On the cutting edge: Working with teens who self injure On the cutting edge • History of self-injury • Why do people self-injure? • Types of self-injury • Description of a self injurer • Role of the counselor • Family dynamics Types of self-injury Cutting skin Burning oneself Hitting oneself Head banging/extracting hair to excess Scratching to excess Severe nail biting/biting oneself Interfering with healing wounds Chewing lips, tongue, or fingers Ingesting sharp or toxic objects Facial skinning Breaking bones Amputation of limbs, breasts, digits, etc... Eye removal Self-injury characteristics • Self-injury is a behavior done by yourself • Self injury means there is some kind of physical violence • Self-injury is not performed with the intention of suicide • Self-injury is an intentional act • Self-injury is not an alteration of appearance • Self-injury is not ritual mutilation • Self-injury is not a fad • Self-injury is a purposeful act of self-help Why do people self-injure? Self-injury is a maladaptive coping style Self-injury is a means of escape from over-whelming feelings Self-injury is a release of pain Self-injury is an addiction (the endorphin theory) Self-injury is a way to feel something Self-injury is an abuse pattern Lack of role models and invalidation as a child Brain chemistry/biological predisposition theory The self-injurer •All types of backgrounds •Typical onset is puberty •Above average to superior intelligence •Low self-esteem •Problem avoidance •Eating disorder/alcohol and substance abuse •Angry, impulsive, anxious, aggressive •Senses are overwhelmed (dissociation) •Relies on actions to gain relief •An attempt to maintain psychological integrity •Self-injury quickly and dramatically calms the body •Trouble forming intimate relationships The family • Traumatic losses, illnesses, or instability • Neglect or abuse-physical,sexual,emotional • Rigid, dogmatic code of values • Impossible standards of perfection • Lack of role models and invalidation • Child takes adult responsibilities • Poor communication • Expressing feelings not allowed What the family and friends should know • Look for telltale signs; scars on arms or legs, a pattern of abrasions • Signs can also be scarce or very subtle • Being secretive or disappearing frequently • Makes weak excuses for the wounds and may become guarded or anxious • Wearing long sleeves and pants in warm weather • Finding miscellaneous tools like razors or paper clips in odd places Psychological issues • A history of trauma • Physical or sexual abuse • Dissociation • Eating disorders • Substance abuse • Borderline personality disordrer Behavior changes to watch for • Social withdrawal • Sensitivity to rejection • Difficulty handling anger • Negative comments about themselves • Showing feelings of shame, worthlessness, or self-loathing What parents need to know • Openly talk with your teen as soon as you find out, more importantly, be a non-judgemental listener • Clearly say that you want to help, acknowledge their feelings • Avoid punishment and calling them crazy • Control initial reaction • Avoid power struggles and threats • Consider the self injurer’s privacy • Be available and supportive • Take care of yourself and seek your own counseling if needed • Although difficult, examine your part in the problem What the counselor needs to know • Your theoretical orientation does not matter • Your ability to form a therapeutic relationship does • Your gender does not matter • Do not try to control your clients use of self-injury • Lack of experience is not a barrier to working with self-injuring clients • Self-injury us a symptom of a more serious problem Any Questions?
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