Our Self-Injury Treatment Program

Our experience and research suggest that psychotherapy is the best treatment for self-injurious behavior.  It is not uncommon for clients to have tried many different therapies, programs, and self-help strategies before coming to S.A.F.E.; and there are a few who find our program earlier in their journey to recover.  Regardless, most of our clients believe they are somehow different, out of the ‘normal’ circle of humanity in their coping and can’t fathom giving up the coping strategy that they believe, in fact, keeps them alive.  This thought dissipates after a period of self-examination.  Thousands of clients have done this, and you can too.  We encourage you to have an open mind and to strive for the desire to learn as much about yourself as possible.  There is nothing magical about getting better-it takes a lot of courage and hard work. 

To benefit the most from our program the self-injurer should want to get better.  While it may seem obvious to others, that the self-injurer should want to stop the behavior, often that is not the case.  Clients self-injure for many reasons-the behavior serves a purpose for them; it is a comforting and ingrained habit-and many are in strong denial about the scope of the problem and the toll it takes. 

Our methods and strategies are specifically tailored to self-injuring clients however they have proven to be successful in treating other problems such as disordered eating, poor impulse control, compulsive behavior, and substance use. 

The S.A.F.E. program has been described as an eclectic approach, utilizing multiple theoretical orientations.  The boundaries between these orientations are not rigid and are often combined in a single session. 

Therapeutic Approach

 Psychodynamic or Insight Oriented therapy focuses primarily on understanding the motives for a client’s behavior.  The client’s choices are seen as complex outcomes of wishes, fears, memories, unresolved feelings, and conflicts.  The client may or may not be aware of some of these motives that drive their behavior.  The premise of the therapy is that the more someone learns about their unknown inner world, the less they will feel compelled to engage in maladaptive strategies to cope with life. 

Cognitive-behavioral therapy starts from the premise that the way a person thinks strongly influences the way they behave and feel.  Therapy focuses on helping clients recognize and change their automatic thoughts (their internal dialogues and statements about themselves), underlying assumptions (the beliefs they hold about what people are like and the way the world works), and cognitive distortions (errors in logic that lead people to draw faulty conclusions).  The behavioral aspect of cognitive-behavioral therapy combines work on faulty thinking patterns with teaching, training, and guided rehearsal of coping strategies.  The client and therapist will work together practicing new behaviors (often in the form of logs and other assignments) and the examination of belief patterns. 

Supportive therapy focuses on helping the client mange the day-to-day practicalities of their lives.  Rather than treating underlying or past issues the focus becomes support and guidance for daily living problems. 

Treatment Modalities

S.A.F.E. Alternatives offers 3 types of therapeutic interventions:  individual, family and group psychotherapy. 

Individual Therapy
All clients enrolled in the S.A.F.E. program must be in individual therapy, either with one of our therapists or their own primary therapist.  Some clients who have a therapist outside of our program benefit from adjunct work where we work alongside the existing therapist and provide some targeted work on the self-injurious behavior.  The frequency of sessions is based on the severity of symptoms.  Typically, clients are seen once a week however during periods of decompensation clients are seen twice a week. And when clients have stabilized and feel secure in their recovery session frequency is reduced.  Sessions typically last 45-50 minutes. 

Family Therapy
Most adolescent and some adult clients benefit from some level of family involvement, either in the form of parent education/coaching, parent therapy, family treatment/progress meetings, and/or family therapy.  Much is taken into consideration when making these recommendations and may not be initially made at the time of assessment.  Again, we are happy to coordinate care with an existing family therapist.  The client’s primary therapist should not be the identified family therapist. 

Group Therapy
This treatment modality can be a vital tool in the recovery process.  While it is not difficult for self-injurers to find others who engage in the behavior in on-line platforms; this has proven to be ineffective in changing the behavior.  In fact, it can be quite triggering, and increase self-injurious behavior.  Sharing war stories, comparing wounds, and counting stitches is one of the many ways they have learned to avoid facing their feelings.  The structure of our group therapy program, S.A.F.E. Choice, provides an arena for growth and change.  Some of our groups are structured in that clients are guided through an assignment (logs, process questions, art prompt, etc.) that challenge their belief system and encourage practicing new coping strategies.  The group process provides the clients an opportunity to share what happens when they attempt new choices and learn new options from one another.  In unstructured groups, the clients learn about their relationship patterns, and how they may use maladaptive defenses or avoid issues directly with the people in their lives, which opens the door for destructive coping. 

Currently, we have 4 adolescent groups.  Each group meets once a week, for 90 minutes.  Clients are placed in group based on clinical presentation, age, and school (every attempt is made to not place clients in a group where they may know someone else).  Clients must be in individual therapy (either with a S.A.F.E. therapist or outside provider) to participate in one of our groups.  Clients will be asked to sign the S.A.F.E. Promise (treatment participation agreement).  The program was designed to be an adjunct to their individual therapy therefore clients typically stay in the groups for an extended period.