In my experience focusing too much on SH itself just made me want to do it more. Talking or thinking about it made it almost irresistible. What was helpful was talking about coping strategies which was boring, so boring! But for me SH was very exciting, gave me a rush and made me feel alive (but paradoxically was also sometimes calming) so it was helpful to find other ways to feel alive or calm down or cope with an unbearable feeling. Also helpful was picturing who I wanted to be. I got to a point where I really, really didn't want to be someone who SH'd and had scars everywhere and had to feel embarrassed every time it was hot out or I went swimming or wanted to have sex etc.

So I don't think it's necessarily helpful to talk about SH all the time, every time you do it etc. Talk about the times you wanted to but didn't. Talk about a feeling that triggers your desire to SH and have your T help you defuse it right there in session. Have her breathe with you or go for a walk together or just talk about how you are not the feeling. Pretend your brain is a big screen in a movie theatre. The images are vivid but fleeting. The images are on the screen but they are not the screen. Your feelings aren't forever.

BTW Melissa, I think you're anything but a coward. You have dealt with this bravely despite how scary it's been for you. You are working really hard on it. Most people don't stop self-harming from one day to the next. You do it less and less frequently until, wow!, you've gone a day, a week, a month, six months, a year, ten years and you realize that you're dealing with your feelings some better way. You don't need to feel awful about yourself every time you SH. It's just a setback and that's okay.