15. Self-injury behaviour (cutting, self-harming) (Index)




CHPT 1: INTRODUCTION                                                                                   

  • Introductory remarks                                                                                                 
  • The importance of a holistic approach                                                                 
  • Relevance and statistics                                                                                           
  • Defining some terms                                                                                                  
    • What self-harm is not                                                                                           
      • It is not a failed suicide attempt                                                                   
      • Not a ‘girls’ problem                                                                                       
      • Not a ‘teenage problem’ that people simply outgrow                            
      • Physical pain is not the point of self-injury                                              
      • Self-mutilators are usually not psychotic, grazy or mentally ill          
      • It’s not just an attempt to get attention                                                      
      • It’s not just a fad                                                                                              
      • Self-injury is not merely body modification taken to an extreme                                                                                                 



  • It works                                                                                                                          
  • The consequence of abuse and/or sexual abuse                                              
  • I need a way to ‘release’ pain                                                                                   
  • A pressure relief valve                                                                                               
  • “I just feel so alone”                                                                                                   
  • “I can’t say it any other way”                                                                                   
  • “I need to control something”                                                                                 
  • “I just want to feel something, anything”                                                 
  • Self-punishment                                                                                                          
  • The role of the atmosphere within the family                                                      
    • Family breakdown                                                                                                
    • Not enough time for children                                                                             
    • Control and manipulation                                                                                   
    • The negative influence of an authoritarian father                                        
    • Communication difficulties in their homes                                                    
    • The role of internalized lies                                                                                
      • The role of family secrets                                                                              
      • Houses with a lack of emotional honesty                                     
      • Emotional incest or parentification                                                
    • Unresolved trauma                                                                                               
    • Painful interpersonal relationships                                                                  


CHPT 3:  CLUES THAT SOMETHING MAY BE WRONG                                        




CHPT 5: THE DYNAMICS OF THE PROCESS ITSELF                                           

  • It is contagious                                                                                                
  • A cyclic pattern of behaviour                                                                                   
  • Intentionally interfering with wounds that are healing                          
  • The tolerance factor (Appendix A)                                                             
  • The debilitating cycle (Appendix B)                                                                       
  • Triggers                                                                                                                         
  • Possible relationship with body piercing and tattooing                                   
  • Challenges to the counselor                                                                        
  • Important qualities                                                                                                      
    • Humility                                                                                                                    
    • Authenticity                                                                                                
    • Acceptance                                                                                                             
    • Gentleness                                                                                                              
    • Firmness                                                                                                                 
    • Willingness to be well informed                                                            
    • Hopefulness                                                                                                           
    • The ability do deal with own emotions                                                           
    • Therapeutic flexibility                                                                                          



  • Untangling family system knots                                                                             
    • Help the family to break through denial                                                          
    • Hints from past treatment experiences                                                           
    • Unsuccessful parental solution patterns                                                       
    • Two important therapeutic tasks                                                                      
    • Five connection-building experiments and rituals                          
      • Family storytelling                                                                                          
      • Adolescents mentoring parents                                                                 
      • Solution-oriented family sculpting and choreography             
      • The compliment box                                                                                      
      • Building new connections with peers and inspirational others         
    • Eight important assessment questions                                                          
    • Explore past successes                                                                                      
    • Intervening as early as possible                                                                       
    • The importance of neutral, nonthreatening discussions                           
    • Practical guidelines within the nursing profession                         
    • Focus on the person’s potential and abilities                                               
    • Practical guidelines as formulated by Harmless                                          
    • Withdrawal symptoms                                                                                         
    • Enhance capacity to cope and regulate emotional perceptions and impulses                                                                                                           
    • Make room for client story telling                                                                     
      • Explore the past                                                                                              
      • Identify any unresolved sexual trauma                                                     
      • Ask how it all started                                                                                      


CHPT 7: PASTORAL PERSPECTIVES                                                                                   

  • Correcting misbelieves about God                                                            
  • Jesus’ blood and His wounds                                                                                 
  • Replace the lies with the truth                                                                                 
    • Challenging the assumptions                                                                           
    • Renewing the mind                                                                                              
    • Examples of unchallenged assumptions                                                       
      • “My choice to self-injure doesn’t effect anyone but me”               
      • “This is my body and I can do whatever I want with it”                   
      • “If I stop cutting I won’t have any effective way of dealing with my pain”                                                                                              
      • “If I don’t self-injure, people won’t know how much I hurt inside”
      • “I need to cut, so people won’t get close enough that they can hurt me”                                                                                             
      • “I’m still guilty, and I could never punish myself enough”
      • “If I give up self-injury, I’ll end up doing something even worse”
  • Revisit hurtful places                                                                                                 
  • Remind yourself about all the good of the past                                                  
  • The role of forgiveness                                                                                             
  • The role of Holy Communion                                                                                  
  • Pray and meditate                                                                                                       
  • A ministry of presence                                                                                               
  • Examples of spiritual breakthroughs                                                                    
  • Thought patterns and behaviors that can be modeled for the self-injurer
    • Living in healthy self-perception                                                                      
    • Using appropriate communication skills                                                        
    • Dealing with life patiently                                                                                    
    • Choosing when to relinquish or exert control                                              
    • Establishing and maintaining healthy boundaries                          
    • Practicing emotional sobriety                                                                            
    • Giving and receiving appropriate physical touch                                        
    • Recognizing the importance of spiritual healing                                          
  • The possible contribution by the church                                                 


CHPT 8: BE PREPARED ON SLIPS                                                                             

  • Discovering and developing personal strengths                                               
  • Keep track of positive triggers as well                                                                  
  • Slips are opportunities for new growth                                                                


CHPT 9: CONCLUSION                                                                                                   


APPENDIX A: The law of diminishing returns                                                           
APPENDIX B: Cycle of self-injury                                                                                 
APPENDIX C: Organizations, web sites and books devoted to
                         understanding and recovering from self-injury