Your First Appointment

What to Expect At Your First Appointment

Bringing your child for treatment is a big step and I am glad you are considering making an appointment.  I’ve written this article to give you an idea of what usually happens during your first visit.

Like many parents, you may feel frantic; not understanding what would make your child hurt themselves on purpose. When parents bring their child in for an appointment, it is not unusual for the teen to slump down in the chair looking sullen, refusing to make eye contact with their parent(s) or with me.

This is normal so do not worry that your child is being rude.  They are handling the situation in the best way that they can at that moment.

Here’s how our first session usually evolves…

I listen to the parent’s story of how they discovered their teen’s cutting and watch for reactions from the teen. I then ask the teen if they want to tell the story from their perspective. Most don’t, and I then ask to speak with the teen alone. Most teens who self-injure feel like there is something wrong with them or that they are crazy and they feel ashamed and guilty about their behavior.

Before talking with the teen alone, I first ask the parent to state, in front of the teen, why they called to make an appointment so we all know what information I have been told. I also discuss the confidentiality of any discussions had in any and all future sessions with the teen;  anything the teen tells me without the parent present is confidential except if it is something that is going to hurt them or someone else.

If and when that information is disclosed by the teen I would tell them that is something I need to share with their parents for their own safety. I also let the teen know there might be times they want to tell their parents something but do not quite know how to say it. Those are instances I can be of help and talk to their parents, with or without them present, to share that information.

It is my professional opinion that in most cases, the teens I see who cut themselves are not doing it to hurt themselves. In fact, it is the complete opposite and they are attempting to make themselves feel better.

When I speak with the teen alone I start with a few general questions and then ask more about the cutting. I find most well intentioned therapists tend to avoid discussing the behavior directly, when in fact many teens are very comfortable discussing it themselves without their parent present when asked specific questions.

I ask about the feeling the teen has that gives them to urge to cut. I ask what types of situations occur to get them to feel that way (anxious, upset, angry, sad, out of control etc). If reluctance is noticed I back off and let the teen know I have no intention of making them uncomfortable or having them talk of anything they do not wish to talk about.

These may be the same types of questions you have asked but your child was reluctant to respond or give answers that made sense to you.  This is one of the reasons seeking help is so important.

Your child most likely wants to talk to someone about this but most kids are not comfortable having this conversation with a parent.  When you work with me, over time, one of our goals will be for your child to learn how to comfortably talk with you about these and other issues they are worried or concerned about.  Each child is different and will handle this differently and at their own pace, but their comfort level can grow.

Once I have asked those initial questions, I then ask the crucial question: ”Do you want to stop cutting and if so, why?”

In many cases, the teen feels they have found something that works, so why would they want to stop?

Most will say they want to stop because they see how upset it gets their parents. If their parents didn’t know or get upset – and if the scars didn’t show – they wouldn’t necessarily want to stop. This also somehow may “ruin” the effect the cutting has had in the past as the positive feelings they get from it are now mingled with the guilt and shame.

The simple truth is, parents do get upset, and the scars do show, so what can we do to help these children who are in so much emotional pain that they would inflict physical pain on themselves in order to temporarily stop the emotional pain? Or to help those who cut because they feel numb and just want to make sure they are alive and can feel something.

In general, I have found three main reasons why teens cut.

One is a “lashing out” in which the teen, who has difficulty managing their emotions, lashes out at whoever is around them. Once their anger subsides they feel guilty about their behavior and subsequently, when that guilt becomes overwhelming, they self-injure.

A second reason I have found is related to the teen who has difficulty with impulse control. They have a negative feeling and do not take any time to pause to consider consequences of their actions. Their own guilt and/or shame reaction to their impulsive behavior might cause them to self-injure. With these teens one suggestion I give is using a “Pause” button, similar to the “Easy” button branded by Staples.

The third reason is to self soothe. The teen can find no other healthier way to release their negative emotions other than to cut.

Think of it this way:  When you have a headache what do you typically do?  Most people take some type of pain relief medication and then basically forget about the headache.  After a little while, possibly without even being aware, the headache is gone. Many people keep a bottle of pain relief medication (such as aspirin or another choice) in their medicine cabinet just in case they need it one day. Possibly simply knowing you have it there might be enough to make you feel more at ease for the next time you get a headache.

Now change the word headache to “problem”, “issue” or “emotional injury”, and change “pain relief medication” to “razor blade or cutting tool” and read through the above paragraph again. This is one way to understand why a teen chooses to self-injure.

If your child is self-injuring – or even if you suspect this might be happening, please call me to schedule an appointment.  I am here to help you help your child and to support you in dealing with any issues causing you deep concern.

You can reach me at 914-329-5355.