Thread by @TaniaAMarshall

Therapist Thread 🧵 The difficulty in treating 'self-hatred'. BPD, other PD's, autism, aspergers, gender dysphoric clients who often present with extreme self-hatred. They have a great need to avoid their subjective internal experience or deflect it with external anger of hatred

They may be there in therapy but emotionally avoid, highly dissociate &/ or use drugs & alcohol, are hostile ("I hate all people", "no-one can help me", Shame- prone, isn't regular with appointments, never had a role model that cared for them in their life #therapy #hatredofself

Patients who attack themselves verbally or other is distressing for the #therapist The client has often hidden the level of self hatred they have. They have adapted in ways to hide this from themselves & others. Some feel they are punished by fate or karma. Some can't show how

Repulsive they are. Ignoring it also doesn't work. These methods do not work #Autistic and PD &/or traumatised or sexually assaulted clients often have enormous self hatred, even if you can't 'see' it or it is not mentioned. Self-hatred is unbearable. Often they will look in the

Mirror and see something disgusting, even if they're good looking (common in BPD & gender Dysphoria). Long term therapy is often needed. Self hatred is disliking your body, can have good self-esteem, articulate, can be engaging, may not show obvious signs of shame & guilt, may be

Affect-wise & body language wise. They believe that they deserve hatred, should be punished. Melanie Klein discussed persecutors object as a harsh critic that torments the 'self' in 1935. Now a lot of evidence of chronic early rejective, attachment issues, rejection social issues

Existential shame, Shame is very unpleasant. Triggers are being excluded, causing physical & emotional Shane & collapse & hide. Shame is I am personally wrong. Guilt is I did something wrong . Shame is I am wrong, averting the eyes (you can't see my disgusting self & I can't

See your dislike). Shame is self hatred. How do we deal with shame? We withdraw from there, ourselves, disconnection, #disassociation, attack others, use drugs & alcohol, use violence. They may attack themselves by self harm, suicide, negative self-talk. #negative #mindset #DID

Self hate is caused by chronic attachment or neglect. Not being seen or recognised for who you are, being deposed or rejected causes repeated failures & normal health needs for connection are fused to a shameful horrible #self #mentalhealth

Grown up selves hate selves for feeling needy, vulnerable & weak. Adding sexual assault is particularly #toxic situation. How do we help? The patient can't bear themselves, so watch out for 'countertransference'. The therapist can gently & unconsciously find themselves aware of

Little things to despise them Unknowingly. If we are out of time with them, they experience a rupture, further shame & further self-hate. Ignoring the self hatred is not recommended. That's pretend therapy. Secondary issues: discussing shame is shameful & fearful #goeasy

Of being 'flooded' with shame. Attachment trauma is incomplete or fragmented memory or #dissociation of alcohol gets in the way or DID gets in the way of a cohesive self. A BPD narrative is chaotic. To feel inhumane is unbearable, inferior & thus attack therapist. They fear

rejection & Non- recognition, may not get the intensity of it as they describe is less vividly. Some feel the poison will spread to the therapist. Chronic relational shame needs a warm non judgemental recognition & curiosity & love, repeated experiences of non judgement &

Recognition. Response to their authentic internal experience & continual authentic connection. Be aware of disconnections, dysfunctions, disruptions. No colluding with hiding the hate or shame. Also can't force it out to the light. Gaze aversion hunching soft voice (masking)

silence, avoiding subjects, Intellectualising, attacking therapist, adaptation so don't look ashamed so therapist has to guess. Create a space where safety is allowed for them. It is not easy as a lot is hidden. These can be signs of social camouflaging in #autism

Therapists need to be slow in approaching shameful parts &not early on in therapy. Look for what is hidden. Screen them for Autism & social camouflaging. They need their diagnosis, if appropriate.

Be aware of subtle dysfunctions, what is hidden, encourage but don't push, invite exploration & or repair, psycho education of shame (careful here), no big positive big words (they cannot handle it). Mindfulness can be tricky without a sense of self, common in Autism/BPD/trauma

They will go to their self loathing. Try attention focused or guided meditation. Be careful. ACT (diffusion), narrative (externalising) is useful. Self compassion therapy and somatic work can be helpful. Remember teens, PD, BPD, #autism #ADHD #genderdysphoria #trauma #abused

have shame. Especially if they have been late diagnosed, have a history of being bullied, trauma, FOO issues, developmental trauma. A comprehensive assessment & diagnoses are. Must, as is therapy before any medicalisation, drugs or surgery. Internalised shame or self hatred can

Be the Cause of suicide. Developmental conditions, trauma, shame, guilt & self hatred must be addressed first. Autistic #aspergers clients need modified therapies as typical ones are ineffective. Growing up undiagnosed can cause enormous self hatred, shame & guilt. This MUST be

Addressed in the first instance by the appropriate regular long term therapy and experienced trained therapist. END/ #autism #aspergers #ADHD #hatred #shame #guilt #anger #violence #noself #nocoreself #trauma #therapy #psychology

Thank you @PeterFHyatt