Treatment for Self-Injury

How to Stop Self-Injuring
online conference transcript

Dr. Wendy Lader our guest speaker, is an expert on the treatment for self-injury.  She is the clinical director of SAFE (Self Abuse Finally Ends) Alternatives.  She is the author of the book "Bodily Harm: The Breakthrough Healing Program for Self-Injurers".

David Roberts is the HealthyPlace.com moderator.

The people in green are audience members.

BEGINNING

David: Good Evening.  I'm David Roberts.  I'm the moderator for tonight's conference.  I want to welcome everyone to HealthyPlace.com.  I hope everyone's day has gone well.  Our conference tonight is on "Treatment for Self-Injury. How To Stop Self-Injuring".

Our guest is Wendy Lader, Ph.D., who is the clinical director of the SAFE (Self-Abuse Finally Ends) Alternatives Program.

Dr. Lader is an internationally recognized expert on the treatment of the self-injurer.  She is co-developer and clinical director of S.A.F.E. (Self Abuse Finally Ends) Alternatives, currently housed at MacNeal Hospital in Berwyn, Illinois.  Developed in 1985, S.A.F.E. remains the only inpatient and partial hospitalization program designed exclusively for the self-injury patient.

She is the co-author of the book, "Bodily Harm: The Breakthrough Healing Program for Self-Injurers" and has published journal articles and lectured extensively on the subject.

Good Evening Dr. Lader and welcome to HealthyPlace.com.  We appreciate you being here tonight.  Just so everyone is on the same page here, please give us your definition of self-injury, what is it and what it isn't.

Dr Lader: Self injury is the deliberate harming of one's body in a non-lethal way, with the purpose of managing uncomfortable emotions.  It isn't a suicide attempt.

David: Please correct me if I am wrong about this, but people are not "born" being self-injurers.  In other words, there's no genetic predisposition to self-injury.  What is it then that pushes someone into this type of behavior?

Dr Lader: You're correct.  There is no gene for self-injury.  However, there may be some predisposition for lower tolerance for frustration.  In general though, we find most of our clients come from homes in which communication is indirect or at times violent.

David: I have heard people who are self-injurers say that by cutting themselves, they actually feel better.  I think that's difficult for some people to understand.  Can you elaborate on that?

Dr Lader: Self injury is a form of numbing, similar to drugs or alcohol.  It may even release naturally occurring opiates that make people feel better.

David: And when you say that people come from homes where communication is indirect, can you explain that to us please?  And why would that result in self-injurious behavior?

Dr Lader: The answer to this question is complicated.  In general, families have difficulty expressing feelings through words.  Instead, sometimes these feelings are expressed through action or just not talked about at all.  So, people may learn the only way to get attended to is through action or it "turns up the volume" so that people notice that something is wrong. 

David: So, are you saying that in some instances, this may be an attention-getting mechanism?

Dr Lader: That's minimizing the problem.  When people need to express themselves in this way, it's because other avenues have not been responded to.  This creates tremendous frustration and anger without an outlet. 

David: You also mentioned the numbing sensation, similar to drugs and alcohol.  Would you say that self-injurious behavior is addictive or similar to having an addiction?

Dr Lader: We don't believe it's an addiction, because we do believe that people can fully recover.  However, it's addictive-like in that it helps people feel better, though temporary, and it often increases in severity and intensity over time. 

David: Here are some audience questions Dr. Lader:

siouxsie: I know a lot of self-injurers have been abused but I have never been abused in any way and I am a Self-Injurer.  Is this common?

Dr Lader: Yes.  While many self-injurers have experienced physical abuse or sexual abuse, a large number have not.

Exfear: Why do most self-injurers like myself, find that we have to self injure in order to get the help?

Dr Lader: Many people come from families that do not respond to more subtle cries for help.

daybydaymomof2: Is self-injuring in any way hereditary?

Dr Lader: Self injury itself is not hereditary.  However, family histories of mood disorders, low tolerance for frustration and other forms of addiction are common.

Silkyfire: I have felt that the feeling of the blood running down my arm is a symbol of the stress leaving.  Is that average?

Dr Lader: We hear that very frequently and blood letting has a long history in our culture as a release of "toxins."  And maybe in this case it's toxic feelings.

savanah: Is there such a thing as healthy self-injury?

Dr Lader: We don't believe there is.  We view self-injury as an escape from dealing with the "real" problem which is facing uncomfortable events and feelings. 

wonder: I run the website Self-Harm Links.  I receive emails weekly asking for help for self-harm.  I am not a doctor.  I have only my personal experience.  Given the lack of professionals who deal with self-injury, what do you think a good response would be to refer people who need more help than I can offer?

Dr Lader: Tell them to call the informational line - 1 800 DON'T CUT or they can read our book, "Bodily Harm: The Breakthrough Healing Program for Self-Injurers". 

David: I want to get into the treatment aspect of self-injury.  First, can you give us some details about the SAFE Alternatives Program-- how it works, what the goals are, what the costs are.  Then we'll get into other aspects of treatment for self-injury.

Dr Lader: We forgot to mention that we have a website - www.safe-alternatives.com.  On our website, we also answer some of those questions.  In general, we're a thirty-day inpatient/day hospital program that uses a combination of impulse control logs, writing assignments, individual and group therapies.  The cost depends on the amount of inpatient days versus partial, and many insurance companies cover much of these costs.

David: Does insurance cover the costs, or most of the costs?

Dr Lader: It really depends on the insurance company and each individual's benefit plan. 

David: And just to give people in the audience an idea of the costs involved, can you give us a range please?

Dr Lader: Approximately $20,000 for 30 days.

David: Before I get into the treatment details, I'm wondering if a person with self-injury can be completely "cured" or is it like an addiction, where they live with it day-to-day and manage it day-to-day?

Dr Lader: We believe that people can be completely cured. 

David: Regarding treatment for self-injury, what are the various treatments available and how effective are they?

Dr Lader: I can only speak for the effectiveness of our program.  Our preliminary outcome data indicates that approximately 75% of our clients are injury-free at the two year post-discharge mark. 

David: And what kinds of treatments are available to help someone recover from self-injury?

Dr Lader: We believe in a combination of cognitive-behavioral and psychodynamic approaches.  In other words, we attend to the symptom of self-injury as a clue that indicates underlying unresolved issues.  But we also believe that as long as one is edging in the symptom and therefore self-medicating, that it is harder for them to deal with the underlying issue. 

David: How do you make someone stop self-injuring?

Dr Lader: One of the reasons we do this in an intensive care setting, is because we know that self-injury is a difficult symptom to give up without twenty four hour support.  Once someone has recognized alternative choices, and has learned how to deal with the feelings, self-injury is no longer necessary.

David: Earlier, you mentioned the use of "impulse control logs".  What are those and how do they work?

Dr Lader: Impulse control logs are designed to give clients a "window of opportunity."  This means putting a thought in-between an impulse to self injure and the actual action.  We recognize self injury as a clue that one is wanting to avoid a seemingly intolerable emotional state.  The logs identify the precipitant of the impulse, the related feelings and what the individual is trying to communicate to others, and what the consequence for the action would be. 

David: Our audience members have lots of questions Dr. Lader.  Here are some:

Marci: What are the main things that one can do to manage self-injury, especially if a program like yours is unavailable to them?

Dr Lader: We strongly advise being in individual psychotherapy.  We also encourage within this therapy, the use of impulse control logs and our writing assignments (also included in our book) to help structure the therapy. 

sadeyes: I haven't had any success with impulse control logs.  Do they work for some, and not for others?

Dr Lader: In general, the clients who come here find them extremely helpful.  It may be that you need some guidance in how to use them, and for some it takes some practice.  They don't always help right away. 

tiggergrrl555: Is it possible to recover from self injurious behavior without going to a program like SAFE?

Dr Lader: Yes, many people do.

David: And how do they do it?

Dr Lader: Through supportive individual therapy, and the willingness to take the risk to face the uncomfortable feelings.

wendles: Many people I have met and asked about my scars have never heard of self injury.  What is the best way to explain it to them so I can get help?

Dr Lader: Self injury has been my way of coping with intense feelings.  It has helped me survive but I would like to learn how to communicate feelings through words instead of action. 

David: And that also brings up another point, Dr. Lader.  Some people have great difficulty finding a therapist who will treat those with self-injury.  How does one deal with that?

Dr Lader: I think it's good that certain therapists admit that they don't know how to deal with this particular issue.  It's fine to interview therapists to find one that has treated other self-injurers or is willing to get supervision. 

David: For those in the audience who are self-injurers, I'd be interested in knowing what you did or said to let someone know about your self-injury behavior.

What about the use of medications, Dr. Lader?  Are there any that are used in the treatment of self-injury?

Dr Lader: Our clients come in on many different medications and we do believe that medications can help clients deal with the acute and intense anxiety that many clients experience.  It has been our experience that low dose of neuroleptics help with this acute anxiety, and the hope is that clients only need to be on them for limited amounts of time.  Other medications that some people find helpful are anti-depressants and mood stabilizers.

David: Here are some of the audience responses to  how do you let someone else know about your self injury?  Hopefully by sharing these, we'll be able to help each other:

wonder: I only let people know about my self-harm if they ask.  I am very scared that they will interpret it as attention seeking if I tell them without their asking.

Liz Nichols: The first person I told was my mom. I didn’t know what to tell her, so instead I just showed her the cuts/scars and started crying. She thought they were suicide attempts but later on she started to understand what it was.

kayla_17: The first time that someone found out, he was shocked, and he didn’t really know what to do.  He asked me about it and wanted to know why I've done it.  But I really was trying to let him see it because I needed someone to know

Lela: When someone asked me about my scars, I said that I deliberately cut myself.  I added that it was the dumbest thing I'd ever done and that I don't recommend it for anyone.

Chickie96: One of my friends brought up her problem, and it turned out that another two people present (myself included) in this group of four were doing it too.  We use each other for support, and we talk to each other about our problems too.

Trainer: How my husband found out?  I had been very withdrawn.  I couldn't bring it up verbally so I purposely left drops of blood on the floor by the toilet.  He then confronted me on it.

BPDlady23: I tell people that ask about my scars that I self injure.  I go on to explain that I cut myself, but am not a danger to others.  This usually leads to more questions, which I am glad to answer.

David: What is it like to get treatment for self-injury, Dr. Lader?  You mentioned the possibility of needing anti-anxiety medications.  For instance, alcoholics need to "dry out" first and go through the "shakes".  Do people who self-injure have similar withdrawal experiences?

Dr Lader: People have all kinds of fears about what will happen if they don't self injure such as, "I'll go crazy,"  "I'll explode,"  "I'll start crying and never stop," or  "I’ll die."  But in all of the fifteen years that we've been doing this, I've never seen any of these happen." 

David: Some more audience responses to how you shared the news with others that you self-injure:

darknesschild: When people say "what happened?" I just say "razor blade."  Then they don't ask anything else.

Cathryn: I've only told a few close friends.  No one in my family knows, not my husband nor my daughters.

ang2 A: The first person that asked me, saw wrists bandaged and motioned a question so in private simply told him whole story.  The second one found me out one night and asked how I was.  When I said "I've been better," he questioned me what's wrong. So told him what was bothering me and the whole thing.

wendles: I never tell anyone unless they ask.  Sometimes I tell them my dog scratched me.  I finally confessed to my mom and my best friend.

bluegirl: I told a friend that I had tried to hurt myself.  I didn't really say self-injury or suicide attempt or anything.  And I told her that I had been at the hospital getting stitches and they had tried to admit me involuntarily.  She was the first non-therapist-type person I told.

Rabbit399: What is the draw that a person may have that moment right before they self injure for the first time?  Have you any information on the reasons why a person may pick up that object and hurt himself or herself without ever doing so before?  Also, is it more common for people to just be self-injurers, or is it something they become because they first saw it and wanted to try to see if it worked?

Dr Lader: Most people don't know why they picked up the first object to hurt themselves.  It's becoming more common, however, for people to have heard about it from other people and then try it.

David: For those of you who are wondering if it's possible to recover from self-injury, here's a comment from one of our audience members tonight:

mazey: I have been in treatment 2 times with Dr. Lader being my psychologist.  I have been injury-free, I'm honestly not sure, maybe going on 2 years now.  I didn't think that I would ever stop, but I did.  Not easily, though.  It's been a lot of hard work and tears.

I attended treatment.  I have impulse logs in my car, by the computer, in my binder so when I'm in class, I surrender.  I barrel right on through the emotions.  I take it head on because I have the tools to not injure.  I try to just say it, and I cry and cry and don't try to stop the feelings.  The thoughts of injuring lessoned until I realized I was thinking about it all the time

Lela: I've been a self-injurer for 2 years and recently decided to quit.  But I keep occasionally going back to it.  How can I stop completely?

Dr Lader: It's to recognize that the self injury itself is not the problem.  Many people have been able to go for months and sometimes even years between episodes, but unless they deal in more direct ways with their feelings, the symptom is likely to persist. 

David: For those who asked for it, here's the link to the HealthyPlace.com Self-Injury Community.  You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Now, to follow-up on that comment, what you are saying is, even after attending a treatment program like yours, it's important to receive follow-up therapy on a regular basis?

Dr Lader: Absolutely.

thycllmemllwyllw: I have not been self-harming as long as some people but I know a lot of people that have self harmed for a while and they come to me to vent, and they are always threaten to die.  I want to know what are some ways that I can calm them down without talking about myself or getting myself down about it?

Dr Lader: I would suggest helping them focus away from the "escape" (self-injury or suicide) and focus instead on identifying feelings and finding solutions for the problem.  Also, to identify and challenge thoughts that fuel escalation rather than calming.

mammamia: It's important for me to cut veins, in order to see the blood run out.  It feels almost like I'm ridding my body of all the bad stuff.  I'm getting very weak because of this.  It has become very serious; I'll cut 3 or 4 times a day.  How do I get help when living so far away from Illinois?  I'm scared.

Dr Lader: It's important to be in therapy and to recognize that the object is not to rid oneself of anything but to accept uncomfortable feelings like anger and sadness.  These feelings are not "bad" just uncomfortable. 

Cathryn: OMGosh! mammamia, I do that for the same reasons too!!  Actually I cut different ways for different reasons. I am trying so hard to get the feelings out, rather then cut.  But being threatened with abuse for crying as a child, dries up the tears.  I cry red tears now.

David: And mammamia, even if you can't get to the SAFE program, hopefully you can find a therapist near where you live who can help.  That's the most important thing.  Finding a treatment specialist who can help you.

Sometimes I hear people say, "What you are saying is triggering to me.  I have to cut myself."  For some who are not self-injurers, it's difficult to understand how just saying something can induce someone to self-injure.  Can you explain that phenomenon to us?

Dr Lader: Some of these questions are very complicated and we recognize that some of our answers may seem and in fact are simplistic.  However, in answer to this question, triggers are important clues.  Don't lose that information.  Analyze it and try to understand and face the fear directly. 

We B 100: Is it normal to not know why I self-injure?

Dr Lader: Yes.  Most people don't know why they injure.  The action itself is at first so automatic that the reason is often lost.  In fact the purpose of self-injury is to distract from the underlying problem. 

David: Here are some audience comments about what is being said tonight:

insight: My experience has been that it was easier to self-injure to prevent memories of past abuse to surface.  The emotional pain was what I was afraid of.

sweetpea1988: We all need to learn to let ourselves express our feelings

sweetpea1988: Plus it is what we were taught about anger

jenny3: I have been cutting since I was 17 and I am now 26.  I find it is very hard to keep hiding from  people.  I am on medication to help me with this but they don't seem to be working yet

sweetpea1988: To not know why, is because we have not learned to express ourselves in the safe way.

Lela: The reason I first cut was out of curiosity.  A girl at school triggered me and I picked up a pair of scissors.  I was amazed by the way the pain left me so quickly.

tree101: I find that when I am triggered, it's because what someone is saying is taking me back to uncomfortable feelings or situations.  It increases my feeling of been bad and my need to be back in control

wonder: There has never been an instance where someone has said something that made me want to cut.  But usually I feel like I want to cut after reading a lot about it or very graphic descriptions on the net.  It brings up old "junk" when I think about self-harming too long.

cherrylyn24: My parents are not very supportive of me and I have reached out for help in other ways.  They have gotten angry at me for that, and whenever they yell at me, it seems like the answer is to cut.  I know I need help, but have been  in therapy before and hated it, plus my parents complained about taking me.

Chickie96: my father's alcoholism numbed me as a child, and now I can't really deal with admitting emotions easily.

jenny3: My parents don't know that I cut and I don't want them to know

TeddybearBob: We need to see that self-injury is a lie that it takes pain away from us.  It doesn't give us any real control..

Liz Nichols: The first time I ended up cutting myself was when my family was having a fight.  When I was cutting myself I was more thinking about killing myself than anything. Then I started feeling better.  I started when I was 16 and I'm now 18.

wendles: I took chunks of skin out of my arm with a fingernail clipper.  I didn't even realize what I was doing was self injury.  I still don't understand why I did it.

David: Here's the link to our Journalers in the self-injury community who keep online self-injury diaries of their experiences.  You can read them and post your comments on their bulletin boards.  And I'm getting some comments about Dr. Lader's book "Bodily Harm" not being available in stores.  If you click on this link you can get it now: "Bodily Harm: The Breakthrough Healing Program for Self-Injurers". 

ang2 A: The book is wonderful, finally people that understand

Dr Lader: Thanks!  That 's what we hope for.

David: Here are a few more questions:

imahoot: Is severe head banging to the point of fracturing skull common in Self-injury as is cutting?

Dr Lader: Yes.  Many of our clients hit various parts of their body severely.

ktkat_2000: I was told by my psychiatrist that the self-injury behavior would be in my life until I am in my 50's, when I will "grow out of it".  Is there any truth to this?

Dr Lader: No.  We have many teenage clients as well as young adults who have stopped this behavior.  It's not a matter of growing out of it.  There are things you can do to take true control.  We know that people don't just grow out of this, as we have many clients calling us and coming to our program of all ages, including those over 50.

Maddmom: Is it uncommon to not plan, not have a favorite tool, and to hurt in other ways rather than cutting?

Dr Lader: No.  Some clients have rituals and plan their self-injury, but an equal number or maybe more, act impulsively. 

David: Maddmom breaks her fingers.  Does that fall under self-injury?

Dr Lader: Yes, it does.

biker_uk: Do you think that message boards are a good or bad thing for self injury?

Dr Lader: I think there are many people, including therapists who try to be helpful, but may not be accurately informed.

David: Thank you Dr. Lader for being our guest tonight.  We're grateful that you came and shared your knowledge and insights with us.  The SAFE Alternatives phone number is 1-800-DONTCUT.  Their website address is: www.safe-alternatives.com.

Dr Lader: Thanks so much for having us.  The audience and moderator questions were excellent.

David: I also want to thank everyone in the audience for coming tonight and participating.  I hope you found tonight's conference helpful.  Also, if you haven't already, please sign up for the self injury mail list on the front of the self injury community, that way you can keep up with events like this on the site.

Thank you again Dr. Lader.   I hope you'll agree to come back and be our guest again.

Dr Lader: We'd love to. Good night.

David: Good night everyone.

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