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Angela Klein, Ph.D.
Pathways to Well Being through Psychology &
Dialectical Mindfulness-Based Practice
Creating self-compassion/ Regaining your voice/ Finding peace
Self-harm is often misunderstood. It is often misinterpreted as suicidal behavior. Although it is absolutely associated with an increased risk of suicide and can overlap with suicidality, it can actually be intended by individuals to be a way to stay alive--a way to cope with emotion when an individual has learned to use this behavior to do so. That said, at the same time, it is still a life-threatening behavior and is a #1 target in therapy at Centered Ground if it is present.
Stopping this behavior requires learning other ways to cope with emotion and a willingness to disrupt patterns that are maintaining the behavior. Repeated hospitalization can be one pattern that maintains the behavior and at Centered Ground usually hospitalization is considered a last resort for safety. Instead therapy focuses on helping you learn new ways to cope in your own environment, as long as you are committed to using skills instead of engaging in self-harm and as long as we are communicating effectively.
In addition to self-harm behaviors such as cutting and burning, skin picking and hair pulling can also cause tissue damage and are classified by some researchers as self-harm. I consider these behaviors from an emotion regulation perspective, as well. In this case, the emotion that underlies the behavior is usually anxiety, and the pattern of behavior is usually more compulsive rather than impulsive, which means, in part, that the behavior can be more methodical and urges may feel different than those associated with other forms of self-harm. In both cases of behavior, learning to tolerate and accept emotion is critical, along with behavioral strategies to create a new pattern.
Typically a combination of individual therapy, group skills training, and coaching calls are recommended for self-harm. I use dialectical behavior therapy, as well as concepts drawn from the approach known as acceptance and commitment therapy. This approach is supported by multiple randomized trial research studies.