Treatment Strategies

Self-injurious behavior can be reduced and eventually extinguished once the adolescent is ready to embrace alternative behaviors designed to promote healthier communication, self-comfort and genuine healing.

Psychotherapy — It is extremely important to work with a helping professional who has an expertise in self-injurious behavior or related disorders. Psychotherapy can provide a non-judgmental and supportive environment where self-injury can be processed openly and the meaning behind the injury can be explored. Trained therapists can provide safer, alternative ways to communicate, self-soothe and cope. The use of journaling, art therapy, relaxation techniques, visualizations, cognitive re-framing and affect management are all recommended and useful.

Appropriate contracts that encourage the teenager to write, draw, exercise and self-soothe before engaging in self-injurious behavior are more effective than contracts that demand the immediate cessation of the behavior. When the self-injury is severe, the teenager is unable to integrate strategies and abide by a safety contract or additional problems such as substance abuse or a threatening eating disorder are evident, inpatient treatment is often required.

In addition to working with a trained therapist some teens are able to utilize resources such as personal journaling and drawing, meditation, spiritual support and healthy self-injurious behavior substitutes such as physical exercise.

Psychopharmacology — When self-injurious behavior connects to untreated depression or anxiety, medication can be extremely useful. Anti-depressants can dramatically reduce the negative feelings and cognitions associated with the cycle of self-harm. Anxiolytics prevent the escalation of panic and generalized anxiety, which decreases the need for dissociation and self-injury. Providing a pharmacological safety net also may allow adolescents to process painful trauma memories without becoming flooded or overwhelmed.

[taken in part: *PRP Online]* Performance Resource Press

Self Injury Is Functional?

"We must understand that in the trauma survivor, self injury is functional. It always performs some deep, underlying function. Most generally, it’s an attempt to ward off worse harm."– David Calof

Tonight when I read this quote it was the first that resonated for me personally. I suffered a trauma at 11 and left for dead. After the hospitalisation & police investigations ended, my parents solution was to move us from the city & it was not to be spoken of again . Life was good, new home, school, family, horse and dog.

At 13-14 I remember I was in an out of control rage, against myself, family anyone near me. I was destructive, violent, smashing things, threatening others, running away being returned. I began carrying a knife (I still have that habit to this day) I liked that people feared me but I was also frightened of what I was capeable of. I had no way to control what I was feeling ,this rage, let alone understand it. It was raw & pure. I still don't know what triggered it. It alienated my father, who hasnt spoken to me to this day & confused my brothers who loved me.

My parents and the system inflicted school counsellors, psychiatrists, hospitalisations for violence and failed suicides. However I learnt that hurting myself stopped that anger, lessened it, dulled it. It stopped me reacting instantly (if that makes sense) .... It stopped the outward, out of control rage, it stopped me hurting others ...

Until I read that quote I never thought of it as functional or an attempt to ward of greater harm but in reflection thats what it was. At the time I thought I was the only one that was aware. Like the initial trauma, it was something that became not spoken of, secret, shameful. Counsellors all liked the change in me, (I stopped being emotionally honest and faked calm) they and my parents each patted themselves on the back and happily wrote me off as cured. My self destructive life had begun.

It occured to me tonight that after being hurt at 11, I then spent over 20 years hurting myself ... what an incredible price to pay...

ps... the quote is from Cavalcade has specialized in producing training videos for therapists and other professionals working with clients who have a history of psychological trauma.