Around the country, there are many therapists and counselors who work with self-injury, including a significant number who claim it as a specialization.
If you aren’t in the Los Angeles area (where we work), how can you find the a therapist who is right for you?
Here are some traits to specifically seek out:
First and foremost, find a therapist who understands families, and who will treat the self-injury as a family problem.
When cutting is treated as an individual problem, like a behavioral disorder or an addiction, all too often the treatment fails.
We at KISI understand self-injury to be fundamentally a relational issue, and one that requires relational — meaning family — treatment.
Find a therapist who isn’t squeamish — with blood or with conflict.
One of the most common negative experiences cutters have with therapists occurs when a therapist reflexively assumes that any self-injury must equal suicidality, and has the cutter hospitalized.
We certainly understand this reaction; the therapist is aiming to protect the cutter. Many parents, of course, react the same way.
But hospitalization when it isn’t really necessary can do more harm than good. The cutter comes away only feeling more isolated and misunderstood.
A good self-injury therapist can properly differentiate common cutting (“non-suicidal self injury,” in diagnostic language) from truly suicidal behavior. A good self-injury therapist will also be able to recognize and work with the often-unspoken family conflicts that can lead to self-injury.
In many ways, the work we do often isn’t pretty. Your therapist has to be prepared for that.
Find a therapist who will take the time to do a thorough assessment.
In our view, too many therapists have decided on a treatment plan for self-injury before they have even met their client.
While we believe self-injury is often a family problem requiring family treatment, it is only by thoroughly assessing a family that we can determine the nature of the problem we are truly dealing with.
If it is the type of self-injury we usually treat, the assessment process helps us learn where the relational problems are and what needs to be fixed in a family to render the cutting unnecessary.
Look for a therapist who will meet with your family, both individually and together, before making key decisions about how counseling will go and what the focus will be.
What happens if you can’t find a therapist who has all of those traits?
Depending on where you live, you may have few options. We’d be quick to say that a therapist with one or two of the traits above is still preferable to a therapist with none of them.
Still, for the best possible outcome, seek out these traits. Shop around until you find them.
Many therapists offer initial consultations for free, and even with those who do not, it can be worthwhile to meet for an initial session and get to know the therapist before committing to treatment.
It is important that all of the family be “on board” with the therapy for it to work, so find one you all can agree on.
-Benjamin Caldwell, PsyD is a California Licensed Marriage and Family Therapist (#42723) and Director of Operations at the Kahn Institute for Self-Injury.