David: Are you saying that one method of treating self-injurious behavior is to taper off; sort of like quitting smoking cigarettes, where you smoke lower nicotine cigarettes or use nicotine substitutes until you finally quit?

Dr. Farber: I am not suggesting anything about how they do it. I think when people feel understood, they start to understand the how and why of why they felt the need to hurt themselves and they'll find other ways to make themselves feel better and the self injury quite naturally diminishes.

You see, when I talk about treatment, I am not talking about a treatment of just the symptom (the self injury), I am talking about a treatment of the person who has that symptom.

I think, very often, that people who hurt themselves tend to have relationships with others that are very painful, where they really cannot trust other people and I think that when someone can start to feel really safe in a therapeutic relationship, really safe with the therapist, that this attachment with the therapist, this relationship, can even become stronger than the relationship to self harm, than the relationship to pain and to suffering.

David: Then what you are saying is: that until the person can work through their psychological issues, it is very difficult to control the self-injury.

Dr. Farber: I am saying that people need to do both at the same time. They kind of work together, both understanding how and why the need for self injury arose. Therapists can help their patients find ways to control the self harm behavior. One way I find extremely effective is when they are feeling the impulse to hurt themselves, if they can try just to delay it for five or ten minutes. During those five or ten minutes, pick up a pencil and start to write. Try to put into words what you are feeling. In the process of doing that, in the process of using words to put shape or form into the pain you are feeling inside, the pain inside starts to diminish and by the time you finish writing, the urge to hurt yourself may well be much, much less. It's a way of starting to use your mind to deal with the pain rather than to use your body to deal with the internal pain, and that's the key to recovering from a life of self injury.

David: We have many audience questions and I want to get to those. I have one last question for the moment. I know that you teach therapists how to treat self-injurers. In your estimation, are there many qualified therapists out there right now to provide proper self-injury treatment?

Dr. Farber: Not many at all, unfortunately. There are a number of reasons for this. One is that therapists become very anxious around people who hurt themselves, and really, there is nothing much in our training that teaches us how to handle people who do this to themselves.

One of the things I have become very interested in doing, and have begun doing, is teaching other mental health professionals how to understand and how to treat people who harm themselves. I want to make therapists less frightened. One of the ways that I am doing this is this summer I will be teaching a seminar at the Cape Cod Institute in July on the treatment of people who harm themselves, and anyone who is interested can go to the Cape Cod Institute website. I also have a toll-free phone number (888-394-9293) for information about the program this summer. You will receive a catalog with the registration information.

David: I ask that because I know that self-injury is still not understood, or is misunderstood, by many. So where does one go for qualified treatment? How do you find proper treatment for self-injury?

Dr. Farber: I wish I could answer that, really. It can be difficult. First, find a therapist who is willing to learn about self-injury, if they don't already know about it. Then, you really need to search for qualified professionals. I know there are a number of websites about self injury that have names and addresses of different clinics or therapists that are interested in working with patients who self injure, so that may be a good way to do it. Also, there are some therapists that are learning to do DBT (Dialectical Behavioral Therapy) and this is often a group treatment for people who harm themselves in different ways, who have various kinds of self-destructive behavior.

David: So, for those in the audience, that means if you are looking for treatment, you need to interview the therapists before starting treatment with them. Make sure they have an understanding of self injury, or at the very least, they are willing to find out more about it. Here are some audience questions:

shattered_innocents: Hi Dr. Farber. Do you recommend any kind of art therapy for dealing with self-injury?

Dr. Farber: I think that anything that can help you express your emotional pain can be helpful - art therapy, poetry, music. Anything to help you express what you are feeling inside, so you don't have to use your body to express it, is wonderful.

Crissy279: Are there any alternatives to cutting or burning that you find have a high success ratio?

Dr. Farber: As I have already said, I think if people can get themselves to sit down and write what they are feeling inside, that can be enormously successful. Often people are afraid to write. You are not writing for publication, so forget about grammar and spelling. Just write what is in your heart. Just as you could use art or poetry or music or dance to express what is feeling inside - these are all much healthier, much more constructive ways of dealing with your emotional pain than using your body to express your pain. You deserve better than to hurt yourself in that way.

angels0ul: Am I just crazy, because my parents are together, my family is supportive and functional, I'm a straight A student, busy in my community, and have never been through what you could really call "trauma" - not even death of relatives or friends, and I still SI and struggle with anorexia?

Dr. Farber: As I have said before, trauma comes in all different forms and sometimes it is not nearly so obvious. If you can sit down with a therapist who wants to understand, you may be able to piece together why self-injury came about in your life and why it is something you need to use. You may not be able to know this now or articulate this now, but in time you may be able to.

jjjamms: I really would like to know why I cannot have feelings - good or bad ones. I have anorexia, MPD and self injurious behavior. I try so hard to get through the feelings, but they are intolerable. How do I HAVE feelings?

Dr. Farber: Well, to be able to feel your feelings, I think first you need to be able to try to express them to somebody. Often that can be a therapist, and often at the beginning it doesn't come out as something understandable or intelligible. For most people, to go from the experience of inflicting pain on your body to the experience of articulating your pain into words is a long process that doesn't happen overnight. It is also one of the reasons that short-term therapies are not that effective.