I first started seeing Nell because her Father, with whom she lived, said she was involved in self-harming and he knew nothing about it. Like most parents, Nell’s father thought she was trying to kill herself, a terrifying thought since his own uncle had done that at the age of 40. Fortunately Nell’s cutting was more of the emotional pain release variety, also quite serious nonetheless. Many therapists put self harm in the category of borderline personality disorder because of the emotional instability behind it, not to mention the craving for attention, and the lack of more useful coping skills.
Nell was a spritely 13 year old, ahead of her years because of an early divorce and a mentally ill mother. With her purple hair and some henna tatoos, she marched confidently into my office. But just beneath the surface was the deep scar of depression and trauma.
Step one is to ALWAYS take a careful history and assessment. Turns out her mother had a very odd profile of personality issues. This would come in handy later on when abandonment and loneliness became the overarching theme. Nell was also an artist, so she was accustomed to expressing herself colorfully. Her style was unique, but off-putting to her peers in it’s contrast and confusion. There was something chaotic about Nell’s presentation but I couldn’t put my finger on it.
*With individual therapy we teased out the very resistant source of her cutting to numb. She missed her mother and she blocked out the pain with cutting. She had not realized just how painful it was to lose a mother she never really had.
*With group therapy we found that she was unsure of her sexuality, something that would not have come out individually. One day the group was bantering with each other about it and she blurted out – “I’m not sure what I am and I’m ok with that!”
*And with family therapy, we were able to have her reach out to her father in a more connected way — that is not to wall-off her feelings from him. She thought that she might upset him. But I coached him to be as supportive and reassuring as possible following what might be called “providing a safe attachment.” She needed to feel safe to complain to her dad.
*And with psycho-education we went over DBT methods of breathe, yoga, mindfulness and relaxation with worksheets, handouts and homework.
But there was still a missing piece. Where was her mother and why had she disappeared? This, of course, was going to take longer. I might call in the father again. I might have to gently push her.
Finally, one day, she was talking about her long distance boyfriend and she started laughing.
“What is so funny,” I asked.
She replied, “Nothing, I just realized I’m exactly like her.”
“Like my mother of course. The reason she is no longer my caretaker is because she couldn’t handle any pressure, just like me!”
And that was the beginning of discussing her mother. A journey.