Sitting in her bedroom, Mary looks at her reflection in the mirror, "I hate myself," she thinks. Mascara is smeared down her cheeks, her top is ripped to reveal her left shoulder, and her hair is in a massive, jumbled, matted mess. "I really hate myself," she repeats to herself.
This was not the case last night. Last night Mary was high. She was prepping for a binge. Mary knows the routine, a highly meticulous and ritualized process: Put on loud music; smoke cigarettes; shave legs; mousse hair; apply lipstick; dress in black mini-skirt, stiletto heels, and low-cut top; and, of course, buy condoms.
"I just wanted to screw my brains out," Mary says. "I was on a rampage, a regular screw fest," she continues with more intensity in her voice.
"What triggered this binge?" I ask.
"I have no idea," she says, shrugging her shoulders.
"Well, it's important that we figure that out."
"Well, you tell me then." she says.
Mary came into therapy seeking treatment for her addiction to sex; she acted out with men, often in unsafe places with unknown partners. When the risk and danger were her high, it was an addiction she believed would ultimately kill her. The binges she began many years ago had progressed into more and more dangerous situations. Her binges could last several days, and they always ended in feelings of degradation and shame.
"Had something happened that you allowed yourself to be triggered?" I ask again.
"Yes," she says in a defeated tone. "That afternoon, my boss came up to explain the next phase of this project we were working on. I was standing over the renderings when he came up from behind, reeking of alcohol. He put his hand on my shoulder and slowly let his hand slide down my back. And then, inadvertently," she say, gesturing quotations with her fingers, "he brushes my ass. I was so shocked, I even second-guessed myself, like, 'Did that just happen?' -- when I knew full well it did."
"This happened the same afternoon you acted out?"
"Yes, I know. I had a bad reaction."
Mary's reaction is typical adaptation aimed at alleviating the pain and horror of her past. Unfortunately, the reaction will unmercifully take Mary back into her shame core; it's the only way Mary knows how to cope.