S.A.F.E Expressions

Self-injury is a choice.
There is only pain, not relief, in self-injury. Self-injury negatively affects all portions of a person’s life-physical, mental, emotional and social. There is no compromise with self-injury. The goal of treatment is complete abstinence.

S.A.F.E. ALTERNATIVES® Adolescent Expressions® is an outpatient program for adolescents who self-injure. It is one of the S.A.F.E. ALTERNATIVES® Programs. S.A.F.E. ALTERNATIVES® is a world-renowned treatment program that has helped thousands of people successfully end self-injurious behavior.  A treatment team of experts uses therapy, education, and support to empower adolescents to identify healthier ways to cope with emotional distress.  This program has been utilized with the following tracks:  early intervention, ambivalence about recovery, and school-mandated treatment.  The S.A.F.E. ALTERNATIVES® philosophy and model of treatment focus on shifting control to the adolescent, empowering them to make healthy choices, including the choice to not self-injure.  One of the biggest challenges faced when raising or working with adolescents, is how to prevent power struggles.  It can be difficult to convince an adolescent that their self-harming behavior is unhealthy.  In fact, the adolescent usually sees those who want to stop them as intrusive, and as “taking away” something that helps.  As a result, fear sets in at the thought that there will be nothing to replace the relief that self-injury provides.  Adolescents will often choose to deny that self-harm is a destructive coping strategy, rather than give up the behavior.  One of the treatment goals for Adolescent Expressions® is to help the adolescent understand the consequences of their choices, and learn healthy ways to manage their distress.

Adolescent Expressions® differs from the 30-day Intensive program in the following ways. Inpatient criteria require that the client has made an honest commitment to want to stop self-injurious behavior. Adolescent Expressions® criteria allows for ambivalence towards having an honest commitment to stopping self-injurious behavior. The goal is to stop self-injury, however, for many, the focus will be on getting the client to the point of making that commitment. The 30-day program has a structured manner in which self-injury within the program is addressed; whereas Adolescent Expressions® will encourage clients to not self injure and will assess the client for a more acute level of care if self injurious behavior continues and interferes with their treatment or the treatment of their peers.

Program overview:

  • The program operates Monday through Friday, 6 – 7 hours per day
  • Intake screening at no charge
  • Individual, group, milieu, and family therapy
  • Impulse control management
  • Education and support
  • Medication Management
  • Case Management
  • Collaboration with referring professionals
  • Aftercare planning

Treatment Team:

  • Psychiatrist
  • Clinical Therapist
  • Registered Nurse
  • Behavioral Health Support Staff
  • Expressive Therapist

Program Requirements

  • Sign the S.A.F.E. Promise
  • Identify five alternative ways to manage impulses
  • Actively participate in all groups, including individual and family therapy
  • Address all forms of self-injury, including food and nutrition issues
  • Find an outpatient therapist for ongoing treatment

S.A.F.E. ALTERNATIVES® Medication Philosophy

The S.A.F.E. ALTERNATIVES® philosophy is centered on individuals expressing feelings rather than suppressing them or acting on them. This philosophy extends to the use of routine and PRN medications. The goal for S.A.F.E. patients is to experience core affect and learn to tolerate their feelings. We believe that the least amount of medication possible should be prescribed. For example, anti-anxiety agents mask the patient’s true affect. If a patient is anxious we want them to learn that they can tolerate the anxiety (versus reaching for medication to suppress it), and learn to process the underlying issue. This subsequently teaches the patient appropriate ways to manage their feelings and provides them with a sense of mastery over their emotions.  Therefore, anti-anxiety medications and changes in prescription medication should not be prescribed unless absolutely necessary and in consultation with the treatment team.  In addition to emotional distress, many of our patients report somatic complaints.  With regards to PRN medications (pain relievers, anti-anxiety, and other dis-inhibitors) patients will be asked to perform alternative activities such as verbally processing their issue, using one or more of their alternatives and/or completing a PRN medication log prior to requesting or taking the medication.

Appropriate Candidates

Adolescent males and females (12+ years) whose self-destructive behavior negatively impacts their lives are eligible.  Adolescents who do not require inpatient hospitalization and whose safety can be maintained on an outpatient basis are appropriate candidates.


Many commercial insurance plans will pay for this treatment.  Coverage by Medicaid is limited and determined by the state in which the client resides-clients may contact us via or 800.DONTCUT® (366-8288) for more information.  Each insurance company has its own set of criteria for admission and each policy has its own unique package. The patient services/intake department will be able to assist in determining individual policy coverage.