Cutting Down: A CBT workbook for treating young people who self-harm
Routledge – 2015 – 228 pages
A quarter of adolescents engage in some form of self-harm and even experienced therapists can find working with these young people difficult. Based on Cognitive Behaviour Therapy (CBT), a highly effective method for working with emotional problems, Cutting Down offers a practical and accessible programme for mental health therapists from different professional backgrounds working with young people who self-harm.
The programme is comprised of four parts, each covering a specific stage of therapy, and is split into 27 short modules. Although designed to be delivered over a course of 14 sessions, the programme is presented in a way that allows the therapist to decide which combination of specific modules is chosen and how long is spent on each, based on the specific clinical needs of the person they are working with. Throughout the programme, virtual patients are used to illustrate the various exercises and strategies. Part One, What’s Going On?, introduces self-harm and CBT and aims to develop insight into feelings, problems, goals and the concept of change. Part Two, Feelings, Thoughts and Behaviour, looks at working on activities, managing depression and identifying and managing negative thoughts. Part Three, Coping Strategies, introduces modules on problem solving, assertiveness, mindfulness and alternatives to self-harm. Part Four, On You Go!, finishes up the programme with a review of goals, identifying triggers and developing a ‘first aid kit’ and a ‘tool box’ of skills to reinforce the programme. Downloadable worksheets enhance the practicality of the text.
Designed to support clinicians working with adolescents engaging in self-harm, this unique workbook is ideal for counsellors, counselling psychologists, clinical psychologists, CBT therapists, IAPT practitioners, CAMHS mental health workers and nurse therapists as well as students and trainees.
"This innovative guide will be invaluable to clinicians helping young people who self-harm. The distress and chaos that often surround a young person who self-harms, requires a treatment that incorporates structure and practicality to achieve the best outcomes. In this accessible manual, the authors bring ‘order ‘ to the management of self-harm which will give both therapist and patients confidence and direction. The experience of the authors is evident throughout, not least in demonstrating that adhering to evidence-based strategies does not mean abandoning flexibility. The most effective cognitive-behavioural approaches are presented in an engaging and individualised way. This means that although some strategies are prescriptive, the overall approach is collaborative, and will stand the best possible chance of engaging the young person to work within the protocol. Without being patronising, the overall stance of positivity and normalisation, will reassure young people and their families that they can reduce and stop self-harm. The therapist and young person will work together towards recovery with the help of this book, both becoming experts in the themes and detailed strategies that really work." - Professor Isobel Heyman, Consultant Child and Adolescent Psychiatrist, Psychological Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust
"Self harm is an increasing problem for adolescents, their parents, and schools, and hence the publication of this treatment manual is timely and important. Cutting Down provides staff working with self harming adolescents an extremely clear and detailed treatment plan for a brief intervention (14 sessions) based on the principles of cognitive behavioural therapy and dialectical behavioural therapy (both evidence based interventions for self harming adolescents). Particularly impressive and helpful about this treatment manual is the accessibility of the information on CBT for those with little or no background in CBT as well as those with extensive knowledge and experience in CBT techniques. The handouts are designed to appeal to the typical adolescent, giving relevant and helpful information in a fun and non-intimidating format. The manual provides a range of well conceived age appropriate metaphors to highlight the concepts. The style of writing is engaging in both the therapist crib notes and the adolescent handouts, thus increasing engagement with the material. The clinical examples provided, for therapist and adolescent, bring the material to life and provide a point of discussion – helpful when faced with a reluctant and uncommunicative adolescent. Overall I highly recommend this treatment manual and will be using it within our own specialist unit." - Dr. Janet Feigenbaum, clinical and strategic lead for personality disorder services, North East London and Senior Lecturer University College London
Part I: What’s Going On? What is Self-Harm?, The Function of Self-Harm, Problems and Goals, What is CBT?, Getting to Know Your Feelings, Relationships and Strengths, Are You Ready to Make Some Changes? Part II: Feelings, Thoughts and Behaviour. Feelings diary review and activity scheduling. The Help Triangle. Negative Automatic Thoughts (NATs). Thought Distortions and Thoughts Challenging. Beyond the Help Triangle: Core Beliefs and Rules for Living. Formulation – ‘My Journey’. Part III: Coping Strategies. The Coping Tree. Problem Solving. Assertiveness. Basic Anger Management. Taking Care of Yourself. Facing the Situation. Riding the Wave. Being Mindful. Self-Soothing. Alternatives to Self-Harm. Part IV: On You Go! Reviewing Your Goals. Identifying Triggers. First Aid Kit and Tool Box. My Path and Certificate.
Lucy Taylor is a consultant clinical psychologist at the National & Specialist Child and Adolescent Dialectical Behaviour Therapy (DBT) Service, Michael Rutter Centre for Children and Young People, South London and Maudsley, NHS Foundation Trust. She is BABCP accredited and has a private practice based in Surrey.
Mima Simic is Joint Head of the Child and Adolescent Eating Disorder Service and a consultant child and adolescent psychiatrist for the Child and Adolescent Dialectical Behaviour Therapy Service at the Michael Rutter Centre for Children and Young People, South London and Maudsley, NHS Foundation Trust.
Ulrike Schmidt is Professor of Eating Disorders at the Institute of Psychiatry, Kings College London and Honorary Consultant Psychiatrist in the Eating Disorders Unit, South London and Maudsley NHS Foundation Trust.