Due to a recent suggestion, this blog will cover a few key elements about the behavior of cutting. Cutting is not a new topic but an ongoing issue that raises great concern. I’ll be taking two perspectives on this topic because I feel it is helpful to view cutting from the perspective of a person who cuts as well as a person who cares about a person who cuts, often a parent or friend. The language and structure is my attempt to inform people who may not know what cutting is or who have little experience in working with cutting. If it doesn’t seem academic enough but it is extremely informative and helpful, I have done what I hoped.
Though I have an abundance of experience working with many people who cut (notice I stay away from labeling a person a “cutter”), also known as self-mutilation, there are things I learn every time I work with the issue. The most important thing I believe I can say is “make no assumptions”. A person who is cutting is a unique person. They are NOT cutters, they are people who cut. What it takes for them to stop cutting is unique to the individual. In my opinion, anyone who tells you they can make someone stop cutting with a specific technique that “always works” is full of crap.
Definition
Cutting is a form of self mutilation or self injury in which a person typically uses an object that is capable of leaving a scar and/or making themselves bleed. There are physiological concerns as well as psychological, sociological, cultural and even moral concerns with cutting. A teen cutter, for example, often has plenty of reality training from caring adults and friends about the physiological concerns of cutting. However, I suggest we ask what psychological, sociological, cultural and moral(maybe religious) understandings of cutting are? Chances are, there is a lot less understanding of these areas than the physiological. Please know that I have seen people who cut due to moral pressures as much as I have seen people who cut because they lack moral structure.
The Person Behind the Cutting
A person who cuts often does so out of a feeling of need. They get something they deem necessary and positive from the cutting experience. I’ve been told things like, “I have to do it” or “I can’t stop myself”. No matter how difficult this is for a caring person to understand, it is the reality of the individual that they feel a great need to cut themselves. This does not imply a need or desire to die. The reasons for cutting vary and depend on the person. In many cases, there are multiple factors working simultaneously. An analogy I like to think of when working with any client facing a potentially dangerous problem is the analogy of a key. This is how the analogy goes:
Let’s take the key to a house or car as an example. First and foremost, the process of making the key only matters because the key does something in the end that is useful. Without a need, there is no reason to open the door. The house or car might keep a person warm, dry or give a sense of safety. At some point the process down the path of cutting started from a point where the behavior was useful.
The next step in forming a key is by giving it exactly the right shape. Only with the exact right shape will the key be effective and open the door. Emotionally, the behavior has to be reinforced multiple times (the ridges of a key are being formed) in order for the shape to take hold and the behavior to become a pattern. For example, a person who cuts the first time and they feel no relief or comfort will likely stop cutting. There is no need to continue a behavior that doesn’t serve the individual.
The final stage of the key is being able to use it when you want and know that it will work. If a person goes out of town and returns three weeks later, the key still opens the door, starts the ignition or gets you in the house. A person can emotionally have no need for cutting themselves for hours, days, weeks or even years but the ability to access that place still exists. Once a key is made, it is very difficult to unmake the key. In some cases, it isn’t even possible to unmake a key. There is a position of hope though. In situations that don’t allow for destroying the key and starting over, we make a new key that is more effective and less dangerous. Thus, we replace a dangerous behavior with a healthier behavior that fills the same psychological, sociological, cultural and/or moral void that is being filled with cutting.
***What is healthy for one person may not be for another. There are many factors and it’s a good idea to seek wise counsel before making major changes. Wise counsel may or may not be a professional counselor but for the sake of my profession, I hope you would find professional counseling to be a great experience.
Caring other
Anyone who hears about someone cutting or behaving in a manner that doesn’t appear to be healthy and chooses to care is a “caring other”. It seems to be unusual, at least in my experiences, to have a person who cuts come out and say so before I hear it from someone else. Often times, there is a fair amount of shame behind the act of cutting. To make things simple, I am going to highlight what I often teach parents and guide caring people through when dealing with a person who is doing any act that is dangerous like cutting.
- This isn’t a time to run away from or become afraid of the person even if it is a bit scary.
- There is a reason for the behavior but you may never know what that reason is so be prepared to accept that you won’t know. (If you learn why, then that’s just a bonus!)
- The person is what’s important. They are NOT the problem.
- Show the person respect because the feelings are REAL and the behavior is probably only a less typical way of processing something.
- Don’t assume you know how to fix the problem. Chances are, the only one who can truly fix it is them.
- If you don’t know what to do, say or think, then be open to setting the example for them by seeking good counsel yourself. There are good counselors out there who would love to know you.
Sunday, September 18, 2011
Monday, August 15, 2011
What does “person-centered" mean?
In my practice, I identify myself as a person-centered counselor. I’ve had people ask me what that means on many occasions and I thought it would be good to blog about it as a way of getting the information out to anyone interested in my condensed version. This is not the only theoretical perspective and it is not the only perspective that has research supporting it.
The following is what it means to me to be person-centered. Many people have written books on this material. This is my attempt to distill the research available in a concise manner. My attempt to be concise may leave you with many questions. If so, please discuss it with your counselor, family and friends. You can also feel free to post questions on here but please know that I can’t guarantee anonymity if you do so.
The person-centered approach is a researched theoretical approach to counseling clearly defined by Carl Rogers (Wilkins, 2010; Ellis, 1948; Kearney, 2009). The underlying theme throughout the person-centered theory is that change is always happening. Carl Rogers states “it is our design to self-actualize” and he goes in depth about the process (Rogers, 1942; Rogers, 1951; Rogers, 1957; Rogers, 1975). The key is that it happens whether we want it or not and whether we actively participate in it or not.
~If change is going to happen regardless of our desire, should we participate actively in how and what changes occur?
The person-centered approach to counseling suggests six guiding elements called necessary and sufficient conditions by Carl Rogers (1957:96). Those conditions are:
1. Two persons are in psychological contact.
2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.
If all these elements are present, there is evidence that significant and positive change will occur in the client (Stiles, Barkham, Twigg, Mellor-Clark & Cooper, 2006). If you are anything like me, you make question what “significant and positive” means. In counseling language, significant is based on statistical significance. This means a person is statistically a number of percentage points more likely to be happy, fulfilled and content if they have a relationship with a counselor as described above. Positive change is a measure of how a person perceives their life before and after a therapeutic relationship that contains the six elements Carl Rogers described. I view this as the more subtle, but not less important, perspective of viewing the world from a half full perspective as apposed to a half empty one.
~Can seeing the world from an optimistic perspective make a person happier?
Yes. There is an entire category of psychology called positive psychology. I’m not going to go in depth with this right now but it is important to know that the research supports the idea that thinking positive matters immensely.
~okay, you gave us the components but now what?
You’ll notice the first thing on the list is the necessity of a relationship. As a professional counselor, I take this to mean I have to be authentic in the relationship. For example, I can’t expect a client to work on the things that brought them in unless I too am willing to be attentive to and work on things in my personal life. It’s a way of life, not just a cool idea.
The second and third components assume that brokenness is part of each and every person and health is also a part of each and every person. If we work with the assumption that we all have brokenness and we all require relationships with others, then the difference between relationships that improve our well being(are healthy) and those that harm our well being(are unhealthy) is simply the judgment to know what information to share and what to withhold for the sake of the other person. In this way, a counselor must be aware of and filter personal influences that may negatively influence the relationship while the client must attempt to be honest with the counselor or risk slow progress or stagnation.
The fourth component of unconditional positive regard is how a person-centered therapist maintains the attitude that “I am in this with you no matter what”. To be in a relationship with someone who is “in it no matter what” builds trust and encourages the growth process. Having unconditional positive regard does not imply taking on every relationship. Sometimes unconditional positive regard means handing off a relationship to a person more capable of working with the person where they are. That’s why I am willing to refer people to other counselors when my skills don’t match up with a client’s needs.
More and more research is being done that shows the importance of empathy in relationships. For our purposes at this time, we won’t go into a lot of depth. However, I think it’s essential to know that empathy is a set of skills that can be learned and improved. There are many techniques that can be taught to even the most rigid or chaotic people that will project the sense of togetherness. I may go into more depth about empathy in another blog.
The final component is all up to the client or the person who wants to improve their life. The ability to receive empathy and unconditional positive regard (trust) takes a willingness to admit areas of weakness and areas of strength. As the relationship grows and points out such areas, clients often feel a desire to avoid the growth because it hurts. Maintaining a positive direction is not easy and can only be encouraged. It is still up to each of us to stay focused on our progress and growth. The pain is part of the process.
The reason I choose to call myself a person-centered counselor is because it fits me and I fit it. I see it as a way of living as much as a theory because it applies to all relationships whether personal or professional. If you are interested in learning more about the details of a person-centered approach, I provide a few resources below. The Wilkins book called Person-centered therapy is one of my favorite because it has historical perspective as well as current research.
Ellis, A. (1948). A critique of the theoretical contributions of non-directive therapy. Journal of Clinical Psychology, 4(3), 248-255.
Kearney, J. (2009). Rogerian principles and the writing classroom: A history of intention and (mis)interpretation. Rhetoric Review, 28(2), 167-184. doi:10.1080/07350190902740034
Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton-Mifflin.
Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin Company.
Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.
Rogers, C.R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2-11.
Stiles, W., Barkham, M., Twigg, E., Mellor-Clark, J. & Cooper, M. (2006). Effectiveness of cognitive-bahvioural, person-centered, and psychodynamic therapies as practiced in UK National Health Service settings. Psychological Medicine, 36, 555-566.
Wilkins, P. (2010). Person-centered therapy: 100 key points. New York, NY: Routledge Taylor and Francis Group.
The following is what it means to me to be person-centered. Many people have written books on this material. This is my attempt to distill the research available in a concise manner. My attempt to be concise may leave you with many questions. If so, please discuss it with your counselor, family and friends. You can also feel free to post questions on here but please know that I can’t guarantee anonymity if you do so.
The person-centered approach is a researched theoretical approach to counseling clearly defined by Carl Rogers (Wilkins, 2010; Ellis, 1948; Kearney, 2009). The underlying theme throughout the person-centered theory is that change is always happening. Carl Rogers states “it is our design to self-actualize” and he goes in depth about the process (Rogers, 1942; Rogers, 1951; Rogers, 1957; Rogers, 1975). The key is that it happens whether we want it or not and whether we actively participate in it or not.
~If change is going to happen regardless of our desire, should we participate actively in how and what changes occur?
The person-centered approach to counseling suggests six guiding elements called necessary and sufficient conditions by Carl Rogers (1957:96). Those conditions are:
1. Two persons are in psychological contact.
2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.
If all these elements are present, there is evidence that significant and positive change will occur in the client (Stiles, Barkham, Twigg, Mellor-Clark & Cooper, 2006). If you are anything like me, you make question what “significant and positive” means. In counseling language, significant is based on statistical significance. This means a person is statistically a number of percentage points more likely to be happy, fulfilled and content if they have a relationship with a counselor as described above. Positive change is a measure of how a person perceives their life before and after a therapeutic relationship that contains the six elements Carl Rogers described. I view this as the more subtle, but not less important, perspective of viewing the world from a half full perspective as apposed to a half empty one.
~Can seeing the world from an optimistic perspective make a person happier?
Yes. There is an entire category of psychology called positive psychology. I’m not going to go in depth with this right now but it is important to know that the research supports the idea that thinking positive matters immensely.
~okay, you gave us the components but now what?
You’ll notice the first thing on the list is the necessity of a relationship. As a professional counselor, I take this to mean I have to be authentic in the relationship. For example, I can’t expect a client to work on the things that brought them in unless I too am willing to be attentive to and work on things in my personal life. It’s a way of life, not just a cool idea.
The second and third components assume that brokenness is part of each and every person and health is also a part of each and every person. If we work with the assumption that we all have brokenness and we all require relationships with others, then the difference between relationships that improve our well being(are healthy) and those that harm our well being(are unhealthy) is simply the judgment to know what information to share and what to withhold for the sake of the other person. In this way, a counselor must be aware of and filter personal influences that may negatively influence the relationship while the client must attempt to be honest with the counselor or risk slow progress or stagnation.
The fourth component of unconditional positive regard is how a person-centered therapist maintains the attitude that “I am in this with you no matter what”. To be in a relationship with someone who is “in it no matter what” builds trust and encourages the growth process. Having unconditional positive regard does not imply taking on every relationship. Sometimes unconditional positive regard means handing off a relationship to a person more capable of working with the person where they are. That’s why I am willing to refer people to other counselors when my skills don’t match up with a client’s needs.
More and more research is being done that shows the importance of empathy in relationships. For our purposes at this time, we won’t go into a lot of depth. However, I think it’s essential to know that empathy is a set of skills that can be learned and improved. There are many techniques that can be taught to even the most rigid or chaotic people that will project the sense of togetherness. I may go into more depth about empathy in another blog.
The final component is all up to the client or the person who wants to improve their life. The ability to receive empathy and unconditional positive regard (trust) takes a willingness to admit areas of weakness and areas of strength. As the relationship grows and points out such areas, clients often feel a desire to avoid the growth because it hurts. Maintaining a positive direction is not easy and can only be encouraged. It is still up to each of us to stay focused on our progress and growth. The pain is part of the process.
The reason I choose to call myself a person-centered counselor is because it fits me and I fit it. I see it as a way of living as much as a theory because it applies to all relationships whether personal or professional. If you are interested in learning more about the details of a person-centered approach, I provide a few resources below. The Wilkins book called Person-centered therapy is one of my favorite because it has historical perspective as well as current research.
Ellis, A. (1948). A critique of the theoretical contributions of non-directive therapy. Journal of Clinical Psychology, 4(3), 248-255.
Kearney, J. (2009). Rogerian principles and the writing classroom: A history of intention and (mis)interpretation. Rhetoric Review, 28(2), 167-184. doi:10.1080/07350190902740034
Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton-Mifflin.
Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin Company.
Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.
Rogers, C.R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2-11.
Stiles, W., Barkham, M., Twigg, E., Mellor-Clark, J. & Cooper, M. (2006). Effectiveness of cognitive-bahvioural, person-centered, and psychodynamic therapies as practiced in UK National Health Service settings. Psychological Medicine, 36, 555-566.
Wilkins, P. (2010). Person-centered therapy: 100 key points. New York, NY: Routledge Taylor and Francis Group.
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