Challenges That Face A Psychotherapist Mindset Essay

Self-harming is a manifestation of emotional distress; a sign that something is wrong rather than primary disorder. For each person the contributing circumstances are individual but commonly they include difficult personal circumstances, past trauma (including misuse, neglect or damage), or communal or monetary deprivation, as well as some level of mental disorder.

It range from suicide attempts as well as works where little if any suicidal intent is included. The RCP declares that 1 in10 young people will self-harm sooner or later, but it can happen at any time. It is more common in young people, women, homosexuals and bisexuals. Cutting is the most common form of do it yourself harm.

The crisis point of self-harming is apparently strongest at the developmental stages where parting is a problem (Gardner 2008); adolescence is one particular stages. It is partially dependent on certain characteristics, i. e. narcissism, aggression, hypersensitivity and omnipotence, all of which are heightened in adolescence, and might clarify why self-harming is so widespread in adolescents.

Self-harm is about people in problems and are diminished further by being known as 'self-harmers' or 'cutters' etc

"Such terminology can prevent those who put it to use from trying to comprehend the complexness of what is going on for those with whom they are working". (RCP 2010, p21)

For many people self-injury remains a hidden knowledge activity. Trusting others to keep their problems confidential is a reason behind great anxiety. Teenagers may have particular problems with disclosure of self-harm. In particular, they fear that by disclosing their self-harm they'll lose control to others

"Their lack of control can exacerbate their self-harm" (Mental Health Foundation, 2006).

Motz (2003) areas

"Deliberate self-harm makes public the private pain and expresses that which cannot be spoken, or even considered. It replaces and inhibits thinking. In addition, it inscribes a significant narrative on the body itself, with the hope that it will be understood and taken care of immediately by others".

As well as the self applied directed meanings, self-injury can even be fond of others, for

example, to generate response, attacks carers who neglect to protect, talk rage

and stress, defence against intimacy (regulates distance) and enlists help, support or

concern, often in the therapist.

Motz (2003) implies it is not usually a suicide look at more an attempt to stay alive, expressing or conversing something to others, possibly in the hope that a need can be achieved, although at times there is certainly clear risk of death.

Gardner (2008) is convinced the scars induced by cutting symbolise psychic pain to the outside world, an expression of something can not be spoken, or even thought about. It really is a coping system.

"It is a significant narrative on your body itself, with the expectation that it will be understood and taken care of immediately by others" Gardner (2008).

The common floor is that they are longing to liberate, and this is how it can be positively viewed by the therapist who can then begin to help them to find yet another way of expressing their pain.

The symbolic need for the skin and its own mutilation is central in understanding self-harm. Bick (1968) wrote about the capability of the newborn skin to provide as a container to experience; an infant receiving positive mom love introjects the knowledge of being covered which protects the infant from anxieties of 'dropping to portions'. A quality Gardner (2008) recognises in her use children who self harm.

Pines (1993) examined the significance of skin-to-skin contact in early bonding, providing the foundations for the structure of a self. Cutting the skin expresses a divided personal and is, in a sense, a reflection of the initial relationship between the self and another. Nursing the self-inflicted wounds is seen as a re-enactment of the early infantile experience of being tended to and looked after by another, usually though not always, the mother. This is actually the other side of the divided self, the caring, nurturing and attentive aspect.

"Cutting the skin is seen in part as a settlement for having less more romantic contact during infancy, a memorial for your deprivation; the wounds become a 'path of remembrance'. Pines (1993)

Gardner (2008) sets huge significance to the therapeutic relationship in relation to this

"The thought of the therapeutic relationship acting as another pores and skin allows release of the strain on the person's actual epidermis, and attacks on the therapy can be kept and handled by the therapist" p36

Symbolism of the parts that are attacked is often seen, e. g. biceps and triceps evoke memories of your mother's arms that are intended to comfort, but didn't, or kept down and beat them. Scars around, keep people away. It may also be an harm on your body of the mother, as symbolised by the woman's own body, or eliminating 'bad' parts or intimate parts.

Signing with a scar tissue (Straker 2006), a primitive way of using the marks on your body as a direct way of connecting one's mind-set to another; a private language which has unique relevance and indicating - 'not just a message'. Self-injury fits the need to make, in a concrete way, endured experiences. Understanding this is of these wounds, and allowing these people to speak about the happenings they represent is an essential step in helping those to find other forms of self-expression.

Fonagy and Aim for (1995) offer a way of understanding why some people choose, or feel compelled to rely upon, a violent action rather than using other forms of self-expression. They claim that developmental problems in connection impair the capability for mentalisation: i. e. the inability to put into words feelings of anger and fury, forcing those to be managed in a physical way.

"Violence, aggression directed against your body, may be directly linked to failures of mentalisation, as the lack of capacity to take into account mental areas may drive individuals to control thoughts, values, and dreams in the physical domain name" p53.

Not all DSH have been abused, but issues in past parts from abandonment, physical or mental mistreatment is well recorded. Anna Freud's (1936) Identification with the Aggressor is a concentrate on negative or feared attributes. I. e. if you are afraid of someone, you can overcome that fear by becoming similar to them.

The function of self-injury for individuals who've been sexually abused range from release of stress and stress and also discloses the creation of the split self, where the body represents the sufferer and the mind that attacks it is the aggressor, allowing the mind of the self-harmer to briefly be freed, split faraway from the brutality the body has endured (Motz 2003). This displays the defence of splitting, an attempt to safeguard good objects by attacking the bad ones-in this case the badness is located in the body. It could be soothed and cared for by your body that attacked it; attacker and carer existing jointly. Nursing the wounds is often an important part in the ritual of self-harm and it is significant in the 'account' of the client and materials the therapist may use to bring consciousness.

The sense of release and euphoria quickly fades, and the desire to do something again, is intensified as emotions of guilt, major depression, shame and emptiness go back, explaining the round aspect of self-harm that gives it the sense of a perversion, addictive and compulsive, mirroring the circuit of assault and perversion first identified by Welldon (1988) where violent fantasies are produced as a kind of release and escape, but ultimately fail to comfort and additional action is required to achieve the same impact again.

As well as aiding in the regulation of emotions, self-harm can help regulate distressing self-states, for example dissociation or depersonalisation (feeling unreal or in a few extreme cases just like you are useless). These self-states, common after injury, are really distressing and unsettling and harming self can bring a return to the reality of the moment or to an increased sense of being 'alive'. It really is when in these areas of mind that a person can harm themselves and feel no pain. (Gardner 2008)

The need for self-harm for a customer can be gleaned only through sensitive analysis. Therapy should be predicated on close examination of the thoughts and wishes that gave surge to their behaviour (Motz 2003). Understanding the reasons why is the first stage in enabling those to find other, less violent, ways to articulate their stress and relieve their pain.

There is much debate in what should be the primary focus of therapy; addressing the problems that underlay the behavior, arguing that whenever these problems are resolved the behavior will stop, or, the behavior itself be the main focus, particularly if the it is especially frequent or particularly severe, or associated with significant mental health disorders, as failing to do so place the individual at risk. Which can be the effective option for just about any one individual is likely to depend on a number of factors, including the intensity of the self-harm, if the specific is highly suicidal or not, their capacity to function generally, their own preference for therapeutic strategy and an intensive understanding of how self-harm relates to other areas of their life.

The Assimilation Model (stiles et al 1990) is a useful model for the therapist to examine the level of assimilation a customer has of their problem, and then work with the client to move the problem from one level to the next. This provides sub goals, levels in the model, and

"allows the correct responsiveness to the customers requirements as they emerge. . . "(Stiles 2002) p359.

That is to say, just how of responding to the client who is trying to suppress unwanted thoughts (level 1) would differ from just how of giving an answer to a customer who has already formulated a difficulty to work on level 3.

The therapist must make an assessment of safety at the start of therapy which will determine the path they first take. The very first task must always be to evaluate the client's basic safety also to keep them safe; where, how and with what are they harming themselves? Is loss of blood under control, could it be life threatening? Is there safety factors set up: a support network, health care, do they have centered children, is there suicidal purpose, have they spoken at length about 'closing it', which must be evaluated at each procedure.

The problem for therapists is to create a working alliance based on respect, heat, and trust in an inherently unequal romantic relationship while requesting clients to show seductive details. Therapists balance the chance of alliance strains against the necessity to help clients confront unpleasant experiences.

It is important and essential for a therapist to be backed through reflective practice and supervision, and acknowledge counter transference and its own underlying meaning and have a thorough knowledge of the psychological theories associated with self-harm clients. Gardner (2001) claims that working with someone who self-harms requires

". . perseverance, hopefulness in the face of despair and the capacity to learn about and deal with intense countertransference feelings, a few of which are experienced in the torso as well as your brain"

The insufficient interest to avoid self-harming behavior can be frustrating for a few therapists and may make clear why the self harming client has been reported among the "most frustrating consumer behaviours" (Deiter et al 2000)

Therapy efforts to help a desire to improve while preventing potential power battles and attempts to regulate the client (e. g. forcing or demanding clients stop injuring). Miller & Sanchez (2004) talk about

"Attempts to control clients typically increase resistance to change and is known as unethical".

Although the therapist might want the cessation of home harming to be the principal goal, the customers may not be ready to change. Research completed by Miller & Rollnick (2002) implies that confrontation, education, and authority elicit client resistance, whereas cooperation, evocation, and autonomy help in therapeutic alliance and foster an environment ready for positive change. Almost always there is ambivalence about preventing

"Ambivalence is the state in which a person feels two ways about something and has a job in most mental health problems" (Miller & Rollnick 2002).

Rogers' Person-Centered Therapy (PCT) way creates a safe, accepting and genuine environment, building rapport and trust and allowing your client to feel valued as an individual. It really is a non-directive procedure for freeing a person and taking away obstructions so that normal growth and development can carry on and the client can become 3rd party and self-directed. The center conditions facilitate this technique.

Bryant-Jefferies (2003) consider this non directive style is sufficient to move someone towards change. However, Kress (2008) suggests there are constraints to this strategy and to be able to move a client successfully throughout the circuit of change, immediate challenges with their distorted behaviour and presenting new ideas at the appropriate time is an important aspect of remedy.

Kress (2008) implemented approaches to this specific client group which may have previously proven effective in conditions of habit; Motivational Interviewing and the Trans-Theoretical model (TMM) (Prochaska & DiClemente, 1983; Prochaska et al 1992) because

"Individuals who self injury often battle to withstand the impulse" (Brain et al 1998), and provide a path for therapy.

One of the key constructs of the TTM is the Levels of Change Model (Prochaska and DiClemente 1983) demonstrating behaviour change as a progression through a series of stages. They also proposed that therapy is most successful when the client is ready for change and the process of therapy is specific to the particular stage the client is at. Prochaska et al (2001) confirmed that

"The client is much more likely to complete remedy if change operations are appropriate to their current stage of change"

Prochaska and Norcross (2001) declare that optimum psychotherapeutic success is achieved if the stage of readiness is first accessed and then the process is designed to that stage, which changes as the client progresses to the next stage

"Once the therapist understands a clients stage of change, then it'll be clear which marriage stances to apply to allow them to progress to the next stage" p312.

The TMM shows that procedures of change are in different ways effective at certain levels of change. For example, consciousness raising will help a client progress from pre-contemplation to contemplation; by increasing their awareness the client can start to see benefits to psychotherapy. Do it yourself re-evaluation and emotional arousal to their problem are other types of functions of change that must be functioned through before change is often possible.

Norcross (2001) is convinced that it is more useful to adopt processes from the experiential, psycho-analytical and cognitive techniques for consciousness bringing up, awareness, self evaluation and readiness in the pre-contemplative and contemplation phases and more behavioural changing operations in the later action and maintenance levels

"trying to modify behaviour without recognition is a common criticism of radical behaviourism" p312

Motivational interviewing (MI) is known as

"directive, client-centered counselling style for eliciting behavior change by assisting clients explore and take care of ambivalence" (Rollnick & Miller, 2002, p. 326).

It departs from traditional PCT through this use of path, where therapist models out to affect clients to consider changing, rather than non-directive exploration of home. It recognises and accepts that clients who need to make changes in their lives address remedy at different levels of readiness. MI attempts to improve the client's knowing of potential problems, effects of their behavior, and risks encountered as a result of their behavior. These are helped to envisage a better future, and be increasingly motivated to achieve it. Either way, the strategy seeks to help clients think in a different way about their behaviour and eventually to think about what might be gained through change.

Critics argue MI is manipulative; the therapist is using their electricity and knowledge to get their way, possible if attention is not used. It is important to understand that it's client centred allowing personal choice all the time. Ethical problems may occur when there is a mismatch between readiness and involvement, which is why evaluating the client's drive to change and only intervening at the correct level is important

"It is a subtle balance of directive and client-centred components, designed by way of a guiding school of thought and knowledge of what causes change. If it becomes a trick or a manipulative technique, its fact has been lost" (Miller, 1994).

PCT creates an environment that is safe and accepting allowing a romance of trust, which can be a real issue for anyone who has been abused or has already established a distressing experience. The significance of self-injury can be gleaned only through hypersensitive research of the thoughts and needs that gave surge to self-harm, and its own psychological function.

Through reflective and empathic hearing, the therapist conveys a sense of collaboration with the client, through acceptance, knowledge of ambivalence, and ultimate support of their autonomy to improve or not change.

In psychodynamic working the unconscious will emerge in the transference romantic relationship with the therapist and skilful interpretation can disclose what is not verbalised. Understanding the reasons why a person self-harms is the first level in enabling them to find other, less violent, ways to articulate their problems and relieve the pain that they feel.

The client must not feel judged with a therapist who may have a clear knowledge of their problem which is not frightened of these or their wounds - grounds a therapist might suggest a 'no self applied harm' rule; it isn't helpful to your client because it is removing their coping system and autonomy. Because self damage clients are not able to express their trauma verbally other types of communication can establish useful, e. g. artwork, writing, poetry.

By trusting themselves to therapy they are really subjecting themselves to a situation which disadvantages further abandonment and loss and rejection therefore therapy breaks and endings have to be mindfully managed, which can also provide materials for the therapist to work with e. g. unresolved damage as described in Worden's (2006) tasks of mourning model.

Whitlock et al (2007) creates about the internet as an "inescapable and powerful tool". For those who self-harm it may be a means of expressing suppressed emotions and of joining with others like themselves. Because self-expression and healthy interconnection are critical the different parts of recovery, the Internet may have a successful and effective devote treatment. "These qualities, however, also make the web a probably dangerous place for clients who use online activities as an alternative for development of offline skills and romantic relationships" p1142

The indirect victims are therapist or carers, who see these functions and the scars that they produce. The failure to protect individuals from home harming can cause thoughts of guilt in these others and taking care of these responses is an essential part of the management of self harm. The violence attacks the thoughts of others who try to stop or prevent it, fearing that suicide is the ultimate outcome. Managing self harm requires the capacity to 'keep' it as a therapist for your client to find different ways to communicate intolerable states of mind. The pull of the loss of life instincts and their masochistic characteristics means they are objective on creating despair and hopelessness in the therapist, through projection, who can get caught up in the destructiveness rather than the restoration. Gardner (2008) state governments

"the task is for the therapist in which to stay connection with the area of the client that wants to maintain life also to preserve their own capacity to think about the experiences they may be being shown and made to feel without shedding themselves in the hopelessness and horror"

Counter-transference responses are resources of information, providing therapists with material about the intentions and expresses of minds with their clients. The problem for the therapist is to simply accept the self-harm as important while allowing their client to give it up, if they choose to, or have the ability to, and become free of its hold on them. Gardner (2008) believes the task of the therapist is to hold on to hope and show them that despite their assaults on themselves they can endure this assault and re-integrate ambitious and loving thoughts in a safe and controllable way

"The capacity of the therapist to stand up to the hostility and their own distress conveys expect the likelihood of containment, and understanding. . . . . It is challenging for a therapist"

Projection is the unconscious take action of denial of someone's own features and imagining another has them. Clients project their pain, an indication that unconscious ideas are trying to break through the mindful head so by recognising this is happening and then bringing it into recognition a therapist can help a client identify it, acknowledge and understand it and eventually assimilate it.

"patients want to live with mind-boggling mental pain and project this into staff through various communications such as self harm physical assaults and vicious personalised disordersthe unconscious expectation is usually that the therapist can take action positive with the communication. , . " (Aiyegbusi, 2004)

Clients often show their marks with their therapist in the desire of a response. It is important how the therapist responds to their wounds, however difficult that may be. It may be a deciding factor concerning whether the therapist wishes to utilize this consumer group.

Until a customer can look back again, bring into consciousness and embrace their injured selves they'll continue to respond from their story places. In therapy there might be a whole lot of anger, pain, damage or sorrow in this technique but by making the past conscious and stop acting from it and blaming it, healing can be done - days gone by must be accepted, owned, accepted, forgiven and slipped.

Working with somebody who self-harms requires perseverance, hopefulness and the capacity to know about and take care of intense countertransference emotions. The therapist must feel self-assured in dealing with these folks, strong because the outcome she actually is working towards might not be attainable or it may take quite a while. Despite its difficulties, and the chance of accident that can overshadow the work, engagement can be done and allows the person who self-harms to develop their capacity to take into account, symbolise and talk their experiences and eventually reduce their reliance on violent methods of self-expression.

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