Self-Injury: Steps to support adolescents who self-injure

On average, the prevalence rate for self-injury is 15-20% of adolescents (Heath et al., 2009).

#1 Know what self-injury looks like

• ·      Self-injury is intentional, self-inflicting, and is performed to reduce and/or communicate psychological distress.  Self-injury typically has low lethality.
• ·      The average onset on self-injury is 12-14 years old.
• ·      Types of self-injury include cutting, scratching, carving, excoriation of wounds, self-hitting, self-burning, banging head, self-inflicted tattoos and hair pulling. Self-harming behaviors often accompany self-injury such as eating disorders, substance abuse, and risk taking.
• ·      Be aware of contagion behaviors – On occasion, adolescents begin self-harming after learning about this behavior from a peer. 

#2 Stay Calm

• ·      It is important for all parties involved to stay calm.  This includes parents, teachers, coaches, counselors, and extended family.
• ·      When discussing self-injurious behavior, it is important to remain “low-key” with neutral responses.  It is important to avoid having reactive responses when discussing or learning about self-injury.
• ·      Create a safe place by displaying a nonjudgmental attitude regarding the behavior. This does not mean you accept the behavior. Rather you are providing a safe place for the adolescent to discuss the behavior openly, which is the first step to making changes.
• ·      Display respectful curiosity.  This suggests you want to learn more about the problem rather than have the problem go away quickly.
• ·      Remember: Self-Injury is not necessarily suicidal behavior.  When someone is suicidal, they would like to terminate consciousness.  When someone is self-injuring, they would like to modify consciousness (i.e. self-soothe).
• ·      When approached regarding self-injurious behavior, you should not minimize or dismiss the behavior.  

#3 Know what effective treatment approaches are available

• ·      It is important to refer an adolescent who is engaging in self-injury to a clinician who has experience in working with adolescents who self-injure. 
• ·      Treatment providers should also present as low-key and non-judgmental.
• ·      Agencies and providers should offer both individual and family treatment to assist self-injuring adolescents.
• ·      Thorough assessment of self-injurious behaviors should be conducted upon initiating treatment.  Assessment should include many dimensions such as environment, family and adolescent personal history, biological, cognitive, affective, and behavioral.
• ·      Treatment approaches should include strengthening the adolescent’s ability to manage distress, regulate emotions, and develop self-soothing coping skills.

Equine Assisted Psychotherapy - NEW Addition to HBH!!

What is Equine Assisted Psychotherapy (EAP)?

EAP is an experiential form of treatment, therefore making it suitable and effective for most populations.  It is a collaborative approach, combining a licensed psychotherapist and an equine specialist, also known as a “horse person.” EAP is an effective form of treatment because it provides clients with the opportunity to learn about themselves, the environment, and others, as a result of participating in activities with horses. Throughout the course of therapy, clients have the opportunity to process the thoughts, feelings, and behaviors, which have been creating difficulties and barriers to healthy functioning.

What are the benefits to EAP?

The benefits to EAP are countless, although some obvious benefits include the hands-on nature to learning and processing.  Research has shown that experiential forms of treatment tend to promote higher levels of progress. In addition to the experiential nature of EAP, the client is working with a living being.  This living being, the horse, has powerful energy that cannot be replicated in other forms of treatment.  Horses respond to thoughts, feelings, and behaviors, giving clients the opportunity to gain valuable insight they may not otherwise develop.

Can EAP be combined with traditional therapy?

Yes, often times your therapist will further process your EAP experience with you following your EAP session.  At times, other treatment modalities may also be combined by EAP.  For example, Cognitive Behavioral Therapy or Dialectical Behavior Therapy. Our program focuses on combining both EAP and traditional therapies.  This allows each client to have an eclectic experience.

What are my therapist’s credentials?

Your therapist is a Licensed Professional Counselor in the state of North Carolina, Nationally Certified Counselor, and has also been certified in EAP by OK CORRAL Series.  In addition, your therapist is a Certified Clinical Trauma Professional to better assist those suffering from exposure to trauma.

Questions Parents and Caregivers Should Ask About Treatment

If your child or teen is receiving mental health treatment, the following questions are vital for you to ask.  This will ensure your child's needs are being met and all parties are on the same page.  No one can advocate for your child better than you can!!

• Does my child need additional assessment and/or testing (medical/psychological etc)?
• What are the recommended treatment options for my child?
• Why do you believe this form of treatment is indicated for my child? How does it compare to other programs or services which are available?
• What are the advantages and disadvantages of the recommended treatment?
• *Does my child need medication? If so, what is the name of the medication that will be prescribed? How will it help my child? How long before I see improvement? What are the side effects which commonly occur with this medication? 
• What are the credentials and experience of the people treating my child?
• How frequently will treatment sessions occur?
• Will the treatment sessions occur with just my child or the entire family?
• How will I be involved in my child's treatment?
• How will we know if the treatment is working? What are some of the results I can expect to see?
• What should I do if the problems get worse?
• What are the arrangements if I need to reach you after-hours or in an emergency?
• As my child's problem improves, does this program provide less intensive/step-down treatment services? 
• How will the decision be made to discharge my child from treatment? 
• Once my child is discharged, how will it be decided what types of ongoing treatment will be necessary, how often, and for how long?

Source: American Academy of Child & Adolescent Psychiatry (AACAP), 2000.

*Please note: My personal clinical approach to the mental health treatment of children and adolescents is to include medication ONLY after consistent psychotherapy has been attempted.  I recommend in most cases, a child or teen begin with outpatient therapy prior to being considered for psychotropic medications.  If it is determined that my clients would benefit from a medication regime, I work closely with prescribing psychiatrist to promote accurate medication regimes.  It is my goal to help all my clients establish the necessary skills to function without medications following successful outpatient therapy. In the majority of the cases, this is a reality.  On occasion, it is in the best interest of the child or adolescent to remain on medication indefinitely.