Jo-Ann

Brief Outline:

Jo-Ann’s daughter began cutting herself at the age of 11 but, looking back, Jo-Ann thinks some of her behaviour as a very young child was a form of self-harming. Jo-Ann has learned to understand the way her daughter sees the world and the fear that makes her self-harm.

Background:

Jo-Ann is 50, separated with one child. Ethnic background: White British.

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Jo-Ann’s daughter always seemed to be extremely emotional and stressed when she was a very young child, on one occasion threatening to throw herself out of the bedroom window. She would hit herself, bite herself and smash her head against the floor or wall. At the age of eleven she started cutting herself, claiming she’d scratched accidentally on brambles when asked about it. She started cutting more deeply about four years ago, at the age of sixteen.

Jo-Ann initially thought that her daughter was copying her own self-harming, begun at the age of about thirty nine. She felt guilty about this and was strangely relieved to find that her daughter had been self-harming before she started. Because of her own experience with self-harming, Jo-Ann was not, at first, scared of it. She has become more fearful as her daughter has begun to cut more deeply. 

Jo-Ann has suffered from depression since she was a teenager, though she was not diagnosed. She had post-natal depression after the birth of her daughter and continued to suffer from depressive episodes. Jo-Ann talks about family members in her own and previous generations suffering from depression, borderline personality disorder, obsessive compulsive disorder and claustrophobia.

Jo-Ann’s daughter had care and treatment from child and adolescent mental health services (CAMHS) since she her mid-teens. She now has care from adult mental health services, including psychiatrist, community psychiatric nurse and the crisis team. Jo-Ann says there have often been difficulties in her daughter’s relationships with therapists. Jo-Ann is having dialectical behavioural therapy (DBT) herself, which she finds very helpful in learning new skills to manage her emotions and her responses to her daughter.

Jo-Ann gets support from close friends who live nearby, who are also very supportive of her daughter. Jo sometimes needs to manage the way she presents her daughter’s behaviour and way of seeing the world to protect her from criticism. Jo-Ann’s own family have always, she says, been judgemental of her daughter in ways that are not at all helpful. She also gets support from sharing experiences online and by looking for information on relevant websites. She has also found books on borderline personality disorder very helpful.

Jo-Ann is positive about her own future, and hopeful that her daughter will achieve peace of mind. Jo-Ann’s message to others is that it’s not the severity of the cutting that is important, it’s the severity of the feelings that make you cut. Don’t ignore it, even if it just looks like scratches, and don’t be afraid to talk about it or to get help. Be understanding and try to be empathic, she says, because young people don’t need judgement: they need your support and your love and your care.

Jo-Ann said her daughter finds it difficult to feel that people she loves are bad, so she cuts to stop those feelings.

What does she say herself about the reasons for her self-harming?

Well, I, after I left her dad I had another relationship, a seven year relationship, which ended in July, and she says that she was self-harming because she can’t, she couldn’t cope with the thought of me having a physical relationship with somebody because for her, it’s bad and evil and dirty. And so for the person that she loves most in the world to be bad, she can’t deal with. So I didn’t realise that she was self-harming because of that. She got on very well with my partner, never, in fact, probably I was the one that felt left out in the [laughs] relationship quite often. But it was just that she feels that people in general are bad and finds it difficult to, finds it difficult to feel that people that she loves are bad and so she cuts to stop to stop her feeling those feelings because it concentrates her emotions. It focuses her emotions on something physical. And so I don’t know for the rest of the time. I think that’s, that’s a newish thing but those feelings have got more extreme now and so the thought of me having another relationship is very, very frightening for her, very frightening and she is really struggling. She’s got the crisis team coming at the moment to, to help her. And so that’s, for these years, that’s her reasoning. 

Although her family tried to help Jo-Ann found their responses very difficult.

I would say the most difficult are my family. They’re very judgmental of her and she knows that. My mum is trying really hard. My mum is seventy three and, you know, she is trying very hard but she still comes out with things, you know, my family used to say things to me like, “Give her to me for a week, I’ll sort her out.” And [laughs] you can’t imagine what that feels like a) As a mother, they’re saying, you’re doing, you know, and b) my most beautiful child has got these difficulties. They are, they say they’ll fix her and ah, the amount of times that people have said it and also, the other things that they’ve said to her is, “You’re making your mother ill. She’ll be back in hospital if you don’t stop.” 

Jo-Ann is afraid of the intensity of her daughter’s emotions. She uses skills she learnt through dialectical behaviour therapy* [DBT] to explain to her daughter how she feels.

To be honest I’ve always been really scared of her. I’ve been afraid of her emotions, afraid of her anger, just afraid of the intensity of her feelings and not knowing where they came from and what to do with them because I never, I never experienced those things myself. So I know everybody could say, well, if I was a better parent, this wouldn’t have happened… but it’s true. I have no idea. I have no idea that if I had been stronger, better, happier, whatever, that she wouldn’t have experienced these things and I just have to tell myself that it’s not too late, that I can, not make things right for her, but I’ve always done the best I could and I, as long as I can hold on to that and the fact that I’ve always loved her, those two things, I know that things will be okay as long as [my daughter] can keep hold of that. And she does, when she’s not, when she’s calm she knows those things but when she’s not calm, which is a lot of the time, she forgets. She, she thinks I don’t love her and that’s difficult and it’s kind of another form of self-harm, pushing me away, who she says I’m the person she loves most in the whole world. So not accepting my love is, is only, well, it does hurt me but I do understand but it hurts her more and so it’s, it’s just another form of her hurting herself. 

And so it is very, very hard and what I’ve done now this this week, I know it sounds like I’ve just made this up, it’s not, [daughter] and I had a conversation this morning, where it was quite intense because we’ve had this really difficult week, and she told me how she felt and I’ve used my skills, my DBT [dialectical behaviour therapy*] skills, to put into place and I have said to her, she said to me, “I feel responsible that you’re unhappy because you’ve parted because of me.” And I said, “No, hang on a second. I take responsibility for that because you could have had difficulties with me having a relationship and I could have said, ‘okay I understand you’ve got difficulties but I’m going to do this anyway and this is how I’m going to be. I’ll be as kind to you as I possibly can but I’m also going to live my own life.’” 

And so that actually now is what I’ve put in place that I’ll, I’ll be kind to her in as much as I can but I, I started living her reality and it’s not my reality but that’s what, I’ve built a prison for myself because of her difficulties. And I’m now trying to gently, not push her away because I I’m always very, very, I’ve told her I’ll always love her, I will always be there for her and I always will and I always have but I need my own life as well because one day, she’s going to have her own life and I won’t have one. I’ll be just left so in the kindest possible way, that’s what, I said, you know, I’ve told her.

* This is a form of therapy (using individual and group work) that helps the young person to learn skills to manage their emotions, cope with distress and improve their relationships. DBT helps the young person see that their suicidal and other unhelpful behaviours are part of their way of coping with problems and encourages them to develop more helpful behaviours and solutions.

Jo-Ann’s daughter worried that people would see her scars, but Jo-Ann herself was not ashamed by self-harm.

Most people that know us know. They, they know that I’ve self-harmed and they, and they know that she does. She’s more private about it than I am but, for me, I don’t see I don’t see shame in it. I don’t see anything to be ashamed about. And so, you know, she tends to wear long sleeves. She does pull her sleeves up sometimes but then worries that people have seen her scars and I haven’t really come across people judging you. I think people are more compassionate and maybe would like to know more but I myself, can’t, you know, obviously, I can’t speak for [my daughter] but I don’t, I don’t think that she’s had any problems. But I’ve always been open about it and, as I say, I, I’ve never come across anybody that’s condemned me

The CPN (community psychiatric nurse) had a good relationship with Jo-Ann’s daughter and was very understanding.

And she has an ongoing relationship with a CPN does she?

Yes, she does, yeah. 

How does that go?

That’s pretty good. The CPN is very, very honest with her and will, she won’t buy into what she’s saying. She will challenge her. Sometimes it doesn’t go down very well, as you can imagine. Sometimes she’s very angry with her but, on the whole, they have a trusting good relationship and that’s really important. It’s important for me to know that somebody is going to come in and they’re going to speak to her and I’m not going to come back to her being distressed and cutting, you know. It’s quite important for, for my piece of mind as well as hers. 

That’s the only thing about the crisis team, you get different people each time so you don’t you don’t get, each day you get a different person speaking to you. Sometimes people are very caring and empathic, sometimes they’re not so, sometimes they’re quite brusque and that’s very difficult then because then she doesn’t feel cared about and she feels that they’re just trying to fob her off, you know. 

So that’s, that’s quite hard but yeah, her CPN, they’ve got a very good relationship, thankfully. In fact, this CPN took her on. She was meant to have a different one and you could tell right at the beginning, it wasn’t going to work and so this CPN works with a lot of people with borderline and understands it a lot more and so it’s really good. And she doesn’t push me out either. She understands that we are living together. We have a relationship and that we bounce off each and that one affects the other, whereas with the other therapists it’s, “Well, it’s not about your mum.” And they’ll say to me, “Well, it’s not about her.” And it’s, really, sometimes it is, you know. It’s very difficult so she’s very understanding.

Jo-Ann’s daughter was referred to the Crisis Team by her Community Psychiatric Nurse.

Can you talk a bit about the crisis team?

Yeah, They, the crisis team, her, [my daughter’s], her CPN came on Thursday. [My daughter] requested her to come. She normally comes once a fortnight. She came last week because she was pretty distressed and, while she was here, she said, “I will refer you to the crisis team.” The crisis team are there, they put in place, I don’t know if they exist in the rest of the country, but they’re put in place here to stop you being admitted to hospital. They’re a barrier because they don’t want you to go to hospital. It’s not and it, it isn’t the right thing. There have been many times when I’ve felt that it would be the right thing but that might be selfish reasons on my part actually. So they come they come to the house every evening if you need them. So they’ll phone you each day and they’ll ask you if you need them to come and if, if they thought you needed admitting, they would admit you. If they thought you were at risk or at risk of hurting somebody else they would, you know, put things in place. They have they have, you then have access to them. You can phone them if you’re in distress and there’s no nowhere else for you to go. 

So they have also arranged psychiatric assessment with the consultant for Thursday, so [my daughter] has got a feedback for a different assessment on Wednesday but they’ve made this appointment, and it’s not with her psychiatrist. It’s with the, the consultant, who works with them. So I don’t really know what that’s about but they can also administer drugs so they can prescribe you or bring with them diazepam, temazepam, which is what they’ve done with her to help her calm and help her sleep. So yeah, that’s basically what they do.

Jo-Ann’s daughter has epilepsy and obsessive compulsive disorder so it was difficult to get her medication right.

Is she on regular medication?

She’s also on propranolol, which is a beta-blocker, which is for anxiety as well. She’s on drugs because she’s got epilepsy as well so she’s on drugs for those are for, you know, for anti-epilepsy drugs. They’ve also put her on fluoxetine and citalopram, not together but they’ve had to take her off both because that affects her epilepsy and, but they put her on those for, not for depression, but for the intrusive thoughts. She’s got OCD as well and so they thought they would, that would help with the intrusive thoughts but, unfortunately, they’ve had to take her off. 

They’ve also talked about anti-psychotic drugs but they affect her epilepsy as well so they don’t want to do that. I don’t really, you know, [sighs] she never wanted to go on any drugs and now she can’t function without taking her anti-anxiety meds. If she forgets them, the effects are immediate. You know, by, by lunchtime, she’s restless, she’s climbing the walls, she doesn’t, she can’t, sometimes she can’t even go in the kitchen because there might be crumbs in there. And I’ll say to her, “Did you take your tablets this morning?” And, you know, it’s pretty obvious she hasn’t and but now she’s upset now because she can’t function. The anxiety is as much as it was when she wasn’t on them but she’s now got side-effects of the, of the anti-anxiety tablets to contend with on top of the anxiety itself. That’s just so upsetting. She can’t come off them now because she’s just too anxious.

Jo-Ann describes the dialectical behaviour therapy (originally designed for people with borderline personality disorders) which helped her.

Could you talk a bit about dialectical behavioural therapy and how that affects your life?

Right. It’s two and a half hours skills group and then one hour individual one to one therapy. So the, the one to one therapy, you talk about whatever has come up during that week. Right, so basically you have diary sheets and on that diary sheet you, on one side it’s there’s a grid and you have to put, have to rate each emotion that you have that day , your strongest emotions. You know, so there’s things like quitting therapy, suicidal urges, self-harm urges, urges to take drugs or alcohol. And then there’s so they’re the urges and you, you rate them. Then you rate joy, pain anger, shame, fear, you rate them and then then you rate whether you have self-harmed so action to urges and underneath that you write what each day has held for you so that you know what’s triggered things. 

And then on the back, there’s a lot of skills. So there’s four modules. There’s mindfulness, interpersonal skills, distress tolerance and emotional regulation and within those modules there are many skills. So then you have to write down which skills you’ve used and whether they, whether you’ve thought about them, whether you’ve used them, whether you could couldn’t, whether they worked, whether they came naturally to you at a rating of one to seven. So you, you rate those and then you go to group and you feedback, not your personal stuff. You feedback your personal stuff to your individual therapist and she’ll go through what, what you’ve experienced and then the group therapy, you read your skills, so what skills you’ve used during the week. You don’t you don’t tell anybody why you’ve needed them unless it’s appropriate. You never ever discuss self-harm. There’s a lot of rules in place. It’s very, very strict and structured and then you learn, so we’re on mindfulness, the mindfulness module now and distress tolerance. 

So you learn those skills and then you go away and practise them. And when you’re going through anything, once you start learning them, when you’re going through like, for instance, when [my daughter] was smashing her head on the on the floor, my immediate response was grab her, just stop her, do anything you can, panic, you know, just the emotion kicked in. But the DBT skills I used them and they enabled me just to sit through the emotion, know that it’s upsetting, but I could sit through it and I could get through it, just take a step back, not immerse myself fully into what was happening. And so you put, you, you just think of the skills, they just become fairly natural to you once you, it’s a long intensive course. It’s a year at least but I’m on a top-up course now so this is, I’ve done the year and then I stopped and went back. I was referred back. This is six months to a year and actually, it’s more embedded now and I find that I use the skills more easily. Things like using opposite emotion action, if you don’t if you don’t want to go out, if you don’t want to see anybody, the, the right thing would be to actually go out and see somebody. So you do opposite and, you know, sort of increasing positive emotions and there are so many. 

It it’s very, very therapeutic and it is very structured and it’s not based on what’s happened to you in the past. I believe a lot of people are, have been abused, that go there, it’s about radically accepting. You can’t change the past but you can let go of the suffering and you can still have the pain, but let go of the suffering. It’s quite Zen. It’s very Zen based and it does really, really help. I would say anybody that is having, it’s not just, it is designed for people with borderline personality disorders but, where we live, it’s, it’s traits of as well. So although I’ve just got traits of, they accept me but one of the criteria is that you self-harm. So they, you know, unless you’re a self-harmer, you wouldn’t get onto the course but I would recommend anybody that’s struggling, if they could get on this course, it’s fantastic, very, very good.

Jo-Ann and her daughter both self-harmed. Jo-Ann says no one can stop you self-harming, you have to make the decision yourself.

Some people have spoken to me, who have not got a history of self-harm themselves and whose daughters, in each case, are cutting.

It’s very important for them to think about stopping, about, about how the young person is going to stop, been able to stop and they hear from therapists that it’s got to be their decision. They’ve got to want to stop themselves. I’m just wondering for you and, and her what, what role does the whole idea of stopping self-harm.

Play?

For [my daughter], speaking for [my daughter], she doesn’t want to self-harm. She doesn’t like doing it and she doesn’t want to do it. She doesn’t want to scar her body any more than it is and she really hates herself for doing it. For myself, I never had any of those problems. When I met my partner, he was very anti self-harming and he said to me that, not that he was disgusted by it, not that, but it hurt him.

Is this her father?

No.

No.

This is. 

Your more recent partner.

My recent partner, her father never took any notice at all [laughs] of it, not one bit. My most recent partner, makes me sound like I’ve had loads, I’ve only had two, [laughs] he was a recovering alcoholic when I met him and we kind of made a pact, not literally, but a kind of an understanding if he drunk, I always said if he drunk I wouldn’t be with him. But he, it was, well, he wouldn’t drink and I wouldn’t cut because my cutting upset him so much. Plus I, once [my daughter] had established this self-harming, I felt that I was compounding it by self-harming myself so I felt that if I could stop myself self-harming, I could lead her by example. So I wouldn’t be hurting her and I wouldn’t be hurting my partner. 

And I think this recent self-harming that I did was it was kind of a backlash because I’m not with my partner anymore, that was my decision and because [my daughter] had self-harmed in front of me, it was like actually, I want to do this for myself. I know that probably sounds really strange for somebody who’s never self-harmed but it was something, I wanted to self-harm and because I’d stopped myself doing it for other people, it just overwhelmed me and I, I really, I wanted to do it. It wasn’t even a need. It was wilfulness on my part. I was saying, “I’m important.” I know it’s a strange concept because I was actually, doing something fairly destructive but that was my thinking. I’m not proud of it, but that was the way I was thinking. 

So with regard to your question about, you know, the self-harming and stopping self-harming, it’s, the only person, you have to make that decision yourself, as difficult as it is for other people. They can’t stop you self-harming. You can decide not to self-harm because you’re hurting them. If, you know, if that’s something that you can get your head around but it is a really difficult thing to stop doing because you feel like something’s been taken away from you and you have to make that decision yourself.

Don’t judge, be understanding and compassionate. Your children need your support and love, says Jo-Ann.

Be understanding. Don’t be frightened. Don’t be frightened to talk to them about it. Don’t be frightened to get help. Get help as soon as you can because, even if your child has just got a scratch that they’ve done themselves, that can escalate and also it’s not the severity of the cutting that’s the important thing, it’s the severity of the feelings that make you cut. So even if it’s only a scratch, it doesn’t mean that your child isn’t in as much pain as somebody who cuts with a Stanley knife or whatever it is that they do. Take notice. Don’t ignore it but try and be empathic and compassionate because they don’t need judgments. They feel, they feel as bad about themselves as it is. They need your support and your love and your care, yeah, that’s what I would say.