Common elements for the psychotherapeutic management of patients with Self Injurious Behavior
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OBJECTIVES: Current research suggests that effective psychotherapies for Self Injurious Behavior (SIB) in the context of Borderline Personality Disorder (BPD) contain generic common elements which are responsible for their success. Because of the links between BPD, SIB, and child abuse, it is likely that these common elements can also be applied to the psychotherapy of survivors of child abuse who engage in SIB. This article will reviews several common elements which recent literature has suggested are important and suggest techniques by which community practitioners can incorporate these elements into their practice with adult survivors of child abuse who engage in SIB. METHODS: This article summarizes recent key articles on common elements in psychotherapy for BPD. It refers to the treatment manuals for the specialized psychotherapies as well as General Psychiatric Management (GPM), a novel and more accessible approach, to further elaborate on these common elements and their potential usefulness in the community. RESULTS: This paper identifies seven common elements which appear both in the recent literature and in GPM: a coherent model to understand SIB, an active therapeutic stance, validation balanced with change-oriented techniques, encouragement of self-agency, establishment of a connection between actions and feelings, a method for assessing lethality, and access to supervision. By referring to current treatment strategies for BPD, this paper suggests methods by which these common elements can be incorporated into practice by community practitioners working with adult survivors of child abuse who engage in SIB. CONCLUSIONS: Despite a lack of access to intensive training or the resources required for multimodal treatments, there are many strategies from established treatments for BPD which can be used by community practitioners to address SIB. Because treatments for BPD often focus on addressing SIB, and because adult survivors of child abuse often engage in SIB, whether or not they have BPD, it is likely that these techniques are applicable to practice with adult survivors. Further research is, however, necessary to empirically examine these common elements and their potential utility.
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