Self-Hate and Self-Bullying Witham, Essex
Diagnosis: Borderline Personality Disorder. Target behaviour: self-harm and occasional suicidal ideation
"Katie" (not her real name) had reached a point in her therapy where she was no longer actively suicidal and was using Distress Tolerance well enough to manage her crises. She said, "I feel as if I have more control over my behaviours but I still get really low when this internal bully, this self hating side of myself takes over. It just starts without warning and I don't know how to manage it."
I asked her what she did do when this happens and she replied, "Well, I might be anywhere, in a supermarket, at home, with my daughter or parents and all of a sudden it starts up...
'YOU ARE VILE'.
'YOU SHOULDN'T BE ALLOWED TO LIVE'.
'YOU'RE A HOPELESS FAILURE'.
"Sometimes I try to tell myself 'it's not true' but I dont really believe it, and then I just listen to it and get more and more depressed UNTIL I want to die"
I decided to work on a number of strategies with Kate to reduce the self-hate and help her to assert a defence of herself, learning how to defend (change skills), and how to ignore (acceptance skills).
In session, together we made a list of all the self hate statements Katie would hear on a regular basis, and matched it against another list of all the evidence that she could use to argue back against these statements. We also looked at ways of drowning out or ignoring the "critical voice".
She would achieve this first by counting backwards out loud from 100 in sevens. Or by observing and naming objects in the room, or by going through the alphabet and thinking of all the girls names she could from A-Z, or even putting her hands over her ears and shouting "La La La La La" or singing her favourite song on the top of her voice.
Katie and I role-played this, with me taking the part of the critical voice, increasing in volume and intensity and her using defending and ignoring skills to manage emotions.
At the end of the exercise Katie gave the following, insightful feedback:
"I can see how hard I have to work at this. When I was defending myself, it really worked if I got angry at the voice and spoke more aggressively to it, I also noticed that when using the ignoring skill, if all else failed, putting my hands over my ears and singing loudly worked - I was able to shut it all out if only for a moment. It's funny though, I really think this will help - I can see that this self hating part can only make me feel bad if I LISTEN to it!!"