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Cutting is a form of self mutilative behavior which refers to a patient causing self injury usually by using an object that causes pain or wound.
Many different patients do cutting behavior. It may be more prevalent with
adolescent females or patients with a trauma history.
Typically patients will do cutting behavior on their arms or legs, although it can occur on any body part.
You will want to pointedly ask your patient if they are engaged in behaviors of self harm during the risk assessment portion of your intake.
You may see that a patient has scars on their arms or legs in view, although this is unusual. A patient will typically attempt to hide the evidence of this behavior.
Why do people do cutting behavior?
Most patients report that they either have overwhelming feelings that they cannot handle or they feel emotionally numb.
Doing the cutting allows them to be able to feel again.
Likely the behavior releases some type of neurochemical response that is soothing to the individual for some reason.
This creates almost an addictive type attraction to the behavior. For this reason, secrecy around the behavior needs to be broken down.
Cutting may or may not be related to more serious forms of self harm such as suicidal behavior which requires a more drastic intervention. ALWAYS, ALWAYS, ALWAYS!!!! Assess for all potential types of self harm behavior.
Cutting is a coping mechanism for the person who finds satisfaction in the behavior.
When a patient reveals this behavior, develop a safety plan with the patient. The safety plan needs to include telling other people so that the secrecy is lifted.
The patient should agree to get rid of the item used for the cutting if they have it stashed somewhere. The patient should also identify 3-5 quick coping skills they can use as an alternative before the next appointment.
The primary focus of counseling might be to develop other coping skills which might not be as easy or effective as the cutting behavior. As one of the initial homeworks, the patient will need to identify a list (I suggest a 20 item list) of coping skills that they find soothing.
Coping skills require practice to become second nature, so assign the patient’s practice of these skills as homework as well.
Another technique for managing these urges to cut is to have the patient use an ice cube and rub it on the area usually cut. This provides a lot of sensory stimulation, a tactile sensation close to
pain and again diverts the patient from the more harmful cutting.
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This link takes you to a documentary on childhood schizophrenia: http://tinyurl.com/7flrs2m
This is a fascinating topic. As many years as I've worked with children, I have to say that I've only seen maybe 3 or 4 children who had schizophrenia. For sure, it's a devastating diagnosis. As so many challenges, it highlights any other issues in the families who deal with it.
The documentary is worth watching even if you don't deal with children or others with this diagnosis.
All the world needs is a little more love, a little more caring about each other, right? While this rings of truth to most of us, you have to wonder, is it possible to care too much? In this world where balance exists on all things, whether gentle and sweet or violent and chaotic, you have to expect that there is a situation where someone might care too much. To quote Arthur Schopenhauer, “Almost all of our sorrows spring out of our relations with other people.” Caring for others does give us the greatest cause for gladness and distress.
Emotional stress is a sign that we may be in this state of too much caring. We display our best judgment when we have just the right measure of caring and detachment. In fact, when we are too emotionally attached to a situation, we are said to have lost objectivity. This causes us to make irrational decisions.
What are the signs that we care too much?
For starters, we feel emotionally upset by what is going on. It is a hard thing to stop this feeling. As a mother, I have been emotionally upset greatly by things that my children did or did not do. As a counselor, this scenario plays out
for me in my office many times a week. A child, for their own reasons, behaves in a way that a parent thinks is
not in their best interest. The parent and the child may let their emotions get the better of them. Once voices are raised, rationality has left the building!!
I have made it a practice and encourage others to do self examination whenever strong feelings of any type emerge.
What is underlying these feelings? Are you afraid that your child is engaging in things that are going to bring them harm? Are you feeling neglected by your spouse and therefore more sensitive to a comment? Teasing out these feelings and exposing them to the bright light of day often reduces their ability to impact a person.
If you feel you are forcing a thing, this might also be a sign that you’re caring too much. At times, we feel we see the most direct or best route to an end, and so we try to force the “how” of achieving it. The more you push, the less “flow” can occur. Who can argue that the universe has a serendipitous way of easily making things happen? Often in spite of our so called assistance!
Examine yourself. If you have areas in your life where you feel you are in a state of too much caring, give yourself direction to take a step back. Determine what thoughts or beliefs your fear is drawing you towards. Look around.
Aren’t there an infinite number of other possibilities?
Think of all the possibilities in the world. Isn’t it thrilling to know that if we let go of the thoughts that will hold us back, anything at
all is possible?
If you allow yourself to just imagine anything at
all, what would it be? Don’t your thoughts feel free?
Now start to notice those little niggling thoughts that pop up that would hold you back. Now ask yourself “is that the truth?” So many times, we just accept these limiting beliefs without questioning.
Just for a moment (because it can feel threatening and scary) let your imagination go to the places where you would love to go? Try to do this a
little every day. It’s good for your soul.
As the time of the year changes, we experience different things, temperatures change, the time changes for most of us, activities change. It seems to drive some momentum, all this change.
I pondered the fresh perspective that I have when I wake up to a crisp autumn day and I consider that it is the “change” that gives me hope anew. Isn’t life like that?
Sometimes, we get shaken out of our current “status quo” by some change. It may be subtle, like the season’s change, or it might be violent, like a hurricane which we sometimes experience here in Florida.
Either way, change brings newness. This newness in itself forces us to go places that we haven’t gone before.
I wonder what would happen if we allowed change every day? Would we be afraid of the chaos of being out of routine?
Or would we reach heights we never dreamed of because of the momentum of sheer movement?
“I’ve crossed the line from forgiveness to stupidity”
Isn’t that a great insight? A friend said this to me as we processed an event that is unfolding in her life. It got me thinking about forgiveness and how we fallible human beings get all wound around the drama of forgiveness. We are afraid that by forgiving someone, we are condoning their actions that brought us pain.
According to Wikipedia: Forgiveness is typically defined as the process of concluding resentment, indignation or anger as a result of a perceived offense, difference or mistake, or ceasing to demand punishment or restitution.
While I can’t feign to be of the ultra-forgiving camp (those who know me can attest to this), this very definition implies judgment and a moralistic attitude. After all, how else can we determine that forgiveness is needed? Who are we to make the determination of what is right and what is wrong?
Certainly wrongs are done in this world, but most people behave in the way they do because they perceive it as the “right” thing for them to do in that moment. Looking at it from that perspective, you can almost always forgive most things.
Are you stuck on the issue of forgiveness? Either needing it or needing to give it? I certainly have a couple of pain points in my life right now.
So, where is the line between forgiveness and stupidity? Ultimately, the line is where you go from respecting yourself to feeling you let yourself down.
Licensed Mental Health Counselor
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