Questions:
15.1 What does the author mean when he/she says that self-mutilation often starts in its pathological or “sick” form immediately within an already existing illness?
15.2 How is maladaptive behavior learned?
15.3 Just as there are reasons attached to increasing achievements, the mind looks for further avenues to intensify disordered behavior. What rationales are applied to depend the case of self-mutilation?
16.1 Why might a client that mutilates his/herself come into a session angry, dissatisfied, and acting as if they wanted to end the relationship?
16.2 What does therapy offer to patients who mutilate themselves because of physical abuse and neglect from a parent?
17.1 What is the “assignment” of a client who has a history of not being able to confront others, or even to disagree with others and has become comfortable as a secret dissident follower?
17.2 What technique can a therapist use to help coach their client in handling an anticipated conflict?
17.3 Why is it important for clients who mutilate themselves to learn to become more assertive when dealing with confrontations?
17.4 In assertiveness training, what might a therapist help their client do?
18.1 What does self-mutilation do for clients with Trauma Reenactment Syndrome?
18.2 What is a common goal of many of the types of self-harm included in the TRS pool?
19.1 What is in a cycle of self-harming that a TRS victim experiences?
19.2 What is it that TRS victims enjoy about their self-harming cycle?
19.3 What happens to women when they stop their self-injurious activities?
19.4 Each part of the self-harming cycle is a part of a reenactment of what?
20.1 What is the generalizable pattern in which TRS women alternate between?
20.2 The rapid shift between asking for help and then rejecting exhausts personal and professional caretakers, causing them to withdraw in exasperation. How might this affect the TRS victim?
20.3 What are some examples of extreme reactivity that marks a TRS woman’s behavior and is often a clue to her history of abuse?
21.1 What is the primary task of healing a person with multiple personality disorder?
21.2 In multiple personality disorder, what are the three fragments in the Triadic Self?
21.3 Multiple personality disorder in women is usually developed by what kind of trauma experience?
21.4 What is one way of healing a woman with multiple personality disorder who has one personality that engaged in self-destructive behaviors?
22.1 What is one aspect of PTSD treatment that can increase the TRS woman’s loneliness and rage about feeling different?
22.2 How does a PTSD-diagnosed woman work towards recovery?
22.3 According to the author, what types of trauma point to PTSD?
23.1 What are some adaptive ways that self-injurers use to meet their needs for affection?
23.2 Why do self injurers have a low capacity to form and sustain stable relationships?
24.1 Even though parents of self-injurers report that they treated each of their children equally, what might the one child who self-injured themselves perceive about the way their parents treated them?
25.1 What is an alternative that a self-injuring person can do if they want to see scars or pick scabs?
25.2 What is the benefit of going through the Self Assessment questions?
25.3 If a self injuring person wants to see blood, what is an alternative that they can do?
25.4 If self-injurers want to try something violent and physical, what are some safer alternatives that they could do?
25.5 What is an alternative that a person who self-injures themselves do if they are craving a sensation, feeling depersonalized, dissociating, and feeling unreal?
26.1 What two types of self-mutilation were first explored by Karl Menninger in 1935?
26.2 What are culturally sanctioned body alterations?
26.3 Why do inmates in prison self-injure themselves?
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Answers:
A. How much pain can I take, how much disfigurement of my skin can I tolerate, how much bleeding can I stand
AA. Draw on themselves with a red felt-tip pen, or draw on the areas that they want to cut using ice that was made by dropping six or seven drops of red food coloring into each of the ice cube tray wells
B. The illness does not evolve from a mild, acceptable form of behavior, but it begins as a sick feature from its onset that may develop or deepen into such a frequent and severe form that it overshadows the illnesses from which it sprang
BB. They complain of poor social skills, including hypersensitivity to other people's faults and an inability to tune in to the needs and concerns of others
C. It is inferred and may be need-based or copied from a role model without direct encouragement or instruction, self-taught, and often unconscious
CC. Do something that creates a sharp physical sensation such as slapping a tabletop hard, snapping your wrist with a rubber band, take a cold bath, or squeeze ice hard.
D. The client does not have the relationship skills or the ability to reflect upon what was really bothering them
DD. Get a henna tattoo kit and put the henna on as a paste, leave it overnight, and the next day they can pick it off as if it was a scab.
E. Encourage her to express her likes and dislikes to others, both within the family and social settings
EE. Hit a punching bag, rip up an old newspaper or phone book, go for a walk/jog/run, or get a few packages of silly-putty and squeeze it, bounce it off a wall, stretch it, and snap it.
F. Gives them the opportunity to learn that they can depend on another person and to deepen their trust and attachment to provide more leverage to the counselor to help the client
FF. That they were left out, slighted, or unfavored in some way
G. If they don’t confront others, they will get inwardly angry at themselves and take it out on themselves
GG. It can slow a client down enough to interrupt their impulsivity as well as make them think about what they are about to do, and it will help them identify the feelings that are triggering the urge to self injure
H. To develop assertiveness, whether it is to initiate a plan with friends or family, or to disagree with a plan initiated by others and to defend her personal rights
HH. Culturally sanctioned forms and pathological forms
I. Role playing can help the patient practice discussions, often exchanging roles, to prepare for possible confrontations
II. To obtain medical or psychological care, to maintain a façade of toughness and status, and because they know that it is a strategic play for attention
J. The desire to break out of numbness and the opposite desire to attain it
JJ. Endurance of pain is experienced during initiation rituals, in which children or adolescents are demarcated as social and sexual beings
K. Creates a powerful release from their psychic suffering, creates a pattern of persistent arousal that can actually change the person’s biochemistry, and develops a craving or need from frequent experiences of excitement
L. Avoiding social contact and then frantically clinging to partners, friends, family members, and sometimes colleagues
M. The planning, the anticipation, the secrecy, and the activity itself all creates an experience of pain and excitement or arousal that replicates the excitement in childhood abuse cycles
N. Childhood trauma
O. There was a certain element of excitement, a charge of fear that heightens all of their reactions
P. They feel an intolerable emptiness, dullness, flatness, or depression
Q. Childhood sexual abuse, adult rape, battle trauma, and natural disasters
R. Quick to imagine snubs and criticisms, questions the motives of everyone around her, is hyper vigilant, and quick to perceive any incipient danger whether it is real or imagined
S. They experience rejection, reinforcing her mistrust of relationships and so the cycle escalates
T. To frame the story of a childhood abuse in a polarized term
U. By concentrating on the trauma itself: remembering, reliving, and then when the trauma has been ventilated, reworking her self-image and her relationships
V. The integration of the various parts of self into a more unified and better functioning whole self, or at least improvement in coordination of the various selves
W. Work directly with this alter on their self-harming patterns and then either persuade the alter to stop the behavior or integrate the alter with the parts of the self where there is more capacity for self-protection
X. Child sexual abuse
Y. Abuser, Victim, and Nonprotecting Bystander
Z. Through their career choices (such as choosing a medical field or social service) or love of pets
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