Chapter Twenty-One:  S.A.F.E. Alternatives

Saturday December 1, 2012

“Here we are,” Blaine said as he pulled into a parking spot outside the CenterPointe Hospital in St. Charles, Missouri.

Kurt remained silent. The hospital seemed to loom up above them. He was sure inside it was just like any other hospital:  white walls, tile floors, the scent of cleaning solution and illness. But this hospital was not like any other in the country. This hospital housed the first program centered on treatment for self-injurious behavior. This hospital would be Kurt’s home for the next thirty days as he would take up residency in the adolescent ward.

“This is it,” Blaine said, reaching over the console to squeeze Kurt’s hand.

“There’s no going back, is there?” Kurt asked with a sigh.

“Would you want to?” Blaine asked, already knowing the answer.

“No. I want to get better. I’m going to get better. I’ve been mentally . . . bad before but never this bad and . . . and I won’t be this bad again,” Kurt said. His voice missed conviction but Blaine knew he meant every word.

“I’m proud of you,” Blaine said.

Kurt blushed, looking down at their hands.

“No, really, I am,” Blaine insisted. He put a finger under Kurt’s chin, raising his head until their eyes met.

Well you can't eat, can't sleep down on the floor

Cause you never fell this hard before.

Now there's nothing in this world you want more than to be free.

And you're lost somewhere you swore you'd never go;

And the way back looks like a dead end road.

But with one step, one breath, one smile at a time.

Kurt’s eyes were brimmed with tears but they had yet to fall. Blaine climbed out of the car, coming over to Kurt’s side. He opened the door for his fiancé, letting him take his own time to leave the safety of the car.

Let me get you out of here!

Wipe away all your tears.

Now you're safe in these arms of mine.

I won't ever let you down!

Your heart will start to come around.

We're gonna change your life

One sunrise at a time.

Blaine held Kurt’s hand, leading him to the back of the rental car. He grabbed the single suitcase from the back of the car while Kurt handled his toiletries bag. Blaine had known Kurt was going to protest when they found out he was only allowed 6 outfits due to the available laundry facilities (which led to yet another protestation). But somehow Kurt had picked out six outfits, including accessories though it had been recommended against in the pamphlets, and fit them in a single suitcase with a stationary kit, his iPod, several folders with writing utensils and paper, and a copy of the book used by the program entitled Bodily Harm.

Well, you can't get rid of all his lies;

Thinkin' 'bout him all the time.

Can I be the reason you've got nothin' on your mind?

Blaine closed the trunk of the car. Adjusting his grasp on the suitcase, he turned to Kurt. Only when Kurt was ready did they begin their slow trek across the hospital parking lot.

Oh, let me get you out of here!

Wipe away all your tears.

Now you're safe in these arms of mine.

I won't ever let you down!

Your heart will start to come around.

We're gonna change your life

One sunrise at a time.

Inside the hospital lobby everything was as expected. Blue had been the chosen color for the décor and Kurt could not find fault with the choice. He allowed Blaine to lead him to the elevator, using his new surroundings as a distraction technique.

Let me hold you tight

All through the night

Till you awake;

Till all this pain

Is gone with yesterday

Gone with yesterday!

Oh, let me get you out of here.

Inside the elevator was quiet except for Blaine’s voice as he continued to sing. The elevator rose too quickly for Kurt’s liking and before he was ready Blaine was urging him to step out onto the floor where he would reside for the next thirty days.

Oh, I won't ever let you down!

Your heart will start to come around.

We're gonna change your life

One sunrise at a time.

Oh, one sunrise

At a time.

Blaine led Kurt over to a desk and informed the young nurse that they were there to admit Kurt Hummel for the thirty day intensive adolescent program. She typed into the computer, asking them to wait a moment while she disappeared into the back. When she returned there was a short red-haired lady with her. She appeared to be middle-aged and had a kind face.

“Hello, I’m Ruth Stroble, the head nurse on the unit. Which one of you is Kurt Hummel?” she asked with a friendly smile.

“I am,” Kurt said softly, his heart racing with fear.

“And I’m Blaine Anderson, his fiancé,” Blaine introduced himself.

Ruth shook their hands, continuing to smile at the pair. Kurt watched as a nurse took his bags from him. He opened his mouth to protest but shut it quickly.

“I’m glad you could be with us today, Blaine. I know your presence will make the transition easier for Kurt. Now if you two could come with me we will get down to business,” Ruth said.

She led the two into her office, shutting the door behind her. Situated behind her desk, Ruth’s countenance turned serious. Kurt and Blaine sat opposite her, their hands still tightly clasped.

“Now, Kurt, when we spoke over the phone we asked for you to bring your birth certificate, immunization records, your medications, and the records of your current treatment for your injured arm. Did you bring those things?” Kurt nodded. “Good. We will have to administer a TB test but that will be over very quickly. Here’s Lara to do it now.” A young brunette woman stepped into the room with the necessities to administer a tuberculosis test. “Kurt, this is Lara Thorp. She’s a nurse here and will be helping to take care of you during your stay. Lara, this is Kurt and his fiancé Blaine.”

Lara smiled politely. Kurt did his best to ignore her while she pressed the needle into his skin but he had never been a fan of needles. Once Lara left, Ruth continued on.

“Okay, Kurt, let’s see what we have here,” Ruth said leafing through some papers before her. “Let’s begin with the S.A.F.E. Questionnaire. You completed this before your arrival but I want you to check that everything is correct.”

Kurt looked at the paper she handed him. There was a list of questions, each of which Kurt had answered in Andrew’s office the week before. He read through it quickly:

SECTION ONE

1. I was often told as a child to be strong.

[X]True [ ]False

2. I do not remember much affection being displayed in my family.

[ ]True [X]False

3. Anger was the feeling most often displayed in my family.

[ ]True [X]False

4. I rarely felt I could express my feelings to my family.

[ ]True [X]False

5. As a child I remember my mother and/or father as overly intrusive.

[ ]True [X]False

6. As a child I remember being sexually abused.

[ ]True [X]False

7. As a child I remember being physically abused.

[ ]True [X]False

8. As a child I remember being emotionally abused.

[ ]True [X]False

9. As a child I remember my mother and/or father being emotionally absent.

[ ]True [X]False

10. I remember times when I was punished for strong feelings, such as when I was angry or upset and in tears about something.

[ ]True [X]False

11. When I was upset or frightened, my mother and/or father often ignored me.

[ ]True [X]False

12. I grew up in a very religious household.

[ ]True [X]False

13. I had a parent who was unable to raise me due to a physical illness or trauma.

[X]True [ ]False

14. I grew up with a lot of double messages.

[ ]True [X]False

SECTION TWO

15. I often think of myself as a "bad" person.

[X]True [ ]False

16. I often believe that I'm at fault for everything that goes wrong.

[X]True [ ]False

17. I often think that everyone would be happier if I were dead.

[ ]True [X]False

18. I often believe that negative attention is better than no attention.

[ ]True [X]False

19. I hate change.

[X]True [ ]False

20. I seem to have an all-or-nothing attitude.

[X]True [ ]False

21. I usually can't find words that explain how I feel.

[X]True [ ]False

22. I don't have many friends.

[X]True [ ]False

23. I am a perfectionist.

[X]True [ ]False

24. I think I am a burden to others.

[X]True [ ]False

25. I do not want to die; I just want to stop my emotional pain.

[X]True [ ]False

26. I get scared when I get close to anyone.

[X]True [ ]False

27. I could never intentionally harm anyone else.

[X]True [ ]False

28. I do not know how to get attention in positive ways.

[ ]True [X]False

29. Some people think I am childlike.

[ ]True [X]False

30. I am:

[ ]heterosexual [X]homosexual [ ]bisexual [ ]unsure

Questions for females only

31. I hate my periods.

[ ]True [ ]False

32. I strongly hate having a pelvic exam.

[ ]True [ ]False

33. I would be better off without a vagina.

[ ]True [ ]False

34. I am jealous of men.

[ ]True [ ]False

Questions for males only

35. I hate my genital organs.

[ ]True [X]False

36. I would be better off without my genitals.

[ ]True [X]False

37. I am jealous of women.

[ ]True [X]False

38. I wish I were a woman.

[ ]True [X]False

SECTION THREE

39. I have had elective plastic surgery more than once.

[ ]True [X]False

40. I have had plastic surgery against the advice of a doctor.

[ ]True [X]False

41. My friends and family have become concerned about my body piercing.

[ ]True [X]False

42. I have decided to continue piercing despite the fact that one or more significant others have told me that they are repulsed by it.

[ ]True [X]False

43. I find that when I tattoo or pierce, I feel different afterward - I get a rush, or I feel like I'm much calmer than before the session, or I feel sexually aroused.

[ ]True [X]False

44. I become anxious when anyone tries to stop me or prevent me from getting a new piercing.

[ ]True [X]False

45. I have problems with drugs or alcohol.

[ ]True [X]False

46. I have exercised to the point that I have become sick or injured.

[X]True [ ]False

47. I have sometimes neglected to seek medical attention for an illness or injury when part of me knows I should have.

[X]True [ ]False

48. I have an eating disorder, or have had one sometime in the past.

[X]True [ ]False

49. My doctor has told me I am underweight, but I would still really like to lose a few more pounds.

[X]True [ ]False

50. I am secretly delighted when I can avoid eating a meal.

[X]True [ ]False

51. I have stolen things.

[X]True [ ]False

52. I have - or have had - a tendency to be promiscuous.

[ ]True [X]False

53. I have overdosed on drugs.

[ ]True [X]False

SECTION FOUR

54. I often obsess about self-injury.

[X]True [ ]False

55. I sometimes can't explain where my injuries come from.

[ ]True [X]False

56. I get anxious when my wounds start to heal.

[ ]True [X]False

57. I often believe that if I don't self-injure, I'll go "crazy."

[X]True [ ]False

58. No one can hurt me more than I can hurt myself.

[X]True [ ]False

59. I can't imagine life without self-injury.

[X]True [ ]False

60. If I stop self-injuring, my parents win.

[ ]True [X]False

61. I often believe that if I don't self-injure, I'll explode.

[X]True [ ]False

62. I almost always carry something with me that I can use to self-harm.

[X]True [ ]False

63. I often self-injure as a way to punish myself.

[ ]True [X]False

64. I often self-injure to show others how bad I feel.

[X]True [ ]False

65. Self-injury helps me feel in control.

[X]True [ ]False

66. I have carved words or symbols into my flesh.

[ ]True [X]False

67. I have used self-injury to control others.

[ ]True [X]False

68. The sight of my blood comforts me.

[X]True [ ]False

69. Self-injury helps me feel "real" again.

[X]True [ ]False

70. Self-injury helps me control my mind when it's racing.

[X]True [ ]False

71. Self-injury helps me feel relaxed.

[X]True [ ]False

72. Self-injury helps me feel less lonely.

[X]True [ ]False

73. Self-injury helps me feel less depressed.

[X]True [ ]False

74. Self-injury is my best friend.

[X]True [ ]False

75. The first time that I self-injured, I didn't let anyone know.

[X]True [ ]False

76. I have self-injured:

[ ]Only once [ ]2-5 times [ ]6-10 times [ ]11-20 times [ ]21-50 times [X]More than 50 times

77. My decision to self-injure is usually made (check all that apply):

[X]On the spur of the moment [X]An hour before [X]Several hours before [ ]A day before [ ]A week before [ ]More than a week before

78. I often have a regular routine I follow when I self-injure.

[X]True [ ]False

79. Immediately after I self-injure, I usually feel:

[X]Better [ ]No change [ ]Worse

80. The amount of pain I feel when I self-injure is usually:

[ ]None [ ]A little [X]A moderate amount [ ]A great deal

81. I have lost relationships because of my self-injury.

[ ]True [X]False

82. I am unable to hold down a job because of my self-injury.

[ ]True [X]False

83. I have at times missed school because of my self-injury.

[X]True [ ]False

84. I like the attention I get from people when they find out that I have physically harmed myself.

[ ]True [X]False

85. List the ways in which you have harmed yourself. List them in order in which you most often harmed yourself, e.g., 1. Cutting, 2. Burning, etc.

1) cutting 2) limiting food 3) burning

86. When did you last harm yourself?

[ ]Within the past week [X]Past month [ ]Past six months [ ]Past year [ ]More than a year ago

87. My self-harm helps me atone for my sins.

[ ]True [X]False

88. Sometimes my self-harm puts me in closer contact with God.

[ ]True [X]False

89. I consider my tendency to self-harm an addiction.

[X]True [ ]False

90. Many times I harm myself more out of habit than for any specific reason.

[X]True [ ]False

“It’s correct,” Kurt said, pushing the paper back across the desk to Ruth.

“Good,” Ruth said, filing the paper away. “Now let’s talk about the No-Harm Contract. You are required to sign this before we can admit you.”

Kurt read the paper over carefully, only pausing briefly before he signed it.

As a candidate for the S.A.F.E. Alternatives program, I recognize that self-injury interferes with all aspects of my life. I am committed to treatment of my problem and to stopping all self-injurious behavior. I am aware of and agree to the following guidelines for my treatment:

1. No self-damaging or property-damaging behavior throughout my hospital stay. Failure to comply will lead to dismissal from the S.A.F.E. Alternatives program.
2. If I have a concurrent eating disorder, I agree to follow treatment recommendations to address this problem. I understand that failure to comply may lead to dismissal from the S.A.F.E. Alternatives program.
3. Sexual contact with others, physical threats, assaultive behavior, stealing, use of nonprescription drugs, or use of alcohol may lead to dismissal from the S.A.F.E. Alternatives program.
4. Elopement will automatically lead to discharge from the S.A.F.E. Alternatives program.

Kurt passed the paper back to Ruth who signed it as a witness and added it to his file.

“Next is the impulse control log,” Ruth said. “This helps us pinpoint where the impulse to self-mutilate comes from. Whenever you feel the urge to hurt yourself, in any way, we require you to write down your thoughts and feelings associated with the particular urge and whether or not you go through with the act.

“With that comes the Five Alternatives. We ask each patient to make a list of safe alternatives to self-harm. You are required to start with five but may add to it throughout your stay. Most patients do.

“Last are the writing assignments.  You will have four or five assignments a week that are aimed at helping your organize your thoughts and focus your energy in a safe and constructive manner. These assignments have no length requirement but they must be done. Then of course there is daily group therapy, one-on-one therapy, and visiting hours. Blaine, you may visit as often as you like for however long you like so long as Kurt completes what is required of him. We also offer family therapy sessions and individual sessions for you as well.

“Do you have any questions?” Ruth asked.

Kurt shook his head though a thousand different questions were running through his mind.

“I’m sure you will later and always feel free to ask. Now, I will show you to your room. You’ll be sharing a room with Tristan Yates. He’s a very nice boy. I’m sure you’ll get along fine.”

Kurt grasped Blaine’s hand even tighter as they exited the office. How was he going to survive a month in this place?