Date: October 12, 4:00 PM.

General topics discussed:

• Relationship with parents

• Self-harm

• Suicide/death

• Past worries/fears

• New job

Amy was more responsive this week than most. In general was willing to discuss matters at length, with accurate descriptions of events/feelings etc. Certain topics are still off-limits, including the circumstances surrounding the onset of her depression. She still struggles at times to verbalize thoughts:

”The words never come out right. I can’t ever say what I actually mean.”

She spends a significant amount of time thinking before speaking, although parent-relationship topics appear to frustrate her, and as such is prone to rapid, defensive responses.

Amy brought up the relationship between her and her father spontaneously at the start of the session. She described an incident in which her father got angry when she questioned him about doing the dishes:

“Some shit about money and how he works all day.”

Said her father’s response was to ‘get drunk’. She has referred to her father’s drinking on numerous occasions, but signs do not implicate alcohol dependence. Alcohol may be a coping mechanism.

She also expressed a reference to sex, which is extremely unusual for Amy:

“Then he fucked mom.”

She appears to be extremely sensitive about this topic, although this is not unusual for teenagers her age. Her phrasing and tonality were extremely negative, but it is unclear whether this is in relation to the act of intercourse itself or the general anger she feels toward her father.

She has referenced a ‘distance’ between her and her father on several occasions. The repetition of this topic suggests that there is a desire for closeness that she is not receiving. Her father appears to have been emotionally distant for most of her life. Possibility: Amy was an unplanned pregnancy?

We spoke at length about death and suicide. She initially described a state of being she refers to as ‘numbness’. She finds a lack of emotion/sensation to be comforting. This was brought up reference to self-harm, which she is continuing to do. She claims that she does not self-harm for any sensation of pain, but instead to ‘see the blood’. She appears to find the sight of blood emotionally releasing. There is a strong sense of shedding negativity.

Bring up leech metaphor if appropriate.

Amy likened her numbness to being in a grave. She seems to find a sense of protection, of safety in this state. However, this led to the first roadblock of today’s session: probing about this sensation of safety triggered a shutdown with regard to perceived threats.

It is possible Amy sees death as a place that is safe. However, at the moment the risk of completed suicide is not high:

“I want to be dead, but I don’t want to die.”

For the moment this ideation seems to suffice. She referenced contemplating multiple scenarios of death, though most seem to be taken from the canon of ‘urban myths’, including cyanide poisoning and injecting air into the venous system. She also suggested wrist-cutting, though it does not appear that she has done any significant research into effective methods. This is something to monitor closely over the next few weeks. […]

Read the full chapter here.