Non-Suicidal Self-Injury and Motivational Interviewing: Enhancing Readiness for Change

Abstract

The authors advance motivational interviewing and the transtheoretical model of change as a conceptual framework for counseling clients who engage in nonsuicidal self-injurious behaviors. The major principles of motivational interviewing are applied in a case study of a client who self-injures. Recommendations are made for mental health counseling practice.

Nonsuicidal Self-Injury: A Review of Current Research for Family Medicine and Primary Care Physicians

“…As described by Kress and Hoffman 76 in their work on the use of MI with selfinjurers, appropriately framed questions can be used as effective tools for eliciting the necessary information for risk assessment, thus allowing the practitioner to make referrals for appropriate services. More importantly, these types of inquiries can elicit a patient's commitment to getting treatment for their self-injury, making follow-through on referrals to behavioral health services more likely.…”

Key Considerations for Using No‐Harm Contracts With Clients Who Self‐Injure

“…The motivation and ability may ebb and flow depending on a variety of internal and external factors (Kress & Hoffman, 2008). Walsh (2006) contended that requiring clients to contract for safety can promote dishonesty and secrecy, because "the expectation (or demand) is that they endure their usual intense level of emotional distress (or emptiness) without using their preferred management technique" (p. 122).…”

“…Walsh (2006) contended that requiring clients to contract for safety can promote dishonesty and secrecy, because "the expectation (or demand) is that they endure their usual intense level of emotional distress (or emptiness) without using their preferred management technique" (p. 122). He added, "Asking individuals to give up self-injury when it is their best emotion regulation technique can be both unrealistic and invalidating" (Walsh, 2007(Walsh, , p. 1061 and may consequently lead to premature termination of treatment (Kress & Hoffman, 2008;Walsh, 2006Walsh, , 2007, because clients may feel a lack of control or that they have failed themselves and/or the therapist (Alderman & Marshall, 2006). Alderman and Marshall (2006) argued that NHCs may set up clients to fail because they would not be seeking help if they were able to refrain from harming themselves.…”

“…Given that clients may be ambivalent or reluctant to change their behaviors (Kress & Hoffman, 2008), they may become angry if asked to sign an NHC. Although anger could provoke open and productive discussion, it also has the potential to increase distance and reduce therapeutic alliance (Range et al, 2002).…”

“…L. Miller et al, 2006;Muehlenkamp, Ertelt, & Azure, 2008;Range et al, 2002;Rudd et al, 2006;Walsh, 2006Walsh, , 2007, because they provide clients with some choices regarding treatment and are more akin to therapeutic contracts. A therapeutic contract articulates the roles and obligations of the client and counselor in the treatment exchange and are therefore egalitarian in nature with the assumption of shared responsibility for treatment decisions (Kress & Hoffman, 2008;Rudd et al, 2006). Too often, NHCs deprive the client of choices (Lewis, 2007).…”