trichotillomania.
“Okay, Sylvia, you add that to the list as well.”
Sylvia added ‘HAIR’ and put it right at the top.
And so the session continued until there were seven items on the list.
“Now, Sylvia, we’ve almost come to the end of the first session and what I want you to do is to concentrate on the first problem: the hair pulling. What happens after you’ve pulled your hair?”
“I feel horrible and ugly and I cut myself.”
“Okay, and what do you think makes you pull your hair?”
“Being on my own.”
“Okay, so what about if I gave you some homework for next week so that you’re not on your own all the time? Let’s say that you go to the library for a couple of hours every day to read where you’ll be with other people but you won’t have to talk to them. Do you think you could do that?”
“I’ll try,” said Sylvia, looking up for the first time in the session.
“Good,” said Emma. “So, I’ll see you next week; same time, same place. By the way, that’s a nice bag you’ve got there; it’s an unusual colour.”
“Yes, I’ve had it for ages. It reminds me of being in a field with buttercups and feeling safe.”
Emma showed Sylvia out. She took a deep breath and decided that she was glad she wasn’t doing CBT full time; that first session really was like getting blood out of a stone. It was also just too close for comfort, although Emma’s self-harming happened very rarely these days. She thought about the lemon bag and the ‘feeling safe’ and came to the conclusion that there was still a lot more of the iceberg beneath the surface. And it was a shame you can’t do something about toxic parenting or fathers who stray from the marital bed at night.
October 1993
Sylvia seemed to be making progress despite Emma’s relative inexperience in CBT. Emma’s supervisor thought she’d hit the nail on the head with the observation about the yellow bag but agreed that diving into the depths of what that meant shouldn’t be hurried.
“Come on in, Sylvia,” said Emma.
Sylvia sat down. Unfortunately she’d reverted to wearing the same purple dress that she had on for the first session six weeks ago. And the canary yellow bag was still a constant fixture and fitting. Emma started to fantasise about what it might contain. And Sylvia seemed to have lost weight.
“Okay, Sylvia, let’s review what we did last time and the homework I set you.”
Emma heard silence. Sylvia made no eye contact and her head was hanging low. She’d taken several steps backward, by all appearances.
“How are you feeling today, Emma?”
No response.
“I see that you’ve got that nice purple dress on again; does that mean something special for you, Sylvia?”
No response.
“You know what, Sylvia, I’m just going to pop out to get both of us a glass of water and I’ll be back in a jiffy.”
Emma went out to get some water. On her way back she checked through the one-way glass in the door to see whether Sylvia had changed in her posture; she hadn’t. By this point, Emma was getting concerned that her client had become virtually catatonic, which was way outside her comfort zone as a pain physician in training.
Emma went back in and offered Sylvia the water; she reluctantly accepted the cup, and then, slowly and very bizarrely, poured the contents over her head.
Emma bent down and briefly caught a look at Sylvia’s eyes through the dripping curtain of her hair. Emma took a sudden step back and knew that the answer was in that canary yellow bag after all. Sylvia’s SOS message was flashing yellow, white, red…yellow, white, red…
“Sylvia, I think I know now that the answer is in your bag. Is it alright if I take a look?”
Sylvia let the bag slip out of her hands and Emma opened it. Inside she saw something crumpled and white. She carefully removed it and discovered a child’s white dress covered with grotesque splodges of something which she
“Okay, Sylvia, you add that to the list as well.”
Sylvia added ‘HAIR’ and put it right at the top.
And so the session continued until there were seven items on the list.
“Now, Sylvia, we’ve almost come to the end of the first session and what I want you to do is to concentrate on the first problem: the hair pulling. What happens after you’ve pulled your hair?”
“I feel horrible and ugly and I cut myself.”
“Okay, and what do you think makes you pull your hair?”
“Being on my own.”
“Okay, so what about if I gave you some homework for next week so that you’re not on your own all the time? Let’s say that you go to the library for a couple of hours every day to read where you’ll be with other people but you won’t have to talk to them. Do you think you could do that?”
“I’ll try,” said Sylvia, looking up for the first time in the session.
“Good,” said Emma. “So, I’ll see you next week; same time, same place. By the way, that’s a nice bag you’ve got there; it’s an unusual colour.”
“Yes, I’ve had it for ages. It reminds me of being in a field with buttercups and feeling safe.”
Emma showed Sylvia out. She took a deep breath and decided that she was glad she wasn’t doing CBT full time; that first session really was like getting blood out of a stone. It was also just too close for comfort, although Emma’s self-harming happened very rarely these days. She thought about the lemon bag and the ‘feeling safe’ and came to the conclusion that there was still a lot more of the iceberg beneath the surface. And it was a shame you can’t do something about toxic parenting or fathers who stray from the marital bed at night.
October 1993
Sylvia seemed to be making progress despite Emma’s relative inexperience in CBT. Emma’s supervisor thought she’d hit the nail on the head with the observation about the yellow bag but agreed that diving into the depths of what that meant shouldn’t be hurried.
“Come on in, Sylvia,” said Emma.
Sylvia sat down. Unfortunately she’d reverted to wearing the same purple dress that she had on for the first session six weeks ago. And the canary yellow bag was still a constant fixture and fitting. Emma started to fantasise about what it might contain. And Sylvia seemed to have lost weight.
“Okay, Sylvia, let’s review what we did last time and the homework I set you.”
Emma heard silence. Sylvia made no eye contact and her head was hanging low. She’d taken several steps backward, by all appearances.
“How are you feeling today, Emma?”
No response.
“I see that you’ve got that nice purple dress on again; does that mean something special for you, Sylvia?”
No response.
“You know what, Sylvia, I’m just going to pop out to get both of us a glass of water and I’ll be back in a jiffy.”
Emma went out to get some water. On her way back she checked through the one-way glass in the door to see whether Sylvia had changed in her posture; she hadn’t. By this point, Emma was getting concerned that her client had become virtually catatonic, which was way outside her comfort zone as a pain physician in training.
Emma went back in and offered Sylvia the water; she reluctantly accepted the cup, and then, slowly and very bizarrely, poured the contents over her head.
Emma bent down and briefly caught a look at Sylvia’s eyes through the dripping curtain of her hair. Emma took a sudden step back and knew that the answer was in that canary yellow bag after all. Sylvia’s SOS message was flashing yellow, white, red…yellow, white, red…
“Sylvia, I think I know now that the answer is in your bag. Is it alright if I take a look?”
Sylvia let the bag slip out of her hands and Emma opened it. Inside she saw something crumpled and white. She carefully removed it and discovered a child’s white dress covered with grotesque splodges of something which she
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