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DVD - Interventions for Cutters Substituting Self Control for Self Mutilation
 Cutters continuing education counselor CEUs

Section 25
Instructor's DVD Handout: Self-Injury
Self Assessment and Alternatives

CEU Question 25 | CEU Test | Table of Contents | Self-Mutilation
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Self Assessment Questions
The following questions were taken from the Bodies Under Siege website, http://buslist.org/ cgi-binlaf.cgi. They are designed to be used by individuals who are feeling the urge to self harm. You can give these questions to your clients and ask them to answer them before they engage in self harm. Individuals can also go online and answer them there and then email the answers to themselves.
1. Why do I feel I need to hurt myself? What has brought me to this point?
2. Have I been here before? What did I do to deal with it? How did I feel then?
3. What have I done to ease this discomfort so far? What else can I do that won’t hurt me?
4. How do I feel right now?
5. How will I feel when I am hurting myself?
6. How will I feel after hurting myself? How will I feel tomorrow morning?
7. Can I avoid this stressor, or deal with it better in the future?
8. Do I need to hurt myself?

By having an individual go through these questions it can slow a client down enough to interrupt their impulsivity as well as 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. This can help them to use more appropriate substitution behaviors in that they can match their feeling to a substitution behavior.

Alternatives to Self Injury
You can increase the chances that a distraction or substitution behavior will help calm the urge to self injure by matching the behavior to how you are feeling at the moment.

Take a minute to look behind the urge. What are you feeling? Then match the feeling to a substitution behavior to calm the urge to hurt yourself.

Feeling angry, frustrated, restless.
(These strategies seem to work better if you talk to the object you are cutting/tearing/hitting. Start off slowly by explaining why you are feeling hurt and angry. If you end up screaming and yelling that is okay as it can help you to vent feelings.)

Try something physical and violent, something NOT directed at a living thing:
• Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
• Flatten aluminum cans for recycling, seeing how fast you can go.
• Hit a punching bag.
• Use a pillow to hit a wall, pillow-fight style.
• Rip up an old newspaper or phone book.
• On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture up then.
• Make Play-Doh or Sculpey or other clay models and smash them.
• Get a few packages of Silly-Putty or some physical therapy putty and squeeze it, bounce it off a wall, stretch it and then snap it.
• Throw ice into the bathtub or against a brick wall hard enough to shatter it.
• Break sticks.
• Crank up some music and dance.
• Clean your room (or your whole house).
• Go for a walk/jog/run.
• Stomp around in heavy shoes.
• Play handball or tennis.

Feeling sad, soft, melancholy, depressed or unhappy.
• Do something slow and soothing, like taking a hot bath with bath oil or bubbles, curling up under a comforter with hot cocoa and a good book, babying yourself somehow.
• Do whatever makes you feel taken care of and comforted.
• Light sweet-smelling incense.
• Listen to soothing music.
• Smooth nice body lotion into the parts of yourself you want to hurt.
• Call a friend and just talk about the things you like.
• Make a tray of special treats and tuck yourself in bed with it and watch TV or read.
• Visit a friend.

Craving sensation, feeling depersonalized, dissociating, feeling unreal...
Do something that creates a sharp physical sensation:

• Squeeze ice hard. (Note: Putting ice on a spot you want to burn gives you a strong painful sensation and leaves a red mark afterward, kind of like burning would. This really hurts.)
• Put a finger into a frozen food (like ice cream) or put ice, water, and salt in a pitcher and put your hand in it for a few seconds.
• Bite into a hot pepper or chew a piece of gingerroot.
• Rub liniment under your nose.
• Slap a tabletop hard.
• Snap your wrist with a rubber band.
• Take a cold bath.
• Stomp your feet on the ground.
• Focus on how it feels to breathe. Notice the way our chest and stomach move with each breath.

Wanting to Focus...
• Do a task (a computer game, writing a computer program, needlepoint etc.) that is exacting and requires focus and concentration.
• Eat a raisin mindfully. Pick it up, noticing how it feels in your hand. Look at it carefully; see the asymmetries and think about the changes the grape went through. Roll the raisin in your fingers and notice your hand that way. Smell the raisin; what does it remind you of? How does a raisin smell? Notice that you are beginning to salivate, and see how that feels. Open your mouth and put the raisin in, taking time to think about how the raisin feels to your tongue. Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. Are there little seeds or stems? How is the inside different from the outside? Finally, swallow.
• Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. Include everything: size, weight, texture, shape, color, possible uses, feel, etc.
• Choose a random object, like a paper clip, and try to list 30 different uses for it.
• Pick a subject and research it on the web.

Wanting to see blood...
• Draw on yourself with a red felt-tip pen.
• Take a small bottle of liquid red food coloring and warm it slightly by dropping it into a cup of hot water for a few minutes. Uncap the bottle and press its tip against the place you want to cut. Draw the bottle in a cutting motion while squeezing it slightly to let the food color trickle out.
• Draw on the areas you want to cut using ice that you’ve made by dropping six or seven drops of red food color into each of the ice cube tray wells.
• Paint on yourself with red tempura paint or a red lip-liner pen.

Wanting to see scars or pick scabs...
• Get a henna tattoo kit. You put the henna on as a paste and leave it overnight; the next day you can pick it off as you would a scab and it leaves an orange-red mark.

Another thing that helps sometimes is the fifteen-minute game. Tell yourself that if you still want to harm yourself in fifteen minutes, you can. When time is up, see if you can go another 15 minutes.
- Ways to Help Yourself Right Now (n.d.), retrieved 2/22/04 from http://selfinjurvoigdocs/selthclp.html

Personal Reflection Exercise #11
The preceding section contained information about self-injury self assessment questions and alternatives for your client. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 25
What is a benefit of having a client answer the self-assessment questions? Record the letter of the correct answer the CEU Test.

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