1. when despair and suicidal ideation are not at full blast and the troubled person may see things might be better tomorrow but sees no way of getting through the day without incurring more damage to his/her sense of well being.
2. when a troubled person in question has narrowly focused intense experience of what triggered his/her emotions, urges, ideations of various kinds, the person could care less about how permanent the damage is going to be on his/her body or life. just need a quick solution to get out of the jam that seems to suck the life out of the troubled person.
3. perfect opportunity: when clearly other coping mechanisms don’t seem to work (ones taught in group and individual therapy), the target action, the self destructive behavior which has never gotten itself taken off the roster comes in as a pinch hitter or a pinch runner if you will (using baseball terminology) to get the aggitated person out of an emotional/psychological/physical jam.
4. for more advanced mental health patients/clients – you know a full blown out od/mis-use of prescribed or over the counter meds would land you back in a psychiatric ward for a few days at the least, if not week or months. and you also know when you come out of the hospital, certainly more time has passed. no one promises you that things are going to be easier now after you put in some days in the hospital. no one makes that promise because fact of the matter is, things get harder before they get better. i don’t just mean there are more difficult obstacles to overcome. but also, whatever is going on, by choosing not to engage in target behavior you are choosing to take on the pain, anxiety and suffering that you were trying to avoid by engaging in self -destructive actions.
5. why should i give up what i have until you show me something better? here are skills i have learned in DBT group to self soothe which engages five senses in a positive way to bring positive feelings to be experienced. and there are also many other ways of reflecting what you are doing either by consciously pushing it away or actively picking up something that is unrelated to the crisis you are having. all good right? perfectly sound. except i’m picturing someone in extreme pain such that inflicting physical pain seems to be a better alternative, so what’s the idea here? walk up to him/her and hand over a soft silky scarf and ask them to touch it, feel it, smell it and see it with some kind of hope or promise of their pain alleviating somewhat?
on any given day, on a good day, sure i might be able to go for a walk, enjoy being in nature blah blah blah. but then on a bad day, fair enough, by practice one hopes to use these skills to feel better even slightly better. land when it doesn’t improve the suffering then what? the patient hasn’t practiced it well enough under less stressful conditions or maybe the skill in question is not one that works for him/her. but something ought to work.
and when all else fails, well, then we’re back to square one. go back to your old ways of coping, i.e., your target behaviors, until you find ones that are not as damaging can replace the target behaviors.
sucks to deal with psychiatric issues!