Dalia is a 14-year-old adolescent exhibiting certain deliberate self-harming behaviors. These behaviors include the use of alcohol and physical altercations with peers, which can be described as self-poisoning (Moorey, 2010). Furthermore, Dalia’s highly sexualized behavior can be construed as a self-harming behavior, as well (Fredlund, et al., 2017). To a lesser extent, her truancy and argumentative behavior with authority figures. These behaviors stem from the changes in her family dynamics and subsequently strained relationships with her parents. These reasons are evidenced by Dalia’s views of her parents, as well as the parents’ conflict at the therapy sessions where they were both presents.
Dalia is experiencing a strained relationship with her mother, whom she views as overly controlling and strict. Conversely, her father is hardly present and fails to maintain their relationship or provide influence or guidance. This dynamic leaves Dalia in a position where she gets no support from either parent, creating feelings of helplessness and hopelessness. These feelings are associated with difficulty in coping with stress, which ultimately manifests as self-harm or suicidal behavior (Moorey, 2010). Thus, Beck’s cognitive therapy should be applied to help Dalia develop the required coping skills and strategies before her self-harming behavior deteriorates to more deliberate and potentially fatal acts (Moorey, 2010). This approach is specifically designed for cases of deliberate self-harm.
Under Erik Erikson’s psychosocial theory, Dalia is undergoing a crisis that is typical for her age: one of identity versus role confusion. Considering her parents’ conflicting views, she is unable to process the many roles she plays into a cohesive identity for herself (Zastrow, et al., 2019). Specifically, she cannot reconcile her father’s overly lax attitude with her mother’s controlling attitude. Her parents’ open disagreement and blaming one another complicates the matter by undermining both of their authorities, leaving Dalia with no clear authority or carer figure from whom she can seek guidance.
Based on these conclusions, it becomes crucial to target the underlying problems that are causing Dalia’s problems related to achieving identity. Thus, the first goal when observing indicators of self-harm in a similar case would be evaluating the situation to determine their underlying cause. A therapeutic relationship is critical in this early stage as a therapist can serve as a “source of safety during crises” (Moorey, 2010). Furthermore, Dalia can be guided towards monitoring and reflecting on her self-harm incidents (Moorey, 2010). Once the environmental triggers to her self-harming behavior are identified, one can determine the underlying cause of such behavior and take steps to alleviate it.
In Dalia’s case, family therapy is critical as this conflict is the primary cause of the issue. Thus, a significant part of resolving Dalia’s problem is regulating her parents’ conflict and contradictory stance regarding her. However, such a resolution may be impossible; therefore, cognitive behavior threapy for Dalia should focus on emotional regulation. The primary assumption is that self-harming behavior is often caused by “problems in managing stressful events and their emotional consequences” (Moorey, 2010). Based on this assumption, therapy should focus on developing skills and techniques that can compensate for this shortcoming. Most importantly, she should be taught emotion regulation techniques to cope with her immediate issues (Moorey, 2010). Once she is capable of distancing herself from them, her underlying beliefs that cause her difficulties in coping can be examined critically, identified, and, if possible, restructured (Moorey, 2010). Ultimately, the therapy approach to Dalia’s case should seek to address the problems in her environment if possible and prepare her to cope with such problems in the future.
Fredlund, C., Svedin, C. G., Priebe, G., Jonsson, L., & Wadsby, M. (2017). Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health. Child and Adolescent Psychiatry and Mental Health, 11(1). Web.
Moorey, S. (2010). Managing the unmanageable: Cognitive behaviour therapy for deliberate self-harm. Psychoanalytic Psychotherapy, 24(2), 135-149.
Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Boston, MA: Cengage Learning.