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Kirsten Bolt, MEd, LMFT | Clinical Therapist | Adolescent Girls

December 16th, 2017

Understanding Self-Harm and Treating it in Wilderness

Kirsten Bolt, MEd, LMFT | Clinical Therapist | Adolescent Girls

Q: What is self-harm?

A: “Self-harm” refers to “non-suicidal self-injury,” or intentionally harming one’s body without suicidal intent and in a manner that’s not socially-sanctioned. Often self-harm includes cutting, scratching, burning, or carving words into the skin. Those tend to be the most common methods but there are more extensive forms of self-harm. Socially-sanctioned body modifications like piercings and tattoos are not necessarily self-harm although they could become so.

Q: What are the most common myths surrounding self-harm?

A: The biggest myth is that self-harm is an attempt to commit suicide. Understanding that this is not the case can be a challenge for parents and treatment professionals who haven’t had much experience working with self-harm, as self-harming behaviors can be alarming. It is important to distinguish self-harm from actions meant to end one’s life. In reality, individuals who self-harm usually turn to such behaviors as a coping mechanism to support living.

Another common myth is that only girls turn to self-harm. We see it across genders, ages, races, sexual orientations, and socioeconomic status. Some hide it more than others.

It is a myth that self-harm is always a manipulation to gain attention. While some people use self-harm in that manner, it can be pejorative and judgmental to label the behavior “attention-seeking.” True self-harm is not inherently manipulative. Instead, I typically reframe it as “attention-needing” to ensure these people get the support they need. In reality, these individuals usually need attention to their emotional or mental needs, and often, self-harm is the only way they know how to communicate those needs.

It’s also a myth that if a person is not hurting themselves severely, it’s not a big deal. It’s important to know that the severity of one’s physical self-harm and pain is not necessarily indicative of the severity of someone’s emotional pain.

Q: Why do people use self-harm?

A: There are three primary reasons that people self-harm: The most common is to moderate overwhelming emotions. Creating a focus on physical pain distracts from emotional pain. The flip-side is also true: sometimes people feel “numb” as their status quo, and the physical injury helps them to feel something; to feel alive. The third primary reason people use self-harm is to communicate to others their level of internal distress when they don’t know how to do so verbally or in a healthier manner.

Adolescent Girls Therapist Kirsten Bolt's approach to self harm treatment in wilderness

By considering self-harm through the lens of Glasser’s Choice Theory, we find that self-harm is typically used to satisfy two of the five categories of needs, in particular: love and belonging, and power and control. When someone feels a lack of love and belonging, that person may turn to self-harm as a way to connect with friends, communicate a distress they’re feeling, or to temporarily decrease the shame they might be feeling. Or, perhaps a person feels out of control and powerless to regulate and manage their emotions. They may start to use self-harm as a way to feel “in control”.

Fundamentally, self-harm is a “short-term gain; long-term loss” solution: alleviating the problem in the moment, but leading to long-term risks that reinforce the person’s inability to cope emotionally. Until one learns how to manage emotions effectively, one is susceptible to taking on other unhealthy coping strategies, (i.e., drugs, promiscuity, eating disorders, aggression, etc.). These unhealthy behaviors tend to leave individuals feeling hopeless because they become stuck in a cycle that is increasingly difficult to interrupt.

Q: What is Open Sky’s therapeutic approach to individuals who self-harm?

A: It almost goes without saying, but is important to note, that the safety of our students is always the primary concern for my guides, myself, and the entire Field and Clinical Teams. We consistently monitor and check for new signs of self-harm and attend to them medically as needed in ways that are not shameful to the individual. They cannot do the emotional work if their physical needs are not met.

The first step of self-harm treatment is a thorough assessment. We gather information from field guides, parents, and the student. With assessment (and constant reassessment), we start to understand the history, severity, circumstances, and intentions surrounding the behavior. Though self-harm doesn’t inherently equate to suicidal thoughts, we also assess for suicide. We do address the behavior, but it’s important not to lose sight of the most significant issue at hand: the underlying emotional challenges that led to the behavior. Focusing too much on the behavior can reinforce it and keep the individual from meeting his or her needs in healthier ways.

Assessment and reassessment inform the treatment plan, bringing us to the second step: intervention. This step is individualized, based on the information gathered in the assessment and the individual’s progress. When the student is stable, we can focus on deeper work, like understanding the levels of need in Glasser’s Choice Theory and can reflect on the effectiveness and risks of the behavior, as well as how the self-harming behaviors actually inhibit meeting one’s needs long-term. We help our students develop skills to regulate emotions and communicate their needs to others. This is particularly effective in wilderness therapy due to our 24-7 supervision and monitoring by staff and the continuous ability to intervene amid challenges.

Peers can be a source of support to individuals who self-harm, which is one of the ways that wilderness therapy can be highly effective and unique. There is usually someone else who has experienced the cycle of self-harm, which can help individuals not feel so alone, and to hold each other accountable. The peer group is an emotionally safe and structured place for everyone to share their emotions. Our guides are trained to monitor every conversation and intervene if discussions go in unhealthy directions about self-harm (or other concerning coping strategies), as opposed to discussion about the emotions beneath the actions.

The entire process of self-harm treatment at Open Sky is intentional and individualized. What one person needs might not be what another person needs. In every situation, our team displays compassion and empathy, always validating the emotions one is feeling without validating the behavior, and strives to understand and not judge those who self-harm.

Q: How are parents involved and able to support the healing process?

A: Involving the family in the self-harm treatment is an important component of the healing process. The child may inform his or her parents for the first time about the behavior, acknowledge the severity of it, and talk about why he or she does it. We work with the parents on understanding the motives and risks and help them do their own personal work.

We talk with parents about how to support their child during the transition after Open Sky. We always predict that there will be transitional challenges in adapting to an environment with less containment than wilderness therapy. But the work that both the student and the family do during their Open Sky process prepares them to face these challenges without self-judgment, and with the skills to overcome them.

 

CLICK HERE to listen to Kirsten’s podcast episode on the topic of self-harm.

Kirsten Bolt, MEd, LMFT | Clinical Therapist | Adolescent Girls

December 16th, 2017

Kirsten Bolt, MEd, LMFT | Clinical Therapist | Adolescent Girls