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Mental Health

Working with Ayla

A school counsellor’s story about student self-injury and recovery

Nicole Paley, BEd, MA, RCC

Reprinted from "Young People: Self-Injury" issue of Visions Journal, 2017, 13 (2), p. 26

I work as an elementary school counsellor for the Vancouver School Board (VSB). Not so long ago, I was a secondary school counsellor for the VSB. In that rewarding position, I was fortunate to meet and work with Ayla* while she navigated her early years of high school.

As a school counsellor, I provide individual, family and group counselling to young people who are dealing with a wide range of mental health matters, including mood issues, anxiety and stress, body and self-image concerns, and social and family problems. Fortunately, self-injuring is rare in my school counselling practice. But in more than 10 years as a counsellor, I have worked with many students who were self-injuring.

Depending on the severity and the intention of the self-harm, I sometimes refer students to a Child and Adolescent Response Team (CART) counsellor. CART specializes in providing care to young people who are self-harming and could be at risk to themselves. I have also had the good fortune of being able to consult with adept counselling colleagues on a case-by-case basis. As a therapist, I always feel privileged to be able to work with the individual to heal and to establish healthier coping strategies. Ayla and I worked together to do just that.

Ayla and I met when she was in Grade 8. At first our connection was practical: as her school counsellor, I helped her establish her course schedule and we chatted lightly about unimportant things. But in Grade 9, Ayla decided to share her struggles with me, and to seek my help for her mental and emotional anguish and her self-injuring.

If you saw Ayla in class, hanging out with her friends at lunch or after school, or out and about in the city, you would likely believe that she was a free-spirited type who approached day-to-day life with enthusiasm, bright eyes and an open heart. On paper, she excelled in school. She had a bevy of pals around her, and she had a stable and successful family life (a high-achieving older brother, caring and hard-working parents, a beautiful home). She played on a number of sports teams and was kind and polite to people of all ages.

Behind closed doors, though, and in the privacy of her own mind, Ayla suffered. What the outside world, including her family, couldn’t see was that Ayla found life overwhelming, anxiety-producing and sometimes quite dark. She worried incessantly about how others saw her: Was she interesting? Was she funny? Was she too much or not enough for others? Was she … weird? And how could she keep up her straight-A average and her rigid, no-room-for-error study schedule? On top of all of that, Ayla worried about how she could be more beautiful—and by more beautiful, she meant skinnier.

All of this worrying left little time for joy or relaxation. When she achieved a good grade, got a compliment from a friend or saw a lower number on the scale, her feeling of happiness lasted only a millisecond before she was back on the twisted and confounding path of worry.

The only way Ayla found relief was by cutting her arms or throwing up what little food was left in her system. The pain she experienced during these acts gave her a momentary feeling of relief. She also felt on some level that she deserved the pain, telling herself, “I am not a good person and I don’t deserve happiness.”

Through her Grade 9 and Grade 10 years, Ayla and I met regularly for therapy sessions. Our therapeutic relationship started off warmly and softly. My intention, as it is with all of my clients, was to create a safe and supportive atmosphere for her to feel free to share the thoughts and feelings that were hard for her to live with. I talked about my office and our relationship as being like a diary where, hopefully, she could share anything she needed to get out. By encouraging her to release the difficult stuff, and providing her with compassionate responses and suggestions for emotional wellness, my hope was that Ayla could start experiencing herself and her life in an empowered, gentle and healthy way.

Through our counselling sessions, we discussed how she could develop healthy ways to cope with the harsh human realities she was facing, such as her perfectionism, her anxiety and her self-criticism. We would talk about the battle in her mind—between her rooting-for-health self and the part of her that felt darker and weaker. We spoke about how one can’t eliminate feelings, but one can work lovingly and patiently to manage challenging feelings and thoughts in ways that make one feel strong and safe in the world.

We also used many creative activities that explored how Ayla could live more from her healthy, strong self while having empathy for the darker parts of her mind. I would also assign her counselling homework, like writing a daily log of all of the moments throughout the day that she felt peaceful, relaxed or happy. I asked her to make a note of what was going on at the time, and what she thought contributed to her positive feelings. I also assigned Ayla some books to read at home about body-image and self-compassion and then to report back to me the parts of the books that really resonated with her.

By the end of Grade 10, Ayla had stopped using cutting and purging to feel better when she felt overwhelmed or when anxiety or sadness kicked in. She found new, healthier ways of caring for herself during those rough moments. For example, instead of rushing off to the washroom to self-injure or purge, Ayla would choose instead to go for a walk in nature or listen to music. She also discovered that she could use her sensitivity and empathy to be “the counsellor” for her friends, a skill that made her feel strong and confident and useful. Through our therapy sessions and her own reflections, she learned how to experience her difficult negative emotions without running away from them or feeling consumed by them. She learned it was okay to be an emotional person, even an anxious one or an imperfect one, without hating herself or feeling she had to present a false happiness to the outside world.

I can relate to Ayla. When I was in my young teenage years, I had an eating disorder that stemmed from being highly sensitive and not having the right skills (as many don’t!) to cope in a healthy way with difficult thoughts and overwhelming emotions. By the time I was an adult, I had become passionate about my own overall health—I believe our mental, emotional, physical and spiritual health are all interconnected—and about helping others with theirs. I am grateful to have been a witness to Ayla on her journey of developing greater self-knowledge and, over time, a deep desire to choose self-compassion and take loving care of her precious being.

Psychological issues usually arise from a complex set of factors. In Ayla’s case, I believe what she needed most was a space for all of her feelings and thoughts to breathe, to be heard, to be validated and tended to in a way that made her feel comforted—and from this, to begin developing greater self-knowledge. She also needed to trust her inner voice when it encouraged her to make healthy and empowering choices, while having empathy for that part of her that wanted to be self-destructive.

While Ayla responded to this sort of therapy, other youth who are self-harming may benefit from attending therapy groups with other young people who face similar issues, reading about the subject matter or accessing online resources. A particularly good online mental health resource for young people is www.keltymentalhealth.ca.

If you are concerned that a young person in your life is self-harming, please encourage the individual to talk to his or her school counsellor, or help the youth get in touch with a counsellor online at www.youthinbc.com.

*pseudonym

 
About the author

Nicole is a school counsellor and a registered clinical counsellor in Vancouver, BC. She believes that creativity and movement are important components of well-being. Currently, Nicole is playing with the uncertainty and complexity of life with more fierceness than fear, enjoying lightheartedness and humour and continuing her practice of self-compassion

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