Self-Destructive Behaviors, Self-Injury and Nonsuicidal Self-Injury:
A Therapists’ Guide for Family Work and Support
by
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This book is a set of exercises for therapists to use in therapy with patients/clients who self-injure to help with the family work. For purposes of consistency, the individual in treatment will be referred to as patient, although remember these are people who have problem behaviors, deserving of respect, compassion and dignity. The term is one of consistencies. Never forget the person and people we discuss. Secondly, we are talking about a range of self-destructive behaviors that involve thinking, behaving, reacting, perception, attribution, understanding and efforts at managing. It involves the entire approach to and interaction with the self and the world. Topic Page Instructions and Request for the Family 5 Instructions and Request for the Therapist & Counselor 9 Therapy with Someone Who Self-Injures 10 About Self-Injury Behaviors & Thinking 16 Definition 16 Self-Destructive Behaviors and Thoughts 16 Who Self-Injures? 17 Why?...or a better question, HOW is it helpful? 17 How it is different from suicide 18 Are there other problems too? 19 About changing the behavior and thinking patterns 19 What you can do to help… 19 Important Ideas for Parents & Family Members 23 Activity: Parenting Style and Goals 23 Defining Health 24 Activity: Defining Health for Your Family 24 What does a healthy family need to be healthy? 25 Family Foundation: Goals & Values 27 Activity: Values = Principles, Morals, Standards 27 Activity: Family Values Discussion 28 Family Foundation: Values 29 Activity: Identifying Your Values 29 Rules & Expectations 30 Activity: Values and Expectations or Rules 30 Activity: Expectations, Rules & How Well Is It Working? 31 Roles & Hierarchy 32 Activity: Roles & Hierarchy 32 Activity: Want Ad – Family Member 33 Activity: Letter to Someone I Love 34 Accountability & Responsibility 35 Activity: Standards, Rules and Accountability 35 Activity: Telling You My Thoughts about Your Behavior 36 Activity: How do you impact other people? 37 Activity: Understanding the Choices I Make 38 Activity: What Would You Say? 39 Rights & Privileges 41 Activity: Defining Rights & the Opportunity to Earn Privileges 41 Responsibilities, Obligations and Reasonable Consequences 42 Activities: Responsibilities, earning trust, respect and privileges 42 Investment in the Family Unit 45 Why the family and family structure is important 45 Why the family & family structure is important for the person who self-injures 46 In this family, we……… 47 Family Patterns 48 What about family patterns? 48 In Summary 50 Important Communication Skills 52 Healthy Communication Patterns 52 Rules for Healthy Communication 53 Activity: Communication Rules 54 Family Contract 55 Activity: Defining Expectations and Consequences (If...then...) 56 Family Contract 57 Attitudes and Beliefs 63 Unhealthy and Destructive Attitudes and Beliefs 63 How not to be healthy: How to feed and grow self-injury 63 Activity: Unhealthy and Healthy Attitudes 64 Activity: Identify Your Family’s Attitudes and Beliefs 69 Purpose 70 Activity: Creating Purpose and Direction for Your Family 70 Activity: What I Want You to Know About Me 72 Activity: Taking Our Family Inventory 73 Activity: Identifying a Problem and Creating Possible Solutions 74 Activity: What limitations, problems, or weakness… 75 Activity: Understanding Purpose of Self-Destructive Behaviors 76 Activity: Family Life Journey 77 Activity: Our Personal Family Crest 78 Activity: Our Family Creed 79 Friends 80 What about friends? 80 Activity: Define the rules for healthy friends and relationships 81 Self-Expression & Self-Definition 82 A brief word on SELF-EXPRESSION 82 A brief word on SELF-DEFINITION versus SELF-ESTEEM 82 Self-Expression and Individuality 82 Why your self-injuring kid needs limits, boundaries & expectations 83 Healthy Relationships 85 Activity: What are the rules of healthy relationships? 85 Activity: Communicating Important Thoughts & Opinions 86 References 88
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About the Book
This book, along with its sister journal text, was written to help therapists working with people who are struggling with self-destructive behaviors and want to change their lives and need a component to help with the family/significant other piece. Self-injury and self-destructive behaviors can become such a big part of life and relationships, that the thought of change is overwhelming. This is a long process, one that many people don’t understand, and will ask not just the person, but their entire family and social network to change with them. This book is a set of exercises for therapists to use in therapy with patients/clients who self-injure to help with the family work. For purposes of consistency, the individual in treatment will be referred to as patient, although remember these are people who have problem behaviors, deserving of respect, compassion and dignity. The term is one of consistencies. Never forget the person and people we discuss. Secondly, we are talking about a range of self-destructive behaviors that involve thinking, behaving, reacting, perception, attribution, understanding and efforts at managing. It involves the entire approach to and interaction with the self and the world. Our role as a treatment provider includes several goals. These goals include providing education, information, consultation and support for community services. It also is important to include family and other supportive people when necessary and appropriate. And then take it a step farther, have the patient/client help teach supportive family members these important self-management skills. A necessary part of treatment includes family and friends who can help be supportive. This guide was written for people who are willing to work towards the goal of helping someone they care about learn new and healthier ways of coping with living. Why do written work and talk about it therapy? Journaling is often a part of the therapy process. And, when used to augment therapy, it can be a powerful and helpful tool. These exercises were designed to provide structured interactions, hopefully in a contained and directed manner. This journal is to give therapists working with families and people with deliberate self-destructive impulses, urges and behaviors a structured way to work on one important lesson at a time and create meaning around the lesson.
About the Author
K. R. Juzwin, Psy.D., is a clinical psychologist who has worked with people with self-injury, trauma and eating disorders (CEDS) for more than 15 years. She is the Consultant Clinical Director of the Self-Injury Recovery Services programs at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Illinois. These programs are designed to help those people with self-injury, eating disorders, substance abuse and trauma backgrounds. She is active as an educator, consultant and researcher in these programs. She can be reached at kammie.juzwin@alexian.net or 1-847-882-1600, for the SIRS program, speaking or consultation. She is also an Associate Professor at the Illinois School of Professional Psychology in Schaumburg, Illinois. She teaches courses in Self-Injury, Eating Disorders and Trauma; She can be reached at kjuzwin@argosy.edu. She also works in the area of crisis intervention/CISM, forensic trauma and response, LE, first responder and disaster psychology. Join the online community of Overcoming Self-Destructive Behaviors at http://krjuzwin.wordpress.com/ for ongoing discussions, strategies and support.