1. On the cutting edge: Working with teens who self injure

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Psychological issues A history of trauma Physical or sexual abuse Dissociation Eating disorders Substance abuse Borderline personality disordrer

10. 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

11. 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

12. 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

13. Any Questions?