Hitting myself during therapy

During my therapy sessions someone gets really upset. Not all of my sessions, but some of them and I will end up hitting myself over and over again with my fists and hands, till I bruise. I often get extreme urges to cut myself during therapy, but I often deny myself this right and end up in extreme amounts of emotional agony where I will just start and not be able to stop. I have told my T about the urges to cut myself during therapy, but I can't seem to control them even so. I have these urges to hit myself outside of therapy too, but I feel really bad acting on them in therapy.

My T suggested we get a foam bat. But they don't sell them anymore. I looked EVERYWHERE online and in stores. I found one on Amazon, but it looked like I would destroy it after one session.

I just get so upset and so trapped. In therapy right before that time, I just want to run away. But I feel trapped there. One time I did run from my T, because I was terrified of him. We were taking a walk beside the woods and I didn't feel as if I was stuck there, because the woods there are plenty of places to hide. But in his office, there are other people. It's in town. I don't want to get in trouble. I don't want to run somewhere where I might get hurt. I don't want to be hurt by the other staff, or him.

But when I did run, he followed me. Which made me run faster and farther. I just wanted to get away from him. I ran until I came to a ledge that dropped down. I was shocked to see it. I don't think I knew it was there. He freaked out and yelled "STOP!" and I threw myself into the crevice of a tree to avoid him. I was shaking and terrified and crying. But I didn't hurt myself. Minus all the thorns I ran through.

I feel like if I can't run, then I have to hurt myself to avoid him hurting me. That if I hit myself then it gives me control over the pain I feel, rather then him controlling it.

I always considered asking for a "safe spot" somewhere in the local vicinity. So when I get like this I can go there, even if it's right in the middle of my therapy session. A safe spot can be as simple as a quiet corner somewhere. But he'd have to leave me alone and not follow me. I am trying to get away from him, because some parts of me begin to fear he is my abuser.

I wish I could figure out what triggers this. Or causes me to float over to being afraid of him all the sudden. =/

There are foam bats on child therapy sites. There is also a sort called a bataka bat which might be more sturdy for your needs.

if you really would like a foam bat or any other therapeutic tools you can let your therapists and mental health agencies obtain their therapeutic tools from medical/mental health supply companies. Around here we don't buy off line. when buying off line you cant be sure you are receiving good quality, up to state standards equipment. We have a medical/mental health supplier that specializes in selling goods that are safe, dont contain lead in the production of it and they dont break apart which is essential when working in therapy with both adults and children.

Having a safe place to get away from your therapist during therapy.. um whats wrong with ending the session and going home. Are you in a court situation where the court has ordered you attend the full therapy sessions?

around here unless you are court mandated clients and therapists can end the sessions at any time they want to. Just because the session is set for an hour doesnt mean both parties are forced to hold their sessions to an hour.

I have many times ended therapy sessions because the client needed to leave due to dr appointments, other plans and even because they needed to get out of therapy.Around here clients running away or trying to harm their self is a symptom that the client or therapist or both are moving too fast in therapy.

When we have such situations where the client is unable to control their urges to run or harm their self we have to let the client go, dont interfere in any way other than making a call to 911 and the police department. those people are specially trained in locating people on the run and those that are a danger to their self and others. once the client is located that client is taken to the nearest emergency room where they are assessed for possible intake to locked mental health unit where they can safely address their self injury and running away symptoms. once they can be safely treated in an out patient setting again we resume therapy but at a much slower process.

upon intake our clients are made aware that they must remain in control with no counter productive measures like Suicide, self injuring and running away, our agencies and the state rules for losing control like this. each client and therapist here must develop therapeutic goals upon intake and sign the rights and responsibilities paper. It is at that time we address contracts for safety, and safety measures.

Talk with your therapist. there are probably agency rules for how he must deal with things like self injury and running away. you can also make a safety plan where the two of you can slow down which may prevent these urges to self harm and run. Your therapist can also explain to you that here in the USA clients and therapists can end their sessions any time they want unless there is a court order requiring you to attend full therapy sessions. This way when you get that urge to run just tell your therapist you need to leave now and walk out the door and go where ever you feel you can keep your self safe. if that means you go home, back to work or put yourself in the hospital. your being safe and keeping your self safe is in your hands and is your responsibility as an adult.

If this was an outpatient therapist I would agree with all that you said, but he's from an ACT team, and their main goal is to keep me out of the hospital. Mainly because hospitals traumatize me much, much more. I haven't been in one in two years and it's only because I do have an ACT team. Because ACT deals with severe mental illnesses, most even more severe then ours, it is their "job" to keep us safe. And by job I mean they are "inpatient system in the community". They have to follow us through every crisis. Especially ones with cops involved. Only because too many severe mental illnesses get hurt by cops, who are not educated. If it came to me driving someplace or hurting someone else, they may ask for the cops help. Otherwise they are trained well in restraints. But it never came to that. I would hit myself and he would let me. He almost has to let me, touching my during a time like that would not be good for me in the long run.

I am not court mandated to therapy. I am sort of mandated to the program itself. Meaning if I tried to sign myself out of it, I wouldn't go very far, so I haven't, because I prefer to handle things myself. But I don't HAVE to do therapy, if I skipped too many there may be a complaint thrown in. But that would be awhile down the road, because I usually make my own decisions about stuff. And I can't just get in my car and leave, I don't have my license. not just for the dissociation, but because I have Narcolepsy. Someone has to drive me home, and it's usually my therapist. I can end the session, but really there is no place for me to go... and that's where I feel trapped.

I'm in this program because I've experimented a good bit the "normal" way of doing things and never succeeded. And the bat is my responsibility. Because it's a state organization they don't have funding for stuff like foam bats. I will have to check child therapy sites. But we also considered boxing gloves... although their pricey.

Very interesting, LydiaB. Here's a description of one of my "episodes." It hasn't happened in therapy, yet.

You are not alone.

That's almost exactly what it is! I am glad I am not alone in this. I hate saying "they are uncontrollable". But they are very matter of fact, not controllable. I started out of therapy, years ago, when I was still a teenager. I was triggered (usually the things that raise my stress level are things that remind me of the past). And in a response I would just start hitting myself. When I was in my freshman year of college and had very little support, I dealt with a broken arm for weeks before I finally saw a doctor, who I told I slipped on ice. I don't know how someone, who is control of their rages gets far enough to break their own arm, without realizing. I would also do this in psych wards when triggered, because they are naturally high stress, which got me restrained a lot. Which is why I can't do hospitals anymore. I'm too on my guard there, which lands me in situations like this.

When I started doing it in therapy, it was actually a "break through" of sorts, because I allowed myself to confront issues, which may or may not trigger it. And it allowed me to see that someone won't jump on top of me for doing it. Meaning I hold the control. It was a relief that I controlled my hurt instead of other people. i think my therapist knows as well as anyone, that if I didn't allow myself to do it there, I would wait to be triggered at home where I would be unable to control it. If I end up really wreaking havoc, which has only got near it once. My therapist will say something like "Lydia, Lydia come on, come back, you're too far". And he'll give me paper to draw with to distract me. Although me alone, or me in psych wards were unable to "just stop". I think my therapist understands this, and so he tries to catch it before it gets to that point.

I wouldn't recommend doing this in therapy, unless you've set clear boundaries with your therapist. As you can see by the above reply, some therapists won't allow it. It depends on the therapist, although it should depend on the individual.

My therapist has suggested hitting other things. I once did this with something against a tree. Smashed it to a pulp and then used the pieces to hit myself. I can't feel satisfied unless I'm doing it to myself. Do you have an OCD diagnosis? Because I always considered this as so. A compulsion to obsessive thoughts.

It's funny though that you mentioned seizures. I also have had tests for seizures, just because I would always randomly loose muscle tone and collapse. It was discovered I had narcolepsy. I also had neurological issues when I was a teenager in college, but I never followed up with the consult.

I also wanted to address something I felt didn't give justice to mental health patients in your response.

"When we have such situations where the client is unable to control their urges to run or harm their self we have to let the client go, dont interfere in any way other than making a call to 911 and the police department. those people are specially trained in locating people on the run and those that are a danger to their self and others. once the client is located that client is taken to the nearest emergency room where they are assessed for possible intake to locked mental health unit where they can safely address their self injury and running away symptoms".

This is really a very old approach to dealing with mental health patients. I am only telling you this, because I used to be dealt with this way and it made me very, much more sick. At least where I live the idea now is to allow patients to stay in the community as much as possible. And turning them over to police without aiding in the process is a death wish to some patients. Our mental health teams are not allowed to turn patients over to police without aiding in the process or calling a CIT team anymore. Cops are not trained to help those who are severely ill. I know this, because my brother is a cop. http://www.civiliansdown.com/Mentall...%20Wounded.htm

This method you describe is very "clinical". And it's not how things are dealt with in my community. Read the story of ACT and you'll understand.

"upon intake our clients are made aware that they must remain in control with no counter productive measures like Suicide, self injuring and running away, our agencies and the state rules for losing control like this."

Is this during sessions? Or in general? If it's during sessions, then it makes more sense. But if it's in general I think you're asking your patients to lie to you. I've had to sign safety contracts at the beginning of my treatment or I would be "terminated" if I acted. Because I wanted help so bad, I signed it. But I didn't stop self harming.

Like I said to another poster. My therapist would much rather me do it when the feelings are fresh, then go home and use worse things then my fists. It would of course depend on the patient. I'm pretty sure he doesn't let just anybody do this, because some I'm sure could take advantage and use it for attention. But mine is from pure, raw emotion. And he knows this. I've been with him for years and he would challenge me if he knew it was anything aside from that. He doesn't put me in hospitals like all the others, and this allows me to trust him more.

Hey Lydia,

I hear what you are saying here. Please remember that when on the internet, even on safe sites like PC, some folks may not be whom they claim to be. 99% of us here are here to offer support, but there's always that 1% who (may) have other, self-serving agendas.

I have had similar issues during my therapy and it is really hard. Thankfuly, gone are the days of the archaic, cold, power-hungry clinical modalities that truly do more harm than good.

Best wishes for you and I hope you keep us posted on how things are going.

no we dont ask our clients to lie to us.

here in NY we are bound by law to fully inform the client during intake to mental health services as to what our agency is - name of agency, agency mission statement, services we offer, who our mental health providers are, how each of our services works. what their rights and responsibilities are, what our rights and responsibilities are including how we must deal with self injury and suicidal actions and what the complaint procedures are so that should they in the future have a problem with the agency or therapists with which they are receiving their mental health care they have what they need to make a formal complaint.

Here in NY it is believed clients cant make informed decisions about their mental and physical health if they are not fully informed by their treatment providers.

how can you make an informed decision about what mental health agency you want to go to and what therapist, psychiatrist you want to work with if you dont know what their services are, how they work with their clients, what is expected from your treatment providers. the only way you can make a fully informed decision about your own mental health care is if someone sits down with you and explains this is what our agency is, this is what we do here, this is how much per session its going to cost you or your insurance, this is what you can expect from us and this is what we expect from you.

Here in NY we do that with all our mental health clients upon intake..to get mental health treatment here in NY you call in talk to a receptionist or therapist. you schedule an appointment and at your first few appointments the therapist explains to you what the agency is, your rights and responsibilities and all that I already stated and then the therapist and client works up a sheet of goals to work on. 6 months later the therapist and client go over their goal sheet to see whats been accomplished and what needs to be carried over to the new goal sheet, and at this time the therapist and client come up with new treatment goals if needed.

during the intake process all prospective clients must fill out a questionnaire .. name address known allergies, medications, what do you see as your problem areas/ what do you expect to accomplish with therapy, diagnoses, use drugs alcohol smoke, do you cut or use other self injury coping mechanisms, have you ever been suicidal, is there any special circumstances that we should be aware of that may endanger yourself or others while in our care....

sure its everyones prerogative to lie but hey they are the ones seeking our services. they lie they are only cutting their self off from receiving help to stop their self injury acting out. We have encountered some situations where self injury wasnt disclosed. One of them - the teen aged boy accidentally killed himself by cutting. now we dont mess around if it comes to light that someone has lied to us about their history with suicide and self injury we immediately have them transported to the hospital for evaluation to assess if there are any recent evidence of self injury. if so that person is held in the mental ward for up to 72 hours on a hold to make sure they are not a danger to their self and others.

the safety of our therapists and clients are number one... would you want to be sitting there in a waiting room and suddenly the person next to you pulls out a knife, razor... and starts threatening you and their self with suicide and self injury in front of you? of course not right . you have the expectation that you are going to be safe on the property of your mental health agency. you dont expect the person next to you to suddenly pull out a knife, razor or other weapons to harm their self and others.

how would you feel if you were waiting to see your therapist and suddenly someone told you sorry you cant see your therapist today, a client lost control during their session and accidentally or purposely harmed, or killed her/him.

therapists also have the expectation to their own safety and wellbeing while treating their clients. we dont know the person cutting their arm up isnt going to snap one day and attack us. we dont know that the client who is threatening suicide is just doing it but wont succeed in actually killing their self and taking the therapist right along with them.

the rules are in place not only to protect those doing the self harm and suicide but also to protect those who may end up getting hurt accidentally or on purpose when someone else is no longer in control.

most mental health agencies in NY now follow the states zero tolerance for violence. that includes suicide and self injury. This state thanks to 9/11 now has rules for mental health agencies on how they must deal with violence to oneself and others.

unlike you there are many people out here in the USA who dont have the opportunity to be in a specialized program like ACT who take care of things for them.

Most people in the US have to rely on being fully informed by their treatment providers and make their own decisions about their mental physical health care including being responsible for their own actions and safety needs.

Must people have to rely on their mental health agencies rules for safety and their mental health agencies following through with enforcing those rules, that will ensure their own (clients and providers) safety from others who have trouble taking responsibility for their own actions and safety.

Im glad you have a specialized program that can do this for you.

your statement of how we deal with things being a clinical way..

yes thats how mental health units work in the United States. they deal with the clinical ..inpatient, diagnosis and treatment. here metal health units are wards in a hospital where mentally ill people get diagnosed, stabilized, medication, intensive inpatient therapy and psychiatric needs met.

your statement of how we deal with our cliets as being old.. I dont know where you are but here in NY something called 9/11 happened. thats when suicidal bombers from another country took some of our planes and -passengers hostage and purposely crashed into the twin towers in NY city.

in recent years we (the USA) have also had instances where people have killed other people and claimed it was because of their mental disorder. then when investigators looked into their history it comes out that the person had a history of self injury and suicide.

here in the USA there are also kids taking guns and knives to school wiping out their classmates and others in the school. in some instances it was discovered the shooter was depressed, suicidal, had self injury in their history..

NY isnt waiting for another suicide bomber, another mentally ill person who may accidentally or on purpose take out others on their way out the door.. or accidentally kill their self. and have the general public start shouting hey you all knew about this and didnt do anything..

since 9/11, school shootings and all, NY has had a zero tolerance for violence including suicide and self injury. I dont see that ending any time soon.

though some agencies do allow their therapists to self evaluate the potential for harm in a case by case situation. here where I am they do not.

our rules I have to work by at the crisis center and hospital is how I previously stated send those who are self injuring and threatening suicide to the hospital for evaluations concerning stability and possible commitment to inpatient services for at the least 72 hours.

But this is such a one fits all approach? It actually makes me sad...

I also don't understand how 9/11 has anything to do with mental illnesses? I mean I would understand people having PTSD if they witnessed it. But that doesn't make them monsters?

I assume you are on this board because you have a mental illness yourself. So then don't you of anybody understand that people with mental illnesses are not just "one fits all". This is such a dangerous method to use. I understand it's company policies, but you speak as if you are completely okay with it. As if you are dealing with objects and not human beings.

"how would you feel if you were waiting to see your therapist and suddenly someone told you sorry you cant see your therapist today, a client lost control during their session and accidentally or purposely harmed, or killed her/him."

Actually this has happened to me. My sessions have been canceled, because other clients have needed my therapist more then me. And honestly that was fine. I didn't usually know what for they needed him for, because telling a patient "o someone killed themselves". Is just inappropriate. But I am okay with this, and I always understand that another patient needs him, because when I really need my therapist, then I am too am put to the front of the line. And if people take advantage of this, then they do what they have to to not let it go any further. They treat us all differently. We all have different standards.

"therapists also have the expectation to their own safety and wellbeing while treating their clients. we dont know the person cutting their arm up isnt going to snap one day and attack us. we dont know that the client who is threatening suicide is just doing it but wont succeed in actually killing their self and taking the therapist right along with them"

hopefully you would know this. violence among mental health patients is no more higher then violence among the general population. You should know if the person has past aggression issues towards other. You should know their diagnosis. You should be aware of signs of aggression in each individual patient. But it's not all the same. It's not one fits all. It's just not. If you always have it in the back of your mind that a patient could "snap" at anytime, working with them is obsolete. Nobody wants to work with someone who is inherently afraid of them. I'm perceptive. If I sensed that, there would be no connection. In psych wards I have talked to forensic bound patients, without a thought in my mind as to whether they would hurt me. If I suspect someone is capable of harming me, I don't go near them. You can't treat someone with depression the same way you treat someone with psychosis mania. And even then you can't treat the same to psychotic manic the same. Some people with psychosis mania become paranoid and avoid everyone. Some hear voices telling them to kill people. You should be aware which one your client reacts to.

"now we dont mess around if it comes to light that someone has lied to us about their history with suicide and self injury we immediately have them transported to the hospital for evaluation to assess if there are any recent evidence of self injury. if so that person is held in the mental ward for up to 72 hours on a hold to make sure they are not a danger to their self and others."

This is just absurd. Self injury doesn't always mean someone is suicidal, nor that they deserve to be held in an institution for 72 hours. If they're lying about their self injury, ask why. Maybe they're afraid of your judgment, maybe they thought you just assumed. You don't just lock people up for no reason. They are human beings. They have souls.

"your statement of how we deal with things being a clinical way..

yes thats how mental health units work in the United States. they deal with the clinical ..inpatient, diagnosis and treatment. here metal health units are wards in a hospital where mentally ill people get diagnosed, stabilized, medication, intensive inpatient therapy and psychiatric needs met."

No it's how YOUR program works. You can do most of that on an outpatient basis. Infact all of it. Human beings do not deserve to be locked up, because they are ill. Like I said, it's a very old approach to things.

Yes sometimes it makes me sad too but the bottom line is I have to have clothes food and shelter. in order to have those I have to work. in order to work I have to follow the rules of my work location and profession in the state where I work. I go against my boss, the agency the states rules then Im out of a job, in turn Im naked hungry and homeless.

So I follow what my boos tells me I have to do, I follow what this states ethics board tells me I must do.

some day when you have a job you will understand nothing is perfect. there will always be rules that you will have to follow whether you like it or not. thats part of being an adult in the workforce. unless you plan on winning the state lottery and becoming a millionaire and not ever working. you can have the best job on earth and still theres going to be rules that dont sound fair to you and rules you wont want to follow but you will have to do it any way.

look Im not going to keep debating how you think how we do things here in NY is wrong just because your ACT program in penn. does things differently. in your original posting you wanted help with your own problems with self injury and running away from your treatment providers.

I told you how we do things here and made some suggestions. now its up to you to decide for yourself whether how we do things here and whether those suggestions I gave you applies to you.

obviously not. and thats ok.

why am I here. Im not going to waste time on that when I have explained that before more than once. you can read my past posts by clicking on my name and then selecting find all posts by amandalouise. If you dont want to read for yourself well the short end of the stick is I came here looking for others with DID that were integrating. there was none at that time so I stayed to help others and I connect with other DID people that are integrating in my off line location.

how 9/11 fits in with mental illness..

try coming here to NY or anywhere in the usa, and talking to the people. ask anyone where they were when the twin towers went down, ask them did that frighten you, did that give you nightmares, did that make you afraid for your own life, did that make you sad, depressed, angry, scared... knowing thousands died that day, Did it make you feel disconnected from yourself or your loved ones, Did that make you afraid that any stranger on the street was ready to take you hostage? Did seeing those videos all day long for weeks and months at a time on tv affect your moods, your sense of self, your sense of well being, your sense of safety? did it make you afraid to go out? did it make you afraid people were out to get you? did every noise real and imagined you heard make you wonder who was doing what and if you were in danger? did you become hyper aware and need things to be a certain way? did you have a panic attack every time you heard an airplane or loud booming noise? did you dream about airplanes crashing into your home, were you able to do your jobs without any problems like anxiety, panic every time someone dropped something or a plane flew over head?

All these things are symptoms of many different mental disorders not just PTSD. they are symptoms of depression, PTSD, personality disorders, schizophrenic disorders, adjustment disorders, OCD disorders, and many others.

you dont have to be right there at ground zero to be a witness to 9/11. every american with a tv, radio and internet witnessed the twin towers going down. every american watching those towers going down felt all kinds of emotions including fear for their lives and panic because we knew we were going to war.. videos of it was on radio and tv nonstop for weeks and months and they are still being played. come September we expect a rise in hotline calls and clients having problems with depression, anxiety and many other mental disordered problems because it will be the annual anniversary of 9/11.

every american was affected by what happened in one way or another some more than others and many are still dealing with it today.

Thats how 9/11 has to do with mental illness. traumatic events cause mental problems for some people. traumatic events like this cause like depression, adjustment problems, ocd and others.

and thats not counting how 9/11 affected those already diagnosed with depression, schizophrenia and other mental disorders.. try telling a schizophrenic no one is out to get them when they just saw a commercial, video or on line clip about 9/11.

talk with your therapist. he can explain more in detail how nation wide events like 9/11, earthquakes of japan and other nation wide / natural catastrophes can be associated with all kinds of mental disorders.

your statement "You should know if the person has past aggression issues towards other"

and how are we supposed to know this. do you tell your treatment provider every single thing that went on during your prior inpatient treatment programs, do you share every single time you hurt yourself while in therapy with every single therapist you have ever had..

there is no possible way therapists are going to always know when a client has been a danger to their self and to others. you yourself said even though you signed a contract you still caused yourself harm.

that is why we ask them during intake and rely on them to tell us the truth and we have guidelines for when it becomes apparent the client has lied to us and could be a danger to their self and others.

I dont expect you to understand or agree with how things are done here and yes I know one way doesnt fil all but when you have a bunch of mentally ill people in one room there has to be uniform rules for all to go by in order to keep everyone safe. you're in a program think about it doesnt your programs groups and services have rules that every client and every therapist must abide by regardless of mental disorder, symptoms and personalities of each of you clients and therapists.

you already told me one uniform rule. you cant miss too many appointments. every agency has their own rules that everyone must conform to.

here those rules are set down by the state and the mental health agency, just like your state and agency sets down what rules your therapists must abide by.

here you are telling me how the rules are different where you are expecting me to accept your rules that are where you are but yet at the same time you are condemning the mental health system here for having rules and regulations that you dont approve of that we have to go by.

I dont make the rules I have to work within. I just have to follow them or lose my job.

thanks though for your opinion of how we do things here is wrong. everyone is entitled to their own opinions.

ok if there is a mental hospital that isnt clinical in the usa I would love to know where it is and what they do.

the term in mental health terms "clinical" means

stabilize
diagnose
treatment

as far as I know every usa mental ward and hospital is a place where people can go to get their medication adjusted (stabilize) get diagnosed with mental disorders and get treated for those mental disorders.

maybe you are using the term clinical a different way but thats what clinical means in the medical and psychological terms.

I do live in the United States. I live right below NY. I know what things are like here. I know about September 11th. You don't have ACT teams in your state, but you will. They will eventually replace state hospitals in total. I felt that your first entry stigmatized mental illnesses and it made me defensive. For a good reason. Because it's programs like yours that gave me PTSD. Yes I have PTSD from hospitalizations. And all the hospitals a well meaning treatment team involuntarily committed me to. And it's not about "following your job protocol" I already said I was pointing out that you supported it. And if mental health workers support it, then it will never get better. I just really doubt that laws are THAT different one state away. You gave me advice based on YOUR program. I didn't approve. That was my decision. But you're constantly talking about "being adult" and "personal responsibility" but you don't realize how demeaning that is. Like were 5 years old and need to be told that? I take responsibility for myself. And when I need help, I ask for it, without fearing that they will tell me to "be an adult" or about "personal responsibility" or "making adult decisions". Because really? I'm not a prepubescent child.

Thank you for your reply to my reply, LydiaB!
I have not been diagnosed with OCD. None of several tests has uncovered definitive evidence of epilepsy, but there was an "incidental finding" of "rhythmic/segmental myoclonus." I've had a couple of sleep/nap studies and in one I approached but did not reach the diagnostic criteria for narcolepsy.

I can attempt to minimize or avoid the circumstances that might trigger an episode (major or minor), but, once the event starts, I can no longer stop it and just have to ride it out. I've had these episodes mostly in private but also a few in public.