Sunday, December 09, 2012

Ruta Mazelis on the Experience of Self Inflicted Violence

This past week we held our annual Day of Learning and Sharing for Risking Connectionsâ trainers. My colleague Steve Brown gets credit for both the vision and the implementation of this event, which offers in-depth training on an important topic in trauma treatment. This is one of our most excellent achievements. The warmth in the room is obvious, as the community of trainers greet old friends and catch up on the latest events. This is a group of the clinical leaders in Connecticut, all of whom have attended Risking Connection training and an additional three days to become trainers. They have also attended Consult Groups and Recertifications to keep their knowledge current. They are seeped in a trauma-informed approach to their clients. They are our partners in changing the world.

This year our guest speaker was Ruta Mazelis. Ruta is a popular speaker and trainer who presents nationally on behalf of Sidran on issues surrounding self-inflicted violence, trauma, and trauma informed care. She frequently consults to SAMHSA's Center for Mental Health Services on topics related to trauma, including trauma-informed care, co-occurring disorders, re-traumatization in systems of care, self-injury, and criminal-justice involved survivors. She provided extensive technical assistance to the SAMHSA Women, Co-occurring Disorders and Violence Study, served as a program manager for the National Center for Trauma Informed Care, and is currently on the board of the National Trauma Consortium. Ms. Mazelis, herself a trauma survivor, has worked as a substance abuse and mental health care provider in inpatient and outpatient settings. She is the editor of The Cutting Edge newsletter which she founded in 1990, and edits the web site,, and she has published numerous books.

Ruta immediately sensed the skill and knowledge in the room, and realized that she did not have to teach this audience the basics about trauma. Instead, she used her personal experience to instruct us about the realities of being a trauma survivor who relies on self-inflicted violence to deal with unbearable pain.
I hope to write more about this training in a later blog. In this post I would like to convey some points that Ruta emphasized: The first is that self injury is not a distinct and uniquely horrible or dangerous symptom. It is just one more way people have found to deal with the unbearable pain that has been part of their lives. She emphasized that we all self harm, and that for all of us it is a method of coping with pain. It is adaptive, as are addiction, aggression, eating disorders, smoking, running away, sleeping all the time. It is actually not the most dangerous thing that many trauma survivors do. The long term harm to the body is considerably less than say alcoholism. Or smoking. It is not illegal, it can be kept hidden, and it does not hurt others. Ruta told us that she has learned from her newsletter that self-inflicted violence is part of the lives of people of all ages, sexes, socio-economic groups, professions, and statuses. She has known many treatment professionals who use this technique to manage their lives.

I was once again struck by the ways that the pressure to achieve change can so often interfere with change. Self harm is adaptive. The trauma survivor will stop doing it when they no longer need it. Therefore, if we immediately jump to methods to eliminate the self harm we are not respecting the survivor’s experience. If we start talking about replacement behaviors (writing on one’s self with red pen), it may seem naïve or insensitive to the client. If writing with red pen would accomplish what I need, I would have done that long ago. It may seem disrespectful: I am not interested in how you came to do this or what it means, I just want you to stop. Ruta said repeatedly that most trauma survivors stop self inflicted violence when they work on the trauma, are no longer in desperate pain, and do not need it any more.
This is such a hard stance to maintain with all the pressures surrounding us, both from our colleagues, from those outside our agencies who monitor our performance, sometimes from the client’s family, and certainly from inside ourselves. It is extraordinarily difficult to stay with such a painful symptom.

So all we have to do is work on the trauma. What exactly does that mean? And particularly what does it mean for those of our children (most) who are far from being ready to talk about the events in their lives? As Ruta presented it, it does not just mean teaching coping skills. It means interacting with the child at every possible moment from the understanding that their behavior comes from fear, shame and despair and is adaptive. If a treater expresses that conviction repeatedly the client may gradually question their own self blame. It means creating a safe enough space that the client can relax, play and sleep. It means engaging in rhythmic rewarding activities with engaged adults to begin rebuilding the brain and reshaping early templates of relationships. Most of all it means love and compassion, for the client, ourselves and each other.
So that’s all we have to do. And gradually the self inflicted violence will fade, along with the other extreme symptoms, as the client moves forward to a life worth living.

Ruta was intense, real, passionate, and at times uncomfortable. Just what we all need to counteract all the push towards shorter, more practical, symptom reduction quick fixes. Thank you Ruta for a reminder of the profound depth of the work we do.

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