Counseling from the Cutting Edge Treating Self-Injurious Behavior in Social Media Consumed Youth. Adele Martelle, LCSW

Transcription

1 Counseling from the Cutting Edge Treating Self-Injurious Behavior in Social Media Consumed Youth Adele Martelle, LCSW

2 Our Agenda Self-Injurious Behavior (SIB) Perception Connection Trauma The Brain Social Media The T.E.A Model Trauma Informed Treatment Approach

3 What is Self-Injurious Behavior (SIB)? SIB is the direct and intentional injuring of oneself King-Miller, 2014 What it is NOT It is not suicidal ideation or attempt 2004 Muehlenkamp & Guterrez Study

4 Diagnosis DSM-IV : Non-Suicidal Self Injury Disorder 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent within the past year To seek relief from a negative feeling or cognitive state, to resolve an interpersonal difficulty, or to induce a positive state Interpersonal difficulty or negative feelings and thoughts eg, depression, anxiety), premeditation, and ruminating on (non-suicidal) self-injury

5 Historical Understanding of SIB 1970s Pursuit of positive reinforcement in the form of attention seeking Carr, Newsom, & Binkoff, s Negative reinforcement in the form of escape Griffin, Williams, Stark, Altmeyer, & Mason, s SIB is used to regulate or express affect, relieve tension, manage dissociation, feel a sense of control, identity, and influence others Andover, Pepper,Gibb, & Lynn, 2003

6 Perception Connection Thinking about trauma differently Trauma is not an event. Events are traumatic Trauma is the emotional response to an actual or perceived high level of threat, risk, criticism, or pain What constitutes as trauma? Experiences or situations that are emotionally painful and distressing, and that overwhelm one s ability to cope, leaving them feeling powerless 2014 The Center for Nonviolence and Social Justice

7 Developmental Stage Identity vs. Role Confusion Attainment of independence, personal exploration, desire for empowerment Developing a sense of self, while desperately seeking social acceptance Success in navigating this stage results in a strong sense of control, identity, and approval

8 Upon Reflection How many of you could honestly say that you left middle school or high school unscathed by an overarching traumatic impression?

9 Research suggests that the precipitants of SIB share a theme of real or perceived rejection, abandonment, threat to sense of identity, AND a highly stressful situation Favozza & Rosenthall, 1993 Now consider the impact of social media!

10 What role do you think social media plays in the experience of adolescence as traumatic? How/Why?

11 Social Media Impact Cyber-bullying Accessibility Cliques Exposure to criticism and pain rate & frequency intensified Immediate reinforcement Isolation vs. Sense of Belonging Permanency Identity formation Valkenburg, Peter, & Schouten 2006 study linking feedback on social media profiles and self-esteem

12 Youth Brain Development PREFRONTAL CORTEX Highest functioning part of the brain Navigates complex social situations Judgment Impulse control Planning and goal setting Problem solving Choice and free-will

13 Cortex Under Construction Youth use more primitive parts of the brain to manage their emotions and make decisions Such as the Limbic System

14 Limbic System FAST Prefrontal Cortex S L O W Pleasure Fear Reward Arousal Planning Future Abstract Concepts Distant Goals NOW is better than LATER

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16 Limbic System Trauma Response Center Brain s epicenter of emotion Induces an emotional reaction to pain Ascribes meaning to emotion and pain Regulates aggressive behavior Acts as an alarm system, monitoring stimulus outside our body that may pose as a threat Fight or flight

17 Youth experiencing their adolescent years as traumatic may be drawn to SIB and SIB related Social Network sites for: A sense of control An outlet for emotion A sense of belonging And a low-bar for acceptance

18 The T.E.A Model Trauma Informed Approach Normalizes symptoms and behaviors that have traditionally been pathologized and viewed as deviant Bloom, 1997 What is wrong with you? is replaced with What is happening or happened to you? Functional trauma response - pain as a biological alert signal that something requires care

19 The T.E.A Model Together - Transform Educate - Empower Accept - Autonomy Acknowledges trauma perception while recognizing what social networks represent - The 3 C s Creates opportunities for change Returns a sense of control and autonomy to youth Services are strengths-based Focuses on prevention of further trauma within the youth s system

20 TEA Don ts & Do s Don t Have premature expectations Focus on symptom management executive functioning skill Dismiss the value of social media Do Optimize the benefits of social media Reshape the way youth engage it Expand their platform for identity formation and acceptance

21 Together - Transform FOCUS: Form a sense of togetherness that supports client transformation Should the client allow, therapists can become an intricate part of their community Discuss client s social network connections Discuss language Ask to see pictures Explore Healthy Online Connection Opportunities Done without forcing clients to stop current social media involvement Offer other online resources Limbic System Calming Cheat Sheet Use to start sessions and for out of session Check-ins Contract with Client and Caregivers for SIB Occurrence Agreement

22 Limbic System Calming Cheat Sheet

23 Educate - Empower FOCUS: symbolizes the importance of the client s own ability to heal regardless of youth Classic active listening and open-ended questions Assess how client perceived their experience as traumatic and gain insight into the role social media plays Validate and educate Explore the Functional SIB Motives (handout) Weigh helpful vs hurtful impact of social media involvement Cooperatively guide the client in assessing attributes of social networking and self harming they would like to change

24 Functional SIB Motives Handout

25 Encourage discovery Create a world beyond perceived trauma Prioritize session time to discuss hobbies, talents, interests, and dreams Invite parents in to explore local resources/activities Acting classes, guitar lessons, horseback riding, worship team Use short motivational video clips/tutorials as a creative way to expose clients to new experiences related to identified areas of interest i.e. TED Talks Move beyond coping skills to think BIG Who are they? Who do they want to be? What if there isn t the means? Recognize the power of your session time For example if an adolescent client with SIB aspires to be a musician but the parents cannot afford music lessons, the therapist can give the client homework related to the area of interest such as writing a lyrical song, or bringing in their favorite song to share in the next session

26 Online Education Resources To Write Love on Her Arms Tjd8scD-3bWtCWzwxWtFvJSLHhc0EAAOwBqVY6svNQD- Auo50aArgKEALw_wcB

27 Accept Autonomy FOCUS: Emphasizes the therapist s role in creating a safe space for clients to process the confusing developmental stage and/or trauma without the fear of rejection Identify qualities of character or choices beyond SIB that are praise worthy Create a charactagram (modeled after Instagram) Identify additional avenues for validation Take for example an adolescent SIB client who was raised in a Christian home but are experiencing a crisis in faith Leg work prior to session Reproduce while letting client lead Include caregivers for follow through Validate process, not result Access and even create alternative online communities that provide anonymity and support for underlying emotional causes of SIB (i.e. depression, children of divorce, or abuse support groups).

28 In Closing When adolescents perceive their world as traumatic, compounded by social media, we are called to point them in a higher direction In fact, through the use of a trauma informed approach such as T.E.A we model for our clients 2 Timothy 1:7 For God did not give us a spirit of fear, but He has given us a spirit of power and of love and of sound judgment and selfcontrol abilities that result in a calm, well-balanced mind. AMP T.E.A encourages joining with the client to promote healthy engagement of social media, real life rewarding opportunities, while empowering youth to discover their own identity