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Interventions for Cutters: Substituting Self-Control for Self-Mutilation
Cutters continuing education social worker CEUs

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Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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Audio Transcript Questions The answer to Question 1 is found in Track 1 of the Course Content. The Answer to Question 2 is found in Track 2 of the Course Content… and so on. Select correct answer from below. Place letter on the blank line before the corresponding question. Do not add any spaces.
Important Note! Numbers below are links to that Section. If you close your browser (i.e. Explorer, Firefox, Chrome, etc..) your answers will not be retained. So write them down for future work sessions.

Questions:
1. Before 1970, what was self injury often mistaken for?
2. What is a person that self harms ultimately trying to accomplish?
3. According to the speaker, what is one major characteristic of many repetitive cutters?
4. In the anecdote the speaker told about a self injurer in a residential facility, what was so alarming about the client wanting to cut herself?
5. If a child never learns to cope with feelings from his or her parents, how can this lead to cutting?
6. What is one reason why the likelihood of self injury increases when a cutter knows his or her family member or a friend self injures?
7. What is one result of withholding attention from the self injurer?
8. In the speaker's case study, why did the mother not want to listen to her cutting daughter's feelings?
9. Name one reason why it is especially important to enforce group boundaries when working with cutters.
10. What does it mean when a cutter believes that overt action is necessary to "communicate" feelings?
11. What is one reason why using alternative behaviors to substitute for the cutting is considered controversial?
12. When using The "Miracle Question" as a Treatment Approach, what can be accomplished by asking your client, "Are any pieces of the Miracle already happening?"
13. To help a client understand that it is important to develop healthy coping skills, how can the therapist address the client's self injury?
14. What is the most important factor for the therapist to consider when deciding if a behavior like getting tattoos or piercings is actually a form of self injury?
Answers:
A. Motivation - the therapist should find out if the person getting tattoos or piercings because he or she likes the art or because the physical pain of getting the tattoo or piercing feels good.
B. The mother did not want to be blamed for the child's cutting. The daughter felt like her mother did not love her.
C. They often identify themselves as cutters because cutting has become such a part of their personality and their make up of who they are that they truly see themselves as cutters.
D. Suicide attempt (weak suicide attempt, failed suicide attempt, or attention-seeking suicide attempt)
E. They are trying to alter a mood state by injuring themselves.
F. When one person in a group does it, other people are going to follow suit. For example, the speaker explained how "emo culture" is gaining popularity with adolescents for fringe behavior including cutting.
G. Though it is always good to set boundaries when working with a group (like no socializing with other members outside of the group), it is especially important with cutters because cutting can be a group activity, and you do not want the group to degenerate into encouraging cutting behavior since they feel like the group
members can identify with them.
H. "Not only do I have to act on my feelings to make me feel better, but I have to do the cutting to let other people know about these feelings."
I. The therapist and the client have to recognize that cutting has been a vital coping skill but it is time to move on to healthier coping skills.
J. After waking from a bad dream, she realized she had been looking for a razor under her bed during the dream because the
urge to reduce anxiety by cutting had become unconscious.
K. Withholding attention from the self injurer just feeds into their feelings of loneliness, worthlessness, and isolation.
L. Using alternative, substitute, behaviors still reinforces the idea that action is needed to deal with feelings, even if the alternative non-cutting behavior is less damaging than cutting.
M. The client can realize that some of the "Miracle" actually is happening, or the therapist and client can work together to try to find a way to make the "Miracle" start happening.
N. The child may turn to cutting as a way to deal with feelings that were never modeled for them.

Course Content Manual Questions The Answer to Question 15 is found in Section 15 of the Course Content… and so on. Select correct answer from below. Place letter on the blank line before the corresponding question.
Important Note! Numbers below are links to that Section. If you close your browser (i.e. Explorer, Firefox, Chrome, etc..) your answers will not be retained. So write them down for future work sessions.

Questions:
15. What is the reason the author gives for the escalation of disordered behaviors, such as self-injury?
16. What was a goal Mona's therapist had for her treatment?
17. Why was it important for Elaine to confront the girls in her sorority about their teasing?
18. How is Nancy's addiction to plastic surgery similar to other patterns of self-injury?
19. What is a reason that self-injurers who stop their self-harm behavior often feel an intolerable emptiness, dullness, flatness, or depression?
20. What are the two extremes of boundary issues experienced by women with Trauma Reenactment Syndrome?
21. According to the author, what is a positive factor in connecting MPD with Trauma Reenactment Syndrome?
22. According to the author, what is meant by "complex PTSD"?
23. According to Conterio, what are the eight characteristics of a self-injuring client?
24. When did Ceci's self harm begin to escalate towards suicidal ideation?
25. What is a benefit of having a client answer the self-assessment questions?
26. According to Hewitt, what are six reasons inmates may self mutilate?

Answers
A. The client's mind has adjusted to the existing level of behavior or achievement, and is now seeking to increase intensity in order to maintain the rush.
B. Undergoing plastic surgery gives her relief from her anxiety and fears, although the process is substantially more delayed than
in other self-injurers.
C. This diagnosis makes important distinctions between adult-onset or one-time-occurrence trauma and trauma such as child sexual abuse, which can be prolonged and more damaging.
D. When she began panicking, because the soothing effects of her self-injury were starting to wane.
E. It can slow a client down enough to interrupt their impulsivity and make them think about what they are about to do. It will also help them to identify the feelings that are triggering the urge to self injure.
F. When the adult Trauma Reenactment Syndrome victim is in a cycle of self-harming, often the planning, the anticipation, the
secrecy, and the activity itself all create an experience of pain and excitement or arousal that replicates the excitement in childhood
abuse cycles.
G. To develop her verbal expressiveness, which would in turn give her more insight into her own feelings.
H. She felt that if she did not get assertive with them, and stop them from teasing, she would experience inward anger towards
them and take it out on herself.
I. Rigid personal boundaries that may lead to agoraphobia and chronic loneliness; and loose and diffuse boundaries that lead to unpredictable behavior and make others uncomfortable.
J. To project toughness; obtain medical care; protest policies; release frustration and hostility induced by extreme boredom; release repressed rage in a way that will not induce punishment; as a plea to be recognized as an individual.
K. Difficulties in impulse control; history of childhood illness; low capacity for stable relationships; fear of change; inability or unwillingness to care for him or herself; low self-esteem; significant parenting deficits; rigid thinking.
L. The problem of dissociation resulting from childhood trauma takes center stage.


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