selfharm

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bicycleclips
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selfharm

Post by bicycleclips » Tue Aug 15, 2017 1:16 pm

Anyone got advice on what to do when a client who self-harms by cutting asks me to "look after" her blades for her while I am away? She wants me to return them when I am back from holiday. I would feel extremely uncomfortable giving her back her blades.
You can learn many things from children. How much patience you have, for instance. ~Franklin P. Jones

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lingua_franca
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Re: selfharm

Post by lingua_franca » Tue Aug 15, 2017 8:28 pm

Hm. For me the question is not about giving the blades back to the client, but why she is asking you to hold onto them in the first place. What does the request mean? I wonder if by trying to entrust you with the blades she feels that she is letting go of this behaviour just long enough not to resort to self-harm while you're gone. It may be that she needs a symbolic way of relinquishing the behaviour, and that as you are a trusted person, she is asking you to 'carry' it. In your shoes my question to her would be why, if she is hoping not to self-injure during your trip, she couldn't just throw the blades out and not buy new ones while you're gone - after all, it's not as if you will be on hand to police her shopping and stop her getting new ones to replace the ones she gives to you! On a practical level giving you the blades doesn't seem to achieve anything, so I think it's important to discover what kind of symbolic weight the request has for her. I'd also be interested to know if these particular blades are special to her in some way, making her more likely to want to give them to a significant person in her life than to get rid of them. It may also be that she sees self-harming as something she can do while you're around to give support, but something that could become uncontrollable and scary if you're not.

I'd be uncomfortable with the request too. Depending on what thoughts and feelings were underpinning it, I would probably just be honest and say something like, "By giving me blades, it feels to me as if you're trying to get me to assume some responsibility for your choices. I'm not willing to do that because I respect your freedom." If she does want the time you're away to pass without self-injury (and I could be wrong about that) I would think about some other symbolic thing she could give me (maybe a letter describing her hopes for how she will cope while you're gone, to be opened when you get back?) that would hold significance for her but that wouldn't put me in the same awkward position as blades would.

I'm not a qualified CP and obviously I don't know this client, so feel free to take my advice with a pinch of salt. This is just what went through my head on reading your post.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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ell
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Re: selfharm

Post by ell » Thu Aug 17, 2017 8:01 am

My immediate interpretation of her request is that she is communicating to you that she thinks she will be more likely to self harm while you are away. (this is just a hypothesis to explore, not a definite truth, and there's likely to be lots at play here... Is there a formulation?)

Which leaves me wondering what support will be available to her while you are away, and does she know what it is? She may also be feeling angry that you are leaving her alone (albeit short term), so that might be an area to explore with her. I'm not sure what capacity you are seeing her in, so obviously stick to the limits of your competence and role.

That doesn't answer your immediate question though. I don't think it's appropriate for you to look after any possessions of a client, blades included. You could maybe say you'll take them to the office base and lock them away there, if she's worried about increased risk of harm to self (and this is something you are allowed to do according to the policies of your service). But if she is at an increased risk of harm to self while you are away then I would suggest some planning around that.

Discuss with supervisor/clinical lead of course.

Hope that's helpful, and that it works out ok.

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ChrisCross
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Re: selfharm

Post by ChrisCross » Thu Aug 17, 2017 9:22 am

Echoing some of the things that have already been mentioned, I would be wanting to explore the client's reasoning behind the request. Has she asked something similar of you before? If not, then why now?

I do wonder if there are deeper feelings to be unpicked about you leaving and what this might mean to her. Like Ell has already touched on, perhaps she is feeling angry that you will be going on holiday or upset about the loss of support. I also wonder if she is wanting you to hold her in mind whilst you are on your holiday - keeping the blades would serve as a reminder and perhaps she does not want to be forgotten.

Have you worked together to make up a safety plan for when you go away? I think this might be quite containing for the both of you.

At any rate, I personally wouldn't hold the blades for her. Like Lingua, I'm also not a qualified CP however so please do take my advice with a pinch of salt and explore more with your supervisor if possible.

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bicycleclips
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Re: selfharm

Post by bicycleclips » Thu Aug 17, 2017 10:09 pm

Thanks very much for your replies. Client has abandonment issues and finds it helpful for me to hold her risk for her.
You can learn many things from children. How much patience you have, for instance. ~Franklin P. Jones

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Loula
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Re: selfharm

Post by Loula » Sat Aug 19, 2017 10:52 am

I would definitely be taking this to supervision ASAP (assuming you are a AP), and if your supervisor isn't available another qualified member of the team. Have you done this?

Also I think this request is quite identifiable. Highly unlikely your client will read it, but if they did they would realise it is about them.

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ell
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Re: selfharm

Post by ell » Sun Aug 20, 2017 10:05 am

Rereading it, you may have a point Loula re identifiable info. I will raise with other mods, as I am not able to do fiddly stuff while I'm just one phone. Or I'll sort later when I'm at a computer.

And yes, to repeat what Loula says, take to supervisor or clinical lead, regardless of anything.

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