Clinical Approaches to Chronic Self-Harm Syndromes
Full Program Title:
Clinical Approaches to Chronic Self-Injury, Self-Mutilation, and Self-Harm Syndromes
Led By: David L. Calof
An estimated three million Americans engage in some form of self injury. Incidence rates are increasing, especially among adolescent and young women. Without benefit of specific training, clinicians’ countertransferences, misconceptions, and lack of information about chronic self-injury can misinform clinical judgment leading to exacerbation of self-injurious behaviors.
For adolescent and adult survivors of abuse and neglect, while suicidal ideation and frank suicidal behavior may coexist with patterns of chronic self-injury, clinicians often misconstrue these acts as expressions of suicidal versus self-regulatory intent. Such a failure of empathy can lead to iatrogenic exacerbation of the client’s self-injurious behavior.
Chronic self-injury in such patients is better understood as an attempt to adapt to and manage a difficult existence, than to end one. Survivors of childhood abuse and neglect most often use self-injury as a way to manage emotional states, body states, cognition, and psychological function. The motivation for self injury often is complex and variable. Personal rationales for self-injury often are “trance logical” (e.g., “hurting will relieve the pain,” “pain is pleasure,” “I can keep you from hurting me by hurting me first/worst”). Self-injurious behaviors are trance-based (i.e., dissociated from their rightful sensations, affects or knowledge).
Client expressions of severe or chronic self harm can trigger primitive countertransference and counterresistance in even seasoned clinicians. Unexplored countertransference reactions, misconceptions, and lack of information about chronic self-injury can misinform clinical judgment and lead to iatrogenic exacerbation of self-injurious behaviors.
Through lecture, discussion, clinical examples, and practical exercises, the presenter will explore the origins, motivations, logical properties, and clinical management of self-injury. The presenter will describe typical motivational frameworks for self-injury among adolescent and adult survivors of abuse and neglect, along with guidelines and strategies for intervention illustrated with ample case material. Building on this theoretical basis, participants then will engage in powerful supervised exercises and feedback sessions designed to: 1. clarify their experience of client self-harm, 2. explore idiosyncratic reactions, and 3. identify and perhaps work through countertransference vulnerabilities in current practice.
The program will assist participants to become intervention-generative in their own cases.
Through lecture, discussion, Q+A, exercises, handouts, and case consultation:
1. Participants will be able to discuss typical developmental courses for chronic self-injury and self-mutilation.
2. Participants will be able to list and discuss gender role differences that contribute to significantly higher rates of self-injury among females.
3. Participants will be able to identify the common mental disorders most highly correlated with chronic self-injury.
4. Participants will be able to identify and discuss at least four typical methods of self-injury in post-trauma-related disorders and distinguish them from frankly suicidal methods.
5. Participants will be able to identify and discuss at least four functional motivations for frank suicidality in post-trauma-related disorders.
6. Participants will be able to identify and discuss common functional motivations for self-injurious behavior among adolescents (e.g., contagion, post-abuse post-neglect sequelae, etc.).
7. Participants will learn a case-based clinical intervention framework that is oriented toward addressing motivational dynamics, not merely self-harming behavior alone.
8. Participants will be able to discuss the role of dissociative processes (e.g., trance logic, depersonalization, derealization, anesthesia/analgesia, and so on) in the development and maintenance of chronic self-injurious behavior.
9. Participants will be able to described and discuss a variety of therapeutic interventions in the clinical management of chronic self-injury and self-mutilation.
10. Participants will be able to identify and discuss common countertransference and counterresistance forms in the clinical management of clients who chronically self-injure.
“I am in private practice and also work fulltime on an agency crisis response team. I recently attended the workshop, “Clinical Approaches to Chronic Self-Injury, Self-Mutilation, and Self Harm Syndromes.” I feel compelled to state my appreciation for that experience. David Calof’s abilities are known and respected internationally. Still, I was surprised by the quality of information he presented. It was also surprising to see the connection he and the subject-matter made with the audience. Considering all the clinics and conferences I have attended—this is the only time I have seen every attendee still onsite and actively participating until the last minute of a seminar! Thanks again for a great clinic.”
—Frank E. Shull, M.Ed. LCPC, LMHC, DMHP, Portland, OR