Self-Injury Group Therapy

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    • 00:07

      [Self-injury Group Therapy]

    • 00:18

      DENISE STYER: In today's session we'llbe working with the self-injury program.And we are doing a group on the long- and short-termconsequences, both positive and negative,for use of self-injury.[role-play]Hey guys, ready for group?Hi, come on in.The self-injury population that we see here at Alexian,[Dr. Denise Styer, Clinical Director at Alexian BrothersBehavioral Hospital, Co author, Self Injury Simple Answersto Complex Questions] 85% percent of them

    • 00:39

      DENISE STYER [continued]: are under the age of 25.We do work in our program for those 12 on up,but for the most part our average age last yearwas 16 years old.Many of them have relational issues.They struggle with emotion regulation,they struggle with how to manage the intensity of feelings,and how not to be self-destructive.

    • 01:01

      DENISE STYER [continued]: Today we're going review positive and negativeshort- and long-term consequencesof our self-injury.So here is a handout that we're going to be working from.Self-injury is the deliberate actof harming oneself without the intent to die.So just because someone purposely hurtsthemself does not necessarily mean that they're suicidal.

    • 01:23

      DENISE STYER [continued]: The treatment model that we use for our self-injury programis the emotional regulation group therapy.And what that basically means is it'scomprised of using dialectical behavioral therapy,cognitive behavioral therapy, and acceptance commitmenttherapy.So looking and identifying our thoughts and our feelings,looking at how they line up with our values,

    • 01:44

      DENISE STYER [continued]: and then looking at how we can changethose thoughts, feelings, and behaviors.So as you've all talked about self-injury works for youon some level, or so you believe right now, correct?All right.And we're all here to learn different waysso that we don't self-injure anymore.Is everyone on board with that today?Yeah, yeah?

    • 02:04

      DENISE STYER [continued]: OK.So everyone who injures-- and you've all mentioned thatin groups, and I don't know if you want to go aroundand just revisit-- what do you get out of self-injury?Why do you choose to self injure?

    • 02:17

      SPEAKER 2: It provides a distraction for mefrom feeling really sad.

    • 02:21


    • 02:23

      SPEAKER 3: It just lets my emotions out.

    • 02:26


    • 02:27

      SPEAKER 4: It calms me down when I'm really angry.

    • 02:30


    • 02:32

      SPEAKER 5: It's the only thing that helps the pain.

    • 02:35


    • 02:36

      SPEAKER 5: I just do it because otherwise I feel numbso at least I can feel something.

    • 02:40

      DENISE STYER: Do you feel alive, or do you just feel?

    • 02:42

      SPEAKER 5: Just feel.

    • 02:43

      DENISE STYER: Just feel, OK.

    • 02:45

      SPEAKER 6: I agree with what she said.How I feel is so bad all the timethat I'd like to feel anything but that and self-injuryactually, as weird as it sounds, sounds better thanhow I feel inside.

    • 02:57

      DENISE STYER: OK.All right.So some similarities, some crossovers,and a little bit differences there mentioned.So it's not done randomly.And it's not just done.It's something that you've incorporated into how you cope,and how you manage, and to help you feel.All right.So for this reason that's why it's so difficult to overcome.

    • 03:17

      DENISE STYER [continued]: It's serving a purpose, it's serving a function for youright now.Today's skills group we were lookingat the positive and negative consequences,both short-term and long-term, of the use of self-injury.And we did a grid format where we started outwith what are the positive short-term consequencesof self-injury.So we have some positive.

    • 03:38

      DENISE STYER [continued]: Have you ever thought there were positive consequencesfor self-injury?[AFFIRMATIVE RESPONSE FROM GROUP]

    • 03:44

      DENISE STYER: OK.In the short-term what are the positives for self-injury?

    • 03:56

      SPEAKER 4: It makes you feel better.

    • 03:58

      DENISE STYER: So self-injury makes you feel better.OK.

    • 04:01

      SPEAKER 2: It's a distraction.

    • 04:03

      DENISE STYER: It's a distraction.From what?

    • 04:06

      SPEAKER 2: Everything else.

    • 04:07

      DENISE STYER: From everything, OK.It's a good way just to not deal with everything right now.You can just tune it out.OK.What else?

    • 04:22

      SPEAKER 4: Yeah I feel with me whenI get really angry I tend to say thingsthat I really regret and hurt people.So when I hurt myself at least I knowI'm not going to hurt somebody else.

    • 04:37

      DENISE STYER: They feel better, they feel calmer,it helps reduce their anxiety, it helps them distract,it helps them to numb out, it helps them to feel.So we had quite a number for the positive short-term.Do have a history of throwing things?Is that something you used to do?

    • 04:54

      SPEAKER 2: In the past, yeah.

    • 04:55

      DENISE STYER: OK, and do you throw things now?

    • 04:57

      SPEAKER 2: No.

    • 04:58

      DENISE STYER: So now you choose to hurt yourselfinstead of smashing a mole or something?

    • 05:04

      SPEAKER 2: Yeah.

    • 05:05

      DENISE STYER: OK.So it's a relief and a release at the same time.

    • 05:08

      SPEAKER 2: Yeah, both.

    • 05:09

      DENISE STYER: All right well let'sgo down to long-term positive consequences.What do you get out of self-injurypositively for the long-term?When we went to the next section of positive long-termthey didn't have any.They weren't able to come up with anything that self-injurydoes for them positively in the long-term.

    • 05:29

      SPEAKER 6: it's good as a short-term solutionbut usually long-term only bad come out of it.

    • 05:35

      SPEAKER 3: I know I think I might feel calmerfor a little bit but then everything comes backand it feels even worse.

    • 05:41

      DENISE STYER: So this calm is just very temporary.

    • 05:44

      SPEAKER 3: Mhm.

    • 05:45

      DENISE STYER: When we moved over to short-term negativeconsequences they're able to really identifythat a lot happens.Short-term.So short-term negative consequences, any?What do you guys think?

    • 06:03

      SPEAKER 3: I have to lie about it more.

    • 06:05

      DENISE STYER: You lie?To who?

    • 06:07

      SPEAKER 3: My family, my friends.

    • 06:09

      DENISE STYER: OK, so increase in lying that you are injuring or?

    • 06:16

      SPEAKER 3: That I've injured, or that I'm upset,that maybe I shouldn't be left alone.

    • 06:23

      DENISE STYER: So if someone was aroundyou might not be engaging-- if you were being monitoredor someone's sitting by you.OK.What are some other of the short-term--

    • 06:32

      SPEAKER 2: It increases hiding behavior too.

    • 06:34

      DENISE STYER: What do you hide?

    • 06:35

      SPEAKER 2: Oh, my self-injury.

    • 06:37

      DENISE STYER: All right.

    • 06:39

      SPEAKER 2: I have no freedom when my parents find outthat I've injured.

    • 06:43

      DENISE STYER: So when you say no freedomyou're kind of being babysat.

    • 06:46

      SPEAKER 2: Yeah, that's what it feels like.

    • 06:48


    • 06:49

      SPEAKER 2: Yeah.

    • 06:49

      DENISE STYER: Have you talked about whatyou need to do to get privileges back?

    • 06:53

      SPEAKER 2: Yeah.I just feel like I have no control over the situation.

    • 06:57

      DENISE STYER: No freedom and no control.OK.All right.How about you guys?They get grounded, they lose trust, they lose privileges,they lose friends.Family members don't want to leave them alone.They lose control over everythingbecause they have no say.So in the short-term at the act you'refine because you're getting everything

    • 07:20

      DENISE STYER [continued]: that you just shared over here.But then when the act is over and it's found out--or you are being honest about your behaviors-- this kicks in.OK.Are there any other short-term negativesthat we didn't mention?

    • 07:40

      SPEAKER 4: I guess a continued loss of trust.

    • 07:43

      DENISE STYER: OK, so there's no trust.OK.

    • 07:48

      SPEAKER 4: Family, loved ones, friends.

    • 07:53

      DENISE STYER: You and your friends?

    • 07:55

      SPEAKER 4: Yeah, I've lost a lot of my friendssince they found out about this stuff.

    • 07:60

      DENISE STYER: And we've talked about that process groupwhere if we hang out with healthy peoplethey're probably not going to toleratethese behaviors for very long, right.They might be caring and understanding at firstbut after a while they may have to put up that wallso they can take care of themselves.OK.All right, what about the long-term negativeconsequences.

    • 08:21

      SPEAKER 3: Trust.

    • 08:22

      DENISE STYER: Trust.

    • 08:23

      SPEAKER 2: Scars.

    • 08:25

      DENISE STYER: Scars.Then looking at the long-term negative consequences,many of them mentioned that all the short-term oneswere then extended.They didn't have a lot of friends,they didn't have any trust from people.People just kind of assume that they're going to keep doing itand never get better and would always be lying.They also spoke about the severity and the frequency

    • 08:47

      DENISE STYER [continued]: of the self-injuring increasing in orderto get that same effect that they used to get.

    • 08:52

      SPEAKER 2: I feel like it takes moreto help get the positive short-term.

    • 08:57

      DENISE STYER: So you increase the number of times you injure.

    • 09:03

      SPEAKER 2: And the severity of it.

    • 09:05

      DENISE STYER: And the severity.They were able to see by looking at the grid on the board--long-term, not so much positive coming out of the self-injury.And able to recognize that maybe it'stime to learn some healthier ways to cope.What about those feelings that you'vebeen working hard to avoid?

    • 09:26

      DENISE STYER [continued]: How are we going to tackle that?

    • 09:29

      SPEAKER 6: Scary

    • 09:30

      DENISE STYER: Scary.For most of you the bad stuff has already happened.We just didn't deal with it because we injured.One of the things we talk about are feeling cycles.Every cycle has a beginning, a middle, and an end.

    • 09:56

      DENISE STYER [continued]: So when you get to that point whereyou chose to injure you literally and figuratively--right-- you cut that feeling cycle off.Then if you follow that feeling good the endorphins kicked in,you felt numb, you felt feelings, you felt relief.You didn't have to deal with the feeling anymore.So you never let it go through.

    • 10:18

      DENISE STYER [continued]: And then as you talked over here-- injuring more frequentlyand severely-- it's like next timeyou started getting upset you rememberyou'd injure so you injured sooner.And there's that decreasing of that toleratingwhat you mentioned.So what we're going to try to do while you're hereis we're going to try-- because we ask you all

    • 10:40

      DENISE STYER [continued]: to report in the morning if you've injured.Fill out the form and the nurse will look at your wounds,right.But we're asking you to work on trying not to injure.But we also know, as you said, there'sno quick fixes in the positive coping well.So it might be hard.But as you work on not injuring we'retrying to work on building that tolerance back up so then

    • 11:02

      DENISE STYER [continued]: you guys can go back into having that feeling cycle.So when you start to feel happy it naturally dissipates.When you start to feel anxious it'll dissipate as you cope.Angry, mad.Make sense?You guys up for the challenge?

    • 11:24

      DENISE STYER [continued]: There is life after self-injury.It might take our individuals a little while to realize that.But they can go on to living without hurting themselves.

Self-Injury Group Therapy

View Segments Segment :


Dr. Denise Styer discusses self-injury--the process of hurting one’s self, without the intent of suicide. Styer brings us in on her group therapy sessions in which clients discuss the long- and short-term consequences of self-injury.

SAGE Video In Practice
Self-Injury Group Therapy

Dr. Denise Styer discusses self-injury--the process of hurting one’s self, without the intent of suicide. Styer brings us in on her group therapy sessions in which clients discuss the long- and short-term consequences of self-injury.

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