Child Colloquia: Cutting the Silence: Impulsive Cutting in Adolescents
by Sharon Karp-Lewis, PsyD, LCSW, Child Colloquium Committee
On November 9th 2013, Mary Brady, PhD, treated us to a compelling presentation on the subject of cutting, focusing on impulsive cutting before it becomes ritualized. After her initial talk, there was discussion of case material provided by Dawn Smith, PhD. More than 40 clinicians attended Saturday morning to learn more about treating teens with the disturbing symptom of physically acting upon their body.
Dr. Brady began her presentation by discussing “cutting” as a failure in symbolization that can evoke explosive feelings in the therapist. She quoted André Green, MD, who talked about cutting as a form of communication. Green concluded that a facilitating environment such as the therapist and the setting are necessary to provide the missing thought and metabolized interpretation essential to give meaning to the often impulsive action of cutting by a patient on their skin. Finding words to express the psychic pain of the patient is difficult, a task poignantly illustrated by Dr. Smith in a case of a teen that was often non-verbal during clinical hours. The audience was empathic and thoughtful about Dr. Smith’s therapeutic challenge to contain the unstated thoughts and affects of the patient, as well as Dr. Smith’s ability