What are the challenges that face a psychotherapist working with self-harm or eating disorders?”
“What are the challenges that face a psychotherapist working with self-harm or eating disorders?”
Self-harm can be said to be the act of self-inflicting physical attacks on the body (Gardner, 2001). In self-harming, the client aims to deliberately, and usually habitually harm their body but not to destroy or kill it. Levitt et al (2004) also says that the act of self-harming is an attempt to draw attention to one’s plight or to scream for help rather than an attempt to achieve death. Self-mutilation and self-starvation are said to be pleas for recognition (Hewitt, 1997 cited in Levitt et al,). Gardner reiterates that self-harming is a metaphoric representation of earlier psychic wounds and also internalised processes obtained from early object relationships (Gardner, 2001). She sees both our real experiences of and our fantasies about parental and other figures/objects as internalised and being embedded in the way we cope with life. I agree with the theorist as it is a fact that the inner objects shape our psyche and influence other relationships and also how we behave. Engaging in self-harm can therefore be perceived as a way of making statements about ourselves, our past relationships and also our previous experiences.
Clients can engage in self-harming behaviours in so many different ways, such as: smoking, drinking or abusing any substances, comfort eating, existing in abusive relationships, denying needs in areas of their lives, doing excessive exercises or hard manual labour. Most of these activities are done unconsciously by people (Chrysalis notes, module 5). The body can also be harmed in a number of ways such as, through eating disorders, frequent and often unnecessary cosmetic surgeries and excessive dieting and many other such ways (Miller, 2005). The most common type of self-harm is cutting of the skin. People who are likely to engage in self-harming are; those who already are into drug and alcohol abuse, have signs and symptoms of depression, those with eating disorders, those who felt unloved as children, those with difficulty to express their feelings and in most cases, those with a history of childhood abuse. (Alderman 1997).
The deliberate self-harm without the intent to die, is generally characterised by unbearable emotional pain coupled with periodic strong and persistent urges to physically hurt oneself. Thus, it is important in any therapeutic approach to acknowledge that self-harm is a way of coping with the pain. The urges may be resisted for a short time, but ultimately the individual becomes overwhelmed with negative emotion and engages in self-harming, often resulting in tissue damage (Simeon & Favazza, 2001; Stanley, Gameroff, Michalsen, & Mann, 2001). In a sense, self-harm is a coping mechanism similar to overeating, excessive drinking and drug abuse. The danger of self-harm, of course, is in its most extreme forms it may cause accidental death. Furthermore, non-suicidal self-harm is one of the strongest risk factors for suicidal behaviour (Muehlenkamp, Gutierrez, 2007). It is fair to say those who self-harm offer a variety of reasons for their behaviour some of the reasons are to experience relief from unbearable tension and upset, to distract themselves from intolerable feelings, to communicate distress, to improve their mood, to self-punish, to restore a sense of equilibrium, to provide proof to themselves that they are, in fact, suffering, and to achieve a sense of control (Brown, Comtois, & Linehan, 2002; Klonsky, 2007; Nixon, Cloutier, &Aggarwal, 2002).
A number of studies reviewed in Landecker (1992), cited in Miller, (2005) found a high correlation between severe childhood abuse or neglect and adult self-destructive behaviour. The adult behaviour patterns are linked to a lack of secure...
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