Freedom from Self-Harm: Specific Types of Psychological Treatments for Self-Harm

Several different types of treatment may be helpful for self-harm, including the following:

+ Cognitive-behavioral therapy (CBT)

CBT helps people learn new skills for managing their emotions, thoughts, and behaviors. CBT is often a fairly structured treatment, with a clear agenda for each session.
Often, the sessions focus on changing thinking patterns and behaviors that cause problems for you, and learning how to cope with stress, emotions, or interpersonal situations. In CBT, the therapist often gives you homework assignments to practice new skills and change behaviors outside of therapy sessions.

+ Dialectical behavior therapy (DBT)

DBT, developed by Dr. Marsha Linehan (1993a), is a type of CBT that combines the kinds of things described above (for example, learning skills, and changing behaviors and thinking patterns) with strategies for helping clients learn how to accept themselves, their lives, and other people. We’ll tell you more about DBT in chapter 8. Also, we include some DBT skills in chapters 11 and 12, where we talk about how you can deal with self-harm urges and overwhelming emotions.

+ Psychodynamic therapy

In psychodynamic therapy, the therapist helps you figure out why you self-harm and the underlying issues that might drive your self-harm. Usually, psychodynamic therapists pay a lot of attention to your childhood experiences and how these experiences influence you today. Unlike CBT or DBT, psychodynamic therapies are normally not especially structured, and sessions usually flow along with whatever you bring up in therapy. Some psychodynamic therapists focus a lot on your childhood, and others pay more attention to how you’re doing in the present.

Right now, DBT has the best scientific evidence in the treatment of self-harm, but there are also some useful CBT and psychodynamic therapies.

INDIVIDUAL THERAPY

Most treatments for self-harm include individual therapy. Most often, individual therapy occurs for one to five hours per week. As we discussed above, the focus of these therapy sessions may differ widely depending on the type of treatment you’re receiving, ranging from more to less structured, and having more or less of a focus on your current difficulties versus the past difficulties that you’ve had. Normally, after the psychological assessment (the get-to-know-you phase), you and your therapist will agree on how therapy will proceed, what the goals of therapy are, and what you’ll spend time working on in your sessions.

Certain therapists might also ask you to make specific agreements before you start therapy. For example, if you self-harm, a therapist might ask you to commit to working on stopping your self-harm. Other therapists might have you sign a crisis agreement, stating that you agree not to attempt suicide, or that you agree to call the therapist, a crisis line, or go to the hospital if you’re at risk of attempting suicide.

GROUP THERAPY

Treatments for self-harm often involve some kind of group therapy. Sometimes, the group therapy is your primary treatment, and at other times, it supplements what you do in individual therapy. Group therapy can be very useful for people who self-harm. If you go to a group, you’ll find out that you’re not alone, and you might learn from the experiences of others. People sometimes also find that groups help them to feel less ashamed of self-harm.

There are three main types of group therapy. One type is a psychoeducational group, where the main goal is to give you education or information that might help you in your recovery process. For instance, the therapist might give you information about self-harm, its risk factors, and the types of problems that often accompany this behavior , as well as information on emotions, coping, or stress. The idea behind this kind
of group is that you’ll be better able to move forward on the road to recovery if you’re armed with information.

Psychoeducational groups are probably most helpful if you don’t know much about the problems you’re struggling with, and are just beginning to explore ways to help yourself. Although it’s always nice to be knowledgeable about your problems (indeed, that’s one of the goals of this book!), keep in mind that no research has shown that having more information alone is enough to “cure” self-harm. Sometimes, you have to learn how to actually use new coping skills rather than simply get more information about your problems.

This brings us to the second type of group: a skills-oriented group, where the main goal is to teach you skills or strategies that will help you reduce self-harm. DBT, for example, includes a skills-training group designed to teach you how to pay attention to the present moment, manage your emotions, tolerate emotional distress, and deal with interpersonal relationships (Linehan 1993b). In other groups, the therapist might teach you how to accept your emotions and move forward in your life in ways that matter to you (Gratz and Gunderson 2006). Yet other skills-oriented groups might teach you how to manage stress or anxiety . Keep in mind that skills-oriented groups (like psychoeducational groups) are somewhat like classes, in that the focus of the group is primarily on teaching you new skills, rather than having group members talk extensively about their experiences, the past, or daily life.

In contrast, the third type of group, a process-oriented group, does involve a lot of discussion about your emotions, your past, and your daily life or interpersonal problems. Process-oriented groups are usually not nearly as structured or classlike as skills-oriented or psychoeducational groups. Normally, you spend time discussing your current problems, patterns of behaviors, and past experiences with other group members while the group leader encourages and facilitates the discussion. People often develop emotional attachments to other group members, and part of the point of many process groups is to discuss the interactions that group members have with one another in the group (and to learn more about themselves in the process).

Excerpt from FREEDOM FROM SELF-HARM: Overcoming Self-Injury with Skills from DBT and Other Treatments (New Harbinger Publications)