Cutting, or self-harming, is intentional self-injurious behavior resulting in tissue damage, illness, and/or risk of death. Cutting is generally not done with suicidal intent, though teens who engage in self-harming behaviors are at a statistically a higher risk for suicide. Despite what your teen may report, these acts of self-mutilation do not represent typical or harmless adolescent behavior. Self-harming behavior is symptomatic of serious underlying emotional or mental health issues that should be addressed with the support of a mental-health professional.

TYPICAL FORMS OF SELF-HARM:

• Cuts or scrapes with a knife, razor blade, or any sharp object
• Scraping the skin with abrasive material, e.g. glass, fingernails, or metal
• Burning the skin with a lighter or cigarette
• Burning the skin with a chemical agent
• Breaking bones

Recent research indicates that up to 46% of teens report having engaged in self-injurious behavior. This high surge in cutting behaviors may be due in large part to recent high-profile cutting cases. The media has made much recently of cutting behaviors described by such celebrities as Princess Diana, Angelina Jolie, and Johnny Depp. Like other coping or anxiety-based behaviors, cutting can spread as a copycat phenomenon. Many teens even seek validation and encouragement for self-harming from popular blogs and websites devoted to self-mutilation.

WHY DOES MY TEEN SELF-HARM?

The paradox of pain:

For a person who has had no experience with intentional self-harm, it is a confusing and frightening phenomenon. Most of us avoid pain and seek pleasure, but the cutter seems to avoid pain by seeking pain. Self-harming typically acts as a form of emotional avoidance and escape from unwanted unpleasant emotions. It is often an attempt to drown out emotional pain by engaging in more manageable physical pain. Many teens report relaxation and emotional numbness after self-harming. Self-harming can also serve as a tool to express strong negative emotions towards others or as an attempt to elicit help or attention from others.

Warning signs:

With the exception of those individuals whose cutting has an attention-seeking dimension, most cutters attempt to hide their cutting behaviors. Parents, educators, friends, and healthcare providers can, however, be alert to signs of cutting that include:

• Wearing long sleeves or long pants or turtle necks when it is warm outside
• Cutting a thumb-loop at the end of long sleeved shirt to keep arms covered
• Suspicious scratches, burns, or bruises anywhere on body
• Band Aids or tape on extremities
• Leaving or stashing razor blades, glass shards, or other “sharps” in the bathroom, bedroom, drawers, backpack, etc.
• Attempting to hide scars, burns, or other injuries
• Dramatic or intense emotional outbursts
• Difficulty expressing emotion appropriately
• Self-directed anger

Cutting is a red flag for emotional distress:

In most cases, cutting itself is just a symptom of underlying emotional distress. It is easy for loved ones to become so distracted by the cutting itself that efforts go toward controlling the behavior instead of addressing the problems underneath. Because cutting represents both a physical danger and a deeper mental health issue, the involvement of a mental health professional is always an imperative. If cutting leads to infection or if cutting goes beyond superficial physical harm, medical attention should be sought immediately. Deep cutting may indicate that the young person dissociates during the act of self-harm; even if the intent is not suicide, this kind of cutting is extremely dangerous and can lead to permanent tissue damage or death.

Cutting can be an indicator of many mental health issues, including:

• Depression
• Anxiety
• Suicidal ideation
• Physical, sexual, or emotional abuse
• Substance abuse
• Related eating disorders
• Personality and/or relational difficulties

EFFECTIVE TREATMENT FOR SELF-HARM:

Mental-health professionals experienced with adolescent issues and self-harming behaviors favor a variety of approaches in the context of a safe therapeutic relationship and/or milieu. These approaches include:

• Cognitive Behavioral Therapies
• Dialectical Behavioral Therapy
• Pharmacotherapy

If you suspect your child of cutting or other self-harm it is vital to consult with a mental health professional. Your child’s self-harming behavior is a warning sign of an underlining mental-health problem that needs immediate professional attention.

Sources:

• Linehan, Marsha (1993) Cognitive Behavioral Treatment of Borderline Personality Disorder, The Guilford Press
• Miller, Alec (2007) Dialectical Behavioral Therapy with Suicidal Adolescents, The Guilford Press

Information compiled and edited by Jack Hinman, Psy.D.

Photo by Morgan Cain

An educational consultant is a placement professional, typically possessing an educational and/or clinical background, whose expertise is matching young people with the appropriate program. Educational consultants who specialize in therapeutic placements are called “special needs” educational consultants. These educational consultants regularly visit and evaluate most or all legitimate treatment programs in the country to gain firsthand knowledge of their staff, clientele, and programming. Special needs educational consultants should also possess a deep understanding of adolescent therapeutic and educational issues, and their solutions.

An educational consultant not only helps match your child to the right program at the beginning of the treatment process, he or she also serves as a support during treatment, helping you navigate the treatment process and advocating for you as necessary. Many will also help you with post-treatment decisions as well.

To find a certified special needs educational consultant in your area, we suggest that you consult the website of the Independent Educational Consultant Association (IECA) at www.educationalconsulting.org. Be sure to ask what services a given consultant provides before, during, and after the treatment process.

Most parents seeking a treatment solution for their son or daughter are themselves in crisis, struggling with a combination of sorrow, fear, anger, and guilt. Add to this the confusing myriad of treatment options available, and it’s enough to push most parents to desperation. No treatment choice, however, should be made out of blind desperation, but from an understanding of your child’s unique set of issues and the available treatment options.

There are several steps you can take to ensure that even in this time of crisis and confusion, you make a rational and appropriate treatment choice for your child.

Professional Advice

The best initial sources of advice regarding placement are educational consultants and mental health professionals. It’s worth the cost of these services to ensure that you have the objective support, guidance, and advocacy you need to make a sound treatment choice. Many educational consultants will also provide third-party guidance and advocacy throughout the treatment process.

Assessment

If your adolescent or young adult will comply, it’s a good idea to have a full battery of psycho-educational assessments conducted to gain insight into the nature of your child’s struggle. With the support of an educational consultant or mental health professional, this information can help you make a better placement choice. If your child is not compliant prior to treatment, however, these assessments can also be conducted during placement. You should check with your mental health professional for his or her recommendation.

Talk to Other Parents

Once you’ve identified a program that seems promising, request to speak with parents. While these parents are likely to be handpicked because they have had a positive experience, those are really the parents you want to talk to! They can offer you program insight, a compassionate ear, and hope!

Visit Your Top Picks

Always visit your top picks and use your brain and your gut to make your decision. Insist on talking with students, staff from every department, and the program director. You should be allowed to tour the entire facility and ask questions freely. It’s smart to come with a list of questions prepared; program visits can be taxing and it’s easy to forget what to ask while you’re touring. It’s also important to listen to your gut when you visit a program; the program you select will be your child’s home for a period of time, and no one knows your child like you do.

Transport Services

If your child is likely to resist a placement decision, it is recommended that you engage the services of a transportation service. Most programs and educational consultants can refer you to a safe, reliable transportation service that will provide professionals with mental health backgrounds who can safely transport your child to treatment.

Create a Support System

Not only is picking a treatment program for your adolescent or young adult stressful, but that level of stress can actually temporarily decrease your cognitive functioning, making a difficult decision even more difficult. It’s important to have the support of friends and family during this time both to sooth your emotions and to help you process information and think through options. This is not the time for isolation or secrecy. This is a time to reach out for support.

Tell Your Story

The first step in any healing process is telling your story. Whether to a friend, family member, a pastor priest or rabbi, or a mental health professional, or a program representative, telling your family’s story is a critical part of really understanding it, and understanding it is critical to finding a solution. It’s also just therapeutic to tell your story during a time of crisis, so don’t try to go it alone if your child and family are suffering.

Check Credentials and Associations

It’s important to check the credentials of the programs and the staff they employ. Some basic credentials to look for include:

Program

• JCAHO Accreditation
• State licensure to operate as a treatment facility
• Academic accreditation from a regional accreditation body such as NAIS or WASC
• Membership in a national therapeutic association such as NATSAP

Staff

• Master’s level therapists
• Clinical leadership provided by PhD and/or clinically licensed therapists
• State-credentialed and/or master’s-level teachers
• Special-education credentialed teachers on staff if your child has learning differences
• 24 hour on-call medical staff (preferably RN, Nurse Practitioner, or physician)
• Psychiatrist on staff or affiliated
• Wilderness First Responder certification for wilderness program staff
• First-Aid and CPR certified staff

Do Your Homework

Some reliable sources of sound therapeutic program information are The Woodbury Report and the National Association of Therapeutic Schools and Programs.

Photo by martinak15

Brian Lombrowski is a Youth Involvement Specialist in New York.  He balances passion with thoughtful responses when discussing how RTCs can better serve youth.  I hope to visit him soon in New York.

Kari Sisson, pregnant with twins, is the Executive Director of AACRC.  She’s a tireless advocate for AACRC’s members.  Without her this conference wouldn’t happen.  Without her this association wouldn’t happen.

Glen Zaugg is the president of the National Association of Therapeutic Schools and Programs (NATSAP).  He has been instrumental in working to build a bridge between AACRC and NATSAP.

Chris Bellonci is the new president of AACRC.  He is unafraid to entertain new ideas and push into the future, yet he honors the past in a way that does not bind AACRC to it.  I am excited to see what he does as he takes the reins.

Margaret Vimont is the past president of AACRC.  Her calm leadership style is refreshing.  She extended trust to me and gave me opportunities to serve early on.  Under her leadership the attendance at conferences grew and AACRC is also financially sound.

Bob Lieberman is the Executive Director of Kairos, a treatment center in Oregon.  Bob is one of my mentors, and is easily one of the most well-respected and well-connected people in the residential treatment world.

Jodi Levison-Johnson is trying to change the culture of treatment for youth in the state of Louisiana.  No small task.  She’s unafraid and clearminded about who she serves.

Neal Sternberg is the leader of the Research Committee at AACRC and has volunteered countless hours trying to get a 10-year comparative study off the ground.

These are just a few of the amazing folks who are influencing me this week.

Calling all mental health professionals in the New York Metropolitan area.  Please join us for a free educational breakfast on Tuesday, October 25th, from 8:30-11:30 AM at The Carlyle, A Rosewood Hotel (at 35 East 76^th Street, New York, NY 10021).  Just in case the lure of a free breakfast isn’t enough to entice you, here are three more reasons to come:

1. Tian Dayton will present the Relationship Trauma Repair model

While we know Dr. Tian Dayton as extremely kind and gifted, her official bio goes way beyond that: “TIAN DAYTON, MA, PH.D.,T.E.P. has a masters in educational psychology and a PhD in clinical psychology and is a board certified  trainer in psychodrama. She is the director of  The New York Psychodrama Training Institute  where she runs training groups in psychodrama, sociometry and experiential group therapy (see psychodrama/training groups). Dr. Dayton is a fellow and scholor’s award winner of ASGPP. She was faculty at New York University for eight years teaching psychodrama. Dr. Dayton has been a guest expert on NBC, CNN, MSNBC, Montel, Rikki Lake, John Walsh, Geraldo.”

In every interaction with Dr. Dayton, we always come away feeling inspired and empowered.  She is well worth your morning.

2. Connect with Leading Treatment Programs

InnerChange- InnerChange provides educational, treatment, and recovery programs for adolescent girls and young women experiencing emotional or behavioral difficulties. Our residential treatment and transitional living programs are clinically sophisticated and designed to facilitate whole-family healing. We are committed to restoring hope in the lives of those we serve. InnerChange programs include New Haven, Sunrise and Fulshear Ranch Academy.

Clearview Treatment Center- Clearview Treatment Programs is a recognized leader in mental health treatment. We provide highly individualized treatment programs for people with psychiatric disorders, alcohol and drug addictions, and dual diagnosis.

Our specialized programs treat people who have struggled to achieve recovery from their psychiatric disorder or addiction in other programs or psychiatric hospitals. We treat individuals struggling with psychiatric disorders, substance abuse, trauma, Borderline Personality Disorder, mood disorders, or eating disorders.

Newport Academy- Newport Academy is a gender-specific, comprehensive, continuum of treatment programs for teens suffering from substance abuse and co-occurring mental health disorders.

Safe Harbor- Drug Addiction Treatment for Women at Safe Harbor Treatment Center for Women is nationally recognized as the premier Women’s Drug and Alcohol Treatment Facility in Southern California. Safe Harbor Treatment Center for Women has been in the forefront and a pioneer in the innovative development of addiction treatment designed specifically for women. We have been breaking the cycle of drug and alcohol abuse with healing, hope and love since 1993.

Sovereign Health- Located in the beach community of San Clemente, California, the Sovereign Health of California Treatment Center (sovcal.com) offers licensed and accomplished practitioners providing treatment of concurrent behavioral health issues with evidence-based, innovative and cutting edge programs in both outpatient and optional sober living residence.

3. Free CEU

You can always use another free CEU.

Whatever your reason, we hope you will join us.  Just RSVP to Ari Terry at ari@innerchange.com or at 801.380.4363 if you plan on attending.  And just in case we missed anything, you can download the official invitation here:

She has been an educator of addiction counselors in many schools including the University of California at Davis in the Addiction Studies Program, and the University of Nevada/Bureau of Alcohol and Drug summer school for Employee Assistance Professionals for 15 years. Dr. Willis has studied and presented at national conferences on multi-generational trauma and addiction.”

We are pleased that Dr. Willis took the time to share her insights on the importance of trauma informed care:

After conducting a nationwide search, we are pleased to announce that Sharon Laney, M.S. has agreed to assume the role of Executive Director with Lake House Academy.  Sharon’s vast experience, coupled with her love for working with families and young people, has been evident throughout her career.  Most recently, she directed operations at Trails, Carolina.  Previously, she was the Chief Operating Officer of Three Springs, a company with programs in 11 states serving youth in wilderness, residential, therapeutic boarding and transitional settings.  In addition to her operational involvement in a wide array of programs, Sharon has also demonstrated effective leadership on a national level as the President of the National Association of Therapeutic Schools and Programs (NATSAP), a role which has benefitted programs throughout the country.  Throughout all of her work experiences, Sharon has always kept her love for helping families and a firm advocacy for ethical, effective treatment strategies as priorities in her work.  Sharon states that she is “excited and honored” to take on the director role at Lake House and she “can’t wait” to get started.

Sharon will be winding down her responsibilities at Trails over the next two weeks, and will be on our campus for all or part of most days beginning this afternoon.  She will assume her full time role on September 20^th.   She plans to meet with each member of the Lake House team in the next three days.

If you have any questions please feel free to call Lake House Academy or reach out to Kimball and Sharon directly at their Lake House Academy email addresses (kdelamare@lakehouseacademy.com & slaney@lakehouseacademy.com ).  Thank you all for your support. We are looking forward to a bright future at Lake House Academy with the addition of Sharon’s talents and experience to our team and the continued support from Kimball and InnerChange.

Sincerely,
Roy “Buddy” Cook
President
Lake House Academy

&

Kimball DeLaMare
Senior Vice President
InnerChange

The more we know about the resources that exist for young women, the better we can serve our girls.  And if you’re like us, *visually appealing* resources are best!

To help us understand the residential treatment world we have started putting together some tools, and here is the first one.  The vast majority of NATSAP programs are excellent, so we mapped them all.  We realize that there will be mistakes, so if you notice any please let us know and we’ll update them.

We’d love to hear your thoughts.  Are tools like this useful to you?  What other tools would help you to uncover the resources that exist for your daughter?

View Parent Choice Treatment Programs in a full screen map

According to Catherine Freer’s website “Dr. Cooley grew up on the McKenzie River in Oregon, where he learned to row a whitewater boat at age four. He made his way through college and graduate school by spending his summers logging, doing Forest Service trail work, and working as a river guide. He earned his PhD in counseling psychology from the University of Oregon in 1979 and has specialized in family and adolescent therapy. He has lived abroad several times and speaks French, Spanish, and German. Dr. Cooley developed and directed a family therapy program at Oregon’s child welfare department and had a private therapy practice, while taking summers off to run a whitewater rafting company. In 1988, he combined his outdoor and therapy interests in founding Catherine Freer Wilderness Therapy Expeditions. Dr. Cooley and his wife Ingrid, a family therapist, live in Albany, Oregon, and have four children.”

We are so pleased that Dr. Cooley took the time to talk with us:

This concludes our week of  videos from our interview with Dr. Cooley.  If you missed any of the videos here are the links:

Monday- Challenges of Leadership

Tuesday- Good Leaders are Humble

Wednesday- On Vision

Thursday- Employees: Hire Right, Train Thoroughly, Treat Well

Friday- Empowering Employees