July/August, 2013 

Summer & School Vacation are Good Times for Psychological Testing

By Sally G. Hoyle, Ph.D., Psychologist

Parents often seek psychological testing for their children to give information relative to a diagnosis of Attention Deficit Hyperactivity Disorder, chronic underachievement, or possible giftedness. The tests I use the most are: Wechsler Intelligence Scale for Children, Fourth Edition, Woodcock Johnson III Tests of Achievement and Kaufman Brief Intelligence Test, Second Edition. Since it works well to have a 1 -2 hour block of time when the child is not under unusual stress - summer and school vacations are often great times to schedule testing.

Questions often arise over insurance coverage of testing. If there is a mental health diagnosis and the insurance company is one that will reimburse for psychological testing then insurance benefits can be used. Giftedness testing is never covered under insurance. Our office is happy to discuss issues of insurance coverage and fees in advance of the testing. If the presenting problems are more applicable for neuropsychological testing, I will make a referral.

I typically spend a few minutes on the phone with the parent, asking about their concerns and why they want psychological testing. I need to be sure the child has not been tested, say by the school, in the past year, and to determine whether my tests are the best for the child or teenager. If parents would like to schedule months in advance for a school vacation, this can be arranged. If you would like to discuss the possibility of testing for your child or teen please give me a call.

Self-Injury in Teens & Young Adults

By Christine Rosignoli, Ph.D., Psychologist
 

A loved one's urge to self-injure (i.e., cutting, scratching, burning, or carving skin; self-bruising; etc.), is often difficult for friends and family to understand. According to the Cornell Research Program on Self-Injurious Behavior (CRPSIB) 12% to 24% of teenagers and young adults have self-injured. About 25% of youth who have self-injured report injuring only once in their lives, while 6%-8% of adolescents and young adults report current, chronic self-injury. Most of these young people are likely to use multiple methods and to injure on several areas of their body (though it is common to have a preferred method and body location). Most often self-injury begins between the ages of 12 and 15, and can last for weeks, months, or years. For many, self-injury is cyclical- meaning that it is used for periods of time, stopped, and then resumed. Self-injury is not, however, a passing adolescent phase; rather, it is a sign that someone is struggling and is in need of support.

 

There are many reasons why people self-injure. The most common triggers for self-injury include feeling overwhelmed by a negative emotion (e.g., anger, fear, anxiety, and sadness), feeling emotionally numb, or difficulty coping with emotional pressure. Self-injury provides a way to manage intense, overwhelming feelings. Some people self-injure to punish themselves because they feel they've done something wrong (in reality, they may not have done anything wrong) - or for not living up to the perceived expectations of self or others. Self-injury is often used to relieve stress; as a way to experience some sense of feeling (rather than feeling empty or disconnected); to gain a sense of control over one's body and mind; to communicate one's needs/feelings to others (people who self-injure often have difficulty verbalizing emotions); as a way of distracting one's self from problems; as a method of reenacting a past trauma in an attempt to resolve it; and/or to protect others from one's emotional pain (e.g., they do not want to upset, disappoint, or burden loved ones - so they internalize their painful emotions and become overwhelmed). Self-injury is also used as a coping strategy to AVOID acting on suicidal thoughts/urges. Approximately 60% of those who self-injure report never having considered suicide. Even so, according to CRPSIB, non-suicidal self-injury is a symptom of distress that, "if unsuccessfully resolved, may lead to suicidal behavior." Regardless of the reason, self-injury is an unhealthy coping mechanism - one that may provide relief in the moment but does not solve the problem.

 

Self-injury often goes undetected by loved ones. Arms and forearms, opposite the dominant hand, are common areas for injury. However, signs of self-injury can and do appear anywhere on the body. According to the CRPSIB, other signs that a loved one might be self-injuring include: inappropriate dress for the season (e.g., consistently wearing long sleeves or pants in the summer); constant use of wrist bands/coverings; unwillingness to participate in events or activities which require less clothing (e.g., swimming or gym class); frequent bandages; odd or unexplainable paraphernalia (e.g., hidden razors, knives, etc.); spending long periods of time alone, particularly in the bathroom or bedroom; and heightened signs of depression or anxiety. It is important that questions about the marks be non-threatening and emotionally neutral. When talking with the loved one who self-injures, it is important to: demonstrate a "respectful curiosity" (e.g., "How does self-injury help you feel better?," "Is there anything that is stressing you out right now that I can help you with?"), listen, validate feelings, offer reassurance, and speak in calm and comforting tones.

 

There are some behaviors that can actually increase your loved one's self-injurious behavior. AVOID saying or doing the following: yelling, lectures, put downs, harsh and lengthy punishments, invasions of privacy (e.g., going through your child's bedroom without his/her presence), ultimatums, and threats. Some unhelpful things to say include: "I know how you feel" (This can make your loved one feel as if their problems are trivialized); "How can you be so crazy to do this to yourself?" or "You are doing this to make me feel guilty."

 

The Cornell Research Program on Self-Injurious Behavior (CRPSIB) in Adolescents and Young Adults has a website with many useful fact sheets for those who self-injure, as well as for the parents and friends of those who self-injure: www.crpsib.com. Self Injury Outreach and Support (SIOS) is another helpful resource: http://sioutreach.org. S.A.F.E. (Self Abuse Finally Ends; www.selfinjury.com) has set up a helpline that can be called when feeling the urge to self-injure: 1-800-DONT-CUT (1-800-366-8288). There are also online chat rooms for those struggling with the urge to self-harm (e.g., www.recoveryourlife.com/).

 

If you or someone you love is struggling with self-injurious behavior, contact NHPA to schedule an appointment.

Skill Building: How to Avoid Self-Injury

By Christine Rosignoli, Ph.D., Psychologist

 

Recovery from self-injurious behavior takes time. It involves a daily struggle to cope with difficult emotions in a healthier manner. Self-Injury Outreach and Support (SIOS; http://sioutreach.org) has provided the following coping strategies that have worked for others, like you, who struggled with self-injury and overcame it. Choose the suggestions that best fit you. 
  • The 15-Minute Rule: When you feel the urge to self-injure, instead of giving into the urge immediately, tell yourself that you will wait 15 minutes and set a timer. During those 15 minutes try some of the coping strategies that follow. Assess how you feel after 15 minutes. Has the urge lessened? Is the urge gone completely? If the answer to either of these questions is yes, make a note of this.
     
  • Ride the Wave: Notice how the urge starts. Urges become increasingly intense and, if resisted, they decrease in intensity - like a wave. Ask your therapist to teach you some breathing, relaxation, and mindfulness techniques to help you "ride the wave" of these urges. You can learn that if you can ride it out, it will decrease and pass. This is why it is helpful to read and think about the times when you have NOT acted on the urge.
     
  • Keep and Review a Log: Keep and review a log, focusing on the times you wanted to self-injure, but did not. In the log, list the urge you felt, rate the intensity of the urge, note what brought on the urge, and list the reasons why you did not self-injure. This strategy requires that when you have the urge to self injure, you look at your log and think about the times you had urges as strong or stronger and did NOT act on it.
     
  • Relaxation Skills: Use relaxation skills. Examples include: progressive muscle relaxation (slowly relaxing different parts of your body), diaphragmatic breathing, meditation, imagery, etc.
     
  • Talk to Someone: You can share your urge to self-injure with another person in order not to act on it. If it is too difficult to share these intense emotions, you can still reach out to someone and talk about other things to distract yourself from your emotions and urges. It may be helpful to make a list of people who you can call to remind you that there are others you can call. If there is no one you can call, you can and should go online to connect with others. For example, there are some online chat rooms for those who self-injure (www.recoveryourlife.com/).
     
  • Do a Creative Activity: Sing, play an instrument, sketch, paint, etc. It can help to express intense emotions through creative outlets like this. These activities can also be distracting.
     
  • Listen to Music: Listening to music, often played loudly, can provide some relief. Dancing to the music can also be helpful. Be sure to avoid triggering music that you know will worsen your mood or remind you about self-injury.
     
  • Exercise: Exercise intensely to raise your heart rate. You can run, jump, climb stairs, etc. Research shows that exercising vigorously to raise your heart rate is an effective way for some people to manage urges to self-injure. It is important that the exercise be intense and lasts until the urge passes.
     
  • Play/Cuddle with a Pet: Cuddling with a pet can be very soothing and comforting - and can help avoid acting on an urge to self injure. 
If you are interested in any of our services please call 724-759-7500 today.
  
Sincerely,

Lori Gephart, M.A.
President / Licensed Psychologist / Collaborative Coach
North Hills Psychological Associates, Inc.
In This Issue
NHPA Locations
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Contact Us
724-759-7500
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NHPA Clinical Staff
Loretta A. Gephart, M.A.
Marc J. Ranalli, M.S.
Andrew Nocita, Ph.D.
Stephanie Kim Phillips, Psy.D.  
Kristi L. Musick, Ph.D.
Lisa A. Aaron, Psy.D.
Shelley Thacher, LCSW
Gail Ludwig, RN, LCSW, ACS  
Laura P. Walsh, LPC, CRC
Mary Koch Ruiz, LPC
Christine P. Rosignoli, Ph.D.
Julie Zubryd, M.A., L.P.C.
Mary Jeanne Hoover, LCSW 
Heidi Stelzig, M.S.Ed., LPC
Stephen G. Huegel, Ph.D.
Mindy Heher, Ph.D.
Thomas Koloc, LPC, NCC
Nicolene Zapach, M.A.
Neha Pandit, Ph.D., LPC
Braden Ambrose, M.S., LPC
Sally G. Hoyle, Ph.D.
Jennifer Croyle, PsyD., LPC
Michelle Metz-Foley, NCC, LPC

 

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