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.