Abstract
This paper will give a case illustration of a fifteen-year-old teenage girl who self-mutilates by cutting her arms and legs. The establishment of the client and counselor relationship will be discussed. A family history of the counselee will be provided. Social, biological, and psychological correlates of the counselee’s behavior will be discussed. An unofficial diagnosis will be suggested as well as an inference on a possible treatment plan to help the young counselee to discontinue self-harm.
The First Encounter
Anna is a girl who stays with her parents in the inner city premises. She is fifteen years old and is studying in the eighth standard. She is particularly fond of jewelry and loves wearing the latest designs of jewelry, clothes and shoes. Her parents live on public assistance and are uncooperative with Ana, which in turn has left a deep scar on her mental health. Her academic records are not up to the standards and she was held up once in the seventh grade. Ana has an older sister, who has no time to listen to her “stupid baby talks”. As her parents are unresponsive and unfeeling to her needs, besides being suspicious of her actions, Ana suffers from acute loneliness as well.
Besides, her mother, who works as a part-time babysitter often, leaves Ana to look after the young children, which Ana hates and describes the children as “stupid little brats”. Ana also blames her mother for her failure to clear the seventh grade. Hence, her grades are directly proportional to her home atmosphere. Ana was referred to counseling because she was failing miserably in her life and needed someone to talk to.
In the very first meeting, we managed to build a good rapport. I met Ana once a week for two months and after each meeting, she seemed to be improving for the better. She was more open and seemed to be sharing information regularly and she described me as “a cool person to be with.” On my eighth cession, I informed her of my plans to visit an orphanage, for which I had to be away for a week. Although she was slightly disappointed, she appreciated the fact that I had informed her of the same well in advance.
Emergency Intervention
The week following my return from my trip abroad, I learned that Ana had been caught mutilating her arms in the girl’s bathroom. A girl caught her in the act and informed others. Soon, a counselor along with two security guards was called in to assist Ana, who in turn threw her razor with which she had inflicted self-mutilation, fell on the ground, and started crying hysterically. The guidance counselor remembers her screaming these words over and over again, “you do not understand.”
I was told that Ana and her family were referred to a psychiatrist. I was told to continue my meetings with Ana as they knew of the trust Ana had bestowed in the meetings with me. In our first session following Ana’s self-mutilating behaviors, I strove to get Ana to the reason for her behaviors. She told me that cutting herself made her feel better whenever she felt “down”. She said that she had been cutting herself for a little over a year and had had recently begun cutting her arms as well.
She told me that she had watched a popular teen show called “Degrassi” where she “watched a girl on there cut herself.” She stated, “When I first saw the girl do it [cut herself] I thought it was disgusting. Then I realized that the girl’s life was just like mine. She could not talk to her parents and she hated her older sister. Then I decided to cut myself whenever I felt down and it worked…I felt better after I did it.” I only had one more session with Ana before the school year was over. However, within that short time, I strove to get Ana to do other things besides cutting herself whenever she felt stressed, such as drawing or writing poetry; these are two things that she loved to do but something that she had not done in a long time (Sam 606-607).
Biological Explanation
Ana could have been adversely affected owing to a number of reasons with the genetic aspect being the single most important reason for them all. While cultural and educational influences play a major role in deciding the overall outcome of a child’s psychology, it is, in reality, the genes that have been passed on from the parents to their children which seem to make all the difference. While there have been numerous biological explanations for the same, there is no substantiate reasoning that has been put in place as yet (Anita; Jay; Janet; Rohan and Barbara 43-44).
Hence, while studying the case of Ana, I came to realize that she had developed her behavior simply because she had been influenced by a pair of faulty genes, which in turn had been passed on to her by her parents. Her parents were again not very helpful to her and although not much is known about their general behavior, it could be possible that she had been suffering from a grave genetic defect. Had Ana been blessed with normal parents, she would never have tried to inflict injuries upon herself.
Negative reinforcement theory can well be defined as a condition wherein the concerned individual, which in this case happens to be Ana, has the inbuilt tendency to increase the future frequency of a behavior when the consequences often result in the removal of an aversive stimulus. A perfect example of linking the negative reinforcement theory with Ana would be a scenario wherein she never got what she wanted from her parents. This led her to believe that her parents were not her providers and that she would have to deal with her problems on her own accord (Carles and Rainer 37-38)
Social Explanation
A social explanation of Ana’s condition would be the most appropriate means of explaining her situation. Ana was a child who needed a strong support group and this is what she lacked completely. Her parents were not approachable and she certainly did not have any peer support, was not a very friendly person and always seemed to have trouble trying to make the best of her life. Had Ana been blessed with a strong peer as well as parental support, she would never have become a victim of self inflection.
Ana was exposed to media and this in turn allowed her to understand that she was lacking in many aspects. While viewing other girls her age through various media channels, Ana came to realize that she was in reality, leading a very purposeless life and that she needed to get her act together through quality effort, which unfortunately was not possible without adequate parental support. Hence, Ana chose to reveal her frustration by slashing her wrists and inflicting injuries on her body.
Youth culture too had a major role to play in the condition of Ana. She was with her peers and was always influenced by the way her peers behaved. This led to a feeling of dissatisfaction, as she lacked qualities that her friends considered normal. This led to a feeling of suppressed guilt and as she ached to break free from this guilt, she found self-mutilation as the only means of escape and satisfaction. As it is, she never trusted her friends and her elder sister did not have any time for her.
Social Learning Theory (bandura) can also be considered as an effective means of explaining Ana’s condition (Cathy, and Joy 213-216). Through observation, imitation and learning, I could fathom the bridge between Ana’s cognitive and behaviorist theories. Cognitive, behavioral, and environmental issues were considered most appropriate while describing the dilemma of Ana, which in turn was the total of the reciprocal actions concerning her attention, retention, reproduction, and motivational movements.
Psychological Explanation
Ana is suffering from a borderline personality disorder, which is often characterized through self-mutilation and although her intention was not to take her life, people who saw her in the state of mutilation, back at the girl’s washroom, interpreted her act as a probable suicidal intent. Ana’s self-mutilation was an act of expression through which she wished to express her emotions, her distress and it also helped her cope with her dissociative state. Ana was definitely suffering from dysphoric effects including multiple causal factors such as biological, psychological as well as social risks.
According to the psychological perspective, Ana’s self-mutilation was an attempt to differentiate between ego boundaries. Some theorists would state this condition as a passable rage against the self. While self-mutilation could be explained as a mechanism to deal with sexual conflicts, in Ana’s case, it was not applicable (Megan; Belle; Danielle; Daniel; Stevens; Michael and Timothy 94-103).
Unofficial Diagnosis
Ana can easily be considered as a depressed individual, who is in immediate need of psychological assistance. She was certainly depressed, unable to express her feelings to others, felt aloof and was in dire needs for adequate parental support. While her parents never paid attention to her demands, her friends seemed untrustworthy and her sister often considered her as an unwanted object. Hence, Ana’s body language and behavior were a dead give way to her depressed self and self mutilating habits.
Ana suffered from mood swings, had black and white thoughts, often considered splitting, had chaotic and unstable interpersonal relationships, had a negative sense of self and suffered from serious identity and behavioral crisis. Ana’s disturbances had a pervasive negative impact on almost all spheres of her psychological life and she could easily be considered as a case of borderline personality disorder, as per the Physiatrist Diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (Arvo 25-35)
Suggestive Treatment
Self-mutilating patients such as Ana could easily be treated through a combination of treatment methodologies. She can be given the choice of reading certain self-help books, especially Dr. Alderman’s books, which have exercises that are equipped to aid self-mutilators overcome their problem. These books involve writing exercises that can allow Ana to understand the consequences of her actions and have her consider the positive and negative consequences of self-mutilation through motivational therapies (Will 379-381).
Ana can also consider medical treatment, which could include psychotherapy cession with a trained psychologist and possibly some mild medications as well. Ana’s feelings and emotions need to be associated with self-mutilation and the therapist should encourage Ana to focus on positive behaviors as a possible alternative to her self-mutilating tactics (Deborah 297-301).
When we talk specifically of medication, then there is no specific medicine that is available to treat self-mutilation, nonetheless in the case of Ana, any medication that helps alleviates symptoms of anxiety, obsessive-compulsive disorder, depression, and sleep impairment, can be considered as effective means of curing her problems. Likewise, certain serotonin re-uptake inhibitors, such as fluoxetine as well as sertraline, can also be used in her condition (Pamela and Debora 125-132).
Ana can also be exposed to the latest psychological process of imagery. An image can be used to simulate the responses which Ana feels without forcing her to actually execute the process of self-mutilation. Ana’s psychological responses can be guided through the means of imagery, which would definitely be a harmless procedure.
Ana can also enroll in the SAFE program, which is located in Berwyn, Illinois. While following the course, Ana should have a heartfelt motivation to stop, the right to withdraw, must sign a no-self harm contract, must not discuss her scars with other patients, should be willing to complete written assignments that showcase the negative aftermath of self-mutilation and should be able to develop and practice at least five alternatives to self-mutilation (Nancy 65-66)
Conclusion
Ana’s case is fairly common and although it is not a case of severe psychological disorder that requires advanced treatment, we need to understand that the girl is fairly young and has a relatively long life to lead. If she is provided with adequate parental support and the required psychotherapy treatment, she can easily be cured of her self-mutilating habits. All Ana requires is adequate attention and homely support.
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