For individuals in the U.S. & U.S. territories
In Self-Injury, Dr. Wendy Lader demonstrates her brief analytic approach to working with clients who purposefully injure themselves. Self-injury, which often takes the form of cutting or burning, is best viewed as a coping strategy: Clients usually injure themselves because they want to avoid some painful emotion, and self-injury brings a sense of control over these unwanted feelings.
Dr. Lader's approach is to analyze early childhood beliefs and relationships and then incorporate psychoeducation and cognitive–behavioral strategies into the session. Interventions are designed to reduce self-injury by increasing awareness of impulsive behavior and expressing any avoided emotions.
In this session, Dr. Lader works with a teenage girl who began cutting herself soon after her mother remarried. Dr. Lader talks with the client about the loss of her father, then gives the client a tool to help her monitor the emotions she experiences preceding the impulse to cut herself. This is an excellent example of a first session with an adolescent client who self-injures.
The S.A.F.E. Alternatives® philosophy begins with the assumption that, although temporarily helpful, self-injurious behavior is ultimately a dangerous and futile coping strategy that interferes with intimacy, productivity, and happiness. There is no "safe" or "healthy" amount of self-injury. Dr. Lader and S.A.F.E. (Self Abuse Finally Ends) Alternatives also believe that self-injury is not an addiction over which one is powerless for a lifetime—people can and do stop injuring with the right kinds of help and support. Self-injury can be transformed from a seemingly uncontrollable compulsion to a choice.
The S.A.F.E. Alternatives® philosophy respects the autonomy and choice-making capacities of the individual. It is not an authoritarian model; S.A.F.E. does not believe that helpers can or should take all the responsibility for keeping the self-injurer safe. Ultimately, the self-injurer must be empowered to learn to keep themselves safe. In order to get well, there must be a shift in the locus of responsibility from the helper to the one being helped. The helping relationship is a partnership, not a "parental" relationship.
At S.A.F.E., counselors try to create a "culture of safety" in which the injurer comes to realize that self-injury destroys relationships, but safety brings people closer to them. S.A.F.E. also does not employ infantilizing, restricting methods of behavior control, which reinforce the individual's sense of helplessness and powerlessness.
Dr. Lader's theoretical orientation could best be described as a brief analytic approach that encourages the reliance on words, in the context of relationships, as the primary means for managing feelings and gaining self-awareness and self-control. Self-injurers have often learned that feelings must be discharged through physical action: If not self-injury, then punching, hitting, self-neglect, or imitating self-injury through "pretend actions."
At S.A.F.E., counselors help clients learn to use the therapeutic relationship as well as other coping strategies (behavioral and cognitive–behavioral) to delay the urge to self-harm, reflect on what one is feeling, and choose an alternative mode of coping. S.A.F.E. refers to this process as "enlarging the window of opportunity" between the urge to self-injure and the actual act of self-injury—a window of time that "frees up" the self-injurer to try something different.
The S.A.F.E. approach is designed for any adolescent or adult self-injurer, male or female, who is of at least average intelligence. It is not designed for those suffering from severe developmental disabilities, autism, or Asperger syndrome. In addition, it is not appropriate for those that are actively psychotic or suicidal, although clients may have experienced these symptoms at various points in their lives. Those diagnosed with severe dissociative identity disorder might also have difficulty with our therapeutic approach.
Wendy Lader, PhD, is cofounder and clinical director of the S.A.F.E. Alternatives® Program at Mercy Hospital in Aurora, Illinois. S.A.F.E. stands for Self Abuse Finally Ends and is the only inpatient unit designed exclusively for the treatment of deliberate self-harm. An internationally recognized expert on the treatment of self-injury, Dr. Lader lectures extensively on the subject and is coauthor of the book, Bodily Harm: The Breakthrough Healing Program for Self-Injurers.
Lader, in affiliation with the S.A.F.E. Alternatives® Program, has been featured on a variety of television programs such as Dateline NBC, 20/20, ABC World News Tonight, CNN, Good Morning America, The Today Show, and CAPA TV (Paris). In addition, she is cited frequently as an expert by the media, including The New York Times Magazine, The Chicago Tribune, Counseling Today, Teen People, Newsweek, Time, U.S. News and World Report, and Marie Claire (Paris). She was also interviewed for two Spanish-speaking television programs, produced by Catholic University of Chile TV Network Corporation and Univision.
- Alderman, T. (1998). The scarred soul: Understanding and ending self-inflicted violence. Oakland, CA: New Harbinger Publications.
- Brown, M., Comtois, K., & Linehan, M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–202.
- Conterio, K., Lader, W., & Bloom, J. (1998). Bodily harm: The breakthrough healing program for self-injurers. New York: Hyperion.
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- Gratz, K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72, 128–140.
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- Shaw, S. N. (2002). Shifting conversations on girls' and women's self-injury: An analysis of the clinical literature in historical context. Feminism & Psychology, 12 (2), 191–219.
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