On the cutting edge

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					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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