Treating Self-Injury, Second Edition


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Table of Contents

I. Definition and Contexts for Self-Injury
1. Definition and Differentiation from Suicide
2. The Relationship between Self-Injury and Suicide
3. An Overview of Direct and Indirect Self-Harm
4. Major Groups in Which Self-Injury Occurs
5. Body Piercings, Tattoos, Brandings, Scarifications, and Other Forms of Body Modification
6. A Biopsychosocial Model for Self-Injury
II. Assessment and Treatment: A Stepped-Care Model
Treatment: Step 1
7. Initial Therapeutic Responses
8. Formal Assessment of Self-Injury, Jennifer J. Muehlenkamp
9. Cognitive-Behavioral Assessment
10. Contingency Management
Treatment: Step 2
11. Replacement Skills Training
12. Cognitive Treatment
13. Family Therapy, Michael Hollander
14. Psychopharmacological Treatment, Gordon P. Harper
Treatment: Step 3
15. Body Image Work
16. Prolonged Exposure or Cognitive Restructuring for Treating PTSD and Related Self-Injury
Treatment: Step 4
17. Treating Persons with Multiple Self-Harm Behaviors
18. Residential Treatment Targeting Self-Injury and Suicidal Behavior in Adolescents, with Leonard A. Doerfler and Ariana Perry
III. Specialized Topics
19. Managing Reactions to Self-Injury: A Guide for Therapists and Other Caregivers
20. Social Contagion and Self-Injury
21. A Protocol for Managing Self-Injury in School Settings
22. Asphyxial Risk Taking (the Choking Game), Amy M. Brausch
23. Understanding, Managing, and Treating Foreign-Body Ingestion, with Ariana Perry
24. Self-Injury in Correctional Settings, Kenneth L. Appelbaum
25. Treating Major Self-Injury
Appendix A: Breathing Manual
Appendix B: Body Attitudes Scale (BAS)
Appendix C: Clinical Scales to Assess Self-Injury
Appendix D: Helpful Websites Related to Self-Injury
Appendix E: Bill of Rights for People Who Self-Harm

About the Author

Barent W. Walsh, PhD, is Executive Director of The Bridge of Central Massachusetts in Worcester and Teaching Associate in Psychiatry at Harvard Medical School. The Bridge specializes in implementing evidence-based practice models according to protocol in public-sector settings. It comprises over 40 programs serving persons with mental health or developmental disability challenges, including special education; residential treatment; wraparound services; supported housing services; a drop-in center for gay, lesbian, bisexual, and transgender teens; and a program for homeless people. A recipient of the Lifetime Achievement Award from the Massachusetts chapter of the National Association of Social Workers, Dr. Walsh has worked with self-injuring persons for over 40 years and has conducted research, written extensively, and presented internationally on self-injury. He has consulted on this topic at numerous schools, outpatient clinics, group homes, psychiatric hospitals, and correctional facilities, and has also served on the clinical and research faculties of the Simmons and Boston College Schools of Social Work.


This clearly written and well-referenced book presents state-of-the-art practical information on the assessment and treatment of impulsive nonsuicidal self-injury in multiple settings. The superb use of case histories and examples of treatment make it an indispensable resource for therapists, teachers, and others who are called upon to deal with self-injurers. Highly recommended!--Armando Favazza, MD, author of Bodies Under Siege
The second edition of Treating Self-Injury is the most up-to-date and clinically useful resource on this extremely important public health problem. Walsh and his collaborators are clinical experts who are also versed in the research literature. From topics like the 'choking game' to self-injury in correctional settings to family approaches and beyond, the book is absolutely essential for mental health professionals who treat any form of self-injury.--Thomas E. Joiner, PhD, The Robert O. Lawton Distinguished Professor of Psychology, Florida State University

Walsh combines extensive clinical expertise and knowledge about self-injury with an accessible writing style and careful attention to the latest research. It is clear that Walsh cares genuinely and deeply about the people he seeks to help. Treating Self-Injury, Second Edition, is one of the most important volumes on nonsuicidal self-injury. The book is distinguished by its practical and thoughtful guidance regarding the intricate, often messy clinical realities that treatment professionals encounter every day.--E. David Klonsky, PhD, Department of Psychology, University of British Columbia, Canada

There are a number of books about understanding and treating self-injury. This is by far the best one. Walsh has been a pioneer in the field for decades, and this second edition expertly incorporates recent research advances and translates them into useful assessment and intervention practices. If I could have only one book to guide me in the treatment of self-injury, it would undoubtedly be this one.--Matthew K. Nock, PhD, Department of Psychology, Harvard University

In this second edition, Walsh solidifies his status as one of the foremost experts in the treatment of self-injury. Combining a nonjudgmental and compassionate understanding of self-injury with practical strategies for treating this increasingly common behavior, this book is a 'must' for anyone who works with clients who self-injure.--Kim L. Gratz, PhD, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center

I described the first edition of this book as wise, thoughtful, and sound. Now I need to add 'brilliant' to reasonably describe the second edition. Not only has Walsh incorporated lessons learned from the explosion of research in this area, but he has also woven in the insights of additional well-chosen chapter authors. As the subtitle says, this is a practical guide--but beyond that, it is the definitive treatise on what is known and how to intervene in this most significant of pathologies, and an essential addition to every clinician's resources.--Alan L. Berman, PhD, ABPP, Executive Director, American Association of Suicidology

Walsh has done it again! This is an incredible resource for those supporting individuals who self-injure--and the second edition is even more comprehensive. New content includes updates on psychosocial and pharmacological interventions, which inform clinicians on the most effective supports; a stepped-care model of service delivery that offers targeted strategies to address each client's unique needs; and chapters on issues unique to various treatment settings. I recommend this practical guide to working professionals as well as students preparing to enter the mental health field.--Melissa M. Pearrow, PhD, School Psychology Program Director, University of Massachusetts Boston-

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