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Therapist’s Notes & Specific Risk Reduction Techniques

This is Part 2, a further exploration of the personal safety checklist from the “Survivor to Thriver” manual.

I have not discussed my answers to the “Safety Checklist” (Part 1) in person with my therapist yet, as I was in crisis when we had it scheduled, and ended up shifting our session priorities. But she did make notes for me that I will share with you here.

Her notes inspired me to be more specific on each of my “YES” answers to the question, “How can I reduce these risks?” and I came up with the following lists.

1. Do you have impulses to harm yourself?

(No therapist’s notes)

Risk reduction techniques:

  • This question inspired my “Help NOW!” page which is a compilation of my favorite and most personally effective techniques. Here is a more complete list, starting with the most effective, for me, to the least:
    1. Good daily self-care – “Daily Maintenance Plan”
    2. Be aware of “Early Warning Signs” and take action when they come up
    3. Breathing exercises, meditation or visualization
    4. Call my therapist and/or make an appointment; regular therapy
    5. Call/Talk to somebody who will take me seriously and be compassionate
    6. Visit iSurvive and read other abuse survivor’s stories; post and share my story or thoughts at that moment
    7. Listen to music (with headphones that cover my ears, incense burning, cat on either side, in a comfortable bed with lots of pillows and blankets works best for me)
    8. Watch an uplifting movie. I recently found a mini-movie series on Hulu from Glamour, called “Reel Moments from Women in Film”. They are all inspirational and uplifting, some from a women’s viewpoint
    9. Play with pets or children
    10. Read something inspiring, or maybe a current book or magazine that is entertaining
    11. Take a nap, or if it is late, go to sleep. Reassess how I feel once I wake up
    12. Remember that perspective is everything, that there is always another viewpoint and that everything is a phase

    • 3. Do you easily feel overwhelmed by feelings, thoughts, memories or bodily sensations?

    My therapist notes:

    • What specific breathing exercises are helpful?
    • Journal or art session about what subjects are helpful to talk about?
    • Who is helpful to talk to? Do specific people increase your agitation?

    Risk reduction techniques:

    • 1-5 from previous list. This is a reoccurring theme. I think these techniques are almost universally helpful to establish a solid foundation, except maybe talking and therapy. Some people are not ready for these steps, or may never be comfortable with these steps. I am not a therapist, that is just my personal opinion. Of course 6-12 can also help.
    • Journaling – no specific topics are helpful for me (that I know of yet), unless I have a newly recovered memory. Then I find it helpful to write it out as fully as I can, and then quickly set it aside for awhile before I start to examine it. Upon re-reading these types of writings, I am usually able to remember even more detail. Specific ideas:
    • Artwork ideas:
      • Collage is one of my favorite art techniques for solving any problem
      • Circle pad from my therapist– she gave me an art-pad of paper with a circle on each page and told me to use it when i felt that something needed to be contained. To do this use one of the following ideas to express what you would like to ‘contain’:
        • Draw symbols or pictures of the issue
        • Use collage, cutting out pictures or symbols of the issue
        • Use words, filling the circle with free-writing about the issue
      • Scrapbooking timeline of your life. I don’t remember where this idea came from, but it is to make a timeline of the significant events in your life, using scrabbooking techniques
    • Talking to others about what is going on at the time, but only choose people who will take you seriously and show compassion.
      • My therapist’s note asked if certain people actually increase my agitation. I think this is because I often try to talk to my roommate/best friend, because to be honest, he is the only person I have to talk to besides my therapist. However, he often says the wrong things. His heart is in the right place, and I can tell he really wants to help, it is just the words he uses are dead wrong for me at the time. I think this sometimes did used to make the situation worse. However, it now lets me see his perspective and compare it to my own, which is more positive, which has actually made me feel better the last few times.

    5. Have you ever attempted suicide?

    (No therapist’s notes)

    The risk reduction techniques that I would use for this question are the same as for question number 1, “Do you have impulses to harm yourself?” and of course the “Help NOW!” page.

    6. Have you ever “lost time” or lost sense of being yourself?

    (No therapist’s notes)

    I believe that this is in my past, but that my continued therapy and self-help efforts will help to reduce any future risk.

    7. Do you use alcohol or drugs to excess?

    My therapist notes:

    • How much alcohol now?

    Risk reduction techniques:

    • I enjoy mojitos, and have about an 1/8th of bottle of rum left from when my brother visited me (otherwise I probably would never have purchased it). I am just not a drinker. However a few times I have thought about downing it when having a particularly bad flashback or panic attack. But even with this urge it has sat in my freezer for a few months now, untouched. So how much alcohol do I drink now – none
    • Any of the techniques from the question “Do you have impulses to harm yourself?”. I guess these are basic techniques that I use to calm myself
    • I have a lot of other resources and techniques that I will write about in future posts. A good book I recommend is “The Recovery Book” by Mooney, Eisenberg & Eisenberg. For now here is a short list:
      • See the Substance Abuse Links and Substance Abuse Downloads sections on the resource page
      • Certain items, such as drug paraphernalia, will remind you of when you used to engage of your drug of choice. Pack these items away, give them away, just get rid of them. Out of sight, out of mind, being the idea
      • It takes constant vigilance to neutralize the cues (things you see, hear, smell, taste, and feel) that trigger the craving to use
      • Changing “playmates, playgrounds, and playthings” is virtually indispensable to avoid using
      • You will be most susceptible to temptations of any kind when you are hungry, angry, lonely, or tired (HALT in AA) bored, sad, worried, nervous, or depressed; or physically unwell
      • So that the bad memories will remain forever an incentive to remain sober, capture them in words, pictures, or both
      • Be sure you are not alone and have support
      • Talk with others who are further along in the process than you are, or who have gone through it before you
      • Stop resisting and relax. Temporarily try to give up control
      • Make certain that you are in a calm and comfortable environment

    Releated Resources:

    My Monster
    My Monster Has A Name… actually many. This blog is a safe place for me to share my healing journey from childhood abuse. The topics covered are at times controversial, offensive, horrific, and hopefully sometimes inspiring. Thank you for sharing in my journey.

    Alternative Healing, Coping Skills & Tools, Diagnosis, Healing, PTSD, Resources, Self Injury, Substance Abuse, Suicide, Therapy