Teenage Self-Injury: Long Sleeves in the Summertime

Yes, Mara was innocent most of the time. She was the type of teenager who worked hard to fit in, to accept others, and also to put herself last. Her upbringing is impressive as far as the amount of money coming into the house and the well-to-do neighborhood. Her father is the CEO of a popular bank. Her stepmother is a practicing attorney. Sounds pretty close to the Cosby's, but not everything is as well handled. Mara has a good relationship with her mother and often feels sorry for her. Her job is not as high and mighty as her father's and his wife's. Mother still lives in an apartment and enjoys her work in the human services field. What disturbs Mara the most is her mother's apparent sadness and history of depression. Mara's mother tries to make ends meet and act as if all is okay, but the sea of bitterness is still casting waves upon her. Mara tries to be the shoulder to lean on and avoids bashing the name of either parent.

She feels accepted in both worlds but has difficulty revealing herself in totality. But, who really does have a desire to lay themselves out on a silver platter for all to view and criticize? Well, it's all in the way you look at it. Being strong enough in your self to stand for yourself. I understand some people just don't feel like engaging in debates over who they are. Others just want to keep their private business personal. All these views are acceptable. Mara's problems introduce themselves because she does not allow the true her to show. Even more so, she claims to be unaware of who the true Mara is. She feels she has adjusted so much in her life to be accepted by others, she became lost. Mara describes it as being a leaf caught up in the wind. Blown far from its original foundation into unknown territory. The leaf sits there so long until blown again that others see it as part of the unknown territory and never learn where it really came from. It never has a chance to get settled, so it eventually fades away through a slow crumble. Slow loss of self. Pieces of Mara have been left behind here and there because she has tried to adapt to new relationships, to old evolving ones, and hopeful ones she wants to see on the horizon.

Because Mara is crumbling, she needs her peaceful meadow to lie in from time to time. Her peaceful meadow is different from that of other teenagers. They like to hang out, talk on the phone, play video games, shop, etc. But Mara, she likes to flee to a place where she can be alone and heal herself for the moment. When Mara came to me, she was so broken. Her nervousness to receive a welcome from an unknown face was apparent. She entered my office by herself, letting her stepmother know she could do this alone. She took a seat in a prim and proper manner yet trying to hide behind one hand that remained near her face. I saw a young lady who wanted to change her course and feel free to be free. She admits coming into my presence to learn how to do that.

I had already received a call from both parents expressing their concern about Mara's isolating behavior, expressions of anger and taking on the problems of all her friends. She has had boyfriends but they have all cheated. She accepts them back, but allows herself to be taken advantage of again. She peers through rose-colored glasses thinking they will change and be nice to her versus her accepting that certain interactions must cease when they are destroying you. So, I am aware of the gist of her story from a parent's view. Now I need hers.

Mara wanted to be certain that her personal thoughts would not be used as a weapon against her. I was able to give her assurance. But I made clear, the involvement of her family is important because everyone has a part and it may not only be her who needs a change. Mara's shoulders relaxed in comfort. I took that as the first sign she was developing her form of connection with me.

As with all my initial sessions with clients, I desired to explore her story. The one she has felt uncomfortable sharing for so long. Mara told me not everyone who does what she does wears long sleeves in the summertime. She identified herself as a cutter. She looked at me with cowering eyes as if preparing for the reprimand. I sat quietly as a gesture that it was her time to tell the story without reprimand, a disgusted face, an FBI probing, or judgment. She went on to express how she first came across this comforting method.

One day she was in the kitchen trying to pull down the window so she could turn on the air conditioner. It was boiling hot and sticky. She had a lot on her mind ranging from the weather to the guy who borrowed money and is now avoiding her, to the girlfriend who has an illness that saps her energy. That same window always gets stuck. She wished her parents would just get it replaced. The window came down harder than she had planned. So hard that it shattered and cut her arm. The cut was comfortable. She thought this unusual but gratifying. All on her mind found a calm place deep in the back. She tried to explain it to me in comparison to scratching an itch. Scratching causes some form of pain or discomfort to the skin, but we are willing to do it, because the satisfaction and feel good sensation from the itch going away is all we experience. Interesting, she is right, I just want to get rid of the itch. I don't resist the itch. The more I try, the more I want to scratch. After I scratch, the area is red but I feel relief. Only until the next itch comes along.

Mara came to me to learn how to stop cutting and burning herself for relief. She felt this pulled her farther away from others because it is weird. Finding comfort in what others see as pain. I assured Mara, there are reasons that have lead her to self-mutilation and once those reasons are revealed, a different form of healing can begin. Mara sat back and listened.

The Self-Mutilation Process

Self-mutilation can arise from many sources just as alcoholism, chemical dependency, sexual addiction, and other repetitive behaviors society identifies as strange and harmful. Although negative, these behaviors are a form of coping for many. We all have coping skills, either it is those listed above or those that do not perpetuate harm to self or others, such as journaling, exercising, talking, and meditating. We tend to use that which can calm our physical or mental discomfort the quickest.

Through my observations, I recognized consistent characteristics amongst those who self-mutilate. First, the expression of feelings is difficult. They hold in many episodes of hurt without resolution. Second, they put themselves last and there is a lack of assertiveness skills. Third, they want to resolve the problems of others and dwell on those issues. Fourth, they feel isolated, unaccepted and different. All these characteristics are temporarily covered, not healed, through self mutilation.

There are several ways self-mutilation can present itself. The use of any object that can cause an incision, for example, a knife, safety pin, razor blade, fingernail. An object that can burn, for example, cigarette, cigarette lighter or candle. Any object that can wear away skin, for example, an eraser or scratching with fingers. Some persons who self-mutilate will reopen sores or bang a part of their body on an object until it bleeds (i.e. nose). Each form seems harsh, but to the self-mutilator, it is relief.

How can relief be found in pain? That's the first question many of us would ask. But it is the wrong question. Pain is rarely felt and pain does not give the relief. As a counselor, empathy is an important practice in my profession. I must be able to come as close to being in my client's shoes as possible. This helps me to help them. I think back on ways, past and current, that I have gotten relief during stressful periods. At those times, I am so consumed with stress that feeling anything else seems impossible. To give a common example, have you ever been angry? Angry enough to the point you want to throw something, hit something, do what was necessary to get that energy out? It does need a way out, whether positive (i.e. talking to friend) or negative (i.e. yelling at someone). Once you find your way, the anger dissipates. You feel calmer, better focused. All you feel is relief. You do not focus on the destroyed objects you know have to clean up, or the relationship you have to repair. All that can be dealt with later, but right now, you want to experience the relief. That example does not capture the process and feeling of self-mutilation, but it may draw you closer to understanding versus judging.

There are many different approaches a counselor and loved one can use to address self-mutilation. I choose to use the one that will keep my client coming back and healing versus running and continuing to hurt. I view each episode of self-mutilation as the end result of a process. I feel my clients have been better able to put a face to self-mutilation when it is identified as a process with specific steps. This helps the client tune into herself, notice the steps and triggers, and try to implement alternate techniques prior to the end result. The goal is to slow her thinking which allows her to: (1) assess the situation, (2) ponder alternative methods, (3) choose and implement a method, (4) experience the result, (5) reassess as necessary. This will decrease her usual pattern of merely thinking then reacting. What this also does is it allows her to truly experience her feelings versus avoiding. There is an underlying fear of experiencing feelings, especially those of hurt and rejection.

As mentioned previously, I segregate the process of self-mutilation into steps. This allows the client more control over the end result. The first step is known as the Trigger. The Trigger is a situation or circumstance which may encourage a negative change in mood. For example, during a group outing with peers, Mara may feel they are excluding her because she is not a consistent part of the conversations. Her self-mutilation process has now been Triggered.

Step two, consists of the rise of Feelings. Mara may feel rejection, inadequacy, or even stupid. She may identify herself as someone who others do not deem worthy to speak to. She may feel others do not see her as fun. Therefore, she proceeds to blame herself for not being fun, for being inadequate. This all may leave Mara with increasing feelings of tension, isolation, and a fear that abandonment is about to take place. Mara has begun to anticipate the worse and her body is starting to react to this stressful thinking.

Step three, which is not initially apparent in all situations, is the Disappointment in self that she uses self-mutilation as a calming technique versus responding in the same manner another person would. For example, letting it go, blowing it off, continuing to interact, focus on fun. She may be disappointed she cannot continue moving forward as others do.

Step four reflects an Increase in tension and anxiety. She is further sending her body the message that a serious threat is imposing upon her and action must be taken immediately. Rational thinking in order to pursue an alternative method has definitely slowed at this point. Her goal is to receive immediate relief from these overwhelming feelings and impending fears.

Step five is the Result. Self-mutilation is implemented and the tension is temporarily released. Mara may go to a bathroom, a bedroom, any place she can be alone, find an object to use or use an object she carries with her. She begins to self-mutilate. The depth of the cut is determined by the amount of feelings she is experiencing. After the release, she may apply pressure to stop the blood flow and hide her behavior from others. Mara is now able to return and function in her environment. Yet, still holding inside a laundry list of negative experiences without resolution that have occurred in her life.

During sessions, I encourage the client to choose the part of the process she feels she may be able to implement an alternate method. For example, if Mara chose step two, Self-talk would be an alternative method. Self-talk is a coping skill one can use which consists of speaking or thinking positive messages to oneself. It can be used in a negative manner as well, which is apparent in Mara's example of determining what others may be thinking of her, and putting herself down. Her goal would consist of saying, "I am adequate", "I have to increase my participation so I can have fun too", "I enjoy talking about that subject", "My opinions are valuable." Even more so, Mara has to put her thoughts into action. Mara lets the negative thoughts immobilize her. All her energy goes into focusing on those thoughts then escaping them. With the positive self-talk, the goal is to take action which will increase her belief in herself. She will then have a laundry list of positive experiences she can draw from when difficult moments arrive.

In choosing step five, Mara has to have alternate methods in mind. For example, she may choose to journal to release the feelings, she may punch a pillow to have a physical outlet, or she may assert herself versus being passive. All these methods are examples that may give her a feeling of control and of taking care of herself in a non-threatening manner.

Just as alcoholism, chemical dependency, and overcoming various addictions takes time, so will self-mutilation. The time span varies for each individual. Does self-mutilation lead to suicide? Self-mutilation and suicide are separate efforts (although a person who self-mutilates can have a history of suicide attempts). The mindset for each is different. Suicide is to end life. Self-mutilation allows her to keep functioning in life. She does this to live only because she does not have the knowledge and experience of other healthy ways. But, with cutting there is a concern that the cut could lead to death if cut too deep or in a critical location on the body.

How can a person who self-mutilates be recognized? The following are some key characteristics to look for in conjunction with one another. (1) A happy façade with periods of isolation, sadness and angry episodes. (2) Level of motivation with school work can vary from average motivation consistent with that of peers or extremely high, perfectionist motivation. (3) Constantly exerting energy in relationships with peers who consistently take advantage of her. (4) Wearing clothes that may be inconsistent with the weather patterns or always covering a certain part of the body. (5) Highly sensitive to rejection. (6) Difficulty verbalizing feelings when hurt or sad. (7) Often speaks negatively about self and rarely recognizes the positive. (8) Has difficulty dealing with negative situations and progressing. (9) There may be suicidal tendencies, history of depression and anxiety, history of abuse, neglect and invalidation by authority figures.

My goals during counseling are to have the client recognize and acknowledge her strengths. To learn and eventually take daily notice of the self-mutilation process. To make the commitment, according to her will, to change the process. To identify coping skills that may be adequate for her. To keep record of how often they self-mutilate so they can hold themselves accountable and keep me informed. I provide praise for every achievement and leeway for personal growth during every period of regression. Remember, we all falter sometimes but it can give us the desire to work even harder. Further goals are to develop assertive language verbally and through body posture. To recognize how the body reacts to tension and learn relaxation methods. To learn to express her feelings either verbally or in written form. To engage in a special activity for self (i.e. take a soothing bath or pursue a hobby). Observe how others respond to difficult situations and determine what behaviors she would like to develop.

The overall goal is to change the part of her personality that believes self-mutilation is the only way and that she is inadequate. This process is more in-depth than explained through these writings. Each girl is an individual and each decision I make is custom made for her. Trigger - Feelings - Disappointment - Increase - Self-mutilation. The self-mutilation process can come to an end.

Note: Mara is a fictional character developed to explain the self-mutilation process and any likeness to a real person or situation is purely coincidental. This article was not designed for counseling purposes therefore if someone is experiencing the symptoms and behaviors presented in this content and desire mental health services, please contact a counseling professional in your geographic area.