Exploring Self‐Injury Through a Relational Cultural Lens

As relational strategies, self-injurious behaviors may seem paradoxical at first glance; however, they can serve as strategies for disconnection, or behaviors that distance a person from self and others, in spite of an essential yearning for connection (Jordan, 2001). For the purpose of this article, self-injurious behaviors (SIBs) are defined as "all behaviors involving the deliberate infliction of direct physical harm [causing tissue damage] to one's own body without the intent to die as a consequence of the behavior" (Simeon & Favazza, 2001, p. 1). SIBs commonly include cutting and burning, but may also encompass other behaviors, ranging from hair pulling to bone breaking (Sutton, 1999). The Relational Cultural Model of counseling seeks to help clients become more connected with themselves and others by examining their strategies for disconnection, as well as what relational cultural theory (RCT) refers to as relational images (Jordan, 2001). These images serve as templates for individuals' assumptions about how others perceive them and will respond to them. In this article, an overview of self-injury is provided, followed by an introduction to RCT. Finally, recommendations for combining relationally focused counseling with evidenced-based treatments for self-injury are presented. * Self-Injury Nonsuicidal SIBs and suicidal behaviors may appear similar; in fact, SIB is often mistaken for suicidal behavior. To complicate assessment and differentiation further, there is a high correlation between the two types of behaviors. For example, 55% to 85% of self-injurers have made at least one suicide attempt (Stanley, Winchel, Molcho, Simeon, & Stanley, 1992). Superficial or moderate SIB has an onset in the early teens to mid-20s (Favazza & Conterio, 1988), and the prevalence of SIB has been increasing, particularly among nonclinical populations including high school and undergraduate students (Favazza, DeRosear, & Conterio, 1989; Gratz, 2003; Muehlenkamp & Gutierrez, 2004). With higher prevalence rates in clinical populations, particularly among individuals diagnosed with borderline personality disorder (BPD; up to 75%; Briere & Gil, 1998; Clarkin, Widiger, & Frances, 1983), SIB was once thought to be a symptom solely related to the disorder. More recent studies, however, have challenged this assumption (Gratz, 2003). Theoretically, scholars have asserted that self-injury reflects biological, sociological, and psychological origins. For example, some have suggested that self-injury is a genetically predisposed behavior and shares characteristics with addictive disorders, such as repetitive cycles (Rao, 2006). Recently, it has been reported that sociological and relational, rather than medical, factors were becoming more helpful in understanding SIB (Adler & Adler, 2007; Rao, 2006). This conflicting information regarding SIB correlates underlies the need for further studies to examine the intersection of life experiences and reasons for engaging in SIB. Some researchers have found that clients who self-injure have suffered from various childhood traumas, including physical or sexual abuse, divorce, neglect, or loss (see Conterio, Lader, & Bloom, 1998; Himber, 1994; Levenkron, 1998; Paris, 1998; Simeon & Favazza, 2001; Suyemoto, 1998; Tantam & Whittaker, 1992; van der Kolk, Perry, & Herman, 1991; Zila & Kiselica, 2001). Other researchers have suggested that this is not the case (e.g., Walsh, 2006; Whitlock, Eckenrode, & Silverman, 2006). Other reasons attributed to SIB include a lack of adaptive coping skills and the inability to regulate emotions or stop ruminating thoughts. Individuals may also self-injure to relieve tension or end feelings of dissociation (Alderman, 1997; Favazza, 1996; Gratz, 2003; Haines & Williams, 1997; Himber, 1994; Levenkron, 1998; Ross & Heath, 2002; Strong, 1998). * SIB Treatment Approaches It is clear that SIBs are on the rise and can be seen in diverse contexts. …