5/7/2013
Developmental Resources Presents
Presented by: Susan Bowman, Ed.S., LPC
Please Ask Questions Via Chat!
Definition of SI According to
S.A.F.E. Alternatives www.selfinjury.com
Self-injury is an attempt to cope with a problem and not the
problem itself. It is often a cry for help (either conscious or
unconscious). Most self-injurers experience themselves as being
invisible. Ignoring the behavior only validates this belief, possibly
causing them to become even more dangerous to themselves. The
key is to focus on the underlying feelings and issues rather than
focusing on the behavior itself.
Top 15 Misconceptions of Self-Injury
1. Only females self-injure.
2. Self-injury is a suicide attempt or failed suicide attempt.
3. Only teenagers self-injure.
4. Anyone who self-injures is crazy and should be locked up.
5. Self-injury is just attention-seeking.
6. Self-injury is untreatable.
7. People who self-injure are manipulative.
8. All people who self-injure have “Borderline Personality
Disorder.”
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
1
5/7/2013
Top 15 Misconceptions of Self-Injury
9.
People who self-injure only cut themselves.
10.
Anyone who self-injures is part of the “Gothic” or “Emo” subgroup.
11.
People who self-injure enjoy the pain or they can’t feel it.
12.
There’s nothing I can do to help.
13.
All people who self-injure have been abused.
14.
Someone who self-injures can stop if they really want to.
15.
Someone who self-injures is a danger to others.
Coping Checklist
Healthy
Unhealthy
• Write my feelings out
• Eat too much
• Do something nice for
another person
• Blame someone else
• Talk to someone
• Play a musical
instrument
• Use humor
• Do something active like
ride my bike, run, etc.
• Sleep too much
• Use alcohol or other drug
• Smoke
• Refuse to talk about it
• Think of hurting myself
• Fight with others
• Play with my dog/cat
• Draw, paint
• Use the Internet to chat
with others
• Use internet to hurt others or myself
"I hurt myself for different reasons, depending on my state of mind.
I do it sometimes as a way to get relief from the pain I am feeling
inside. Other times I do because at the time I feel I deserve to be
punished, or I am angry at myself, but really I think someone else.
Other times I do it to "shout out" to the world that I need help and
here is the proof. I am a incest survivor, so I think that it's some of
the pain that I have had to live with trying to escape my body.”
(Dianne, Age 30, Canada)
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
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5/7/2013
Statistics
National Center for Injury Prevention and Control
• 3 million Americans engage in some form of self-injury.
• An estimated 3 million Americans purposely cut or burn
themselves.
• 90% of people who self-injure begin cutting as teenagers.
• The average person who self-injures starts at age 14 and
continues with increasing severity into her late 20's.
Statistics
National Center for Injury Prevention and Control
• More than half of people who self-injure are victims of
sexual abuse, and most report emotionally abusive or
neglected childhoods.
• Self-injury is prevalent in ALL races and economic
backgrounds.
• In a recent Canadian population based survey of youth ages 14
to 20, three quarters of those who had ever self-harmed were
females and most began in mid adolescence.
Why Do I Self-Injure?
"I cut myself because I feel so much pain inside that I need a way to
release it all. So by cutting myself, it acts as an outlet for that l
pain, I guess, somehow. It feels like it's all running out of me when I
see myself bleeding. I know that probably sounds gross to most
people who don't do this. Yes, I am in group therapy for people who
self-injure".
(Chrissy, Age 17, USA)
© Developmental Resources Inc. May be
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2013” Webinar.
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5/7/2013
Why Do Young People Engage in
Self-Inflicted Violence?
• Relief from feelings
• Method of coping
• Stopping, inducing or preventing dissociation
• Physically expressing pain
• Communication
• Self-nurturing
• Self-punishment
• Reenacting previous abuse
• Establishing control
Types of Self-Injury
1. Major Self-Mutilation: Includes such things as castration,
amputation of limbs, enucleation of eyes. Fairly rare and
usually associated with psychotic states.
2. Stereotypic Self-Injury: Comprises the sort of rhythmic headbanging, etc. seen in autistic, mentally retarded and psychotic
people.
3. Superficial or Moderate: Most Common form of selfmutilation. Includes cutting, burning, scratching, skin-picking,
hair-pulling, bone-breaking, hitting, deliberate overuse injuries,
interference with wound healing, and virtually any other
method of inflicting damage on oneself. Most popular act is
cutting. Sites include wrists, upper arms and inner thighs.
Bullying & Self-Harm
• According to a new study, children who are bullied are three
times more likely than others to self-harm by the time they
are 12 years old.
• A team of researchers from the United States and the United
Kingdom said its findings could help identify those at greatest
risk for this type of behavior.
• Although the study cannot tell us the exact nature of the
relationship between bullying and self-harm, it does highlight
the importance of giving victims of bullying care and support
to cope with the possible emotional and psychological effects.
© Developmental Resources Inc. May be
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2013” Webinar.
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5/7/2013
Princess Diana
The disorder made its first
major public appearance when
Princess Diana confessed that
the strain of her marriage had
caused her to throw herself
down the staircase and cut
herself with razors, pen knives
and lemon slicers.
Internet/Blog Sites
"I knew I was always the ugly one. Don't
say that's a lie because you don't know
what some kids have said and done. It
hurts to think about how mean some
people could be. Even when I started to
look a little better, they still couldn't see.”
“The only reason I even bother to tell my
sad sob story is that someday the public
might know what a teenage girl goes
Kristina, 15 years old
through.”
Researchers studied the top 100 videos of such acts on YouTube
and found they had received more than 2 million page views.
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
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5/7/2013
Suggestions for Professional Counselors
• Create an environment that provides empathy, caring,
unconditional acceptance, trust and rapport. (MacAniff &
Kiselica, 2001; Conterio & Lader, 2002)
• Build on the child/adolescent’s personal strengths and instill
hope. (Selekman, 2002).
• Do’s & Don’ts
Do...
• Show the child/adolescent unconditional acceptance.
• Encourage a commitment to try positive alternative behaviors
for coping.
• Invite open communication no matter what the behavior.
• Communicate that it is okay to talk about self-injury.
Don’t...
• Be afraid to ask the question, “Do you self-injure?”
• Make eliminating the behavior the primary goal.
• Tell the child/adolescent to stop the self-injury behavior.
• Use contracting as a reward or punishment system.
• Make him/her feel ashamed or guilty about his/her behavior.
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
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5/7/2013
Goals for Treatment
• Assess danger to self.
• Assess for referral for inpatient/outpatient treatment.
• Provide safe environment.
• Explore and develop safe alternatives.
• Teach new coping skills.
• Improve self-image.
• Use cognitive restructuring/reframing.
• Improve interpersonal relating.
• Improve self-esteem.
Comfort Kit
• Small journal & pen
• Glitter wand
• Hand lotion
• Drawing pad & markers
• Names of people who you can call
• Biofeedback card
• Sand timer
• An object representing a personal strength
• A soft stone
Reflective Journaling
• Can elicit self-understanding
• Provides a non-threatening way to get out feelings
• Looks at past events and allows expressions of anger
• Recalls pleasant memories that convey hope
• Helps release stress and redirects harmful thoughts
• Keeps them from harming
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
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5/7/2013
The knife at my wrist, the pill on my tongue,
The blood at my hands, the tears in my eyes,
What does not kill me makes me stronger.
It’s that which leads me to this.
It makes me feel clean, washing away all the impurities that
were induced into my body by others when I was a child.
Something has been released - any emotion I’m feeling leaves
my body with blood.
When I saw the blood I felt nothing, just numbness.
It shows me I’m alive and it shows me the emotional pain
I feel is real.
Art Therapy
It is based on the belief that the creative process involved in
artistic self-expression helps people to resolve conflicts and
problems, develop interpersonal skills, manage behavior, reduce
stress, increase self-esteem and self-awareness, and achieve
insight.
American Art Therapy Association
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
8
5/7/2013
Sand Tray
Why Use Sand Tray Therapy?
Sand Tray translates personal experience into a concrete, threedimensional form. As a picture can say more than a thousand
words, a figure or scene can express feelings, emotions and
conflicts that previously had no verbal language. Hence, the
sand-worlds that are created offer a rich and highly
personalized vocabulary for pre-verbal or non-verbal
experience. Without having to depend on words, clients can
increase their capacity for expression through the tray. Selfawareness and communication are enhanced by this process.
Sandplay Therapists of America
Relaxation/Guided Imagery
• A way to work on unresolved issues
• Helps control breathing during stressful times
• An acceptable way to reach an altered state of consciousness
• A way to rehearse skills, visualize the future
• Can control emotional pain
• Healthier way to deal with stress and emotional pain
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
9
5/7/2013
Peer Helping
Resources for training peer listeners:
Elementary Level: Children Helping Children & Becoming a
Friendly Helper by Myrick & Bowman
Middle/High School: Caring & Sharing by Myrick & Erney
Training Peer Helpers by Barbara Varenhorst
Success Stories & Testimonies
Autobiographies & Inspiring Memoirs
• Dave Pelzer (suffered years of abuse by his mother)‫‏‬
• Oprah Winfrey (was molested as a child)‫‏‬
• Fiona Apple (raped at 12, became anorexic)
• Johnny Depp (low self-esteem, drugs, dropped out of school)
• Memoir Star by Karres & Bowman
http://self-injury.net/doyousi/famous/ www.bipolarworld.net/Self-Injury
Developmental Resources Presents
Presented by: Susan Bowman, Ed.S., LPC
Please Ask Questions Via Chat!
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
10
5/7/2013
Available from YouthLight
www.youthlight.com
2013 CONFERENCES
www.dev-resources.com
© Developmental Resources Inc. May be
reproduced by attendees of “See My Pain
2013” Webinar.
11
Presented by Susan Bowman, Ed.S., LPC
Coping Checklist
Place a check next to the approaches that best fits your style of coping with personal
problems.
Healthy
Write my feelings out
Do something nice for another person
Talk to someone
Play a musical instrument
Use humor
Do something active like ride my bike, run, etc.
Play with my dog/cat
Draw, paint
Unhealthy
Eat too much
Blame someone else
Sleep too much
Use alcohol or other drug
Smoke
Think of hurting myself
Refuse to talk about it
Fight with others
Discussion Questions:
How many did you mark under “Healthy” compared to “Unhealthy?”
What are the long-term effects of each one you checked?
What are other ways you can cope with problems? List these below:
2
STATISTICS
• 3 million Americans engage in some form of self-injury
• An estimated 3 million Americans purposely cut or burn themselves
• 90% of people who self-injure begin cutting as teenagers
• The average person who self-injures starts at age 14 and continues with
increasing severity into her late 20's.
• More than half of people who self-injure are victims of sexual abuse, and most
report emotionally abusive or neglected childhoods
• Self-injury is prevalent in ALL races and economic backgrounds
• In a recent Canadian population based survey of youth ages 14 to 20, three
quarters of those who had ever self-harmed were females and most began in mid
adolescence.
• 83.2% reported at least one episode of self-injury.
• Almost 40 % of those who had ever self-harmed, did so repeatedly (i.e., more
than three times). (Interdisciplinary National Self-Injury In Youth Network
Canada)
• Over two thirds of youth who self-harmed believed that they got the idea
themselves, while much fewer indicated that the idea came from friends, family
or the media (Nixon, Cloutier, & Jansson, 2008).
According to the National Center for Injury Prevention and Control more than 250,000
people each year are treated in US emergency departments for nonfatal self-inflicted
injuries.
Most past research indicates that women are more likely to self-harm than men but in
2006, a Cornell University study proved this ratio is quickly closing. The study did show
though, that women are twice as likely to scratch, pinch and cut themselves as men,
who are more apt to punch things to injure their hands.
(http://www.theravive.com/services/cutting.htm)
3
Why Do Young People Engage in Self-Inflicted Violence?
• Relief from feelings
• Method of coping
• Stopping, inducing or preventing dissociation
• Physically expressing pain
• Communication
• Self-nurturing
• Self-punishment
• Reenacting previous abuse
• Establishing control
4
The Internet and Self-Injury: What Psychotherapists Should Know
Article by, Janis L. Whitlock, Wendy Lader, and Karen Conterio
The growing presence of self-injury on the web parallels the proliferation of self-injury awareness of in
American society. Two decades ago, self-injury was largely unknown to the public and generally carried out in
privacy. Researchers speculate that its spread into popular culture gathered momentum in the 1990’s when
more than 14 pop icons revealed self-injurious habits in various media outlets. The same period saw a
significant increase in the number of movies, music, and news articles with self-injury scenes or themes.
Today, a myriad of television shows, such as DeGrassi, Interventions, Grey’s Anatomy, and Seventh Heaven,
portray the physical and emotional details of self-injury in ways that may highlight it as an available emotional
outlet for individuals predisposed to the behavior (Whitlock & Knox, in press).
Indeed, virtual socializing venues such as “myspace.com” have overtaken malls as the primary socializing
venue for teens. Instant messaging (IM) has flourished as a means of exchange with 75% of online teens
(65%) of all teens saying that they use IM to keep in touch with a broad network of friends and family (Lenhart,
Madden, & Hitlin, 2005). With Internet use increasing at a rapid rate, chances are good that when self-injurious
clients enter psychotherapy they will have already used on-line resources to find information about self-injury,
particularly if they are an adolescent or young adult.
In a study of self-injury message boards, informal support and discussion of proximal life events that trigger
self-injury were the most common types of exchange followed by casual and sometimes personal information
related to the addictive qualities of their practice, their fears relating to disclosure, experiences with
psychotherapy, how they self-injure, and other related health concerns (Whitlock, et al., 2006). In most Internet
modalities, users are entirely free to observe and post whatever they choose. In web-based blog communities,
such as myspace.com, xanga.com, and Facebook, anyone can sign up for an account and post content.
However, they may not be allowed to post indiscriminately on the sites of other subscribers since posting
privileges on each individual blog are dictated by the account holder. YouTube uses a similar format with video
creators able to control what is and is not posted on their site. Message boards utilize a slightly different format
and often vary considerably by degree of moderation.
Moreover, individuals immersed in self-injury communities may experience what we think of as “narrative
reinforcement” – the sharing of similar life stories and interpretations which can normalize and subconsciously
justify the use of self-injury. While it is possible that narrative reinforcement may eventually lead people to
recognize the damage suffered by themselves and others by self-injurious behavior, it may also keep them
from identifying and attending to its underlying causes. Despite the fact that psychotherapy, in the popular
mind, equates healing with the cathartic verbal release of pain, research has shown that dwelling on painful
feelings without exploring and challenging irrational thoughts may actually do more harm than good (e.g.,
Pomerantz, 2006). Moreover, sites which feature video footage or photos, such as YouTube, often include
images of severe injury and graphic poetry and artwork – much of which is likely to be highly suggestive or
triggering to self-injurious participants. And, while many people who self-injure express a strong desire to find
lasting interpersonal relationships, they often need help working through a number of impediments to same,
including a history of trauma and past disappointments. Such opportunities are not easily encountered on the
web.
This entire article can be viewed on the following website:
www.focusas.com/Selfinjury.html Janis Whitlock Family Life Development Center Cornell University,
Ithaca, NY 14853
Videos on Self-Injury: http://vimeo.com/20938569
http://www.childline.org.uk/Videos/Pages/WillsStoryRaisingawarenessofselfharm.aspx
Types of Self-Injury
5
Major Self-Mutilation
• Includes such things as castration, amputation of limbs, enucleation of eyes.
• It is fairly rare and usually associated with psychotic states.
Stereotypic Self-Injury
• Comprises the sort of rhythmic head-banging, etc, seen in autistic,
• Mentally retarded and psychotic people.
Superficial or Moderate
• Most common form of self-mutilation.
• Includes cutting, burning, scratching, skin-picking, hair-pulling, bone-breaking,
hitting, deliberate overuse injuries, interference with wound healing, and virtually
any other method of inflicting damage on oneself.
• Most popular act is cutting; sites include wrists, upper arms, and inner thighs.
Famous Self-Injurers
Princess Diana
"You have so much pain inside yourself that you try and hurt yourself on the outside because you
want help." "Diana: Her True Story," a biography written on the princess said that Diana had thrown
herself into a glass cabinet at Kensington palace at various times, slashed her wrists with a razor, and
cut herself with the serrated edge of a lemon slicer. Once, during a heated argument with Prince
Charles, she picked up a penknife and cut her chest and thighs. Her husband still scorned her, and
thought she was faking her problems, that it was melodramatic attention seeking. During a fight on an
airplane, Diana locked herself in the bathroom, cut her arms, and smeared the blood over the cabin
walls and seats. Another time she threw herself down the stairs.
Angelina Jolie
"I was..trying to feel something....I was looking at different things..thinking romantically about...about
blood. I really hurt myself," and also said, "I was just....a kid. I was like 13, And, I was saying that it is
not something that is cool. It’s not cool. And I understand that it is a cry for help..."
Marilyn Manson
In a 1998 Rolling Stone interview he answered some questions regarding his self-injury, both onstage
and offstage. About self-injury he said, "I think that's all a form of wanting to let go, of wanting to get
out," and, "It's not something easily described or understood." About the differences between his
onstage self-injury and offstage self-injury he said, "I think onstage it was more me trying to show
people my pain, and offstage it was just feeling it, period."
6
Trigger Log
Directions: Place a Check Mark or Plus (+) Sign on every day that you DO NOT
self-injure. Place a Question Mark (?) on the day(s) that you DO self-injure.
Week
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Then ask yourself these questions:
1. If you did NOT self-injure…why not. What was going on that day, what did you do? Who did you
have contact with that day? What worked for you on the day you did not self-injure.
2. If you did self-injure…What triggered the self-injury on this day? Was it internal thoughts or
external factors or both?
3. Next try and identify a pattern. Do you mainly self-injure on a weekday? Weekend? Is there a
specific time of day? Can you identify what happens at these specific times?
7
Describing Feelings and Triggers
1. What was happening just before self-mutilation behavior?
2. What was the link to body sensations?
3. How does the self-abusive behavior occur?
Checklist for the Cycle of My Emotions
Focusing on how you were feeling before you hurt yourself, write a B next to each of the emotions
that you felt before you hurt yourself. Then, write a D beside any emotion you experienced during
hurting yourself. Finally, write an A next to each emotion you felt after you hurt yourself.
_____ Anger
_____Wholeness
_____ Euphoria
_____ Frustration
_____ Happiness
_____ Elation
_____ Hopelessness
_____ Disconnection
_____Pride
_____ Sadness
_____ Depression
_____ Relief
_____ Isolation
_____ Hostility
_____ Numbness
_____ Alienation
_____ Tension
_____ Loneliness
_____ Shame
_____ Fear
_____ Emptiness
_____ Anxiety
_____ Guilt
_____ Other
(Adapted from Alderman, 1997)
8
Goals for Treatment
1.
Assess danger to self
2.
Assess for referral for inpatient/outpatient treatment
3.
Assess for co-morbidity
4.
Provide safe environment
5.
Explore and develop safe alternatives
6.
Improved coping
7.
Improved body image
8.
Cognitive restructuring/reframing
9.
Improved interpersonal relating
10. Improved self-esteem
11. Family Intervention
9
Suggestions for Professional Counselors
•
Create an environment that provides empathy, caring, unconditional acceptance, trust and
rapport (MacAniff & Kiselica, 2001; Conterio & Lader, 2002)
•
Build on the child/adolescent’s personal strengths and instill hope (Selekman, 2002).
The primary need for these clients is to be heard, understood, validated, and taught healthier ways of
coping with their emotions. Once a positive, trusting relationship is established, a multifaceted
approach can be incorporated into the treatment plan including learning how to replace selfdestructive behaviors with effective self-management skills (MacAniff & Kiselica, 2001).
DO
•
•
•
•
•
•
•
•
•
•
•
•
Show the child/adolescent unconditional acceptance.
Accept him/her as a person regardless of the behavior.
Make understanding the underlying causes for the behavior a goal.
Encourage a commitment to try positive alternative behaviors for coping.
Suggest a list of coping techniques to be used rather than self-injury.
Understand that this list is flexible and can always change.
Encourage open communication no matter what the behavior.
Acknowledge his/her efforts to cope with very difficult emotions.
Show that you care about the injuries.
Communicate that it is okay to talk about self-injury.
Help him/her discover their identity.
Remember that you are not responsible for the child/adolescent’s behavior.
DON’T
•
•
•
•
•
•
•
•
•
Be afraid to ask the question, “Do you self-injure?”
Make eliminating the behavior the primary goal.
Tell the child/adolescent to stop the self-injury behavior.
Use contracting as a reward or punishment system.
Make a safety contract. This may create a need to please you and further the feelings of
inadequacy for the child/adolescent.
Make him/her feel ashamed or guilty about his/her behavior.
Feel responsible for the child/adolescent decision to self-injure.
Be the only source of support for the child/adolescent.
Leave the family out of the healing process.
Copied with permission from Bowman and Randall. (2004). See My Pain! Creative Strategies and Activities for
Helping Young People Who Self-Injure. Chapin: SC. Youthlight, Inc.
10
Peer-Based Programs
We all know that tweens and teens would rather talk about personal issues to another
peer than to an adult. By training students to be Peer Listeners in the school, students
have someone to talk to about personal problems including any thoughts of self-harm.
It is recommended that those selected to be Peer Listeners are from all social and
ethnic backgrounds and are a good representation of the culture of that school. With
this taken into consideration the next step is to interview potential students to be sure
they would be a good fit. Training needs to be based on the Peer Helping Model and
be led by a school counselor or someone who has experience in Peer Helper training.
The national association has information on training.
(http://www.peerprogramprofessionals.org) It was established in 1984 and its mission
is to help adults establish, train, supervise, maintain and evaluate peer programs using
the NAPPP Standards and Ethics as a guiding principle.
Resources for training peer listeners:
• Elementary Level: Children Helping Children & Becoming a Friendly Helper by
Myrick & Bowman
• Middle/High School: Caring & Sharing by Myrick & Erney
• Training Peer Helpers by Barbara Varenhorst
Some peer led programs:
• Mean Girls Aren’t Cool (http://www.meangirlsnotcool.com/)
• Mean Stinks (www.facebook.com/secretmeanstinks)
• The Bullycide Project http://thebullycideproject.com/)
• Safe Schools Ambassadors
(http://www.safeschoolambassadors.org/aboutssa_video.php)
• K.A.R.M.A. (Kids Against Ridicule Meanness and Aggression)
(http://www.thekarma.org/)
• SHINE, Students Helping Instill New Esteem
(http://www.loveourchildrenusa.org/loc_youth_ambassadors.php)
• PACER Teens Against Bullying
(http://www.pacerteensagainstbullying.org/#/home)
• A WORLD OF DIFFERENCE® Institute Peer Leadership Program
(http://www.partnersagainsthate.org)
11
Copied with permission from Bowman and Randall. (2004). See My Pain! Creative Strategies and
Activities for Helping Young People Who Self-Injure. Chapin: SC. Youthlight, Inc.
12
Journaling
 Can elicit self-understanding
 Provides a non-threatening way to get feelings out
 Looks at past events and allows expressions of anger
 Recalls pleasant memories that convey hope
 Helps release stress and redirects harmful thoughts
 Keeps them from harming
Write a summary for each:
A favorite memory:
A time you felt very proud:
A time you expressed yourself without self-injuring:
Copied with permission from Bowman and Randall. (2004). See My Pain! Creative Strategies and Activities for
Helping Young People Who Self-Injure. Chapin: SC. Youthlight, Inc.
13
Art Therapy
Art Therapy
It is based on the belief that the creative process involved in artistic
self-expression helps people to resolve conflicts and problems,
develop interpersonal skills, manage behavior, reduce stress,
increase self-esteem and self-awareness, and achieve insight.
(American Art Therapy Association)
Recommended Book:
Self-Mutilation and Art Therapy: Violent Creation by Diana Milia
14
Sandtray
Translates personal experience into a concrete, threedimensional form. As a picture can say more than a thousand
words, a figure or scene can express feelings, emotions and
conflicts that previously had no verbal language. Hence, the
sand-worlds that are created offer a rich and highly personalized
vocabulary for pre-verbal or non-verbal experience. Without
having to depend on words, clients can increase their capacity
for expression through the tray. Self-awareness and
communication are enhanced by this process.
Sandplay Therapists of America
15
Relaxation/Guided Imagery
• A way to work on unresolved issues
• Helps control breathing during stressful times
• An acceptable way to reach an altered state of consciousness
• A way to rehearse skills, visualize the future
• Can control emotional pain
• Healthier way to deal with stress and emotional pain
16
References & Resources
Safe Alternatives, http://www.selfinjury.com
Alderman, T. (2000). The Scarred Soul: Understanding & Ending Self-Inflicted
Violence. YouthLight, Inc.
Bowman, S., and Randall, K. (2004). See My Pain! Creative Strategies for Helping
Young People Who Self-Injure. YouthLight, Inc.
Cloud, H., Townsend, J. (1999). Boundaries: When to Say Yes, When to Say No to
Take Control of Your Life.
Conners, R. (2000). Self-Injury: Psychotherapy With People Who Engage in SelfInflicted Violence. Bookmart press.
Conterio, K. and Lader, W. (1998). Bodily Harm: The Breakthrough Healing Program
for Self-Injurers. Hyperion.
Covey, S. Simon, and Schuster, (1998). The 7 Habits of Highly Effective Teens. Free
Press
Holmes, A. (2000). Cutting the Pain Away: Understanding Self-Mutilation. Chelsea
House publishers.
Levenkron, S. (1998). Cutting: Understanding & Overcoming Self-Mutilation.
YouthLight, Inc.
Ng, G. (1998). Everything You Need to Know About Self-Mutilation: A Helping Book for
Teens Who Hurt Themselves. Rosen Publishing Group
Phillips, B. (1995). Controlling Your Emotions Before They Control You. Harvest House
Publishers.
Selekman, M. (2002). Solution-Oriented Brief Family Therapy With Self-Harming
Adolescents. W.W. Norton and Company.
Strong, M. (1998). A Bright Red Scream: Self-Mutilation and the Language of
Pain. The Penguin Group.
1-888-HOPE-307 (National number for teen support) doorofhope4teens@aol.com
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