Understanding Self-Abusive Behavior Within a Trauma Framework

Description of Course:

Session amounts may vary based on the individual needs of the organization.

For individuals, please contact us for more information.

This course sets the stage for therapeutic change by providing a trauma framework that helps clinicians better understand and treat clients who engage in self-abusive behavior. The course teaches clinicians how to provide the necessary structure for their clients with contracting and the clarification of boundaries. Participants will begin to reframe self-abusive behavior by better understanding the purpose it serves for the client. There will be a description and clarification of stages of change that allow clinicians to anticipate and prepare for relapse in treatment. The course will provide hope for clients and the worker by incorporating a strength perspective. There will be clarification around the definitions of suicidal, masochistic and self-harming behavior. Participants will learn how to make risk assessments, so they can better understand what constitutes an emergency situation in the their particular clinical milieu (i.e. school versus hospital or clinic settings).

There will be a review of trauma theory, as well as the normative responses to chronic trauma; the adaptive purpose they serve and how it relates to self-harm. This includes clear explanations and examples of how the following are manifested: fight or flight, learned helplessness, loss of volume control, dissociation, addiction to trauma, identification with the aggressor, etc.

Countertransference will be discussed, as well as an explanation of projective identification and how it works as a key defense. There will be discussion around pejorative labeling (such as: “manipulative”, “attention-seeking”) and a redefinition and shifting of perspectives allowing clinicians to deal with the shame, blame and guilt from which their clients suffer. Participants will develop empathy without playing a role in the traumatic re-enactment and learn to avoid burnout when working with challenging clients.

Multiple concrete interventions will be explained, reviewed and practiced (where applicable) within the context of case examples.

Such as:

  • Non-violence stance: How to staying non-judgmental and avoiding power struggles.
  • Boundaries: How to set limits for both workers and clients.
  • Contracting: How to remain pro-active instead of crisis driven.
  • Emotional Regulation Skills: Techniques for increasing distress tolerance
  • Cognitive Processing: Evidence-based CBT methods for shifting thinking patterns that trigger and perpetuate self-abuse cycles.
  • Avoiding Reenactment: Creative tools that incorporate the five senses to identify triggers and create safety plans.
  • Re-experiencing: Grounding techniques that help with flashbacks, dissociation and nightmares.
  • Charting: Mapping frequency, intensity and duration of incidents to encourage and foster hope.
  • Future Focus: Enhancing social supports and decreasing isolation for both worker and client.

Teaching Methods:

This course is geared toward adult learners. It will be taught with a combination of methods. Didactic lecture and the use of power point will outline in a step-by-step, sequential manner the components of the model. Interactive activities such as role-play and practice time for skills and techniques will allow the participants to begin to internalize the tools and techniques taught in the course, as well as to be prepare for challenges, resistances and avoidance. Video clips are used to stimulate conversation and serve as case examples.
They will be utilized to discuss both theory and intervention techniques. Discussion of how to apply the model to specific cases, as well as case examples will occur throughout.

Learning Objectives:

  • Participants will understand how to define self-abusive behavior what it is and what it is not.
  • Participants will learn how to use tools to assess risk and differentiate between self-abusive behavior and suicidal ideation and suicidal intent.
  • Participants will review normal responses to trauma such as: fight or flight, learned helplessness, dissociation and traumatic re-enactment.
  • Participants will understand how a trauma framework sheds light on the purpose self-abusive behavior serves for the client.
  • Participants will recognize how the helping professional’s counter-transference can provide insight into the client’s experience, as well as clues for treatment interventions.
  • Participants will understand how self-abusive behavior is an attempt to regulate affect and maintain or achieve a sense of control with video clips from films, as well as real life clinical case examples.
  • Participants will learn and then practice myriad treatment interventions.
  • Participants will learn how to integrate treatment interventions with case examples.

Teaching Methods:

The course is geared to adult learners and will use verbal and PowerPoint presentation of material by the instructor; interactive large group discussion of concepts and of participants’ practice; small group work involving experiential exercises and discussion of handouts of resources and tools. Additionally, this workshop uses video clips as case examples and creative exercises that equip participants to assess and decrease risk for clients. Participants will explore and practice a variety of creative and effective techniques with an experienced and accomplished instructor. They will practice interventions for grounding, emotional regulation, cognitive reprocessing and learn how to chart progress, create real-life safety plans and enhance community supports.