MinnieMeth and Carrie the Cutter

MinnieMeth and Karrie the Cutter
     I have a probation group that meets once a week. Plenty of the folks have drug offenses. I asked, “when are you weakest at staying straight?” One woman (let’s call her MinnieMeth) said, "when I'm really stressed out, I have a hard time not using meth". I commented, "amphetamines are not tranquilizers, they stimulants and would usually increase a person's anxiety. Why would you use an amphetamine-type drug when you are maximum stressed?” She responded, " I don’t know. I feel terrible and I just want to feel different".
           My first reaction was amazement: why would you indulge in something that is going to make you feel worse when you are already feeling bad? However, the more I thought about it, the more it made sense. Many of us do something to make us feel differently. The folks with poor coping skills do all sorts of strange things. My little teenagers threaten suicide, cut themselves, run away, go ballistic on social media, to name just a few. Adults with questionable problem solving skills may indulge/overindulge in the drug of their choice (obviously alcohol being the king of the hill), gulp a prescribed tranquilizer (Xanax, etc.), respond with inappropriate anger, and on and on. Although a little sad, they are all fairly common responses to unwanted emotional stressors. Is there a way to alter our responses when times are bad? Sometimes not, but often times, yes.
           Let’s jump to Carrie The Cutter (fake name obviously). At 15, she came in at the “request” of her mother. Medium student, recently quit the school band after a year, Dad’s a irresponsible divorced distant guy with a new wife who didn’t care for Karrie much. She has a younger brother and sister and lives with her Mom who works for a medium-poor wage. K was an over reactor to stresses. Unprepared for a test, boyfriend issues, criticism from her tense Mom were a few of the issues. She had recently been in inpatient treatment for a cutting incident. When I asked her what was the most important thing she learned from her very expensive inpatient treatment, she said, “Well....... that I never want to go back there again! There were some really messed up kids there. And other than groups meeting all the time, there wasn’t anything to do.” In other words, she didn’t learn a damn thing while she was there about self soothing, problem solving, or alternatives to cutting.
           It’s not a “trick” in therapy, but rather logical: I wanted to get a bird’s eye view of home. As I’m not going home with my clients, I asked her for a pictorial essay. I gave her some specific instructions: pictures of each one of their 11 dogs (*sigh*), a shot of each family member (preferably posed), her mom doing something like cooking, and an interesting shot of their home. I gave her a couple of photographic tips like shooting little people or animals on their eye level in order to increase the challenge (and quality of the photos). One effect of such an assignment is that it tells someone that what they do or say is important. My enthusiastic reception (and critique) of her work added to the positive nature of the assignment.
           The second assignment was to have her write down every issue she noticed and how she handled it. An example could be, “your mom comes home from work in a bad mood. She tells you she’s tired of picking up all your stuff and putting it away. Basically, it feels like she’s yelling at you for no reason. You go to your room, plug in your earbuds and cry. That is one example. You can also note some stuff that you have done that makes you feel better, like going outside and playing with the dogs. Give me a sentence about the problem and what you did. Do it every day there’s an issue and let’s review it.
     As this amounted to evil “homework”, I didn’t expect perfect compliance. I was wrong. She enthusiastically followed through, and couldn’t wait to share it with me. Although the next logical step would be to recommend keeping an informal journal (I keep a few cool blank books at the office), her Mom was so bent up, I felt like mommy dearest would sift through her private notes and screw things up. Thus, we kept it Karrie bringing me her writings, and we critiqued them together. After two or three of her assignments done, she got it: “You’re trying to show me there’s a reason for me feeling so bad, and I have a choice of what to do to make myself feel a little better.” She was correct. I reminded her this was a multi-year project, as we will face occasional tough times all our lives. And then she was gone. As always, there were no goodbyes. Counseling just ended by missing the last appointment. However, it seemed that this little cutter was armed with other ways to direct her sadness and anger.
   Although I disagree with the method of MinnieMeth, I have thought long and hard over her statement. Isn't that what we frequently do: feel something bad (irritation, boredom, sadness, etc.) and seek to feel something different? The question is, how many choices do we have other than smoking meth or cutting ourselves up? With (lots of) practice we can engage our brains in times of distress and intelligently “feel something different”.
   
 
John S. Sommer
Licensed Clinical Social Worker
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