Treatment
Self-injury treatment options include outpatient therapy, partial and inpatient hospitalization. When the behaviors interfere with daily living, such as employment and relationships, and are health or life threatening, a specialized self-injury program with an experienced staff is recommended.
The effective treatment of self-injury is most often a combination of medication, cognitive/behavioral therapy, and interpersonal therapy, supplemented by other treatment services as needed. Medication is often useful in the management of depression, anxiety, obsessive-compulsive behaviors, and the racing thoughts that may accompany self-injury. Cognitive-behavioral therapy helps individuals understand and manage their destructive thoughts and behaviors. Contracts, journals, and impulse control logs are useful tools for regaining self-control. Interpersonal therapy assists individuals in gaining insight and skills for the development and maintenance of relationships. Services for eating disorders, alcohol/substance abuse, trauma abuse, and family therapy should be readily available and integrated into treatment, depending on individual needs.
In addition to the above, successful courses of treatment are marked by 1) patients who are actively involved in and committed to their treatment, 2) aftercare plans with support for the patient’s new self-management skills and behaviors, and 3) collaboration with referring and other involved professionals.
When someone You Care About Is a Self-Injurer…
Someone you care about has entrusted you with information about his or her self-injury, or maybe you've seen it unwittingly. However you found out it is important to pay attention to self-injury in a helpful way. Here are some guidelines for dealing with SI in a friend or family member.
Don't take it personally
Self-injurious behavior is more about the person who does it than about the people around him/her. The person you're concerned about is probably not cutting, burning, hitting, or scratching just to make you feel bad or guilty. Even if it feels like a manipulation, it probably isn't intended as one. People generally do not self-injure to be dramatic, to annoy others, or to make a point.
Educate yourself
Get as much information as you can about self-injury in general. Find books that present the voice of self-injurers talking about what they do and why -- it lets you inside the mind of people who SI. Some selections that are particularly valuable are Bodily Harm, by Karen Conterio and Wendy Lader, PhD. Cutting by Steven Levenkron, and The Scarred Soul by Tracy Alderman, PhD.
Understand your feelings
Be honest with yourself about how self-injury makes you feel. Don't pretend that it's okay if it's not -- many people find self-injury repulsive, frightening, or provoking (Favazza, 1996; Alderman, 1997). If you need help dealing with the feelings aroused in you by self-injury, find a good therapist and do your best to not say anything like "My therapist says you should..." Therapy is a tool for self-understanding, not for getting others to change.
Be supportive without reinforcing the behavior
It's important that your child know that you can separate who they are from what they do, and that you love them independently of their behavior. Be available as much as you can be. Set aside your personal feelings of fear or revulsion about the behavior and focus on what's going on with the person.
Some good ways of showing support include:
· Attend to the subject of self-injury. Let it be known that you're willing to talk, and then follow the other person's lead. Tell the person that if you don't bring the subject up, it's because you're respecting their space, not because of aversion.
· Make the initial approach. "I know that sometimes you hurt yourself and I'd like to understand it. People do it for so many reasons; if you could help me understand yours, I'd be grateful." Don't push it after that; if the person says they'd rather not talk about it, accept this gracefully and drop the subject, perhaps reminding them that you're willing to listen if they ever do want to talk about it.
· Be available. You can't be supportive of someone if you can't be reached.
· Set reasonable limits. "I cannot handle talking to you while you are actually cutting yourself because I care about you greatly and it hurts too much to see you doing that" is a reasonable statement, for example. "I will stop loving you if you cut yourself" isn't reasonable if your goal is to keep the relationship intact.
· Make it clear from your behavior that the person doesn't need to self-injure in order to get displays of love and caring from you. Be free with loving, caring gestures, even if they aren't returned always (or even often). Don't withdraw your love from the person. The way to avoid reinforcing SI is to be consistently caring, so that helping the person take care of her/himself after they injure is nothing special or extraordinary.
· Provide distractions if necessary. Sometimes just being distracted (taken to a movie, on a walk, out for ice cream; talked to about things that have nothing to do with self-injury) can work wonders. If someone you care about is feeling depressed, you can sometimes help by bringing something pleasant and diverting into their lives. This doesn't mean that you should ignore their feelings; you can acknowledge that they feel lousy and still do something nice and distracting. (This is NOT the same as trying to cajole them out of a mood or telling them to just get over it -- it's an attempt to break a negative cycle by injecting something positive. It could be as simple as bringing the person a flower. Don't expect your efforts to be a permanent cure, though; this is a simple improve-the-moment technique.)
· If you live apart from the person you're concerned about, offer physical safe space: "I'm worried about you; would you come sleep over at my house tonight?" Even if the offer is declined, just knowing it's there can be comforting.
· Try not to ask, "Is there anything I can do?" Find things that you can do and ask, "Can I?" People who feel really bad often can't think of anything that might make them feel better; asking if you can take them to a movie or wash those (month-old) dishes (if done nonjudgmental) can be helpful. Spontaneous acts of kindness ("I saw this flower at the store and knew you'd love to have it") work wonders.
Take care of yourself
It sounds like hard work, and it is. If you try to be completely supportive to someone else 24/7, you're going to burn out (and they won't have any incentive to change). You have to find ways to be sure your needs are being met. Take a break from it when you need to. When setting limits, remember that as much as you love someone, sometimes you're going to need to get away from them for a while. Tell the person that sometimes you need to recharge and that it doesn't affect your love for him/her.
The balance here is tricky, because if you make yourself more and more distant, you might get a reaction of increasing levels of crisis from the other person. If you let them know that they don't have to be about to die to get love and attention from you, you can take breaks without freaking the person out. The key is developing trust, a process that will take some time. Once you prove that you are someone who isn't going to go away at the first sign of trouble, you will be able to go away in non-crisis times without provoking a crisis response.