Self-injury or self-harming behaviors can be difficult to treat.
While self-injury may be an indicator of borderline personality disorder diagnosis, the behaviors may also be a part of depression, anxiety disorders, eating disorders, psychotic disorders, and even addiction. Self-harm may be a way to cope with overwhelming emotions, disturbing thoughts, or acute stress.
Although self-harming behaviors are referred to as non-suicidal self-injury (NSSI), I believe that it’s crucial to also assess for suicidal thinking or planning when addressing self-injurious behaviors. I strongly recommend Dr. David A. Jobes’ book Managing Suicidal Risk (2nd edition) for graduate students and licensed health care professionals. I also love recommending How I Stayed Alive When My Brain Was Trying to Kill Me to my clients and their family members.
Below I’ve listed 30 treatment planning ideas—but many of these ideas could be used a homework assignment in therapy or treatment.
Ideally, all of our clients would create their own treatment goals but I’ve found that clients (and even therapists or case managers) may need to start with a list of ideas for inspiration.
My hope is that graduate students and mental health professionals will be inspired to find solutions that may help their patients. Please keep in mind that not every idea will be appropriate for every client who struggles with self-harm. You can personalize your client’s treatment plan when you integrate their values, beliefs, and long-term goals.
Many of the ideas below are adapted from or are a part of dialectical behavior therapy (DBT) but clients may also benefit from a treatment like cognitive behavior therapy (CBT) or mindfulness practices (a curriculum like mindfulness-based stress reduction can be a good place to start).
Note: Self-harming behaviors can be serious and should not be ignored. Please do not dismiss these behaviors as manipulative or attention-seeking.
☐ Create a safety plan
☐ Address self-harm from a psychoeducational perspective
☐ Create a pros and cons list of reducing self-harming behaviors
☐ Learn how to self-soothe
☐ Make a list of reasons to stay alive
☐ Keep a gratitude list to help increase desired emotions
☐ Use coping statements when urges to self-harm are high
☐ Read Freedom from Self-Harm
☐ Create an art journal as a way of coping
☐ Practice self-compassion
☐ Create an hourly, daily, or weekly reward system for reducing self-harm
☐ Track progress with a Days Since app
☐ Celebrate very small successes
☐ Practice urge surfing
☐ Identify pro-recovery resources on Facebook, Instagram, YouTube, and TikTok
☐ Increase capacity for self-forgiveness
☐ Address vitamin or mineral deficiencies that may increase self-harm urges
☐ Use the DBT skill of radical acceptance to help manage thoughts or emotions
☐ Reach out to a friend when urges are strong
☐ Reduce reliance on alcohol or drugs to manage emotions
☐ Use the DBT skill of Check the Facts
☐ Read (or listen to) Viktor Frankl’s Man’s Search for Meaning
☐ Improve sleep hygiene
☐ Practice tolerance of the present moment
☐ Reduce shame, guilt, and self-judgments that may be contributing to self-harming behaviors
☐ Practice grounding exercises for dissociation or symptoms of psychosis
☐ Focus on client strengths and values
☐ Create written one year, three year, and five year goals
☐ Find ways to increase feelings of hopefulness
☐ Use a chain analysis tool from DBT to understand behavioral patterns
For additional information about dialectical behavior therapy (DBT), check out:
DBT Self-Help
Art Journaling Prompts for Self-Harm
Please note: Amanda L. Smith, LCSW participates in Amazon's affiliate program.