chapter  12
Working With Dangerous Behaviors: Integrating Relational Psychoanalysis With Dialectical Behavior Therapy With Self-Injuring Patients
Pages 22

Introduction A new patient, Meg, walks into my office for the first time. She’s in her late 30s, thin, soft-spoken. She seems frightened by this encounter, and tells me she has recently been “fired” by her therapist, a colleague of mine, because one too many times my colleague had gotten a call from the emergency room informing her that Meg was brought in drunk, or was bleeding from self-inflicted cuts, or had taken an overdose. Meg tells me that despite the calls from emergency rooms and her own late-night phone calls-speech slurred and reason impaired-she had always denied drinking to her therapist. Meg is smart, a graduate of a top college, articulate, talented in the arts. She is also anxious, sad, full of shame, and so sensitive to hurts, slights, and moments of mis-attunement that it is as if she has no skin at all-like a burn victim for whom even the lightest touch causes excruciating pain. 1 She has a history of near-lethal suicide attempts and is currently living in supported housing. In the previous week, she had been drunk, cut once, and felt suicidal several times. She also tells me she hasn’t eaten much lately, and at 5′7″ weighs around 110 pounds. Although all of this is true, later I would learn that she could easily slip into untruth. In our first weeks together, Meg often subtly absented herself from our conversations. Her eyes narrowed, her body stiffened, and her responses became flat. The changes were barely perceptible, but as I learned over time, tracking and exploring these moments of dissociation were critical to the work.