Natalie: Michelle, when you speak of "treating" self-harm, are you talking about “curing" it, ending it forever? Or is it more like an addiction or many of the psychiatric illnesses, where the patient “manages" the behavior over the long-term?

Michelle Seliner: While some of our clients have been diagnosed with psychiatric disorders which may need to be managed over their lifetime, we do not view the behavior of self-injury as an addiction. It is our belief that once a client resolves underlying issues and learns to tolerate uncomfortable feelings rather than attempting to "stuff" them, self-injury becomes unnecessary. It is also our experience that when a client gets healthier, self-injury becomes painful rather than helpful.

Natalie: Is self-help, alone, a realistically effective tool in recovering from self-injury?

Michelle Seliner: Some people have gotten better with self-help. This means that they stopped injuring on their own and it doesn't necessarily mean that they have resolved the issues that underlie the behavior. Sometimes, these people are at risk for switching to another coping strategy such as drugs, alcohol or eating disorder.

Natalie: S.A.F.E. Alternatives opened its doors in 1985. That's over 20 years ago. Yet there are still relatively few therapists in the U.S. who know how to treat it. Why is that?

Michelle Seliner: Self-injury used to be an obscure psychiatric symptom. Most therapists didn't ever think they would be treating clients who engaged in these behaviors. The escalation of these behaviors has been so rapid that school, hospital , criminal justice, and mental health professionals have been caught off-guard.

Natalie: So are you saying that self-injury is no longer "out of the norm" when it comes to psychiatric symptoms? That a lot of people are engaging in that kind of behavior?

Michelle Seliner: Yes, the most current research shows that 1 in 5 college students engage in the behavior. This study came from Cornell. Similar studies have found similar statistics for middle and high school age students.

Natalie: So how does one go about finding a therapist who specializes in treating self-injury? And what credentials should a prospective patient be asking about?

Michelle Seliner: We have a list of therapists from a variety of states who have expressed an interest in working with self-injurers. In general, they have also received some training in working with this population. While we cannot endorse each of these therapists, it is a place for some clients to start their recovery or evaluation. We welcome any feedback regarding client experiences with the therapists listed on the website.

Natalie: Tell us a bit more about the S.A.F.E. Alternatives program. How does a patient get admitted? How long do they stay? And what should they expect?

Michelle Seliner: We would suggest finding a psychiatric professional who is at least masters prepared as either a psychologist, social worker, or counselor and is licensed in your state. Psychiatrists can help with medication evaluations. Some psychiatrists also do therapy.

The SAFE Alternatives philosophy is based upon the book, Bodily Harm: The Breakthrough Healing Program for Self Injurers. We believe that self injury is a choice; that there is only pain, not relief in self-injury.

Self injury negatively affects all portions of a person's life-physical, mental and social. The goal is complete abstinence. The S.A.F.E. program offers a continuum of care for the self-injuring client.

We have an intensive 30-day program, early intervention partial hospitalization program and weekly group psychotherapy. In addition, for professionals, we offer clinical consultation, program development and training. We have several educational materials available. For more information please visit our website, www.selfinjury.com or call 1-800-DONTCUT.

Natalie: What is the average cost of the program? Does insurance partially or fully cover it?

Michelle Seliner: Yes, insurance typically covers the cost of the program. We have financial counselors available to discuss individual plans.

Natalie: What is the rate of relapse; recurrence of self-injury behaviors after going through the S.A.F.E. Alternatives program?

Michelle Seliner: We find that relapse upon leaving the program is not that unusual. However, the majority of clients find that SI no longer works for them as a soothing strategy as it did in the past. It is our experience that most clients stop the behavior after “testing" it upon leaving the program. In one study, we found that 75% were injury-free two years post-discharge.

Natalie: We have a lot of audience members with questions. Let's get to a few Michelle and then we'll continue on with the interview. Here's the first question:

Andrea484: What type of alternatives does your program suggest to those who come in?

Michelle Seliner: One of the first exercises our clients do is come up with a list of alternatives. When developing your list of alternatives, be sure to choose things that are healthy. For example, you would not want to have an alternative be something that could develop into another issue, like over-exercising. Some good alternatives may be journaling, calling a supportive person, nurturing yourself, going for a walk, reading, etc.

blackswan: What is the one thing you would recommend most to someone who's trying to overcome self injury?

Michelle Seliner: First, I would recommend that they consider an evaluation from a professional so that together an appropriate plan of treatment can be developed. From there, I would develop a list of alternatives. It is important that you and your therapist agree on a plan of treatment.

aynaelynne: What should a therapist do to stop this behavior? I've heard of contracting, but if the client is unwilling what else and how pressing should the therapist be?

Michelle Seliner: First of all, the only person who can stop the behavior is the client. Contracting will only work if the client is motivated to stop injuring. If the client is unwilling, then alternative treatment should be pursued.

Michelle Seliner: Yes, SAFE refers to this as the SAFETY Contract.

Natalie: Where is SAFE Alternatives based out of? And is the program open to people from across the U.S.?

Michelle Seliner: SAFE is based out of the Chicagoland area. We take clients from all over the world.

Natalie: Here's an audience comment and more questions:

saab32d: I am a recovering cutter. I did it for 9 years haven't done it for 16.

Michelle Seliner: Congratulations. Best wishes on your road in recovery.