When I first met Kurt, age 60, he appeared small despite possessing a lengthy frame that should have filled any space he occupied. He spent the first few sessions of therapy discussing the details of his son’s diagnosis with a rare and often untreatable disease. He talked about how the subsequent barrage of doctor visits, hospitalizations and constant state of uncertainty haunted his family, deeply affecting his son, his wife and others close to Kurt. Yet Kurt tended to minimize the impact these events had on him. He described his growing addiction to alcohol and pain pills without compassion, stating that he felt weak and disgusted with himself. He sought counseling for help to change his actions and also to gain an understanding of what had led him down the heavily weeded path of addictive behavior in the first place.

In my efforts to help clients understand their addiction patterns, I explain that avoidant behavior is more about an attempt to preserve the self than an attempt to destroy it. This understanding may be difficult to process, but it is one of the central concepts in recovery. Counselors must not only have a firm grasp on what leads many clients down the road of addiction but must also be equipped to communicate these core concepts in a way that will help clients forge a clearer path.

I explain to my clients that in order to heal, we have to work directly with our pain, and for many of us, this process can feel counterintuitive. When we are hurt, we want to retreat into the comfort of darkness. We are pulled into the cave to lick our wounds as we recoil from the sting of trauma and the pain of loss. It may be human nature to withdraw when we are wounded, yet it is also human nature to evolve. I remind clients that we have to return to life above ground at some point.

Like Kurt, many of my clients resist the natural flow of thought and emotion, afraid to see what may be bubbling below the surface. But in their effort to remain hidden, they may be at risk of turning toward avoidant behaviors such as substance abuse, self-harm and even suicide. Although these behaviors are an attempt to survive, in actuality they will oftentimes amplify pain and can create additional problems. Individuals are at risk of allowing this type of maladjustment to take root as they attempt to protect themselves from the pain of current and further injury by anesthetizing the wound.

I communicate to my clients that we have to intentionally turn off the instinct to flee and, instead, properly tend to the wound, working out the poison and rejoining the race. Once they are able to courageously explore their thoughts and the feelings attached to them (perhaps in the presence of caring others), they can then focus on truly changing their behavior versus trying desperately to avoid the impact of a
painful experience. Through this process, they can begin the task of waking after the long winter.

Using language seasoned with metaphor helped me communicate to Kurt that his addictive behavior made sense in light of recent events in his life. Becoming aware of his humanness helped Kurt understand that his grief was both valid and in need of some attention. This knowledge allowed him to uncover valuable information about his urges to use substances, including an understanding that his urges revolved around a more primal instinct — the instinct to run. Because of his newfound awareness, Kurt was able to cultivate self-compassion, thus allowing him to stretch and grow instead of remaining stuck in avoidant behavior, shrunken and defeated.

Gretchen

Gretchen was a beautiful 28-year-old with thick brown hair that fell just below her shoulders and large blue eyes lined with dark lashes. She was referred to me for depression that had manifested itself in different ways, including a poor self-image and recurrent suicidal thoughts. During our sessions together, and in between long periods of sobbing, Gretchen would talk about how much she hated herself for being overweight. She discussed believing she was unlovable because of her size and her lack of willpower to lose the weight. She felt imprisoned not only in her body but also in her feelings of shame, helplessness and isolation.

Just as finding the right metaphor with each client is an important part of the therapeutic process, it is also essential that we talk with our clients about the various ways they can begin disrupting their dysfunctional patterns. With many clients, core wounds are buried beneath other struggles and must be tenderly exposed. Otherwise, these clients may continue their maladaptive behaviors and become increasingly frantic. As I got to know Gretchen, I remained aware of this process of unearthing the true problems and brought these ideas into our work. With this framework and this language, our therapy quickly deepened. For example, when I talked to her about a need to “sift through the layers,” we discovered how her focus on body size was actually a distraction from the true origins of her painful emotions. “Careful excavation” revealed how these feelings were the reverberations of events that had happened long ago.

Gretchen discussed how brief moments of reprieve from the emotional pain she felt came in the form of nightly binging. But she also described how the pleasure she received from food was a short-lived distraction, the pain creeping back in inevitably after she had emptied the pantry. We talked about how the emotional fullness she experienced from binge eating was an illusion. In actuality, these incidents of self-abuse served only to feed her particularly severe form of self-criticism. During one memorable session, she looked up at me with puffy, red-rimmed eyes and asked, “How did I end up here?”

In our attempt to answer her important question, Gretchen and I embarked on a journey down the various pathways that had contributed to her pain and food addiction. This included the impact of growing up with a critical, alcoholic mother who continued to deny any culpability — most likely because of her own avoidant behavior — for the hurt she had caused her child. Gretchen gained insight into how she had eventually ingested her mother’s criticism over the years and how she now beat herself up mercilessly with her own cruel self-talk. Furthermore, she learned how these earlier experiences had left a powerful mark, creating a diminished ability to self-soothe and a craving for attachment that could not be effectively satisfied.

I explain to clients that when we are not growing, we are withered, an echo of ourselves. Our natural instinct is to learn from what happens in our lives so that we are ever better at survival. When we are hurt, we examine the pieces of the puzzle that have been scattered, attempting to put them back together in a way that helps us understand what has happened and increases our ability to sidestep further injury. Yet through our loss experience, the puzzle is forever changed because we no longer have all the pieces. I explain that it is only by accepting the impact of certain events that we can begin the process of rebuilding after the explosion, putting the puzzle back together in a new way. It is a process that cannot be forced if the bones are to heal correctly. It takes as long as it takes.

I tell clients that it is tempting to assign blame and responsibility in our efforts to understand why the walls came crashing down. Many of my clients, like Gretchen, point the finger at themselves. This type of self-injury is rarely a one-time event but instead a process that has been shaped and sculpted through years of practice. These clients not only attempt to make sense of the loss in their lives by blaming themselves but also may accept responsibility for the pain experienced by those around them. They have come to believe they are the reason that “bad” things happen. Unfortunately, other people in these clients’ lives — many also desperate to avoid pain — may actually encourage these clients to shoulder the blame, shucking their own responsibility and accountability.

Buying into the myth that we are inherently flawed can create torrential pain, as it did for Gretchen. Recognizing self-blame as an attempt to make sense of what has happened encourages us to examine our role in various relationships, including the relationship we have with ourself. Although growing pains may be experienced along the way, I assure clients that this recognition can have a profound impact on healing, self-awareness and self-esteem, creating ample interpersonal growth. It is important to look at our role in connection with the events occurring in our lives so that we can continue to evolve, but oftentimes we are not solely responsible for our losses — and we are certainly not responsible for the losses of those around us.

Painful feelings such as shame, isolation and helplessness can keep us wounded and in the dark, unable to access our inner knowingness and limitless potential. When we are hurt, our view can become narrow. We may collapse in on ourselves and feel powerless to change our situation. Gretchen’s deepening insight about her difficult childhood helped us combat the destructiveness of her critical thoughts. Her situation began to make sense as we painted the picture of her current struggle — a reflection of unresolved grief and loss.

I remind my clients that it is deeply rooted in our fiber to disappear into the cave when we are hurting. We are pulled there to heal so that we can eventually rejoin the rest of the world. However, I also remind them that this hardwiring can at times interfere with other natural states of healing. Instead of working out the poison, we may fail to acknowledge the wound at all so that it begins to fester. When our need to evolve is overshadowed by our need to escape, we are at risk of avoidant behavior and at risk of collapsing under the heavy weight of painful feelings such as shame and helplessness.

Just as probing the wound can lead to fresh bleeding, revealing the impact of trauma with someone is a tender process. Regardless of where we meet our clients on their journeys, we have to craft the right language for each one, whether that means creating a powerful metaphor or helping them uncover core wounds. Our words and caring presence as counselors can help clients put a face on their pain, while also steering them back to their true path; the mirror’s powerful reflection becomes a powerful beacon for someone who feels lost. And our words must also communicate hope.

The richness of life cannot be found in the deep recesses of the hillside. We have to find a way to emerge from the cave, perhaps with the thick skin that only scars can provide. Otherwise, we will continue to suffer, deepening the wound despite our best efforts to avoid the risk of additional harm. We need to encourage clients to step back out into the sunlight, surveying the landscape and all of the possibilities. We have to find a way.

Kim Johancen-Walt is a licensed professional counselor in Durango, Colo., who contributed a chapter to The Adolescent & Young Adult Self-Harming Treatment Manual by Matthew D. Selekman. She has conducted several workshops both locally and nationally on her work with self-harming and suicidal clients. She has also worked in multiple educational settings, including Fort Lewis College. Contact her at johancenwaltks@gmail.com.

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