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Section 14
Interventions for Self-Injury

Question 14 | Test | Table of Contents

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In the last section, we discussed three methods by which self-mutilators avoid discussion in therapy: a blank slate; deflecting; and a false self. With the blank slate or unresponsive client I used short statements. With the deflecting or evasive client and with the client exhibiting the false self, I used direct focused questions.

In this section, we will examine the different challenges teen self-mutilators face when going through the final stages of recovery. These challenges are self-blame; the fear of incomplete analysis; the danger of over-analysis; explaining scars to peers; and regret.

5 Challenges in the Final Stages of Recovery

♦ Challenge # 1 - Self-Blame
As you probably have observed, like I, many self-mutilators blame themselves for their illness. Self-blame stems from the client's belief that he or she does not deserve to recover or be treated as a success. Many clients feel a great deal of shame for having a mental disorder in the first place. They feel that they are behind others their own age as a result of this sickness and worry that they will never emotionally and socially mature.

This issue of self-blame can cause regression and shame. Sylvia, age 17, stated, "If they really know who I have been and who I may be, they would lose all respect for me." This low self-esteem that Sylvia was experiencing inhibited her final stages of recovery. I notified Sylvia's parents and asked them to take a more active role in Sylvia's confidence building. Once her family acknowledged her great achievement, Sylvia's confidence grew and her self-blame began to diminish.

♦ Challenge # 2 - Fear of Incomplete Analysis
Sylvia also suffered from a fear of incomplete analysis. She believed that there were many more issues that still needed to be uncovered. Sylvia was afraid that if any problems were not addressed immediately, she would be left vulnerable and would regress to her old behaviors.

♦ Challenge # 3 - Danger of Over-Analysis
However, over-analysis was also a large danger. The intense experience of self-exploration in therapy can lead a client to become so preoccupied that the search becomes an endless obsession. I soon realized that Sylvia was becoming too involved with her therapy and not enough in her recovery. She did not want to leave therapy and was beginning to adopt a style of self-absorption and narcissism. I reminded Sylvia that the goal of therapy was to make her independent and not reliant on self-analysis.

♦ Challenge # 4 - Explaining Scars
A unique challenge posed to recovering self-mutilators is the presence of scars. Scars, as you know, are an everyday reminder of the challenge and an inherent weakness. Adolescents tend to lie about their scars instead of telling the truth about their illness. Sonia used the excuse of a roller-blading accident. I told Sonia that if the person became a trusted friend she might evaluate if it was appropriate to tell the truth, but limit the details.

I also reminded her that if they begin to ask personal questions such as, "Did it hurt?" or "Did you know what you were doing to yourself?" that she was not obligated to answer them. Such questions could leave Sonia humiliated and create old tensions and thus resurrecting old feelings. However, in cases such as close friends, family, or spouses sharing is natural process, conducive to building intimate relationships.

♦ Technique: "Response" Exercise
To help Sonia become more comfortable with telling the truth about her scars, I used the "Response" exercise. I asked Sonia to make a list of responses to questions about her scars that told the truth, but didn't reveal any information that Sonia did not want to share.

Some of Sonia's responses to questions about her scars included:
-- "These scars are from a very painful time in my life;"
-- "They are a reminder of something I did that I now regret;" and
-- "I once had problems when I was young, but I'm just grateful that it's in the past."

By making this list, Sonia would not have to think of lies to account for her scars. This way, she acknowledges her struggle but also recognizes the achievement she has accomplished.

♦ Challenge # 5 - Regret
Regret, while similar to blame, is rooted more in frustration. Beth, age 19, was disgusted by her scars and the memories they brought on. Beth stated, "How could I have done this to myself? I must have been crazy. Look at these scars! I'll have to get plastic surgery to remove some of them. I used to be so proud of them-they showed I could take pain. Now I want to throw up when I look at them. I hate taking baths. At least in the shower, I don't have to really look at my skin."

Beth could now see how her behavior, which she saw as a solution, destroyed her mental and physical health. In Beth's case, her family and close friends became vital in helping Beth forgive herself for what she had done.

♦ Technique: "Stop, Reflect, and Reward" Exercise
To address Sylvia's feelings of self-blame and Beth's feelings of regret, I found the "Stop, Reflect, and Reward" exercise beneficial. I asked both of them to answer a few questions relating to their change in their health over the past year.

Sylvia wrote, "I feel like I'm a totally new person. I still feel stressed and everything, but now I can handle the stress in constructive ways without harming myself. I don't look at everything as a weapon now and I understand myself so much better. I realize now that my cutting and burning was a way for me to handle the pressure of school and mom and dad's divorce.

"I now wish I hadn't done what I did because it hurt them so much. But as a result of my healing, I'm much closer to my mom. We ate lunch together yesterday and had a long conversation about life and how I was handling everything. I think she'll be much more involved in my life now, because we understand each other a lot better."

By writing down these thoughts, Sylvia recognized the great leaps she had made in her life. Even though the scars are still there, she now knows that without the urge to self-mutilate, Sylvia has completely turned her life around.

In this section, we discussed the five challenges teen self-mutilators face when going through the final stages of recovery: self-blame; the fear of incomplete analysis; the danger of over-analysis; explaining scars to peers; and regret.
Reviewed 2023

Peer-Reviewed Journal Article References:
Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., & Miller, I. W. (2017). An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology, 85(6), 620–631.

Frost, M., Casey, L., & Rando, N. (2016). Self-injury, help-seeking, and the Internet: Informing online service provision for young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(1), 68–76.

Gratz, K. L., Dixon-Gordon, K. L., & Tull, M. T. (2014). Predictors of treatment response to an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5(1), 97–107. 

Kruzan, K. P., Whitlock, J., & Hasking, P. (2020). Development and initial validation of scales to assess Decisional Balance (NSSI-DB), Processes of Change (NSSI-POC), and Self-Efficacy (NSSI-SE) in a population of young adults engaging in nonsuicidal self-injury. Psychological Assessment, 32(7), 635–648.

Nielsen, E., & Townsend, E. (2018). Public perceptions of self-harm—A test of an attribution model of public discrimination. Stigma and Health, 3(3), 204–218.

Sansone, R. A., Sellbom, M., & Songer, D. A. (2018). Borderline personality disorder and mental health care utilization: The role of self-harm. Personality Disorders: Theory, Research, and Treatment, 9(2), 188–191.

QUESTION 14
What are five challenges teens face when going through the final stages of recovery? To select and enter your answer go to Test.

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