Therapy - Part V in Self-Injury series
Therapists should ensure that self-injuring clients have access to nonjudgmental, compassionate medical care for wounds they inflict on themselves (Dallam, 1997), care that does not rob them of their dignity or autonomy. Together, client and therapist can devise a plan for getting physical wounds treated without adding additional stress to the situation. This may involve educating physicians at local emergency rooms about the nature of SIV.
Since successful treatment of SIV depends heavily on teaching the client new ways of coping with stressors so that underlying painful material can be dealt with, hospitalization should be used only as a last resort when the client is at risk for suicide or severe self-injury (Dallam, 1997). Hospitals are artificially safe environments, and the necessary tasks of learning to identify the feelings behind the act and of choosing a less-destructive method of coping need to be practiced and reinforced in the real world.
Favazza (1998) advocates the use of high-dose SSRIs and mood stabilizers to get self-injury under control quickly, then suggests that care be managed under a team concept, with an overseeing psychiatrist who manages meds and coordinates care, a psychotherapist, and a group therapist. He also recommends that hospitalizations be kept brief.
Several SI units have been started in U.K. hospitals, however, where self-injury is tolerated and clients are encouraged to examine their behavior after an incident. The staff accept some SI as inevitable and try to use these occasions as ways to teach about coping without SI. In cases like these, longer hospitalization may have more value.
Approaches taken by those who see self-injury as associated with BPD Dialectical Behavioral Therapy Interpersonal Group Therapy Approaches taken by those who see self-injury as non-BPD-related The CPTSD approach Healing from TRS Rational-Emotive Therapy Psychopharmacological approaches
Individual psychotherapy and how to choose a good therapist
Where to go for professional help Hypnosis and relaxation Hypnotic relaxation techniques have apparently been used, with some success, as an adjunct to therapy. Malon and Berardi (1987) state that treating those who self-injure requires that the therapist realize the conflicting needs of the therapist to be in charge of the relationship and of the patient to be treated like an equal; if the patient's need for being seen as an equal isn't met, no progress can be made with or without hypnosis. The study in question reports success with three types of hypnosis:
Breath counting: the patient is led into a trance and instructed to notice her breathing, counting each deep
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