Cutting and Treatment Strategies

Written by: John Christie MA, LPC

Cutting presents special and specific issues to understand. To begin with, cutting is a behavior and like other negative behaviors or coping skills, it is a symptom. If we address the cutting only, we will not be attending to the cause of the issue. In this way, we might temporarily stop the behavior, but it will resurface at some time in the future. However, we must be diligent in keeping the client safe. Therefore, treating a cutter requires a multi-faceted approach to not only keep the client safe, but address the negative and often irrational thought pattern that enforces the cutting.

First, we need to understand some of the reasons someone self-abuses in this manner. One reason I have seen is personality. Most of the cutters I have had the opportunity to work with are introverts or they at least lean to that side of the spectrum. Being this way, they tend to turn the hurt and anger inward rather than outward to others. Another reason includes a tangible expression of emotion, as we work with many girls that do not know how to appropriately express their emotions. It also provides a release of anger and other emotions. One girl told me that an extreme emotion requires an extreme reaction or behavior. Some have said that it provides a level of comfort. This may be due to the distraction that cutting provides. However, one of the most prevalent reasons for cutting is control. Cutting provides a measure of control over their lives and emotions. Additionally, it is very difficult to completely 'take away' this coping skill from a client. The following are additional reasons for cutting that need to be considered when developing a treatment plan:

• Boredom
• Negative attention seeking
• Distraction
• Self-Punishment
• Copy-Cat Behavior
• Reality - makes them feel something they know is real, something they can see
• Reputation - cutting is seen as more 'cool' than say, punching oneself in the face

Obviously, successful treatment necessitates keeping the client safe. Once safety can be maintained or controlled, we can begin to tackle the thought patterns that lead to the cutting. This work includes discovering the manner in which the past trauma was originally processed. If, for example, they were molested and the thought that developed was, 'that's all I'm good for', that will impact their emotional state in a very negative way, which will in turn affect behavior in a negative manner. These negative and irrational thoughts need to be processed in a more rational way that is external and positive. Along with behavior, work needs to focus on their communication. Communication work includes outgoing as well as incoming communication. Often, clients have a negative and irrational interpretation of the messages they receive from others. The client will often assume that other adults or authority figures in their lives will hurt them. Therefore, they need to learn how to be vulnerable without taking down all their boundaries. If they are able to process this information and re-program their brain to their new surroundings, they begin to gain skills to solve their own problems. That is when true healing begins.