A practical approach in the treatment of self-inflicted violence

After a brief review of the literature on self-inflicted violence, a practical approach to the treatment of patients who show self-injurious behavior and self-mutilation is developed. The treatment model uses therapeutic interventions based on a biopsychosocial understanding of the person and applies knowledge from the biological, psychological-behavioral, and social fields. Interventions discussed include ego strengthening, planning for substitute behaviors, therapeutic imagery, ego-state therapy, reframing, cognitive syllogism, behavioral reinforcement and extinction, and use of behavioral contracts. The case examples presented illustrate the importance of the therapist/patient relationship, which is based on trust, respect, and caring but also on patient responsibility for change.