How to Help Adolescence who Self-Harm with DBT
Susie was 16 years old when she came for treatment at Suffolk DBT on Long Island. Susie is not an actual client but a typical one that we see at our practice. She had been with six other treatment providers in three years due to suicidal ideation and self-injury. Her family members said that they only followed what the school had recommended for treatment.
She started cutting herself when she was 13 after the first boy she liked rejected her. The cutting and suicidal thinking did not seem to diminish with standard outpatient therapy. Whenever she discussed her episodes of cutting with her therapists, she would be sent to the emergency room and usually hospitalized. She felt there was no hope for her to get better.
During her first session, she was told that she should feel that therapy is hopeless, as it had failed so many times for her. In the past, she was told to use coping skills, but she felt that there was something wrong with her and that they never helped. I discussed with her that she would be taught HOW to use skills in DBT rather than “use coping skills.”
In DBT, mindfulness teaches how to have attentional control so that when a crisis occurs, the person has the ability to stay focused on the skills he/she is trying to use. For example, when holding an ice cube, the person will fully focus on the ice cube and notice and describe the experience, such as: the ice cube is cold, it is melting, the shape is square, it is clear, etc. As the person is doing this, his/her mind might wander to worrisome thoughts, but with skill development, he/she can turn the mind back to the ice cube.
Skills like this can help a person like Susie manage and reduce emotional arousal, reduce emotional thinking, and ultimately reduce urges and refrain from self-harm.
After Susie was committed to showing up for treatment, we worked on getting her to first stop cutting and then change her motivation to kill herself. She completed a daily diary card, in which she monitored her urges to engage in self-harm, suicidal ideation, and other behaviors she presented with. She also monitored her emotions and skills daily. During the session, we spent a lot of time looking at what was prompting her to cut, teaching her new skills, and looking at what was preventing her from applying those skills.
She attended a weekly skills group with kids around her age and felt hopeful, as the group was positive. She listened to the other DBT group members as they shared their hope, knowledge, and support.
For the first time, she didn’t feel that she was weird and hopeless or that everything was her fault.
Susie initially would call for phone coaching a few times a week. This is part of the DBT program, and she was able to work through her urges with the support of her individual therapist. She eventually used the skills to manage her urges. She started to see that it was within her the ability to get through a crisis without hurting herself or using self-harm as a way to cope.
Her parents attended the family group once a week and learned how to help their daughter cope. They applied the same skills that she was learning in a multi-family group.
After three months, the cutting behavior stopped and her suicidal thinking diminished significantly. Over time, she gained the ability to manage emotions, improve relationships, get through crises, develop awareness, and see the gray in the world rather than the black or white. She still described feeling sensitive, but her emotions were not as “big,” and she was able to start living her life. She could manage to be an emotional person and not feel ashamed of that.
Far too often, adolescents and young adults spend too much time in emergency rooms and standard outpatient therapy, and they suffer because the treatment is failing them. DBT treatment is the most researched and successful treatment for self-harm behaviors in individuals who are at a high risk for suicide.
Although Susie was not a real client, she is a typical young girl whose life was forever changed by life-changing DBT treatment, her hard work, and her families’ support.
If you find yourself in this situation, the following are resources that you might find helpful on Long Island.
http://www.responsehotline.org/hotlines/ a hotline for immediate assistance in a crisis.
*1-800-334-HELP – Self Injury Foundation’s 24-hour national crisis line.