Treating the Self-Harming Client

Treating the Self-Harming Client

Therapists Must First Get Past Their Own Anxiety

By Lisa Ferentz

September/October 2002

The first time I encountered a client who engaged in self-injury was on a Friday at 4:30 p.m. with five minutes left in the session. Thirty-two-year-old Robin had been in treatment with me for six months. She was a survivor of sexual abuse, with a history of substance abuse and eating disorders. Her father had been alcoholic and violent, her mother was devoutly religious but deeply depressed, and her younger sister was the scapegoat. Robin took on the role of caretaker of the family.

By 14, Robin binged and purged, got high on drugs and alcohol, and was sexually promiscuous. In her mid-twenties, she began having flashbacks of sexual abuse by her father. She saw three therapists in four years, finding it "nearly impossible to trust anyone." With the help of a 12-step program, she was recovering from her substance-abuse problem. Now, still living with her mother, she was in psychotherapy with me to address the "demons and secrets inside."

For the past month, Robin had been working with me to resolve overwhelming flashbacks related to her sexual trauma. That Friday, as we were wrapping up the session, she began to roll up her sleeve and said with a heavy sigh, "Uh, I guess I should show you this." "This" was a two-inch cut she had made on her forearm with the jagged lid of a pineapple can. It was my first encounter with cutting.

My heart was pounding as I struggled to keep a professional facade and figure out how best to respond. Sensing my distress, Robin…

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