Adolescent group: Self-harming behaviors

This is an excellent handout for those needing help for self-harming behaviors.

This 32-page booklet explains

1. Possible reasons for self-harm:

"Many find it almost impossible to understand why young people harm themselves, and how it could possibly help them to feel better. By deliberately hurting their bodies, young people often say they can change their state of mind so that they can cope better with ‘other’ pain they are feeling. They may be using physical pain as a way of distracting themselves from emotional pain. Others are conscious of a sense of release. For some, especially those who feel emotionally scarred, it may be a way to ‘wake up’ in situations where they are so numb they can’t feel anything. Overall, self-harm is a way of dealing with intense emotional pain."
 

 2. What "self-harming" behavior might look like:

"...cutting, burning, scalding, banging or scratching one’s own body, breaking bones, hair pulling,

swallowing poisonous substances or objects..."

3. More vulnerable populations

"Young people in residential settings like the armed forces, prison, sheltered housing, or hostels and boarding schools; lesbian, gay, bisexual, and transgender young people; young Asian women; young people with learning disabilities."
4. Myths and Stereotypes

“Some people do it for attention... that doesn’t mean they should be ignored. There are plenty of

ways to get attention, why cause yourself pain? And if someone’s crying for help, you should give them it, not stand there and judge the way they’re asking for it.” 

5. How to talk about self-harm 

"Some young people have said that the reactions they got when talking to health workers was unhelpful. In this case you can always seek further help. Many GPs and nurses will be sympathetic, and know how to help and no-one should be put off from seeking help because of negative attitudes."

 

"If you are a friend of the person who is self-harming, you might have some of the same reactions that a parent would – disbelief, fear for your friend, worry about what to do for the best. The person may tell you but want you to keep it a secret. This can leave you feeling distressed and isolated, with no-one to talk to yourself."

 

6. Getting help

 

"Most young people who have found help say that having someone to listen to them and help them to work on solutions to their problems and stresses is the most helpful thing of all. This is why counseling or another type of talking therapy is useful."

 

7. Substitutes for self-harm

 

" Young people have shared their most successful ones with us, and these are:

• Using a red felt tip pen to mark where you might usually cut
• Hitting a punching bag to vent anger and frustration
• Holding an ice-cube in the crook of your arm or leg
• Getting outdoors and having a fast walk
• Making lots of noise, either with a musical instrument or just banging on pots and pans
• Writing negative feelings on a piece of paper and then ripping it up
• Keeping a journal
• Putting elastic bands on wrists and flicking them
• Making a collage or artwork"
  

Click here for Facts for Families
Click here for The Cutting Edge: Non-Suicidal Self-Injury in Adolescence by Janis WhitlockClick here for a printable copy of ways a nurse/therapist can help (see below)

Self-harm Seminar

How nurses and therapists can help

1. Be willing to talk about it

2. Assess for history of trauma, abuse, and neglect

3. Don’t engage in power struggles (telling the patient to stop, giving ultimatums)

4. Reframe the behavior as a coping strategy

5. Teach cognitive techniques (restructuring, undoing cognitive distortions or unhealthy thinking styles)

6. Identify the cycle of self-harm. Explore ways to short-circuit the cycle

7. Teach client how to experience and express anger in healthier ways

8. Teach clients how to label and articulate a broader range of emotions

9. Offer stress reduction/relaxation exercises (mindfulness meditation)

10. Teach affect management skills. Autonomic Nervous System worksheet.

11. Address dissociation (triggers, grounding strategies)

12. Encourage journal writing to enhance awareness and insight

13. Address control issues

14. Address issues of shame/self-punishment

15. Teach assertiveness

16. Provide alternatives to self-harm (you may or may not like some of these suggestions)

17. Address your counter-transference issues (guilt, anger, fear, sadness)

18. Explore pharmacological interventions

19. Remember the work takes time

20. Allow your clients to stop on their own terms and in their own time.

Self-affirmations: examples of positive and negative

Every day we carry on conversations with ourselves. This self-talk can be negative or positive. This worksheet is to give you ideas for how to change negative statements into positive affirmations.

Once you decide to take responsibility for your thoughts, feelings, and choices, you can change your negative thinking; and you will begin to feel better about yourself and your life, free yourself from negativity, guilt, doubt, hurt, and powerlessness, give yourself permission to grow and be happy, achieve your goals, and be successful.
Click here for printable copy of self affirmations

Negative I don’t deserve love I am a bad person I am terrible I am worthless (inadequate) I am shameful I am not lovable I am not good enough I deserve only bad things I cannot be trusted I cannot trust myself I cannot trust my judgment I cannot succeed I am not in control I am powerless I am weak I cannot protect myself I am stupid I am insignificant (unimportant) I am a disappointment I deserve to die I deserve to be miserable I cannot get what I want I am a failure (will fail) I have to be perfect (please everyone) I am permanently damaged I am ugly I should have done something I did something wrong I am in danger I cannot stand it I cannot trust anyone I cannot let it out I do not deserve

Positive I deserve love; I can have love I am a good (loving) person I am fine as I am I am worthy; I am worthwhile I am honorable I am loveable I am deserving I deserve good things I can be trusted I can (learn to) trust myself I can trust my judgment I can succeed I am now in control I now have choices I am strong I can (learn) to take care of myself I have intelligence I am significant (important) I am okay just the way I am I deserve to live I deserve to be happy I can get what I want I can succeed I can be myself (make mistakes) I am (can be) healthy I am attractive I did the best I could I learned (can learn) from it It’s over; I am safe now I can handle it I can choose who to trust I can choose to let it out I can have (deserve)

Strength Training: Rear lateral raise and isometric workout.

More strengthening exercises to add to your daily at-home circuit.

 

 

 

Hold these positions!

 

Coping with Stress

Click here for printable copy

In a group or individual setting have each person read through the coping skills one category at a time. Ask each individual to comment on one of the items he or she could utilized when experiencing stress.

Diversions

Getaways: Spend time alone. See a movie. Daydream.
Hobbies: Write, Paint, Remodel, Create something.
Learning: Take a class. Read. Join a club.
Music: Play an instrument. Sing. Listen to music.
Play: Play a game. Goof off. Go out with friends.
Work: Tackle a new project. Keep busy. Volunteer.

Family

Balancing: Balance time at work and home. Accept the good with the bad.
Conflict Resolution: Look for win/win solutions. Forgive readily.
Esteem-building: Build good family feelings. Focus on personal strengths.
Flexibility: Take on new family roles. Stay open to change.
Networking: Develop friendships with other families. Make use of community resources.
Togetherness: Take time to be together. Build family traditions. Express affection.

Interpersonal

Affirmation: Believe in yourself. Trust others. Give compliments.
Assertiveness: State your needs and wants. Say "no" respectfully.
Contact: Make new friends. Touch. Really listen to others.
Expression: Show feelings. Share feelings.
Limits: Accept others' boundaries. Drop some involvements.
Linking: Share problems with others. Ask for support from family/friends.

Mental

Imagination: Look for the humor. Anticipate the future.
Life planning: Set clear goals. Plan for the future.
Organizing: Take charge. Make order. Don't let things pile up.
Problem-solving: Solve it yourself. Seek outside help. Tackle problems head on.
Relabeling: Change perspectives. Look for good in bad situation.
Time Management: Focus on top priorities. Work smarter, not harder.

Physical

Biofeedback: Listen to your body. Know your physical limitations.
Exercise: Pursue physical fitness. Jog. Swim. Dance. Walk.
Nourishment: Eat for health. Limit use of alcohol.
Relaxation: Tense and relax each muscle. Take a warm bath. Breathe deeply,.
Self-care: Energize your work and play. Strive for self-improvement.
Stretching: Take short stretch breaks throughout your day.

Spiritual

Commitment: Take up a worthy cause. Say "yes". Invest yourself meaningfully.
Faith: Find purpose and meaning. Trust God.
Prayer: Confess. Ask forgiveness. Pray for others. Give thanks.
Surrender: Let go of problems. Learn to live with the situation.
Valuing: Set priorities. Be consistent. Spend time and energy wisely.
Worship: Share beliefs with others. Put faith into action.

(Whole Person Press)

Practicing Self-care During Stressful Times

10 Ways to Relieve Stress

Maslow's Hierarchy of Needs 1 of 5

Maslow's Hierarchy of Needs

This pyramid shows the classic theory of motivations and needs a healthy humans move through. Below the image I will focus my commentary on the foundation level as it includes the most important needs and should be met first.

The most fundamental physiological needs are the base of the pyramid, shown here in yellow. This level includes breathing, food, water, sex, sleep, homeostasis, and excretion. Without these basic needs satisfied, a person's body will stop working and he or she cannot move up to the next level.

 

Let's break these down.

1. Breathing. Duh, right? Without oxygen does anything else really matter?  A person should be in an environment where clean, pollution-free air allows for proper gas exchange in the lungs.  See more information on healthy air at the American Lung Association website. Bad habits like smoking, should be avoided. If lung or sinus problems persist like asthma, COPD, allergies, cystic fibrosis, bronchitis, emphysema, etc. please seek help from a medical doctor to manage your symptoms. Help others with breathing issues by clicking here for ways to volunteer. If you have more money than time, consider donating in several ways. This subject is dear to my heart as my ex-husband nearly died from a severe asthma attack and anaphylactic shock. He chose to expose himself to a known allergen in an unsafe environment and miraculously survived, but it was a risk that could have taken his life and left me widowed and two small children. My son also has asthma and I encourage him to take medications that prevent the symptoms of asthma so he doesn't need his rescue inhaler. I also worked at one of the best hospitals in the nation on the pulmonary unit and saw the effects of cystic fibrosis, pulmonary hypertension, COPD, etc. first hand. There are no cures, but the diseases are manageable.

 

2. Food. Any food will keep someone alive I suppose but we should make every effort to eat healthy meals and snacks. I've been reading weight loss stories in magazines and the pattern that led people to gain weight was eating out and especially fast food. This is where I'm guilty. I love Coke and Pepsi, and they help me stay at work when I rotate schedules. Plus I just love the taste. I have given it up for months but can't seem to keep it out of my life, especially when my job as an RN becomes exhausting way before my shift is over.

 

3. There is so much evidence to support the importance of drinking enough water daily. According to WebMD, water helps maintain the balance of body fluids, water can help control calories, water helps energize muscles, water helps keep skin looking good, water helps your kidneys and maintain normal bowl function. Fits.com lists these benefits for drinking water: it keeps you young, it helps you lose weight, it makes you smarter, it's good for your joints.

 

4. Sex is used for procreation and the propagation of the species. It also feels awesome and has health benefits. WebMD lists some of these benefits. Sex keeps your immune system running. Sexually active people take fewer sex days. It boosts your libido. If you want to have better sex, have more sex. Sex improves women's bladder control. Sex lowers your blood pressure. Sex counts as exercise. Sex lowers heart attack risk. Sex lessens pain. Sex lowers the risk of prostrate cancer. Sex improves sleep and lessens stress. And may I add it's fun and is extremely pleasurable.

 

5. Sleep. I don't need any convincing that sleep is awesome. Sleep improves your memory and reinforces new tasks you learned. This is why I did my homework right before bed. The concepts you have just studied will be programmed into your brain while you sleep. Lack of sleep can extend your life and add to the quality of your life. Adequate sleep curbs inflammation. Sleep spurs the creativity in you. Sleep improves athletic performance. Sleep helps improve your grades and sharpens your attention. Makes sense that children, adolescents and young adults should be getting well over 8 hours of sleep. Sleep helps you maintain a healthy weight. Sleep lowers your stress. Adequate sleep helps you avoid accidents. Sleep may keep depression at bay. (click here for info).

6. Homeostasis can mean regulation of body or environmental temperature. the balance of calories in and calories out, the value of blood values like electrolytes. The following diagram is fun to look at.

 

7. Lastly, excretion. Excretion is the process through which bodies naturally remove waste through a variety of means, including defecation, urination and perspiration. Similar to homeostasis, excretion is another basic human need that improves as the body becomes healthier.

Adolescent Group: Bullying

This lesson plan can be accessed as a Google document here.

Bullying

“Are you a bully”?  Questionnaire
“Is this bullying” sheet

Click here for handout: Are you a bully?

Click here for handout: Is this bullying? Print page one for each member of the group to complete prior to the discussion. Page two is your reference for the answers

Who in here has been a bully.
Why?

Kids bully for a variety of reasons.
They are jealous of the person they are bullying.
They hang out with other bullies and want to look cool and fit it with their group.
They don’t have many friends and feel left out.
They don’t have high self-esteem and don’t like themselves so they want to make others not like themselves, too.
They need a victim — someone who seems emotionally or physically weaker, or just acts or appears different in some way — to feel more important, popular, powerful or in control. Although some bullies are bigger or stronger than their victims, that's not always the case.
Sometimes kids torment others because that's the way they've been treated. They may think their behavior is normal because they come from families or other settings where everyone regularly gets angry and shouts or calls each other names. Some popular TV shows even seem to promote meanness — people are "voted off," shunned, or ridiculed for their appearance or lack of talent.

Types of bullying
Physical. This type of bullying includes hitting, tripping and kicking, as well as destruction of a child's property.
Verbal. Verbal bullying includes teasing, name-calling, taunting and making inappropriate sexual comments.
Psychological or social. This type of bullying involves spreading rumors about a child, embarrassing him or her in public, or excluding him or her from a group.
Electronic. Cyberbullying involves using an electronic medium, such as email, websites

What can you do if you are bullied?

Ignore it. Ignore the hurtful remarks, by acting uninterested or texting someone. By showing the bully you don’t care he will probably get bored.
Avoid the bully and use the buddy system.
Be assertive. Clearly and firmly tell the bully to stop then walk away.
Hold the anger. Bullies thrive on you getting upset. It makes them fell more powerful.
Spend time with friends who have a positive influence. Participate in clubs, sports, or other enjoyable activities builds strength and friendships.
Write down the details - the date, who was involved and what specifically happened. Save screenshots, emails, and texts. Record the facts as objectively as possible.
Ask for a copy of the school policy on bullying.
Tell someone.

Who can you go to if you are bullied?

Some one you trust: Parents, teachers, counselors, school nurse, a sibling, and friend, physically attacked or threatened with harm call the police and/or an attorney.

How can you stop being a bully?
Apologize to people you've bullied, and follow it up by being friendly to them. They may not trust you right away, but eventually they'll see that you're for real.
If you're having a hard time feeling good about yourself, explore ways to boost your self-esteem. Pick up a new hobby, do volunteer work, or get involved with a sport.
If you feel like you're having trouble controlling your feelings, especially anger, talk to a school counselor about it.
There are many reasons to kick the bully habit. Many bullies grow up into adults who bully their families, friends, and co-workers, causing all sorts of problems with relationships and careers. It's hard to think about the future when you're feeling something here and now, but take a moment to see how your behavior may be laying down some pretty negative groundwork.

Time Management

Budgeting time is similar to budgeting money. We spend our money and our time on things we value.

There are only 24 hours in a day. You can't earn more so you need to learn how to fit everything in. These suggestions can be utilized by adolescents or adults.

The first thing to do is to keep track of where your time is spent. Click here for a form to complete. Total the number of hours.

If you are over 24 hours, determine where you need to cut back.

If you are under 24 hours, see if there are changes you need to make. 

Another way to determine how much you can get done during the course of a day and where your precious moments are going, Joe Mathews suggests carrying a schedule to record all your thoughts, conversations, and activities for a week. You'll see how much time is actually spent producing results and how much time is wasted on unproductive thoughts, conversations, and actions. 

(Read more: http://www.entrepreneur.com/article/219553)

Now that you know how your time is being spent, you can make a budget for your activities. Be aware of when you have the most energy, are the most alert, and when you get tired or irritable as well as what distracts you from starting or working on your list. 

According to the University of Utah School of Medicine website, it's a good idea to start off "making a master schedule for the week which tells you what time is "committed," i.e. time periods that you have already scheduled. It includes sleeping, dressing, eating, travel time, meetings or classes, housekeeping chores, time with loved ones, friends or children, and some leisure-relaxation-exercise time. This is your fixed schedule. It includes the things you must do. Your master schedule is pretty stable week after week. You need to write it down only once, then make occasional changes as needed. The master schedule identifies the hours that are "free," that you have control over. Doing this doesn't mean you have to do the same thing each week, rather it is a starting point for your planning."

The next two options I prefer for time management are either a to-do checklist or a calendar-book type day planner.

For the daily checklist, simply write down all the tasks you need to accomplish for the day. Prioritize and assign the letter A (those that need to be done the soonest), B, or C (those that are lowest priority), to each item on the list. Begin with the tasks marked with an A, and start with the task that will take the shortest amount of time working your way up to the longest amount of time. Do the same with the B and C category. 

Train yourself to avoid procrastination. Postponing work only makes you feel more pressured for time. It just boils down to will power and making yourself do it. Joseph Fielding Smith said, "Do it! Do it right!, Do it right now!" Write down this quote and put it somewhere you will see it every day.

Plan to multi-task. If you want to read a book but can't find the time, keep it with you and read it while you're waiting to pick up the kids from school, when you're waiting in line, when you find a spare 15 minutes, or instead of playing on your phone. 

Reward youself!