By Daniel Jordan
I recently had the pleasure of attending a Jack Hirose workshop on the 6th & 7th of November that featured Matthew D. Selekman, MSW, LCSW. Matthew is a family therapist and addictions counselor in private practice and the co-director of Partners for Collaborative Solutions, an international family therapy training and consulting firm in Evanston, Illinois.
Matthew is probably best known for his collaborative strengths-based brief therapy approach to his work with adolescents, particularly with self-harming adolescents. At first, I didn’t expect much of Matthew’s presentation to be relevant to my primary interest – men with addictions. Surprisingly, however, self-harming and substance misuse have a lot in common.
Similarity #1 – Rationale for Self-Harming
Matthew listed the most common reasons why teens say they self-harm:
- “it’s like a friend” – “when I’m having problems you are always here for me”
- tension release
- to quickly alleviate emotional pain and distress
- to feel alive inside
- to feel numb
- to have control
- to get a rush
- feel empty
- vent anger
- to feel connected to friends
- to stop bad thoughts
- purge out bad feelings
Even the comment, “the warm blood dripping down my arms calms me” is similar to some of the physical sensations that people who drink or use drugs may experience. Matthew explained that when an individual cuts there is a rush of endorphins which not only masks some of the pain but helps explain its habit-forming characteristics.
Similarity #2 – Feelings After Self-Harming
Matthew also showed research that surveyed how adolescents felt after self-harming:
Immediately = 70 % feel better, 21% feel worse, 9% no change
The immediate effects of self-harm can be said to resemble substance misuse. In his conversations with youth, Matthew will often ask “why would you stop something that works so well for you?” as he recognizes that so many find immediate relief from their problems by self-harming.
Few Hours Later = 30% feel better, 47% feel worse, and 23% feel no change.
This can be explained that after a few hours of self-harming, the endorphins wear off and feelings of guilt and shame return. The cycle then repeats itself as self-harming becomes a way to get rid of these negative feelings.
Few Days Later – 18% feel better, 50% feel worse, 32% no change
Similarity #3 – Frequency and Duration
Just as there are social drinkers, binge drinkers and regular heavy drinkers, so too with those who self-harm:
Similarity #4 – Co-existence of Substance Misuse and Suicidal Behavior *
Adolescent substance abusers are 3 times more likely to make a suicide attempt than non-users.
(*) Note: Suicidal behaviour and self-harming behaviour are not the same thing.
Similarity #5 – Relapse
The presentation on relapse prevention for self-harming behaviour I found particularly interesting. According to Matthew:
“Clients’ slips are inevitable and go with the territory of change. It is important to predict the likelihood of slips and normalize them when they occur. When someone has a slip, you can respond in the following way:
- “We could not have made headway if we did not have a slip.”
- “Slips are like teachers. They offer us valuable wisdom. What did you learn from your slip on Tuesday that will put to use the next time you are faced with a similar stressful situation?”
I do have a problem with the use of the term “slip” as Terence T. Gorski points out that short-term relapses are never accidental. However, I have never heard the term “normalize” used in connection with relapse and I think it is an excellent word to describe an effective response. After all, shame and guilt often follow relapse (see Similarity #2).
Similarity #6 – The Need to Deal With Distress When it Occurs
One great idea that Matthew shared with the workshop participants was the idea of a “chilling out” room as a distress management tool. A chilling out room is a room in the house which is designated by the family as “a safe and sacred space to secure adaptive and positive multi-sensory pleasure when experiencing emotional distress. Second, it serves as an effective pattern intervention for disrupting the problem-maintaining patterns of thinking and behaving that inevitably leads to a self-harming episode.”
Matthew recommends that the chilling out room should:
- be quiet
- have at least one window,
- be regularly stocked with colorful and fragrant flowers
- be regularly stocked with art and photography books and photo albums
- have a music library wih some soothing and contemplative selections (Carlos Nakai, Lonnie Liston Smith, Pharoah Sander were recommended)
- be stocked with fresh clay (most people like to run their fingers through fresh clay and make things out of it)
The chilling out room is also good for other family members as a place where they can decompress.
I haven’t even touched upon the therapeutic approaches that Matthew recommends for dealing with self-harming adolescents, which he calls a collaborative strengths-based brief family therapy approach as well as positive psychology interventions. Matthew offers an integration of solution focused brief therapy, narrative therapy, positive psychology, mindfulness, and multi-systemic family work. His recommendations on using clients’ signature strengths and nurturing resiliency and protective factors are areas that we at Sunshine Coast Health Center have also been exploring with our clients.
Recommended Reading – Matthew Selekman
Selekman, M.D. (2006) Working with Self-Harming Adolescents: A Collaborative Strengths-Based Therapy Approach.
Selekman, M.D. (2005) Pathways to Change: Brief Therapy with Difficult Adolescents (2nd Ed.)
Selekman, M.D. (1997) Solution-Focused Therapy with Children: Harnessing Family Strengths for Systemic Change.
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