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Self-Injury: A Dream

Adrienne said she’s having difficulty holding to our agreement that she reach out to me before cutting herself. The drive to self-injury feels “insatiable,” as she put it. She then told me the following dream: She was outside with her son, and they were having a great time together. She suddenly realized there were snakes everywhere, on all sides.

Most of them were small and harmless but as the dream went on, there were more and more of them. She tried very hard to remain calm, in order to get her son to safety, and finally succeeded. But Adrienne couldn’t go inside along with him.

She felt sad but oddly at peace, resigned to that fact. As she left her son behind, Adrienne knew there were too many snakes now for her to escape with her life. She walked directly toward the biggest, “most aggressive” one. As it struck her, she woke up.

4 Comments to
Self-Injury: A Dream

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  1. Thank you — interesting post! Do you know of any resources to help understand self-injury as it relates to anxiety and, in particular, OCD?

    • Actually, I don’t. What I understand about self-injury has really grown out of my experience working with people who cut themselves, and I don’t believe I’ve read a lot on the subject.

  2. Joseph,

    This is the first time I have commented on your blog though I have been reading it and growing from it for some time.

    This is a very timely post for me as I am an older (ie, not adolescent) woman with children who recently began to self-injure (cutting, hitting, bruising) for the first time since I was a teen. What you have described of your client’s splitting and neediness is spot on. I love that you recognize your client’s need to see you more often as I think many therapists would be tempted in the other direction.

    Let me ask a question, though, as your post resonates with the experience(s) I’m having at present. Does your client have access to internal resources that she can use to help her at this time? What is your plan for therapy when you see her more frequently? What has been your experience in working with people who cut themselves — how have they progressed?

    Also, how do you feel about obsessive exercising as a form of self-harm? I’ve discovered that harmful exercise is MUCH more palatable to the community at large (including therapists) and is not recognized to be as harmful as more overtly harmful coping mechanisms (defense mechanisms actually) such as cutting.

    I know, lots of open-ended questions that may take some time to answer — for that I am sorry. However, your writing has been of tremendous help to me, helping me wrap my head around and find the words to express what is going on inside.

    • As for obsessive exercising — yes, it’s more palatable than blood-letting! Also, even if it’s destructive in its own way, it doesn’t pose the same immediate health threat that cutting does. I think most therapists (most people) find this type of self-injury frightening because they can’t understand or empathize with it, first of all; because it seems “gruesome”, and because they’re afraid of the suicide risk.

      I don’t have a treatment plan per se — I never do as I don’t work that way. But what I expect will happen, if the therapy is effective, is that the issues of anger and need will come into the transference. Helping my client to feel and express her rage in the context of her treatment, and to learn to bear her feelings of need and dependency upon therapy, will help her eventually, over time, to relinquish self-injury as a means of coping. That has been my experience with other self-injury clients in the past.

  3. I suddenly started cutting after 30 yrs old. I feel I cant wear short sleeves now yet still think about doing it and I dont even know why. Crazy thing to do.


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