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Self Care Without Injury. Canadian Counselling and Psychotherapy Association (CCPA) Annual Conference May 11-14, 2010 Charlottetown, Prince Edward Island Presented By Nancy Buzzell, Ph. D., Licensed Psychologist University of New Brunswick Counselling Services

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Self Care Without Injury

Canadian Counselling and Psychotherapy Association (CCPA) Annual Conference

May 11-14, 2010

Charlottetown, Prince Edward Island

Presented By

Nancy Buzzell, Ph. D., Licensed Psychologist

University of New Brunswick Counselling Services

Sarah Smith, Research Assistant

Mount Allison University


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As Laura entered her house she slammed the door behind her. It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Alderman, T. (1997). The scarred soul. Oakland, CA: Harbinger Publishers.


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Self Injurious Behavior It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

All behavior involving the deliberateinfliction of direct physical harm to one’s body without the intent to die.

Simeon, D., & Favazza, A. (2001). Self-Injurious behaviors: Phenomenology and assessment. In Simeon & E. Hollander (Eds.), Self-injurious behaviors: Assessment and treatment (pp. 1-28). Washington, DC: American Psychological Association.


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Self Injurious Behavior (SIB) It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Breaking bones

  • Burning (8%)

  • Biting

  • Cutting (86%)

  • Scratching

  • Hair pulling

  • Head Banging

  • Hitting/bruising (3%)

  • High risk activity

  • Needle sticking

  • Picking

  • Skin picking

  • Starving self

  • Other (3%)

Gratz, K. L.. (2006). Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional in-expressivity and affect intensity/reactivity. American Journal of Orthopsychiatry, 76 (20), 238-50.


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Historical Trends It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Before 1990: Prevalent among individual with serious mental health issues and abuse/trauma backgrounds

  • After 1990: Prevalent among school age children, adolescents & university students

  • Rate has risen by 150% over the last 20 years across a broad spectrum of society

Enns, K. (2008). Self injury behaviour in youth: Issues and strategies. Winnipeg, MB: Crisis & Trauma Resource Institute Inc.


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Who Does It Affect? It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Percent Population Researchers

21% Clinical F/M) Briere & Gil (1998) **

7% University F/M) Gollust et al (2008)

38% University (F/M) Gratz et al (2002) **

37% University (F) Gratz (2006)

44% University (M) Gratz & Chapman (2007)

13.89% High School (F) Ross & Heath (2003)

13.9% Community (F) Ross et al (2009)

Rates of SIB are estimated to be between 12%-38%


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Meta-analysis: 8 Functions of Self Injury (Cutting) It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Behavioral or the reinforcement of destructive behavior & the linking of injury with self care

  • Systemic or a way to express dysfunctional family or environment

  • Suicidal or a suicide replacement

  • Sexual or a result of conflicts over sexuality & menarche

Suyemoto, K. L., & MacDonald, M.L. (1995). Self cutting in female adolescents. Psychotherapy: Theory, Research, Practice, Training. 32(1), 162-171.


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Meta-analysis: 8 Functions of Self Injury (Cutting) It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Expression or a need to express or externalize overwhelming of anger, anxiety or pain

  • Control or an attempt to control affect or need

  • Depersonalization or a way to end or cope with not feeling present & in one’s own body

  • Boundaries or an attempt to create distinction between self & others

Suyemoto, K. L., & MacDonald, M.L. (1995). Self cutting in female adolescents. Psychotherapy: Theory, Research, Practice, Training. 32(1), 162-171.


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General Risk Factors It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Feelings ofpowerlessness

  • Feelings of being aloneorisolated

  • Difficulty recognizing/communicating feelings

  • Few, if any, alternativecoping behaviours

  • Fewself care orself soothing skills

  • History of physical, sexual or mentalabuse

  • Alikable, sometimeshigh achieving person with other problems.

Levenkron, S. (1997). Cutting: Understanding & overcoming self mutilation. NY: WW Norton & Company.


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Specific Risk Factors It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Characteristic Researchers

Depression and anxiety Hoff and Muehlenkamp (2009)

Peer invalidation Adrian (2010)

Family invalidation Adrian (2010)

Academic difficulties Mahadevan, Hawton & Casey (2010)

Disordered eating Ross, Heath & Toste (2009)

History of drug use Saules, Cranford & Eisenberg (2010)

Sexuality Identity Saules, Cranford & Eisenberg (2010)


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Social Context It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Recent research with university students who self-injure found that:

  • 43.6% of students reported that their behaviour was learned socially

  • 86% of participants knew someone who self injured

  • 74% had at least one friend who self injured

  • 65% had talked to their friends about it

  • 17.4% had engaged in it in front of friends

  • 4.3% had engaged in it as a group with friends

Heath, N. L., Ross, S., Toste, J. R., Charlebois, A. & Nedecheva, T. (2009) Retrospective analysis of social factors and non suicidal self-injury among young adults. Canadian Journal of Behavioral Science, 41, 180-186.


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The Dissociation Factor It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Dissociative:

Disconnected from parents, others &/or self. Not secretive about cutting & at times damages self in full view of others. Attention is gratifying (secondary gain) in it’s own right.

Non-Dissociative:

Physical pain becomes a cure for emotional pain. Usually starts with feelings of anger, anxiety or panic. Person “stumbles” upon self injury and discovers it relieves their emotional state. Instant relief. Endorphin rush.

Levenkron, S. (1997). Cutting: Understanding & overcoming self mutilation. NY: WW Norton & Company.


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Often Starts on an It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. Impulse

  • May start because of others in life who are self injuring

  • May learn about self injury through tv shows, music videos, chat rooms

  • May be accidental: injury then person felt soothed

  • May be result of extreme agitation/rage & becomes pattern of self soothing

Enns, K. (2008). Self injury behaviour in youth: Issues and strategies. Winnipeg, MB: Crisis & Trauma Resource Institute Inc.


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Self Assessment Tool It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

If I do this, will it hurt or harm my body? If I answer “no” would other people agree with me?

If I do this, will I need help coping with the repercussions? Will I need to see a doctor, nurse, counsellor?

If I do this, will the people I care about be upset? Frustrated? Frightened? Appalled?

If I do this, will I lose an opportunity to reach my goals in life? Drop out of school? Miss an important opportunity?

If you answer yes to just one, you are self harming.

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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Clinical Assessment It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Frequency, duration, severity, medical history & possible complications

  • Reasons or purpose of SIB

  • Determining client’s stopping point

  • Education about function (both +ve & -ve)

  • Providing appropriate alternatives

  • Ever thought about suicide?

Wester, K. & Trepal, H. (2005). Working with clients who self injure: Providing alternatives. Journal of College Counseling, 8, 180-189.


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Why People Say It It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. “Works”

  • It calms me person down

  • It helps me feel more in control

  • It makes me feel “alive”

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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Why We Think It Works It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Expresses feelings

  • Releases negative emotions & tension

  • Makes emotional pain clearer

  • Punishment

  • Ends dissociation

  • Results in a rush or a high

  • Communicates something to other people

Gratz, K. & Chapman, A. (2009). Freedom from Self-Harm. Oakland, CA: New Harbinger Publishers.


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How it Works It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Like other injuries, it brings about the release of endorphins which are natural pain killers that calm down the central nervous system.

  • It triggers (or ends) dissociation which is the mind’s way of producing a state of trance in which emotion & pain can be disregarded.

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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Reasons it It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. Doesn’t Work

  • Undermines a person’s mental, physical, social & spiritual well-being

  • Does nothing to solve problem(s)

  • Offers only temporary relief

  • Often followed by guilt & shame

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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www.safeincanada.org It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

E

Safe: No trigger

Ascending: Starting to feel triggered

Feeling: Out of control & urge to self injury

Extremely unsafe & strong urge to self injure

SAFE Scale

F

A

S

Baseline

Trigger

Baseline

Self abuse does not allow the person to return to baseline. Next time person start s off at a higher trigger point.


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Addiction Model It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Negative Emotions

Alienation, Anger, Depression, Frustration, Rejection, Sadness

Negative Effects

Shame, guilt, depression

Tension

Inability to control emotions & thoughts of self injury

Positive Effects

Endorphins present, tension & negative emotions reduced

Dissociation

Coping mechanism to reduce tension & later physical pain

Self Injury

Burning, cutting, hitting, pulling hair, scratching

Alderman, T. (1997). The scarred soul. Oakland, CA: Harbinger Publishers.


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Questions We Can Ask It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Think back to a time when you self injured. List three of the most intense emotions you had before you acted.

Describe how you felt when you began to think about hurting yourself. Did your feelings change as you got closer to injuring yourself?

Describe what you went through when you self injured. Did your feelings change throughout the process?

Alderman, T. (1997). The scarred soul. Oakland, CA: Harbinger Publishers.


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More Questions It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

4. What happened after you hurt yourself. How did you feel? Calm? Tired? Peaceful? Anxious?

5. List the ways your self injury contributed to a feeling of relief. How do you define relief?

6. How long did it take after hurting yourself to feel bad again?

Alderman, T. (1997). The scarred soul. Oakland, CA: Harbinger Publishers.


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How Does it Function for the Client? It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • How does not help?

  • I have to do more for it to work

  • I feel bad about myself

  • I have to hide the scars

  • It upsets my boyfriend

How does it help?

  • Makes me feel better

  • Helps me feel in control

  • Takes my mind off things


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Client’s Self Injury Log It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Time & date of self injury

Situation or trigger

Thoughts & feelings before self injury

Location/room where self injury took place

Wounds: How many? Where on body? Use of tool?

Thoughts & feelings after self injury

Reactions of others to the self injury

Enns, K. (2008). Self injury behaviour in youth: Issues and strategies. Winnipeg, MB: Crisis & Trauma Resource Institute Inc.


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Stopping Point It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • When or how does client know to stop?

  • Does client stop when they begin to feel pain?

  • When does the client reach a stopping point?

  • Visual aspect? Sensation of pain or numbing?

Wester, K. & Trepal, H. (2005). Working with clients who self injure: Providing alternatives. Journal of College Counseling, 8, 180-189.


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Alternatives to Self Injury It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Relaxation training

  • Containment strategies

  • Mindfulness, emotional regulation & distress toleranceskills (DBT)

  • Physical activity/yoga/sports

  • Communication with others

  • Negative replacement behaviors


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Alternatives to Self Injury It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Aggression/anger Tear up newspaper or phone book. ` Throw ice cubes, rocks or eggs at a wall. Punch a pillow.

Restlessness Workout, go for a run, walk or bike ride. Clean room. Make noise.

Emotional regulation Meditation, belly breathing, repetitive counting, writing

Visuals Draw red lines on arms. Draw slash marks on paper. Paint areas on body.

Sensations Snap rubber band on wrist. Ice cube on skin. Clod shower.

Adapted from Wester, K. & Trepal, H. (2005). Working with clients who self injure: Providing alternatives. Journal of College Counseling, 8, 180-189.


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Cycle of Self Injury It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Trigger

(Event or situation)

Reaction

Anger, Shame

Automatic

Thoughts

Action

Self Injury

Feelings

Fear, Anger, Sadness

-ve Self Talk

Twisted Thinking


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Cycle of It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. Self Care

Trigger

(Event or situation)

Reaction

Relief That Lasts

Take a Breath

(Slow Down)

Action

Self Care

(Without Injury)

What am I Feeling?

(What Do I Need?)

+ve Self Talk

(I Can Handle This)

Am I Thinking Straight?


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Slowing Down the Process It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

The key to recovery is to slow down the process so the client have time to consider what is happening before they respond.

Trigger - Thought - Feeling - Self Talk - Action

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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Trigger - It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. Thought- Feeling - Self Talk - Action

What you do in response to an event or situation is within your control & depends on the following:

  • What you think about what is happening?

  • Your emotions are at the time

  • What you believe about yourself, others & the world

  • What you say to yourself about what is happening (Self Talk)

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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“Untwisting” Your Thoughts It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Ask yourself am I thinking straight?

Am I jumping to conclusions? Without enough information?

Am I assuming the worst? Catastrophizing?

Am I over generalizing? Always, Everyone, No body?

Am I caught in “all or none” thinking? Extremes?

Haswell, D., & Graham, M. (2008). 5th Edition. Overcoming self-abuse. Hamilton, ON: S.A.F.E. in Canada.


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Changing Thought Patterns It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

1. Identify thought/belief about an event/situation that is leading to unpleasant emotions

2. Evaluate the accuracy of thought/belief

  • Am I taking an extreme view?

  • How else can I think about this event/situation?

  • Am I only looking at the negatives & ignoring the positives?

3. Stop the thought by taking a deep breath & replace the negative thought with a more helpful thought

Enns, K. (2008). Self injury behaviour in youth: Issues and strategies. Winnipeg, MB: Crisis & Trauma Resource Institute Inc.


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Example It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Start with an event: Traffic jam

Self Talk: I am going to be late. This is the third time this week. My boss is going to fire me! (Hot headed thoughts)

Take a breath. Are my thoughts helping? What is another way I can think about this? (Cool headed thoughts)

Alternative Self Talk: I don’t want this to be a habit. Tomorrow I’ll give myself more time.


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Managing Relapses It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Changing thought patterns takes time and practice. Relapses or return to self-injuring patterns are often a part of the change process.

If a relapse occurs ask:

What do I need to do to get back on track a bit?

What has worked before?

What have I learned that will help in the future?


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Self Care Without Self Injury It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did. UNB Counselling servicesSix-2 hr Group Sessions Dr. Nancy Buzzell & Sarah Smith


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Pre-Group Interview It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Opportunity for prospective group members to:

  • Meet facilitators

  • See the group room

  • Ask questions

  • Be supported in determining their readiness


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Pre-Group Interview It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Does person have the ability to function on a day to day basis? Ideally person should not be in personal crisis or in the midst of a major life transition

  • Does person have the ability to discuss her self injury issues without intense anxiety, dissociation or depressive reactions? When it began, what occurred, extent of current self injury

  • Does person have the ability to function in groups? Have they been in other groups? Does she have any concerns about being in a group?


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Suggested Questions It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Introductions

  • Can you tell us about yourself? Year? Program? Living situation?

  • Can you tell us a bit about your self injury? How you are currently doing regarding self injury?

  • Is there anything you are currently doing that helps a bit?

  • What are your reasons for participating in the group?


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Suggested Questions It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

6. What do you want to get out of the group?

7. Can you tell us about the support you have for being in the group? Family? Friends? Health care professionals?

8. Do you have any questions or concerns?

9. Do you think you would like to be in the group?

10. Can you commit to all six group sessions?


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Group 1: Introduction & Safety It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Introductions

  • Group guidelines

  • Goals for the group

  • Why self injury “works”

  • Harm Reduction & Safety plan

  • Belly breathing practice

  • Check out

  • Homework: Case studies


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Group Guidelines It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Attendance

  • Listening & all opinion accepted

  • Confidentiality

  • Self Responsibility & Option to pass

  • Commitment

  • Other: Scents, drinks/snacks


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Group 2: Understanding Your Behaviour It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Check In: Reaction to case studies

  • History & function of self injury

  • Addiction model & relapses

  • Slowing down your cycle

  • Progressive muscle relaxation

  • Check out

  • Homework: Increasing your odds


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Group 3: Coping It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Check In & Increasing your odds

  • Regulation of impulses

  • Fear of losing control

  • Anxiety relief technique (5,4,3,2,1)

  • Surviving the urge

  • Place in nature visualization

  • Check out

  • Homework: Coping Bank


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Group 4: Managing Emotions It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Check In & coping bank

  • Understanding your emotions

  • Emotional expression without self injury

  • Social context of anger

  • Anger management strategies

  • Check out

  • Homework: Self help activities


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Group 5: Facing Your Life It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Check In & self help activities

  • Self esteem 101

  • Self esteem & relationships

  • Boundaries

  • Leaf meditation

  • Check out

  • Homework: Boundary awareness


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Group 6: Living in the Present It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

  • Check In & boundary awareness

  • Your relationship with your body

  • Dear body letter

  • Plans to continue self care in the future

  • The rest of your life

  • Raisin meditation

  • Check Out

  • Circle of gifts


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Web Based Resources It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

www.lifesigns.org.uk

www.canadian-health-network.ca

www.selfinjury.com

www.safeincanada.org

www.siari.co.uk

www.youthnoise.com

www.selfinjury.org.uk/index.html

www.dailystrength.org

www.recoveryourlife.com

www.selfinjury.com/blog


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References It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

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Adrian, M. (2010)  A cumulative risk model of non-suicidal self-injury: Contributions of emotion regulation and contextual invalidation.  Dissertation Abstracts International: Section B: The Sciences and Engineering, 70, 44-72.

Alderman, T. (1997). The scarred soul: Understanding & ending self inflicted violence. Oakland, CA: New Harbinger Publishers.

Gratz, K., & Chapman, A. (2009). Freedom from self harm. Oakland, CA: New Harbinger Publishers.

Haswell, D., & Graham, M. (2006). Overcoming self abuse. http://ca.geocities.com/safebc/new_page_11.htm.

Heath, N. L., Ross, S., Toste, J. R., Charlebois, A. & Nedecheva, T. (2009). Retrospective analysis of social factors and non suicidal self-injury among young adults. Canadian Journal of Behavioral Science, 41, 180-186.

Hoff, E. R. & Muehlenkamp, J. J. (2009). Nonsuicidal self-injury in college students: the role of perfectionism and rumination.  Suicide and Life Threatening Behaviour, 39, 576-587.


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References It had been a bad day, a very bad day. Things at school had been terrible. As Laura locked the door to her bedroom, she was so angry that her whole body was shaking. All she wanted to do was cry, but no tears would come. Laura knew what she needed to do to feel better. She took a small wooden box from under her bed. Carefully lifting its lid, she removed the contents, a single edged razor blade and a packet of gauge bandages. Sitting on the carpeted floor, gently rocking back and forth, she stared at the silver blade in her hand. She needed to do it, she told herself. It was the only way she could feel better, feel normal again. Laura felt no pain as she made the first of several cuts on her left forearm. She watched as the blood spilled from the cuts and dripped down her arm. It felt warm and soothing on her cold skin. After cutting herself in three or four places, Laura wiped the blade clean with a piece of gauze and placed it back in its box. She wrapped her wounds tightly with the bandages, only then feeling the sting. Although she felt tired and drained, she also felt much better. Cutting herself had worked, just as it always did.

Hollander, M. (2008). Helping teens who cut. NY: Guilford Press.

Mahadevan, S., Hawton, K. & Casey, D. (2010). Deliberate self-harm in Oxford university students, 1993- 2005: A descriptive and case-control study.  Social Psychiatry and Psychiatric Epidemiology, 45, 211-219.


Ross, S., Heath, N. L. & Toste, J. (2009).  Non-Suicidal self-injury and eating pathology in high school students.  American Journal of Orthopsychiatry, 79, 83–92.

Serras, A., Saules, K., Cranford, J. A. & Eisenberg, D. (2010). Self-injury, substance use and associated risk factors in a multi-campus probability sample of students.  Psychology of Addictive Behaviours, 24, 119-128.

Simeon, D., & Favazza, A. (2001). Self-Injurious behaviors: Phenomenology and assessment. In D. Simeon & E. Hollander (Eds.), Self-injurious behaviors: Assessment and treatment (pp.1-28). Washington, DC: American Psychological Association.

Wester, K. & Trepal, H. (2005). Working with clients who self injure: Providing alternatives. Journal of College Counseling, 8, 180-189.


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