, and I haven’t, I feel shame. Why am I here, then? If I’m not self-harming, I’m just a malingerer.

Need #5: To feel safe and secure.

I have no fear of being attacked, or being in an accident, or being mauled by my ever-increasing posse of kittens. And yet whenever I see a movie where someone is tortured, or shot, or read a blog post about self-injury I haven’t tried, I’m terrified about whether or not I could endure that pain, and I want to test myself, to make sure that I can. Why do I need to preemptively protect myself against things I’m not afraid of, that I know won’t happen? I have no idea. The chances of anyone making me cut open my own eyeball to dig out a key from inside my head are pretty slim, but if they did, I couldn’t do it. And what if C’s life was depending on it, or my nephews’? It makes me feel powerless and helpless.

Watching Saw was such a bad decision.

Need #6: To learn and experience.

I’m always curious about how things feel. A couple of years ago, I went on an overseas trip with a group of friends to celebrate our graduation from law school. I was with people I loved, doing things that I loved, and it was one of the best times of my life; we went surfing, rafting, hiking, trapezing, and paintballing. And I desperately wanted someone to shoot me at point-blank range with a paintball, because I had to know what it felt like. How bad did it hurt? When other people talked about how intense it was, were they right, or were they just ignorant of what severe pain feels like? I played without any of the optional protective gear, and during the last game, I ran out into the open. I enjoyed the dull ache of the balls exploding against my skin, and I loved the lurid bruises that formed afterwards. This is basically the less extreme version of #5 – if I’m confident that I could tolerate it, then I’m desperate to experience it.

So, I just need to meet these needs in a way that doesn’t involve hurting myself, and I won’t need to self-harm any more? That doesn’t sound too hard.

But it is hard. So what am I missing?

Self Harm Sucks, So Why Am I Doing It?

But I Don’t Want To Be A Grownup

2016-06-20 12.31.33

This is Albus. He is 6 weeks old, and he weighs about the same as a stick of butter. A few days ago he was living on the street, and now he is living in my bathroom, in the basket that used to hold my spare rolls of toilet paper.

We’re all still adjusting.

Albus came to my session with Nikki yesterday, and he wailed the whole way there. Partway down the street I realised I was talking out loud to apparently no one, saying “Oh, I know, it’s so scary. I can hear you’re very upset. It’s okay, mummy’s here.”, and was delighted to find I didn’t give a fuck.

She was instantly besotted with him, and pulled out her phone to snap photos to show her son. We sat together on the floor, closer than I ever could have tolerated with Anna, and Albus gambolled around our legs, pouncing on bits of fluff and falling over. But when I left, I was disappointed and frustrated and upset, and fixated on hurting myself.

At the time, I thought it was just because the session wasn’t helpful. I wasn’t upset with Nikki, because it wasn’t her fault that we’d done nothing but go over old ground – it was general frustration that therapy isn’t helpful and nothing is helpful. We’d talked a little bit about my belief systems about enduring pain being a character strength, but she said that it was a quantum leap to go from the fact that my parents encourage stoicism and shame “wimpiness” to the belief that hurting myself shows strength, and that it didn’t seem like enough to create that belief system, and I felt so embarrassed that I didn’t pursue it any further. Either I’m wrong and stupid, or I’m fucked up and weird and I took a normal experience and turned it into an extreme ideology. Or I could check the facts and stop focusing on the most negative possible interpretations of every statement, but God forbid I actually learn anything from my DBT class.

So I didn’t lead the session and it didn’t go anywhere, but that isn’t really why I was upset. An hour or so after trying to stab myself in the arm with a kitchen knife, I realised that mostly I was just feeling sad and small because she hadn’t really said anything empathetic during the session.

Ugh, that feels gross to write.

She mirrored my affect almost exactly – calm, a little detached, and focused on the facts. When I told her I’m struggling with urges to cut myself with a power saw, put hydrochloric acid on my skin or set myself on fire, she didn’t blink, just calmly asked whether I’d have a wet towel waiting to put it out. When I told her that when I was 16 my school called my parents to tell them that I had third degree burns, and my parents told them I was fine and refused to come in for a meeting, she observed that they were very well defended. When I told her that if I delay self-harm for a week or so, I start hallucinating the people around me hurting each other and hurting themselves, she diverted into asking me why I always hit my cheekbone instead of the back of my head. All very rational…and I was expecting a reaction. It wouldn’t have fixed anything if she’d said “Oh god, that must be awful“, but I guess I would have felt less alone. And safer – it feels like such a risk to show any emotions before I’m sure whether she’ll respond to them.

The part that really stabbed me in the chest came after she asked how Aisha used to react when I self-harmed during sessions with her.

She was chill,” I said, and she was – I have no idea how she really felt about it, because she was totally calm and non-reactive and never asked me to stop, and that made me feel safe. Thinking back now, I’m surprised I didn’t feel abandoned or uncared for, but I just felt held, because there was nothing I could do that wasn’t okay with her.

Is that how you feel you’d like this to go?” Nikki asked.

In the moment, I had no idea. I’m still not really sure.

I don’t know if it makes a difference – I usually do what I’m going to do, regardless of what other people…” I trailed off.

I suppose there’s a danger, if I was to get…kind of…you know, ‘you really need to be trying hard not to do this’, obviously I’m not going to say that, that’s ridiculous. But there’s a danger of it becoming a certain dynamic, where it’s no longer two adults in the room talking and it’s a bit more parent-child and that’s one to watch out for. We don’t want that to happen because you know, it’s your life, you’re an adult and it’s about your responsibilities.

The urge to hurt myself immediately intensified, and I noticed a need to close myself off from her. A voice in the back of my head wryly observed ‘Yep, you’re definitely going to be blogging about this later‘.

She’s right, of course – I am an adult. But I don’t feel like one, and I hate being reminded that I am. To me, adulthood carries connotations of too old to be looked after and you’re on your own. I was so unhappy when Alina wanted me to contract to go to the hospital every time I self-harmed, and yet when Nikki recognises my freedom to make my own decisions, I feel abandoned and alone and miserable. I mean, fucking hell.

Later that night, when I finally realised why I was upset, I felt an aching emptiness in my chest and tears came to my eyes: fuck, I miss Aisha. She was never very reliable, but when she was there she was completely warm and steady and accepting and she never, ever made me feel like I was being difficult. It’s occurred to me for the first time that instead of seeing Nikki a few more times after my 10 sessions are up, I could see Aisha – it would cost twice as much as Nikki, but the benefits would probably be more than double, since she knows me so well. But probably that would just stir things up more, and then I’d have to go through separating from her again.

Nikki is supposed to be speaking to Aisha today. (They had arranged to speak two weeks ago, but Aisha realised at the last minute that she’d double-booked and couldn’t find another time, and it’s so typically Aisha that I had to smile.)  So I guess I’ll find out what happened and go from there.

But I Don’t Want To Be A Grownup

Ninth Time Lucky?

Before I started therapy, I didn’t realise that with different people, silence can sound different.

I met Psychiatrist #9 yesterday, and it didn’t start well. After I walked in and said hello, she proceeded to read the full referral letter from my GP aloud, then said “All right…take it away!

I laughed a little incredulously (um, really?), and when she didn’t step in to prompt with a question, I immediately started seething with rage. If I could have set her editions of the DSM aflame with the power of my gaze, I would have. I was furious at her for not doing anything to put me at ease and for not just asking me what my parents do for a living like every other fucking psychiatrist, and I was furious that I was here doing this again and again it was bad and hard and not fair.

And then…the anger just dissipated. There was no expectation in the air. No sense that she was waiting for me to say something. She was just sitting, still, gaze resting on the floor to my right. Not fidgeting, not reading, not tapping her pen. Just sitting.

It gave me space to settle myself. I noticed the tension in my shoulders, took a breath and consciously let them relax. I let myself see my resistance and discomfort and anxieties about having to take the lead. It felt like longer, but I only held out for two minutes before I said:”I’ve done this so many times I’m bored of my own story, to be honest.”

It was a cheat – saying something without really saying anything, to get her to respond so I wouldn’t have to take the initiative. I didn’t want to just regurgitate my history, but I didn’t know what to say. Her response annoyed me, but I was impressed – she knew exactly what I was doing and she held firm.

I was truthful when I said I’m patient. When people do this sort of work they do it at their own pace.” She paused, then added “So if you want to sit there and just reflect on things quietly, we can do that for as long as you want.”

For the next five minutes, we did exactly that. I looked over her bookshelf, gazed out the window, counted the drawers in her shelving unit, and I thought; why am I here? what is happening in my life, right now? what do I want to share?

Eventually, I broke the silence with a brief explanation about my self-harm. I don’t want that to be the first topic of conversation, the thing that defines me, but it’s the most obvious place to start. We spoke about it a little, then lapsed into silence for almost ten minutes. She only ever looked at me when I was seeking eye contact. As soon as I broke her gaze, she’d look away. I liked that.

I should have been prepared for the conversation to turn to Anna – after all, Anna had contacted #9 when she terminated with me – but for whatever stupid, stupid reason, I hadn’t thought about it at all. #9 had forgotten about her call with Anna until the subject came up, and flipped to her notes to refresh her memory.

I’ve finished my therapy with a difficult self-harming patient,” she started to read aloud, and I felt my whole body tense and my face flinch, in the split second before I took a step back and detached from my body, letting a mask slide down over my face. Hearing Anna describe me as “difficult” hurt, so much.

She read through the next part silently, lips pressed together, then started to narrate aloud again. “Bright lawyer……hospitalised a couple of times this year with self-harm, very rigid views and belief systems…very controlling about what can be said and what’s said…

The mask almost slipped at the word “controlling”, but I imagined a flame against my skin, and I stayed outwardly calm. Just wait until you get home, I told myself. You can burn as soon as you get home. 

She’s the fourth therapist I’ve told the story of Anna and Aisha to, and every time, I’ve stayed bland and unemotional. If she couldn’t help, then I’m glad that she told me. And I liked her a lot, but it was difficult via Skype. There’s so much shame in admitting how much I hurt when they left. I trusted them and I depended on them but to them, I was just a difficult client. Whenever I think about telling Nikki the truth, about how my voice would wobble and my face would scrunch and – oh jesus – how I’d cry, my mind flashes to an image of blood dripping down my arm. Can I move past the hurt and betrayal without expressing it out loud, having it witnessed and understood? I don’t know.

We didn’t talk about anything of substance for the rest of the session. She warned me a few minutes before the end (another point in her favour), and asked me if I had any questions for her. And I surprised myself – for the first time ever, I did.

Her answers were good. I felt a little bit of fluttering in my chest when she talked about the first year being focused on containing self-destructive behaviours – she knows how long this is going to take. She talked about creating a safe contained space, and about working with people whose histories make it difficult for them to function in the world.

I’m definitely not sold on her yet. There’s a lot I like about her, but I question how wise it was to read me comments from my last therapist in our first session. And I’m horrified that she charges $480 for a 35 minute initial appointment. It’s not about spending the money; it’s the concept of somebody in a helping profession charging an exorbitant fee that would prohibit a lot of people from being able to access help. There’s probably a reason for it, but it doesn’t sit well with my values.

So, we’ll see. But for once, I’m not dreading my next appointment.

I’m finding it interesting, comparing the transference with Nikki to the transference with the psychiatrists. I’m getting attached to Nikki, for the wrong reasons. She’s competent enough, I guess, but I don’t care all that much about her therapeutic skills, really. I just want to be nurtured.

I want to curl up on the floor in her office, knees tucked to my chest and leaning against the wall, and I want her to reach across the table to me, silently offering to hold my hand. I want to go for walks with her and colour with her and show her photos of my farm. Basically, I want her to take me home and tuck me into bed and hug me when I wake up with nightmares and spoon-feed me cereal for breakfast. You know, the normal stuff that people want after knowing someone for three weeks.

It feels like I’m trying to re-enact my relationship with Anna. And I’m very aware that even though I’m feeling an intense desire to cling to Nikki, it isn’t really because of her at all. She could be anybody young-ish and pretty-ish and caring. I know that looking to her for comfort isn’t that smart and isn’t that helpful. But fuck my brain. Why does it always get to run the show?

Ninth Time Lucky?

Please, Please Be Safe

My brother was officially declared a missing person this week, and nobody told me.

Last week, his psychiatrist decided he needed to be admitted, and drove him to the hospital. When they arrived, Troy got out and ran. I used to think it was funny, all the experience my brothers have at running away from the cops. No psychiatrist would stand a chance at catching him.

The police called my parents to find out if they’d seen him, and my parents called my brother C. Troy is impossible to trace at the moment, because he no longer believes in corporations and doesn’t own a phone, a car or a computer. He was sighted standing on a bridge looking at the water, then a few hours later on another.

He was found, at some point, and returned home, for some reason, until he disappeared again. Again, the police called our parents to report that he was suicidal and missing and to find out if they’d seen him. They hadn’t. Troy lives a few hundred meters from our parents, by the way.

He was found again, and returned home again, but isn’t answering the door to anyone. He’s schizophrenic and off his meds.

The first I heard of any of this was this afternoon. I was in the car with my parents, turning onto our street, when I heard mum mutter “God, Troy looks awful“. When I looked up from my phone, all I saw was a glimpse of his back as he walked in the direction away from our house. My heart leapt – Troy! – because he was gone for so long and any proximity, any confirmation that he still exists is exciting. No matter what state he’s in.

Is Troy not doing good?” I asked my mother, and she told me he’d been suicidal and gone missing a number of times in the last week, and the police had been calling.

When was the last time you saw him?” I asked.

Mmm…about three weeks ago?” she guessed, and my heart sank. I’d been hoping that he’d gone to them, but more than that, I’d been hoping that they had gone to him.

I felt edgy and uncomfortable pressing it any further – afraid of what I might hear, I think: “he’s a lost cause, Rea, there’s nothing we can do”; “he’s not really our responsibility” – but I persisted, sounding a little uncertain. “Well, shouldn’t we go and see him then?

He comes over when he wants to see us – he kept walking, so he obviously doesn’t want to talk.” Her tone wasn’t dismissive or uncaring, but just so, so passive, and I wanted to shake her.

But shouldn’t we do something?

She didn’t respond, and got out of the car. My dad had been silent throughout the conversation: a relief. He doesn’t like Troy.

I can’t let myself be angry at my parents, but I am. Troy is destructing and they aren’t even trying to help him. I know he’s an adult but I just can’t see it that way – he’s my brother and I want him to be protected and cared for and I hate that he’s all alone. He would open the door for our mother. Even in his worst psychotic episodes, he has literally run at her with his arms open for a hug. It hurts to know that he loves her so much. He lived in our house for years, and he calls her parents Nan and Pa. When he was 13 and he broke his arm, she tied his shoelaces for a month. How can she know that he wants to die, that he might die, and not even walk up the street to knock on his door?

She is who she is, and I have to accept that. She is caring and loving but she can’t step up when it really counts. It’s easier to accept when it’s directed at me than when my brother is suffering.

My brother C and I are about to go to his house and bang on the door, call out to him to let us in, push letters under the door. And then I will have to decide whether to call the crisis team and try to have him admitted. I’m so afraid that he’s going to die if I don’t. I’m afraid he might be dead already.

Please, Please Be Safe

there is a very strong self-destructive force in you

I went back to see Alina on Tuesday. It felt wrong to call and cancel after she’d gone out of her way to see me, and even if we couldn’t work it out and she wanted to refer me on, I didn’t want to end things with her telling me I had to leave, and with me walking out. I didn’t want her to think I was seething in a corner somewhere, downing shots and throwing darts at a photo of her face.

So I went back. We had an appointment scheduled, and I assumed that if our last session was The Final Straw and she wasn’t willing to see me again, she would have had her receptionist call and cancel my appointments. I was wrong.

I arrived at 2pm, and she was with another client. I sat in the waiting room for 15 minutes before I’d constructed enough of a poker face to ask the receptionist, and my cheeks flamed red as I lied unconvincingly that I must have got the wrong day, and stumbled out the door.

I don’t even really understand why I felt – feel – so ashamed. She was unprofessional enough not to communicate with me before booking over my timeslot; how is that my shame? But something about it feels so cringeworthily pathetic, to turn up thinking she would be expecting me, when she’d crossed me out and moved on.

And I felt angry. Who is she to assume that she knows me, to be so sure that I’d just walk off and not show up again?

In the two hours between that debacle and my appointment with Nikki, I cut and burnt, and I really wasn’t in the mood for therapy. I was feeling even more guarded than usual, which basically means I threw a couple extra alligators in the moat to back up the catapults. I didn’t tell her what had happened with Alina, because I dreaded being asked how I felt about it.

I’d wanted to talk to her about working on my belief systems around pain. We only have 8 sessions left now, and if we keep just going through my history, I’m going to walk away feeling like I’ve dug up a mess of bones without any time to clean them up, lay them out neatly and bury them back in the ground. I’m worried about boring her by focusing in on one narrow thing, but I think that’s the only way to leave believing that it was worthwhile. So why didn’t I bring it up? Yes, I was very shut down after what had happened with Alina, and trying to initiate a conversation with Nikki about goals felt abhorrent and impossible. But therapy sucks anyway. Why am I suffering through it in near-silence and getting nowhere, instead of pushing a bit harder, suffering a bit more and maybe actually changing something?

So far, Nikki is following the well-trodden path of psychologists before her. She wants to know what will help me feel comfortable; we’ll go for a walk next week; I should bring Everest along to a session. She asks to see my arms, is distressed at the extent of the scarring, and both sessions run at least 15 minutes over time. She says she’ll make calls, talk to people, try to get more help for me, but says that doesn’t mean she is getting rid of me; she’s more than happy to keep seeing me. I like her, a lot, and if I could afford to keep seeing her I would. But there is nothing that makes me think this person could help me change my life. Can anybody?

The next morning, on my way to work, I got a text from Alina – the receptionist had told her I was there.

I am sorry that our meetings ended in such way. And I am sorry for misunderstanding of what has happened on Friday. I was looking forward working with you although we both know it would not be an easy path. But you said last Friday that you were not ready to sacrifice with staying on line and checking your e-mails while you are at therapy sessions, in fact you said you were choosing e-mails over therapy and left in the middle of the sessions. So I interpreted all of it as a sign that you were not ready to commit to therapy. And as much as I regret that out attempt to work together has failed this time, I also know that I could not do anything else. We know that there is a very strong self-destructive force in you and without clear boundaries and limit setting we will not achieve anything. I think you know that you need a strong therapist, but then you are fighting it at the same time.”

I got angry, I cried, I cut myself, and then I started wondering whether she was right. Not about her retelling of what happened – I certainly never said I was choosing emails over therapy! – but about me sabotaging myself. Did I walk away from somebody who was inflexible and arrogant enough to be certain of her own assumptions, or did I throw away an opportunity to work with someone great because I was too willful and stubborn and convinced that I was right? Or like most things, does the truth lie somewhere in the middle, and if we’d both bent a bit we could have connected?

I don’t know, but I want to. I felt so outraged that she was claiming I was uncommitted and self-destructive when my conscious motive for picking up my phone was to regulate, to stay calm enough that I could stay in the room with her, in therapy.

A little too outraged, perhaps. Usually when I feel that fired up about something, it’s because I know there’s at least a glimmer of truth in it, and I wish there wasn’t.

I’m a bit at sea. There’s no rush, I keep reminding myself, but if my conception of a ‘good’ therapist is completely different to what I actually need to get better, then it doesn’t matter how long I wait. They could land in my lap, and I’d throw them back into the sea.

there is a very strong self-destructive force in you

I’ve Been Quite Busy (Falling Apart)

I’m so angry and sad and despairing and I need to hurt myself but I just don’t want to.

I guess I should start at the beginning.

On Tuesday, my session with Alina was mostly about safety planning.

You told me that you came to therapy because you are afraid that you might kill yourself. And I think you’re right; I think you might.” It hung heavy in the air for a moment, then she continued. “So, I need to think about how to set limits on behaviour that is going to interfere with therapy.

She asked whether I’d had any discussions or agreements with previous psychologists about what needed to happen if I had urges to self harm or commit suicide, and I explained the crisis plan I’d been required to enter with Anna as part of the DBT program; if I was imminently about to hurt myself, I had to call her, and if I wasn’t able to start talking to her within half an hour, she would call the police.

Alina contemplated this for a moment. “I certainly would not think that it would be right to call me. Not because I don’t want to know, and not because I won’t care, but if I’m on the other end of the phone line then there is nothing that I can do.”

That first sentence hit me pretty hard. It would have been different if she’d said ‘not helpful‘ or ‘not a good idea‘, but ‘not right’ felt so harsh. I felt ashamed that I’d agreed to do it with Anna, that that had been wrong, and somehow chastised and rejected, even though I hadn’t suggested or even wanted a similar arrangement with her.

The safety plan Alina decided on was that every time I self-harmed, I would have to go and see my GP, and then my GP had to send me for psychiatric evaluation by the hospital. That wasn’t up for negotiation: “We can do work only under these conditions. When I see you next time, you will have to make a decision.”

I was so angry and upset that for a moment it took all my focus to remember to breathe. This plan is not going to keep me safe. Making me miss work and lose income every time I hurt myself is not going to help me stay stable. Making me go through all my history with a strange psychiatrist every time I hurt myself is not going to keep me safe. Last time I was in the emergency department I smashed my head against a concrete wall 28 times before a staff member came in and yelled at me to stop, and they sent me home a few hours later anyway, so really, the chances of them admitting me against my will just because I cut myself are slim to none.

“I guess my question is, since you said you accept that I’m probably going to keep self-harming for a while, why do you want me to be assessed every time I do?”

I think we need to treat each event of self-harm as a potentially life-threatening event and you need to be assessed. That’s one thing. Secondly, I think you need to know that people take it seriously. And I think GP makes it too comfortable for you. She’s nice, she’s supportive, she talks probably very loving to you, stitch you up, tell you goodbye, give you a hug, say ‘be good’. It’s all very comfortable. So you get double comfort; initially when you’re cutting, and then when you get stitched up.

This made me feel awful. I feel awful, reading back over it. Firstly, she’s wrong. I haven’t had many experiences that are more horrible than having to expose fresh wounds after an emotional crisis and then deal with the physical pain of having them treated. I like my GP, a lot, and I have taken comfort from her, but it’s a terrible process to have to go through. And I understand that she wants to avoid reinforcing dysfunctional behaviour, I do, but the logic behind going You know what, I think your GP is making you feel better after you’ve been in emotional crisis, so I think we should instead make the process as horrible for you as we can is just awful.

I went home, crawled into bed, and sobbed while I thought about which method of self-harm I was going to use; if I was going to be threatened out of doing it after Friday, then I had to at least do it once or twice before then.

On Wednesday, I met the psychologist, Nikki, and went home to calculate my savings and try to figure out how to afford to see her long-term. (The answer: I can’t.)

I really liked her. That doesn’t mean she’d be able to help me, but I felt comfortable. (Ish.) She was warm and empathetic and attuned, and the only time we went far enough out of my comfort zone that I froze up and started getting flashes of blood, she verbally acknowledged “I’m pushing you too hard too soon” and shifted topics.

On Thursday, when I arrived at Margaret’s, she had no idea who I was. She didn’t have me booked in for an appointment, but was willing to slot me in in the afternoon.

And she surprised me. She said she’d been thinking about me, and she’d gone to a monthly meeting of psychiatrists and asked them for advice, and they’d recommended I come off Effexor and start taking Seroquel regularly, and suggested that neurofeedback might be helpful for me. She was still as blunt as an old axe, but softer somehow, and I told her how much I’m struggling with work, and with my relationship with R, and I cried when I told her how much I hate having to be in therapy.

And then I went home and held my arm over the stove with the hotplates turned to full, because now I liked Margaret and I was going to have to decide between her and Alina, and I didn’t know what to do or how to choose and it might be my last chance to hurt myself before I had to contract with Alina the next day and should I even agree to the contract and what am I going to do?

The answer, as it turns out, is fuck shit up royally.

After I’d spent every evening this week flooded with thoughts of self harm brought on by the conditions she’d set out on Tuesday, she didn’t even mention them today. At the start of the session she described my self-harm as ‘attention-seeking‘, but when I pointed out that in the first 13 years of self-harming I only sought medical attention once, she was surprised and let it go. The only condition she set is that I call the crisis team if I’m about to act on a suicide plan.

Her rules around contact out of sessions are no texts and no phone calls unless it’s logistical or to inform her that I’ve been hospitalised. I can send her emails, and she’ll read them but she won’t reply. And that’s okay, I don’t think I need more than that, but I was still upset.

I was so proud of how hard I was trying today. When she asked again what my goals are for therapy, I took out my phone and went back to the list I posted here, and I went through almost all of it – I only skipped food and body issues. I’ve never given a therapist an answer to that question before, and I’ve never looked at something I’ve written down to give a really comprehensive answer to something.

So, all of the groundwork was done. She put down her pen, and said “And now we begin“.

The silence stretched on, and she was just looking at me. I started feeling panicky, and like I was about to cry, and the room was too small and I didn’t have enough space and I needed to calm down. So I reached down to my phone, which was sitting on my chair, and I opened my work email.

Alina asked me what I was doing, and I told her.

Are you testing me?

I thought about it for a moment, to make sure, then said “No, just giving myself a break.” Checking my messages or looking at photos was a strategy I always used with Anna to calm down when I needed to, and if she could see I was struggling then she would suggest it to me.

How would you feel, if I checked my email?

If I wasn’t talking to you, I wouldn’t mind,” I said, honestly. There’s something companionable, to me, about sitting quietly with someone while you both do your own thing.

So it’s like me punishing you?


If we are here in therapy, it’s just you and me; there’s nothing else between us. That’s sabotaging, what you’re doing. So we should put that into our contract. No other activity in session, apart from being in session.

I can’t commit to that,” I said, softly. It’s not that I disagree with her point, and I agree with it as something to work towards, but I’m not there yet. It just feels like too much. I don’t know her and I’m not comfortable with her and if I feel like I need to look at a photo of my cat and take a minute to breathe and calm down so I can try to keep going and keep shoving my hands down my throat to pull out some words, is that such a big deal?

Then I can’t commit to therapy,” she retorted immediately.

Mmm. That’s fair enough.”

Is this what you want to do?” she asked.

Not really,” I said, and there were tears in my voice. “But it’s do this or leave.

Well, that’s your decision, but you will have to leave, then,” she said.

So I did. There was still half of the session to go. I don’t think she was wrong to call me out, but to make me leave? I don’t think I did anything wrong and I feel like she’s not giving me any space for this to be hard and I hate her, even though I don’t. Everyone expects more of me than I’m capable of doing and I can’t.


I ran out of Effexor four days ago and only got a refill today, so I’m in withdrawal; nauseous, sweaty, dizzy and aching. My head is heavy and my body is light and there is nothing behind my eyes. And I keep thinking that Everest is dead, even though she’s sitting on my shoulder.

I’ve Been Quite Busy (Falling Apart)