Monday, November 14, 2005

Low Self-Esteem / How Shame Interferes with Attachment

Low Self-Esteem
Excerpt from "Cutting: Understanding & Overcoming Self-Mutilation" by Steven Levenkron

Low self-esteem has a direct impact on patterns of personal attachment. The individual with low self-esteem is prone to forming attachments with persons who are abusive to her or needier than she is. She believes that she deserves this behavior and unconsciously or unwittingly invites it. Another feature of the self-mutilator's personality, then, may be the tendency to establish abusive relationships that are reminiscent of "home," familiar, and in keeping with her childhood experiences. One component of this phenomenon is that security and pain have become fused.

This fusion of pain with security causes her to "treat" her feelings of insecurity, loneliness, and fear of abandonment with self-inflicted pain, which temporarily produces security and even tranquility. The self-mutilator, then, is someone who trusts only her pain because she connects it with "home." When she is in emotional trouble, she does not turn to another person to express her grief, but to the pain, because she can assure its presence. It is the most reliable relationship in her life, and the most familiar.

How Shame Interferes with Attachment

We have seen, in previous chapters, individuals who have committed acts against themselves which cause them pain and did physical damage to their bodies. In the cases of Jessica who was sexually abused, and Tracy, who was beaten with her father's belt, we saw how each individuals have explicitly used this physical pain and self destruction to make their psychological pain go away.

Any attempts these women made at self-disclosure were accompanied by shame. Both had difficulty describing their behavior, and in both cases they had never shared this information with anyone else. Each of them took approximately a year in therapy (following years with other therapists) to finally let out these secret behaviours they had been so ashamed of.
In Jessica's case, her behavior involved irritating her genitals with soap. This is not something that most people could readily discuss with a friend. Tracy's behavior of cutting herself with the buckle of the same belt her father had used to beat her with was equally difficult for her to reveal. Imagine the shame at having to discuss this information, and the fear of the listener's possible reaction to it. The gives us some idea of how a self-mutilator's isolation and lack of personal attachments become a self-perpetuating cycle.

Another factor that comes into play is the effect that the years of secrecy has on the developing personality. The sense of shame spreads from the specific act of cutting or burning to a general sense of shame about oneself. For Jessica, this constant state of being ashamed, coupled with the shame surrounding the original acts of childhood rape that she endured, combined to create a general sense of self-loathing. The conflict caused her continually to sabotage any chance of success that she might have at any job, or in any personal relationship. This ambivalence came out in her therapy when she became sulky and answered questions by equivocating, thus stalling the progress of the therapy. Unconsciously, she may have felt that she did not deserve success, even in overcoming her psychological problems.

This kind of patient poses special difficulties since she is both a danger to herself and a saboteur to those who wish to help her. She is constantly fighting the attachment she wishes for with her therapist. She knows, intellectually, that he or she is not a danger, but psychologically and emotionally he or she does represent a danger because trusting them would cause her to reorganize and possibly give up her defenses. This last danger can the most threatening of all.

In some cases, the fear is not that an attachment to the therapist would lead to an undeserved cure, or the dismantling of her coveted symptoms, but that the therapist would be rejecting. As we saw with Jessica and Tracy, one reason the self-mutilator lacks personal attachments is that she avoids even attempting them for fear that if someone got to know her, they might be shocked, repulsed, and rejecting of her. This fear extends to the therapist as well as friends.

I am learning an incredible amount about myself through reading this book. I am finding that not only have I adapted some of these maladaptive behaviors, but for the first time there is a great understanding of the reasons behind the behaviors.
I am a little put off by the "attachment to the therapist" as Dr. Levenkron does not elaborate on what level of attachment he is referring to. Personally, I don't believe that forming an attachment to a therapist would be healthy, perhaps instead, the therapist teaching you ways to form healthy attachments in your personal life, with family or friends. This of course, is dependant on the level of attachment. I believe some attachment is required to be successful in counselling, but where is the line drawn?
Boundaries... the ever plaguing wonder...

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