eNewsletter - November 2015

Behavioral Health Partners

Solutions for Self-Injury: Discovering Ways to Overcome 
Kelly Olenski, MSW, LSW

While attending a recent meeting with several behavioral health professionals, the concept of “solutions not symptoms” was brought up. It seems, all too often, symptoms are discussed during treatment instead of solutions to manage those symptoms.  My colleagues agreed that day that we all want to find more solutions for our patients.

As a clinical therapist in the Discoveries program for self-injury at Linden Oaks, I am often asked about solutions for self-injury.  Since 12 to 20 percent of adolescents and young adults engage in self-injury behavior, it is essential to find solutions to help these individuals. 

The first step to help those struggling with self-injury is to improve safety. Professionals can start by identifying the ways an individual engages in these behaviors. While cutting is identified as the most common self-injury behavior, research has indicated there are over 16 forms of self-injury. And, there are even more tools used to engage in these behaviors.  In the early stages of recovery, it is the professional’s role to support individuals and their families in removing or decreasing access to tools used for self-injury, thus improving the recovery environment and their safety.

Another important step is to discover the function of the individual’s self-injury behavior. Common functions include: to relieve intense feelings, to distract from emotional pain, to feel “something” when experiencing emotional numbness, to communicate or express needs, and to self-punish.

Self-injury behavior is often associated with symptoms of other mental health diagnoses. Common co-morbidities include depressive disorders (i.e. major depressive disorder), anxiety disorders (e.g. generalized anxiety disorder, post-traumatic stress disorder), eating disorders, and substance use disorders. Discovering and examining the specific function of self-injury behavior can be an important step in overcoming it.

Additionally, professionals can support struggling individuals in discovering new skills to help manage self-injury urges and related distress.Dialectical Behavior Therapy (DBT) is a well-supported treatment for those engaging in self-injury. DBT encourages individuals to live ‘a life worth living’ through the integration of seemingly opposite concepts – acceptance and change. The dialectical perspective promotes learning and uses skills from four modules in an effort to decrease distress and improve functioning.

The four modules of DBT include skills that encourage mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. This form of treatment allows individuals to explore and address the function of their behaviors while employing skills to prevent relapses.

In addition to discovering skills, professionals should support individuals in discovering personal values. Individuals engaging in self-injury will benefit from identifying how their behaviors align – or misalign – with the things they value most in life.

Acceptance and Commitment Therapy (ACT) is a treatment that works to increase psychological flexibility through the discovery of values and committed action toward those values, in addition to mindfulness, acceptance, and cognitive defusion. ACT serves to help the self-injuring individual live a value-laden life and move toward recovery.

Helping patients discover ways to improve safety, uncover the function of their self-injury behaviors, and learning skills and values for recovery, are all important steps in the treatment of individuals who exhibit self-injury behaviors.

In the Linden Oaks Discoveries program, our patients routinely participate in relapse prevention activities aimed at exploring the underlying function of their behaviors. Daily DBT skills training and ACT discussions support patients in learning and practicing skills that will help them live a value-laden life worth living. Our body image components promote self-acceptance while addressing co-occurring issues such as eating disorder behavior, low self-esteem, and feelings of worthlessness. Our weekly multi-family group demonstrates our commitment to supporting our patients, their families, and their community supports through a group-based program model.

Every patient that successfully learns these skills and completes our program leaves with an inscribed orange bracelet that reads “overcome.” This bracelet is a symbol of awareness and a reminder of the ways our patients have discovered the solutions within them to overcome self-injury.

As professionals, we must be continually committed to discovering and discussing solutions. In doing so, we can be a part of the “solutions not symptoms” approach to self-injury treatment.

More information the Linden Oaks Self-Injury Discoveries Program, CLICK HERE.

Additional research related to self-injury, including information presented in this article, is available through the Cornell Research Program on Self-Injury and Recovery.

Kelly Olenski, MSW, LSW
Kelly worked as a clinical therapist with the Discoveries program for self-injury at Linden Oaks Behavioral Health and is currently a physician liaison. Kelly received her master’s degree in social work from Loyola University Chicago with specializations in mental health and children and families. Prior to Linden Oaks, Kelly worked with various community organizations in Chicago, including Thresholds Behavioral Health and the American Red Cross of Greater Chicago. Kelly is an Americorps alumna having served on the north side of Chicago with the early childhood education program, Jumpstart for Young Children.