Read an Interview with Barent Walsh on Self-Harming Behaviors

In anticipation of his March 19, 2010 continuing education conference at the Brattleboro Retreat entitled "New Developments in Understanding & Treating Non-Suicidal Self-Injury," the Retreat's Education Coordinator Gay Maxwell interviewed Barent Walsh, Ph.D., on the  topic of self-injury.
Click Here To Learn More About This Workshop.

You have been studying, writing and presenting on self-injury since at least 1985. What were the experiences or events that created such interest in developing your expertise in self-injury?

I’ve always worked in populations confronted with major mental health challenges, and a certain proportion of those clients report self-injury. First, it was enough that self-injury was a puzzle that I really wanted to understand and learn how to treat. Secondly, choosing it as a focus was a pragmatic decision. I needed a dissertation topic, and I wanted a topic that I could live with for a long time since writing one’s dissertation can certainly go on seemingly forever. And in my case, my study and writing about self-injury has gone way beyond my dissertation.

Which of your writings do you especially recommend?

My book, Treating Self-Injury: A Practical Guide, (Guilford Press, 2006) is my most comprehensive discussion of the topic.  Another piece of writing that I am proud of is a recent article about the evaluation of outcomes for suicidal and self-injurious behavior in my agency’s DBT residential program for adolescents (Walsh & Doerfler, 2009).

There are many people in our society who might assume that the phenomenon of self-injury is a fairly new development among adolescents and young adults. What is your reaction to that idea? Do you think that the factor of “social contagion” has indeed contributed to a sense that it is epidemic?

The idea that self-injury is a recent phenomenon is not true. It has been written about in clinical journals and books since at least the 1950s. What’s changed is that the behavior has moved from clinical populations to the general populations including middle schools, high schools, and universities. This development has alarmed and confused people and caught the attention of the media. Since about 2000, self-injury has exploded into these new populations who are generally not as impaired as the clinical populations. Self-injury in clinical populations has always been common.

Social contagion of self-injury has been written about since the 1970s. I came upon it anecdotally in adolescent residential programs and special education settings where kids would describe how self-injury would trigger self-injury. I was part of one of the first empirical studies of social contagion, and we collected data that documented that self-injury occurred in statistically significant bursts or clusters. I will address this topic at length in the Brattleboro conference.

Are there cultures in which self-injury or mutilation are socially acceptable – for instance, as a rite of passage, a form of medicine or healing, part of a religious ceremony? How sensitive should clinicians be to those possibilities?

It’s important to distinguish between culturally endorsed body modification versus self-injury. Body modification involves culturally endorsed alteration of the body. This behavior often has religious significance and/ or cultural meaning.  Many cultures endorse body modification; for instance, ear piercing in our own culture, or facial tattooing in the Maori. However, no broad culture endorses nonsuicidal self-injury.

When you have the opportunity to speak to clinical professionals about self-injury, what is it that you most want them to bring back to their practice?

First, self-injury is not about suicide. It’s generally about emotional regulation. It is important to understand how the two behaviors are different, yet are linked. Second, it’s treatable. The way to treat it is to not forbid it or attempt to contract it out of existence. Instead, clinicians need to try to understand it in all its specifics and teach people other ways to regulate their emotions.

References:

Walsh, B. (2006). Treating self-injury: A practical guide. New York: Guilford Press.

Walsh, B. & Doerfler, L. (2009). Residential treatment of self-injury. In Nock, M.    (Editor). Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: American Psychological Association.