self harm and treatment options-1 hr presentation
TRANSCRIPT
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Self Harm and Treatment
Options
More Than Just Coping Skills
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Goals for Today Learn something you didnt know before
Develop a game plan for the difficult ones Laugh & keep from being bored
Get out early
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History of Self Harm Ancient Greece-captured warriors
Religion & penance-flagellants 1897-Gould & Pyle- Needle girls
1960s-Research focused on in-patient
settings
1987-Dr. Armando Favazza-Bodies Under
Siege
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Definitions for Us Today Not for us
Major self harm-true mutilation due to
psychotic disorders
Mental Retardation/Pervasive Developmental
Disorders
Body Modification-but well revisit it
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Our Focus of Behaviors Minor Self Harm
Not designed for death, but can lead to
significant problems
Repetitive and systematic
Usuals-cutting, burning/branding, scratching
Anorexia Nervosa/Bulimia Risky behaviors-sex, drugs, dangerous relationships
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Co-morbidity Depression & Mood Disorders
PTSD & Acute Stress Disorder
Anxiety Disorders
Personality Disorders (mostly Cluster B)
Substance Abuse & Dependence
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Goals for the Behavior Different than the Why?
Not concerned with the origins, just the specific
behaviors and what benefit they serve
Ask What? instead
What are the benefits?
What is the goal? What is the reaction of those around it?
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Goals (cont.) How do we identify the possible goals of
the behavior?
Where are the cuts?
Whats the ritual/pattern to the self harm?
Wheres the focus of attention and reaction?
When in doubt, ask.
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Potential Goals Attention Seeking
My most despised reason ever given
Kinda garbage, but kinda not
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Purpose & Goals (cont.) Connect with the feeling world
Validate/Symbolize emotions
Dissociation and numbness-Angelina Jolie Reconnects with emotions and life
Fits well with the symptoms of PTSD
Release the stress or negative feelings Think circuit breaker
Biological support-endorphins
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Purpose & Goals (cont.) Common theme-
Control
Body Modifications
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Purpose & Goals (cont.) Family dynamics & cybernetics
Serves a purpose not just to the self harmer, but
to the family system as a whole
Homeostasis
What benefit do these actions serve for the family
and the roles they may play
Everyone works together to keep the system in place
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Treatment Goals Reduce/Remove the behavior
Teach how to gain goals without the self
harm
Restructure the family/system to reduce the
benefit of the actions
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What type of change do we
want? 2 ways we can create
change in the family
A riddle for you-please connect these 9
dots with four lines
(not curvy lines!)
without lifting yourpen.
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Types of Change 1st Order Change-a change within the rules
Most common type of change
Works from given or perceived parameters
Great in simple situations-thermostat
Content focused-ignores the rules that govern
it
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1st
Order Change (cont.) Change is minimal due to the rules staying
the same, and old behaviors can return
More of the same ideas
Do the opposite of the problem
Can create a solution as the problem issue-
Prohibition
Force vs. Resistance-think of the
homeostasis
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2nd
Order Change We cannot solve our problems using the
same thinking that created them. Albert
Einstein
Focuses on changing the rule
Thinking around corners-riddles
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Return of the 9 Dot Problem Self imposed rules keep the task impossible
The construction and definition of the problem,
not the problem itself, becomes the problem
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2nd
Order Change (cont.) Change must begin with understanding the
reality then challenging it
Once an event/object gets a category, its
hard to think of it as something else
If the game changes, then it cant go back
because the rules have changed.
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2nd
Order Change (cont.) 4 Step Process
Clear definition of the problem in concrete
terms
Investigation of the solutions that failed
Clear definition of the concrete change desired
Create & implement a plan
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How do we help do this? Understanding the homeostasis
Understanding the reality and the
language
Understanding your own rules and reality
Challenge this reality with a new
categorization
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Interventions Medications
Focused on the diagnosed issue
Antidepressants
Mood Stabilizers
Anti-psychotics
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Structure of Therapy Individual
Family
Sometimes more beneficial, even without the
patient/client
Think of the homeostasis-what does the
behavior give the other members of the family? Group-watch for the evil Contagion
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Warning Professionals!
Do Not Try These in the Office! Logic
Future consequences
The effect on others
Lecturing
Stewart Smalley Straight coping skills
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Conceptualization & Specific
Intervention Ideas
Dialectical Behavior Therapy (DBT)
Research supports usage with borderline
personality disorder
Intricate and structured-asks a great deal of
investment from the system of the patient
Achilles Heel is this investment and structurefrom others (clinical, family, etc.)
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Structure of Personality Disorders Each role is designed
to avoid responsibility
Creates drama todeal with internalconflict
Think Popeye
Hero Victim
Persecutor
DBT seems toreinforce these roleswith Hero &Victim specifically
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Specific Plans for Personality
Disorders Call out the pattern/role-change the rules
Poker tells
Focus on self-the new Golden Rule
Limit the number of sessions-6-8 max
Give time between sessions-their crisis
may not be a crisis Help make the personality disorder into a
style-Dexter them
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Self Harm Interventions
Pattern Recognition and Replacement
Basic cycle work
Logical but can be beneficial if sold right
Works well with compliant clients Triggers-teach them how to avoid them or ID
how they cause them-gives control back
Thoughts-new thinking about the triggers
themselves Physical cues-Coping skills-delay the cutting
until the change in thought can help
Look for the behaviors that give the same
benefit without the present costs
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Self Harm Interventions (cont.)
Harm reduction model
Solution focused concepts
Focus on the harm it causes the patient from the
patients perspective
Develop plans to reduce it without pushing the idea of
removing it and dealing with the negatives
Identify pattern, develop interrupters at each point until
the patient can cut at the right times
Informed consent-challenge them to look at how toaccept the costs they have chosen & challenge the
fantasy they have with the cutting
Model gives control, which is a basic goal for actions
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Self Harm Interventions (cont.) Addiction and 12 Step Approach
Tolerance &Withdraw
Structures life to deal with stressors without
using the addictive behavior
Connections to others and support network
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Self Harm Interventions (cont.) Family therapy
Messing with the system
Reframing the problem as a family issueinstead of an individual issue
A positive spin on the negative action-thinkof the homeostasis
Must understand and believe their view
Sell them on a new view that changes theunderstanding of the behavior
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Ways to Develop a Good Reframe
How does the behavior help the family?
Think of the goal for the patient-how can
you turn that around so it does the opposite?
Think plausible but uncomfortable to the
patient/family
Advertising-wheres the hook?
Let them figure some of it out
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Self Harm Interventions (cont.) Prescribe the problem
Set different limits for the time they can do it
and how
Reward the problem behavior
Odd interrupter-Flip a coin
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Questions?
If I cant answer it, Ill make
something up.
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Suggested Readings Fishing for Barracuda-Joel Bergman
Change-Paul Watzlwick, John Weakland,
Richard Fisch
The Family Crucible-Augustus Napier &
Carl Whitaker
Clues and Keys-Steve de Shazer
Bodies Under Siege-Armando Favazza