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.Psychological TreatmentsAlthough the distinction between psychiatric and psychological treatments is not clearly demarcated, there is overwhelming evidence from consumers of mental health services that they would like to have more `talking therapies'.These include a broad range of approaches, from just listening to more formal psychotherapies.In a survey commissioned by the Mental Health Foundation, the authors, all service users themselves, indicated that clients should be seen as the primary experts on themselves.They endorsed a more holistic approach to mental health which focuses on what works, is accessible to all, and yet still offers a wide choice to individuals.Overwhelmingly, they wanted to have someone to talk to.They found that compared to physical treatments such as medication and ECT, 88 per cent of their sample said they found `talking treatments', far more helpful.However, it must be said that the success of talking therapies does depend very much on the therapist, their professional orientation, and the relationship with the client.In 1992 Dee carried out a small research project based on 25 women and, sadly, she found that the majority of the women she spoke to had not had positive experiences of counselling, group therapy and psychotherapy.The right relationship between therapist and client must be established from the outset, and if you feel that a therapist isn't listening to what you have to say, or appears averse to discussing your self-harm, it is vital that you discuss the problem with them and, if necessary, ask to change to a different person who will help you give voice to your inner life.I've found both doctors and psychiatrists very indifferent and unsympathetic.Although my therapist is understanding, even she finds it very difficult to tolerate and doesn't really like me telling her what I've done or what I felt like doing.ChrissieThe theoretical orientation of a therapist determines the process of the therapy and also the meaning that is given to your self-harm.A selection of those therapies most commonly used today are described in the following sections.Behavioural InterventionsSome women who self-harm are referred to a behaviour therapist (BT) or a Community Psychiatric Nurse (CPN) for help with behavioural techniques aimed at trying to stop the acts of self-harm.Behavioural techniques are based on the idea that only behaviour that leads to reward is repeated.Hence they try and establish what rewards are gained from a particular behaviour.Change is brought about either by altering the way those rewards are obtained or by preventing those rewards from being accessed by that behaviour.Such techniques, however, aim to stop the behaviour without dealing with the real cause.Unfortunately there are behaviour therapists who employ very simplistic approaches to complex problems.One such technique is `thought stopping' which involves telling yourself to stop, and to imagine a STOP sign whenever the urge to self-harm begins to build up.When used alone and without any other form of empathetic understanding of what may be the root of the feelings leading to self-harm, such simplistic interventions do little to gain trust, respect and credibility for the behavioural method of treatment being used.Some women also find these techniques offensive.The programme you are more likely to be offered is one in which you will be expected to look at the factors that lead up to the need to self-harm (the antecedents) and the consequences after you have self-harmed.You can then try and change the sequence of events that cause you to injure yourself.In order to do this you have to keep a very detailed diary to record all your thoughts, feelings and behaviours up to, during and after an episode of self-harm.Thus a personal cycle of behaviour can be derived and you will be able to identify points in the cycle where interventions can be made.An example of such a cycle is shown opposite.Looking at Lucy's cycle, there are several places where a behaviour therapist might suggest an intervention.These might include working on ways to stop the cycle of negative thinking by for example (1) arranging to phone someone when she begins to think like this; or (2) trying alternative methods of reducing tension; or (3) by ensuring she is not alone or is unable to buy the things she needs to self-harm.This is only the most basic of examples, to give you an idea how a behavioural programme might work.Behavioural approaches to self-harm can foster hostile and punitive attitudes in the professionals overseeing them by emphasising control and power over the behaviour of others.This is not a necessary feature of such approaches but can be an unfortunate `by product'.Complex forms of behaviour therapy can help change patterns of self-harm but they do not address how it started or what it means.If there is a traumatic event at the root of the distress, this is unlikely to be addressed.However, learning new patterns of behaviour may be useful and practical for some women who self-harm.Sometimes it is not important for an individual to discuss or process their traumatic material, but it is very important to learn how to avoid harming themselves.If that is the case for you then this form of intervention may be exactly what you are looking for.Other women have stated that this kind of work helps for some time but the relief often seems to be temporary or self-harm is `replaced' by other behaviour such as an eating disorder or a problem with alcohol.They say that it was only dealing with the original trauma that led to a genuine reduction in their level of distress.Trauma-Focused TherapySome therapists, while not ignoring the self-harming behaviour itself, believe that if the trauma is worked through and integrated into the woman's experience, then she will not feel the need to self-harm.This type of approach provides a respectful, validating, positive and supportive relationship.The woman is not seen as `ill' but as a person whose life has been shaped by having to adapt to an unbearably distressing event.My counsellor has never allowed me to manipulate her which is vital.She's made it quite clear she disapproves of what I do but not of me as a person.ChrissieThe aim of therapy is to help the woman approach thoughts and feelings associated with the trauma she experienced that she has spent much of her life avoiding, often engaging in severe acts of self-harm in order to do so.If you are going to undertake this work it is important that you feel safe within the relationship with your therapist and also have some degree of support from friends or family as you will have to face the many difficult and painful feelings that you have had to block out over the years.The aim of doing this is so that you can resolve your previous traumatic experiences, and regain a sense of control over your emotions without resort to self-harm or any other tension-reducing behaviour.Trauma-focused therapy assumes that the more you know of your trauma and your response to it, the more readily you can integrate it into your sense of self.Once you have acknowledged and assimilated it there will no longer be this area of psychic terror that has be avoided at all costs in order to survive.Specific Therapy for Women Who Self-Harm (Bristol Model)This therapy has many features in common with traumafocused therapy but the issue of self-harm is much more prominent and explicit.The starting point is that self-harm `is instrumental: it serves important psychological functions' [ Pobierz całość w formacie PDF ]