Sometimes self-care doesn’t feel good.
Doing emotional work is frequently unpleasant, uncomfortable, or just downright painful. However, the consequences of leaving this work undone are almost always worse. I have been hoping that I would simply grow out of my habit of self-mutilation for years now. But after about a decade of harming my body and insisting that the cutting was not a problem, that it was working well for me, and that I had no intention of stopping, I am finding that the self-harm causes more problems than it solves.
I was introduced to dialectical behavioral therapy (DBT) in one of my earlier rounds of mental health treatment. I hated it and I made no secret of that. I decided it would not help me, that it would never help me, and wrote it off in favor of wallowing in my victim-mentality and dabbling in other forms of self-harm. The modality of DBT at that particular treatment center was a lot of reading aloud from workbooks, mnemonic devices, and worksheets about things like “interpersonal effectiveness.” I was not impressed.
Now, though, whether I accept the diagnosis of borderline personality disorder (BPD) that has been given to me or not, I can at least see that I definitely have borderline traits, namely a really, really persistent self-injury habit. And, it seems that everywhere I turn in seeking help for my disordered (but otherwise sparkling) personality, the treatment is the same: DBT.
As a result, yesterday I found myself in my therapist’s office going over “Behavior Chain Analysis.” She asked me to fill out the eight-step worksheet for next week’s appointment. I started looking over the assignment last night, and I was surprised at what I found.
The problem behavior is, of course, self-harm. When it came to figuring out the prompting event, I turned back in my journal to see what was going on around the last time this happened. As it turns out, this doesn’t “just happen for no reason,” as I’ve often thought that it does. Just a few days before the last instance of self-harm, I had had a very bad night, stayed up far too late, and found myself sobbing on the bedroom floor, wishing I were dead. I was being so loud that Archie (my cat) didn’t even come up the stairs to offer comfort, as he frequently does. All of my notebooks and pens were downstairs, so I grabbed a posterboard and a purple marker, scrawled out a vague note to the tune of, “If I die, it’s for the best,” and finally just went to bed. In the morning, I woke up feeling marginally better, but definitely not out of the woods.
Back to the worksheet: I skipped the second point and began to work on the third one, the vulnerability factors, using context from my journal to fill in the gaps. I most likely had not eaten enough and was hangry. I was intensely anxious about schoolwork and managing my time effectively between homework and my job. I found several references to how stupid I was for making a small mistake, which resulted in having to reschedule a meeting with an intimidating professor. After that meeting, my confidence was shaken.
What I found surprising in the pages of my journal was how quickly I vacillated between moments of inspiration, and intense self-hatred. I went from enthusiastically brainstorming about a new fiction piece I’m working on to describing how lonely and disconnected I felt. Once I got through the chain of events leading up to the self-harm, I realized that my vain attempts to stop the behavior were all coming too late. By the time I already have the blade in hand, it is way, way too late to try to use coping skills and do something else, even if I’m pleading with myself, “You don’t have to do this… You can put it down…” Looking back on the chain of events, I can see several places where I could have done something differently so I wouldn’t have had to plead with myself to put the blade down at all. I think the downward spiral began when I left campus for the day, feeling lonely and sad because I wouldn’t see my classmates until the next class. I started thinking about how lonely I was and how it’s my fault that I “don’t have any friends,” (which isn’t even true). I felt like my professor had attacked me personally, when in reality, he wanted to make sure my essay’s argument was sound and strong. To combat the loneliness, I could have called my brother. We could have even laughed about how intimidating I found my professor. Breaking the chain of events there could have led to a vastly different outcome.
As I wrote on the 12th of last month, “I feel like 99% of the time, I’m just desperately trying to keep a lid on my intensity and my despair, and that almost always I’m seemingly normal, if not a bit awkward and shy. And then I just have these huge outbursts when I’m alone, and then I feel like shit, rinse, rinse and repeat. I don’t know what needs to change…” I was trying to explain this to my therapist yesterday, how I feel that I am at the mercy of my emotions and frequently feel as though I have no control over my behavior.
What I am realizing, though, is that I actually can break the chain with enough practice. My therapist reminded me that I need to approach this workbook with a compassionate point of view. I will not be instantly able to practice these skills. I will have slip-ups. Sometimes the skills won’t work for me. At the end of the session she had written down, “I can handle life without self-harm,” on her notepad and had me repeat it back to her twice. I did not believe it there in her office, but I am at least open to the possibility. What I hope to discover as we progress through the concepts and skills DBT has to offer is someone who can values herself and makes healthy decisions.