Humerah Miah is optimistic that a therapeutic
community programme can help to treat self-harming behaviour.
When I kept going in and out of psychiatric
hospitals as if caught in a revolving door, it soon became clear
that my self-harming behaviour could not be treated on an acute
ward or be adequately supported in the community.
Therefore in the process of considering other
options, which included long-term residential care, the idea of
going to a therapeutic community was mooted. My initial reaction
was “No Way”. I did not want to make a long-term commitment.
However, I was persuaded to go for an assessment and subsequently
offered a place on the Acorn Programme, at a Quaker hospital in
York called the Retreat.
The average length of stay is eight months.
The programme specialises in working with people with
self-defeating behaviour and adopts as its main approach
dialectical behaviour therapy (DBT). In a nutshell, this therapy is
a broad-based cognitive behavioural treatment programme focusing on
developing skills such as “mindfulness”, interpersonal
effectiveness, emotional regulation and distress tolerance.
The programme’s emphasis on taking
responsibility for yourself can sometimes be difficult when the
urge to self-harm is strong. There is a hectic weekly schedule with
group work, including psychotherapy, drama therapy and DBT skills
Each day is started with a community meeting,
where residents and staff talk about how they are feeling or any
other issues that are on their minds. The same process happens at
the end of the day. These meetings can be very supportive and
challenging, as everyone is expected to participate, and members of
the group can raise questions, make observations or comment on
things being said.
I self-harmed one day and, as I am accountable
to the group, I had to say what I had done. I was questioned on why
and how I had self-harmed. I also got a lot of support for thinking
of ways of avoiding self-harm and dealing with my urges in a more
effective way. Everyone is encouraged to deal with their distress
with the support of the group, rather than isolating themselves or
engaging in self-defeating behaviour.
Although the emphasis is on group activities,
there is time to have individual sessions with the consultants,
nurses or the dietician. Everyone has to keep a diary documenting
their self-defeating behaviour and the skills they have used to
overcome them. In addition to the diaries, if someone engages in
self-defeating behaviour they have to do a chain analysis examining
everything from the events leading up to it to the impact on others
For me it is early days on the programme, but
I am quietly optimistic that the approach adopted in this
therapeutic community will be worthwhile. It is not an easy place
to be; after just a fortnight I am finding it more challenging than
any of the other mental health services I have used. However, I am
committed to stopping my self-harm and building a life worth
living. Hopefully, from little acorns great things will grow.
Humerah Miah is a mental health