Therapy - Part V in Self-Injury series
deep slow breath. Positive imagery: the patient is put into a trance state and instructed to visualize herself in a calm, pleasant, relaxing place doing something she enjoys. This image is held for a while. Affect bridge: after trance is achieved, the patient is asked to use the current unpleasant feelings to remember other times in his life when he's felt this way. Memories that are too distressing to talk about in a normal state are sometimes speakable in a trance state. It's important to note that in all of these techniques, the therapist must remain seated close to the patient, offering encouraging words and/or touches when appropriate. Malon and Berardi go so far as to say that "simple hypnotic techniques...offered the most immediate relief when delivered with a strong communicative focus and close here-and-now contact."
Hospital-based treatment SAFE Alternatives (1-800-DONTCUT) is an inpatient program specifically for self-injurers located at MacNeal Hospital in a Chicago suburb (this program was formerly located at Rock Creek Hospital and at Hartgrove Hospital). The program combines milieu therapy, cognitive-behavioral therapies, and group and individual exercises to help patients gain an awareness of why they hurt themselves and how to stop. They claim to be the only inpatient unit for self-injurers in the U.S., though Rock Creek continues to have a program specifically for SI, as do a few other hospitals. Although their zero-tolerance policy toward SI is controversial, they claim to have lost very few clients because of it. There is no empirical evidence of the success of their approach, and I personally am uncomfortable with their overly aggressive marketing style. The hospital is quite expensive, and if you haven't insurance, you probably can't afford it. The Sanctuary at Friends' Hospital in Philadelphia is an inpatient unit for trauma survivors that is aware of the special needs of self-injurers and takes them into account in its treatment program.
Butler Hospital in Rhode Island offers a partial hospitalization program that uses dialectical behavioral therapy to treat a diverse patient population of self-injurers. In a recent assessment of their program, they conclude, "Two years of operation of the women's partial program provides promising anecdotal evidence that DBT, which is an outpatient approach, can be effectively modified for hospital settings. . . . Our experience with more than 500 women certainly suggests that such treatment may be a feasible alternative to inpatient hospitalization" (Simpson, et al. 1998). Butler can be contacted at (401)
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