Lori Vann joins us to talk about non suicidal self injury. She has written multiple books on the topic including “The caregivers guide to self-injury,” and “The practitioner’s guide to the treatment of self-injury.” She talks about the Vann Tree Model and treating the roots of the problem rather than focusing on dead leaves (symptoms). She also talks about how and why the age of occurrence is getting younger and younger as pre-teens are getting online and involved in social media. Enjoy.
The Illuminate Recovery Podcast is about Mental Health, Mental Illness, and Addiction Recovery. Shining light on ways to cope, manage, and inspire. Beyond the self care we discuss, you may need the help of a licensed professional. Curt Neider and Shelley Mangum are a part of Illuminate Billing Advocates (illuminatebilling.com). They are committed to helping better the industry and adding value to the lives of listeners by sharing tools, insights, and success stories of those who are working on their mental health.
Transcript (no grammar): lori vann joins us to talk about non-suicidal self-injury she has written multiple books on the topic including the caregiver's guide to self-injury and the practitioner's guide to the treatment of self-injury she talks about the van tree model and treating the roots of the problem rather than focusing on dead leaves she also talks about how and why the age of occurrence is getting younger and younger as preteens are getting online and involved in social media enjoy welcome to the illuminate recovery podcast we shed light on mental health issues mental illness and addiction recovery ways to cope manage and inspire beyond the self-care we will discuss you may need the help of a licensed professional my name is kurt knighter i'm a husband father entrepreneur a handyman and a student of life i avoid conflict i deflect with humor and i'm fascinated by the human experience and i'm shelley mangum i am a clinical mental health counselor and my favorite role of all times is grandma i am a seeker of truth and i feel like life should be approached with tremendous curiosity i ask the dumb questions i fill in the gaps the illuminate recovery podcast is brought to you by illuminate billing advocates make billing and collections simple with leader in substance abuse and mental health billing services verification and analysis of benefits pre-authorizations utilization management accurate claim submission and management denial and appeal management and industry-leading reporting improve your practice's cash flow and your ability to help your clients with eliminate billing advocates today it is our pleasure to have lori vann on laurie is in dallas she is a global authority on self-injury and perfectionism uh lori has worked for the last 20 years plus in as a clinical therapist she is an author international speaker and media guest with over 280 interviews lori is on a global mission to prevent and intervene in non-suicidal self-injury behaviors and stop needless deaths by suicide with up to a 90 success rate with her van tree model lori is joining us today to kind of talk about that and share some of her insights lori thank you for being here today well thank you it's a pleasure to be here um and maybe it's it's i think it's always good to start out with a little bit of history and give us a background as to how you ended up in this industry and um and kind of you know where you come from well i started probably back in elementary school and to to sort of quickly go through how i'm gonna i'm gonna pause because i did a bad and i didn't start the record button oh okay i'm just gonna pause for a second and do that intro one more time and and i apologize i don't usually i'm not usually that absent-minded but i started testing and then i turned it off today kurt and i have the privilege of visiting with lori vann laurie is in dallas she is a global authority on self-injury and perfectionism lori has spent the last 20 plus years and as a clinical therapist she's an author international speaker and media guest with over 285 interviews um laurie has a global mission to prevent and intervene in non-suicidal injurious behaviors she she really is dedicated to stopping the needless deaths by suicide as well and with the van tree model she has found 90 success rate in those efforts lori thanks for joining us today i'm excited to to talk about you know self-injury and suicidal you know things that we can do to help um prevent death by suicide um so thank you for being on the show today oh thank you it's a pleasure and i always enjoy spreading the information well i think i don't know from my perspective this is a topic you know self-injury and suicide suicidal ideation those of us in the behavioral health industry are very familiar with it and we see it all the time um but there's i think there's a lot of misunderstanding around those behaviors and where they come from and and that might be helpful um maybe just let's start with you giving us some some history of of where you come from and how you ended up in this industry and specifically in in this uh you know self-injury and suicide avenue well the short answer is i've known probably since elementary school that i wanted to be a counselor all signs kept pointing in that direction even when i tried to say no it can't be that simple and yeah kept being directed towards no this is what you should do it just came naturally really and for the self-injury piece it was really i stumbled upon it it's not a topic that graduate schools cover and especially not when i went through graduate school in the 90s the only time it was reference was with the personality disorder and and we're still fighting that stigma today and i i go much more into that in the second book i wrote a practitioner's guide to the treatment of self-injury and discussing like please stop just automatically assuming someone as a person i just were if they do this but i was a intern i was a lpc intern back in 2000 and came across my first client that was engaging in the behavior and one client became two and worked in patient psychiatric on the adult unit came across many more cases and then became one of the directors of a non-profit and started to really actively track cases at that point and that's led to the development of an excel spreadsheet that has over 550 uh pieces of or names and the pieces of information that go with those names and just seeing these trends these patterns and this behavior over the last 20 years wow that's incredible and that's a that's a pretty good you know uh data collection piece there talk a little bit about what you're learning from from collecting that data and working with those individuals what are you learning about people who engage in self-injury i've seen the trend and this the age of onset and that part is disturbing to me when i first started to track the information it was about 2001 roughly the is heavily skewed towards those that were 13 to 17 and over the years i've seen the 12 and younger really take on more presence and i would say and it has been about a year since i've tallied the numbers but it's not just yes still first place i i guess you would say are the 13 to 17 year olds age of onset but running really closely behind them is the 12 and younger and to dispel a myth adults do self-harm i would say at least 10 of the numbers started at 18 and older and i do have individuals that started in their 30s or 40s or i had one gentleman that he was in his 50s the first time he self-harmed wow that's curious it seems like it's an outliner an outlier you don't see that near as much as that 13 to 17 year old age group have you been able to identify what is it about that age group that kind of drives that behavior there for the the 13 to 17 zone i do believe middle school is a big factor and that's also i think while we're seeing 11 and 12 year olds self-harming is because in some states some school districts they've combined six graders with seventh and eighth and cognitively and emotionally speaking a 12 year old is much different than a 14 year old and i think it's sort of dangerous to put all of them together and i do feel that that has been a factor and some of the behaviors that we're seeing in 11 and 12 year olds and it's just because the exposure that they have in middle school and even if you try to separate them out they're still in the same school and we know that kids always want to act older than what they are but that time period is so challenging and and i often have told people in middle school and junior high that look if you can survive this you're golden you can survive anything surviving junior high is one of the more challenging things that you do in life and i i frankly i don't think i have come across anyone that said you know i think back fondly to my middle school years and wow i wish i could relive them right so it it's just it's very challenging it's an awkward period and then i think you also have to acknowledge the technology piece of it we start to give our kids tech earlier and earlier and that is a whole other conversation in and of itself but you have them on technology more and we know that they know how to be secretive on social media and set up fake accounts and they have the one that parents see and then they have the real account that they post on and again they're being exposed to things that they have no business being exposed to at that age and that most definitely includes self-injurious behaviors and suicidal thoughts and statements and you throw in cyber bullying with it and it's just too much for their their minds to handle at that stage well you just said something that i think's curious um are and this may be a you know uh analytic that's harder to identify but how many of them are seen on social media people self-harming and going oh i'm going to try that and how many of them are just deeply in pain and go i've got to get out of pain i need to do something and they start that is there a way to identify the difference i mean i hear their similarities to both but i'm just it's an interesting thought i do track the reasons for the self-injurious behavior and it and it's important to know each time someone self-harms it could be for a completely different reason and it can also be multiple reasons for each episode and i do track the media aspect so it's not in the top ten it's not however do i have individuals that have said yeah i saw it on the media and i sort of i was curious and i was in a lot of pain and thought well let's give it a go let's see if it helps some people have accidentally stumbled upon it that they they had an accident injured themselves and they go oh hey i felt a little bit of relief there there's also on the media aspect just and social media has been better about trying to watch for that kind of content but obviously they find the ways around it very clever hashtags or they send different links or there's websites they connect into they find the ways around it and yes social media does have it where things can be reported sometimes that is erroneously reported for example on youtube i posted a tv interview i had done about self-injury and it got flagged and was blocked i'm like this interview has been on your channel for like over a year and okay whatever uh there's no rhyme or reason sometimes but there to answer the question are they in a lot of pain oh absolutely the emotional pain is so bad and they're just looking for any outlet and whether it's they stumble upon that on social media of a friend says that they did it or they find some kind of post or they're just looking for that reinforcement they've already started to do this act and now they're just wanting to maybe have it normalized and go okay there are others out me others out there like me that are doing this good point and so so we have these you know youth and and people of all ages and and it is concerning that even younger you know under 12 are starting to engage in that behavior um so apparent i mean obviously you know parents are when they finally become aware that something like that is happening they're concerned what are your recommendations of actions that they can take and ways that they can think about it because i know unintentionally parents shame their children not not meaning to because they're scared they don't know what to do this feels really threatening and so talk about that piece a little bit yes the reason i actually wrote my first of the four books on self-injury the caregiver's guide to self-injury was to help parents in this difficult situation and it came out of some of just presentations that i would give and questions from the audience and then some was from the caregivers group that i have that is now online so it's available to anyone in the us canada i suppose europe if we can coordinate the times but i wrote that book so that when they're in crisis in that moment they can flip to that chapter and have the question answered but for their response is it scary absolutely do they feel out of control most definitely do they maybe have some feelings of anger or disappointment or hurt or other emotions most definitely however they have to remember they're the parent they're the adult and how they respond to the situation is going to greatly influence the level of influence the parent has and the amount of trust that's given or taken away so i encourage parents that when you first find out maybe don't address it instantly in that moment because if you're experiencing a lot of emotions that's not the time to have the discussion with the kiddo or if let's say it's in doll it's not the time to have the discussion with your significant other you need to say hey it's i'm aware of this and thank you for bringing this to my attention or yes i've discovered this i want to talk with you about this i want to understand this but first i want to make sure that i have some information and that you know i'm i'm able to think through some things so that we can have a good healthy discussion that's probably the hardest part right for a parent to just not react even if you have the info even if you have the information you just got to dive right in you know it's almost impossible not to react which means we probably ought to talk about what happens how does a parent you know fix that ruptured relationship when they react like that because it's like our brains offline right we are we go to all of a sudden survival mode we got to protect and man we do things we really wish we wouldn't have done we gotta we gotta fix that some of it is being prepared being proactive versus reactive because if it's not self-injury it's gonna be something else that you're faced with and that's where having parents be engaged and be aware of what's going on in their students world is critical and thankfully there are school districts out there that do seminars that do training events unfortunately a lot of parents don't take advantage of those free resources whether it's because of stigma or they go oh well that's not my kid well i guarantee at some point every parent has said oh well that's not my kid and then they're surprised by something they go i never thought that they would do that and that's the fun and joys of parenting is that you just don't know what's going to happen and what situations are going to come together but let's say you did react you had an emotional reaction you said some stuff you shouldn't have said it's time to own it parents have to role model for their kids for their teens what healthy communication is if you want your child to be able to own their mistakes and apologize for them you have to be able to role model it yourself and yeah that means you're gonna have to eat some crow it's gonna be humbling but it will do more to build the relationship with your child and to build that trust than parents that make the mistake and try to dismiss it or they try to rationalize it or justify it and they don't own it because guess what that's exactly what your child is going to do as well so if you made the mistake go to them and humbly say you know what i i did not respond the way that i wanted to respond and i said some things that i just didn't think through and so i'm sorry and i want to try to have this discussion again yeah which is super powerful to like you said to model it because and to recognize as parents that as much emotional turmoil that that puts us in that child is equally or more in turmoil right and then doesn't have the skills and the tools to know how to manage that and so they need somebody that's going to model you know i'm imperfect i'm a human being i make mistakes and we got to be able to figure this out with with it being messy too right and send a message that it's okay it's okay i mess up you might mess up i don't know but right and and and kind of normalize that that's the way human interaction just is right we we're not going to do it well because we're human and we have these strong emotions and it takes us takes that prefrontal cortex offline and boy do we do some things like whoa what just happened [Laughter] and of course i mean with your significant other you should do the same thing so it's there are lots of lessons within that it's not exclusively a self-injury thing it and in that caregiver's guide i go over the 17 to do's and not to do's and you know to touch on one of them sometimes parents make the mistake and they make it about them and it's again an emotionally based response sometimes though it may mean that the parent might need to seek their own counseling to work through some stuff but parents that go oh my gosh do you know how this is gonna look what's gonna happen when people find out and whether that's the pta mom that goes oh my gosh i'm gonna be ostracized and people are to wonder what kind of mom am i and am i qualified to be in this leadership position or maybe it's the dad going oh my gosh you know is this going to cost me a promotion because the boss is thinking my family is unstable and if you can't you know run your household how are you going to help run this company and it's really unfortunate but again i think that probably goes to there's some other areas that may need to be addressed well totally and and that also lends to cultural patterns that have been you know in practice for many many years and that you know our our i'll say my parents generation you know where you you didn't you know i was listening to something the other day that said you know back in the 1980s somebody would start started saying hey have a good day or maybe it was the 70s have a good day and it was like you didn't have a good days prior to that right you just you know do you just pushed through and you did whatever you had to and you persevered and you didn't say anything and and that was the way it was and so now we're coming into a realm where we have to talk about our emotions we have to talk about what's wrong we're trying to create this awareness of you know we're we're not we're not robots we're people and and so it's in the work arena it's in the home it's it's happening across across the world it it most definitely is in self-injury in particular is an international epidemic and it was prior to covid covid has set things on fire so to speak on so many different levels and i've already been trying to i'm starting to reach out to businesses and talk with them of these are some of the things you really need to be aware of as you bring your employees back into the office these are some serious considerations these are things you're going to need to do to make this a successful transition and for schools it's another piece i had mentioned last week i was training a large school district and we covered not just the impact of covid in the immediate sense but also looking at okay and when they return to school in the fall these are the things that need to be in place for your students but also staff and things you need to be on the lookout for it and it isn't just on the self-injurious and suicide piece of course that's big but let's look at the anxiety factor and i think the media is going to have a big influence come the fall and are they going to perpetuate anxiety are they going to help us transition back into normal life and i guess that might depend on the motives of of the media but things of oh today one year ago this horrific thing happened and so are we going to be bringing up and creating the ptsd piece of it and keep people constantly anxious and on edge of like oh my gosh what's the next thing that's going to happen and just really re-traumatizing people yeah well that's what sells right that's what makes money is you know you get somebody upset and and thinking and then they they're engaged right so it's a little bit counterproductive um so this is kind of a scary thing for a parent to find that their child has been self-injuring or is maybe suicidal um and and when they come across that and you know they try and approach that with their child in sensitive ways what's the next step what do they do where do they go well and hopefully in that before they go talk with the kid they've been able to maybe consult with a counselor just to do a quick you know call in do some internet searches i know for myself on my youtube channel i have a whole self-injury playlist they've put together as tons of interviews on it different tips that i've put in their resources there's a facebook group even called nssi you know prevent educate aware that is just you know free resources out there but once they've approached their loved one and said hey i know about this and it's like do more listening than speaking and that's going to be a really key piece it's not the time to let me go in and bulldoze and say this is our five-point plan and what we're gonna do to like get you fixed in essence that's what they're saying even if they don't use that term which is only gonna interrupt the relationship and reinforce all the negative self-talk that that person already has going through their head of oh i need to be fixed that it's all my problem all my fault and it's not acknowledging that maybe the family could be a factor could be a trigger for why they're doing what they're doing that's so that's um laura that's kind of a lot to ask for a parent to think that somehow they may be contributing to these issues that are going on we all know that that's the case but this is a lot to put on somebody that's never been exposed to that right this is a this is a boatload so i love that that you're talking about how they can go out and get help as well but they're gonna have to let down a lot of those you know barriers that they've already put in place to protect them right they've been there for a long time they were taught those as children themselves probably and and the stigma in the community and they're going to have to just recognize that their child is more important than all of those things and that life really is not going to end with this experience it's going to get better but boy it doesn't feel like it it's going to feel really uncomfortable for a little bit it's the caregivers groups that i've done have been so amazing because the parents that attend they have a place where they can vent and they can let their emotions go and they can ask questions and they can just get things off of their chest and it's a completely safe place because every single parent or caregiver in that group has the one thing in common and they're at different stages because some are parents that have college students they're doing this and some are parents of maybe elementary school kids and some it could be all the ages in between some could be that they have a significant other that's doing it and they don't know how to respond or maybe it's a grandchild and whatever it is and and also for that person's level of healing from the self-harm some parents are like hey we remember what it was like to be in the throes of this it gets better there's healing there is hope you know keep getting the help there are the resources out there keep using them and it gives the parents that are just starting off that are just deer in the headlights it's like okay there's a path here we don't have to go this alone yeah and that's that's it feels like that because it's a secret we don't talk about this stuff right the if we're if we don't acknowledge it then maybe it's not really happening and you know it's again it's that defense mechanisms that kick in that we have to go wait is that really the way i want to approach this is that really the way i want to show up and is this really going to be helpful because it is going to be uncomfortable it's unknowns right it's all those unknowns that we're not used to um and it's it's tough it's it's tough to override some of those you know we want to be normal and what's normal right i just want to guarantee that i don't think there's any normal people out there anymore because we all have so much going on and and although the neighbor might look really normal i promise their mess is just different than your mess and you're going to be happy to have your mess and to learn how to deal with your mess and and that there's really there's so much happiness and joy and you talked about the idea that first those parents just need to learn to listen and and i think that sounds like a really simple thing but as parents and i even i've even caught myself doing this and i and i work really hard at it it's like what am i listening for though am i listening to fix my child's problem which i'm really good at and they are really not interested in at all right or am i listening just to hear because as a parent i feel like i have to fix it i have to save them i have to especially as a as a father right as a father figure fathers are like it's my job to protect it's my job too and there's there's that feeling that intensity and so notice those but you're listening to just simply ask questions and understand and you're not going to solve any problems today right like that's off the table and we're just going to listen that's a skill that is like it takes a long time to learn that and you'll recognize when you're not doing it because your kids will be really quick to tell you yep not working shutting this down right now right what um when you work with people that are really struggling with self-injury what is your what is your goal well it a lot of times i think counselors go in and they assume the goal is well they have to stop self-harming and when people put goals onto other people that usually doesn't work out so well it it for example when someone struggles with the substance abuse disorder when they have that dependency and they're thrown into rehab and they're not in a place where they're ready to receive the help that's just 50 000 you wasted and that's why you see the road that you know swinging door or rotating door in and out of treatment centers so our job isn't to go in and make those assumptions and force what we think is in their best interest they have to come to that place themselves in order for this to work now am i saying oh well just don't bring up the elephant in the room no i'm not saying that or to ignore what's taking place what i am saying is you need to build this alliance and understand where they're coming from because there's no way you can start to help them if you don't even know where you're starting from and you need to understand what are those triggers what are those reasons what's been going on you've got to have the context and some honestly may go well it's my body and i'm gonna do to it whatever i want and you can't stop me and my response is you're right i i can't stop you i cannot make you stop self-harming it has to be your decision and if and when you are ready to make that decision it will happen in the meantime can we maybe talk about some of these things that are contributing factors things that are creating stress for you and that's why i call the back door approach and that gets some into that tree model is you know what we'll just put the behavior off to the side it's not gonna i don't need it to be this battleground and you know who's gonna win in that battle because okay great i can get him to stop self-harming if i haven't dealt with those core issues they're just going to go to some other behavior so what did you really gain right and i would imagine that you know we talked about substance abuse disorder and you're taking somebody in to detox them and you know and help their help them function right because by detoxing and getting that drug out of their system their brain's gonna start to function better and they can make better decisions but i imagine that self-harming doesn't have that same mind-altering effect and i might be wrong on that but it's not quite the same so they could continue in that behavior and be effective in treatment well and with self-harm it's and i spent a huge you know chapter in the practitioner's guide to the treatment of it is that self-injury should be considered an addiction and when you speak with many people that are regularly self-injuring they will say i am addicted to it and when i have in the research and when uh i go into the the multi-hour training because there's three levels of training that the institute for non-suicidal self-injury offers but when we get into the physiological aspects of self-harm and the psychological aspects of self-harm the chemicals in the brain that are getting activated or impacted are the same chemicals we see popping up with substances and the thought process and the behaviors the rituals terminology are all very much the same so i think we do have to make that shift and accept that self-injury can be addictive because we have the proof of it i have people that have gone through physiological withdrawals from not self-harming that they've had a jonesing kind of experience and psychologically they have most definitely had those kind of withdrawals of just craving it and fantasizing about it and just feeling that tension and just wanting to do it so badly and wow does that not sound like someone that's craving their substance of choice absolutely absolutely i love that distinction because yes absolutely it becomes an addiction it becomes what they think about all day long is as soon as i can get home or as soon as i can get to this place then i can i can engage in this behavior so it becomes very disabling um and you know all encompassing and so so you talked about kind of how you start to work with them you put it off to the side them engaging in self-injurious behavior does not keep you from making progress in treatment true true and so you start working on those really core pla core core beliefs core um issues that are you know kind of driving you know it's like we say with substance abuse it's just uh it's just a symptom of something much deeper right and when you can when you can address those deeper issues the other stuff kind of evens itself out and it's what i talk about is the the root system you have to get to the root problems and that can go into attachment disorder situations it can go into the impact of abuse whether that be physical emotional verbal sexual bullying most definitely falls into that category self-esteem issues it's getting into all of that root system because the problem i've seen happen too frequently and why i want to get into more treatment centers and train them up so that they understand how how simplistic this model is but how incredibly effective it is is all too often treatment centers focus on what i call that the top part of the tree it's the one that we readily see it gets all the attention and up on that top part of the tree where there should be leaves if it were a healthy tree but we're dealing with an unhealthy tree here that's where you see whether that's eating disorders self-injury perfectionism gaming gambling substances sexual addictions whatever the case may be and so those give our attention they're like though you know problem and we run to go fix that behavior and that's well and good and okay great you stopped that behavior but you didn't get into the root system so now you're going to play whack-a-mole and they're just going to go to another behavior and that's consistent and i learned that over 20 years ago when i worked at a gambling hotline is that there were a lot of people that were in recovery from alcohol that became gamblers so it's just i i saw it over 20 years ago i've continued to see that pattern and i gave a keynote address uh for the the texas state tap conference two years ago and discussed the same situation and meeting with the treatment providers there i'm like well so have you noticed this correlation with substance and self-injury and they're like oh yeah we have a lot of people that will get sober from the substances and now they're switching to self-injury i'm like well what do you do about it and like well we have to refer them out we have to discharge them because we're not trained to handle that and like what that that comes across a little bit as abandonment to me is that they've built this trust and rapport with you and now because you aren't trained to deal with this behavior that often has a lot of shame with it and now you're going to kick him out to a local psych hospital that really has no training to deal with the behavior so i'm just i'm really grappling to understand why this isn't being addressed well what you bring up is is a really good point is that it still comes back to we don't know what to do with this behavior and it feels dangerous it feels like it's life-threatening we got to protect us by sending you somewhere else and they miss the message that that sends because you're right how many how many of these people that engage in these behaviors it is abandonment right it's the same as substance abuse the the um antidote to addiction the antidote is connection and we just abandoned so yeah i like i like those the ideas and the concepts that you're sharing because they're spot on and you've talked about the tree model which we referenced you know really early on and have hinted that what's what does that model look like and how does that help simplify that process of actually taking care and cutting to the root so i show them a picture of it and i show the unhealthy tree and it just it looks like a dead decaying tree and say you know okay so here's the surface part this is where all the behaviors are at and you know that it's the root system that determines the health of the tree well the roots are under the ground it's not what we readily see and human nature is the same way as we can see the outside but we really don't know what the roots are and if we don't really look at that we don't know why people do the things they do so from the roots and there's a handout that i use with people to help them identify what some of these root issues are what they believe their rights are is a big piece of it because if you don't think you have some basic rights let's say the right to your opinion to your feelings to make mistakes to change your mind all of those situations then up comes the trunk the trunk of the tree are the boundaries that's your interactions with people and more times than not people that engage in self-injury tend to be people-pleasers and people-pleasing is a no-win situation well it's a win for the people that you're pleasing but it's a no-win for the person that's engaging in it and when you're always people-pleasing and you're not having these great boundaries and you're saying yes when you really want to say no eventually you create hopelessness oh i guess this is as good as it's going to get it's just always going to be this way oh i wish people wouldn't treat me this way maybe you just feel helpless i don't know what to do differently i i just i don't know to where where to start and maybe it builds in some resentment of like why do they keep treating me this way like what why do i not matter you know why am i just less than and that obviously would contribute to depression and maybe some anxiety of like oh my gosh they're going to ask me to do this and i really don't want to say yes but i really don't know how to say no and so now you all this anxiety pops up so those symptoms now go into the branches of the tree and all those symptoms have to go somewhere they don't just stay put they have to have a release and thus that's where you get the little twigs where healthy leaves should be you get the little twigs those twigs are the unhealthy behaviors so the thing is is if we target that root system then they start to form better boundaries if you have better boundaries then the need for a lot of those symptoms starts to go away if you don't have those symptoms then you don't have the reason for the escapes it's really that simplistic well it's a really great model of recognizing just how it works because it is it's simplistic but it's you can you can catch hold of that and go oh oh right things it it makes sense to people as opposed to you know the subconscious and we don't know what we're doing and we don't understand the underlying causes and how am i supposed to know what that is well you know here's a model that helps you kind of conceptualize that and i'm going to help you um you mentioned this before is that you know someone who's self-inju you know engaging in self-injurious behavior doesn't necessarily have a personality disorder right but we we like to stigmatize you know there's that kind of that idea that we immediately go to they must have a personality disorder um but there's often mental health disorders that accompany some of this behavior do you look at that do you approach that differently if they have say a bipolar or a personality disorder do you approach treatment differently not necessarily of course if they let's say have a mood disorder depression or bipolar then we're going to do very specific coping skills and prevention methods on that end but really there's so much overlap between them because let's say for exercise it's a really great example exercise is medicinal exercise is a great alternative to self-injury exercise is also really helpful in dealing with depression so you're targeting it's like a twofer and for when people are feeling let's say triggered and they're having the thoughts of injury because they're feeling really anxious and overwhelmed well exercise one works for that but there are some cognitive activities that we do some dbt stuff cbt stuff so it works on both ends of it for person eye disorders well if you're dealing with a personality you are definitely dealing in some root system stuff and you are going deeper into attachment disorders quite often we're going to be talking about that ace assessment that adverse childhood experiences and that's where when i do an assessment it lasts at least 75 to 90 minutes because i'm not just gonna get the immediate presenting piece i want context i want the big picture and the little picture i want timelines i want to see how all of this is connecting together and again i think that's where in some of the healthcare models we have it's oh we're on the clock we can only get so much and so let me just you know maybe make some assumptions and fill in the blanks or they get hyper focus on this over here and they are so missing that everything else over in this piece that's driving the patterns right that that self that's self soothing what they're what they're actually what the actual core issue is so that's i love that and i love that the the way you talk about the individuality because they all everybody's going to come in with something a little bit different and so by you know by having that expertise and knowing the different avenues and what you're assessing you can fine-tune that to what they need and what will work for them i mean we all have those different learning styles and different ways of you know conceptualizing our world and so super powerful well thank you and it it is important that while there are lots of similarities between those that self-harm you still have to teach eat treat each and every individual as an individual because we know trauma for example a person you could have two people that experience the exact same thing and have very different perceptions of it and the impact can be very different i'll be doing a trauma training tonight for with the group that's in australia and we're going over trauma and one of the things that i'll talk about is to say one person's trauma is another person's inconvenience and you just you don't know who is it going to be a traumatic event for and who it's just going to be an inconvenience yeah very true and yeah and it's the same as you know in military this may be more extreme but you know someone in military they could be on the front line experiencing the same death and and tragedy and trauma and one of them might develop ptsd and the other one doesn't and it's just different right they just what for whatever reason not everybody does and so you've got to take them individually because you make those assumptions and you start treating them and you're not addressing the core issues again right yeah and assuming that someone you know is just because they've had that kind of experience that they're going to have ptsd is also wrong because not everybody develops ptsd i like that analogy that's important um lori i think we could talk about this for a long long time because i can tell that you're super um you know you've gone really in depth to understand it to learn how to explain it and and i know that not everybody's going to see your face as you're describing these but but you you um you have this presence that allows people to get to know that you get what they're talking about right that you're you're describing it your facial expressions are just depicting what you're experiencing and those emotions and they get right i can just tell that they get you understand what's going on and they have that confidence that that your approach is going to work because you know it's going to work because you've you've got all this experience that shows that it does work so i love that piece and i imagine that even if someone who's self-injuring doesn't want to come and see you or learn more about how they can get help their parents certainly certainly are going to want to have some information so it might be good to talk about where do they seek help and and i know you're in you're in dallas and not everybody that's listening to this is going to be in dallas where can they first start to get some help there's several different options and so the the quick one would be you can go to just my name laurievan.com of l-o-r-i-v-a-n-n.com and i'll connect you to some of the social media pages uh you can also just google lori van and counseling and and i i'm on a lot of the pages of google uh if you are on the social media side you can do on on instagram it's at lori van lpcs which stands for licensed professional counselor supervisor if you want to go the youtube route i reference that there's a whole playlist dedicated to self-injury content and again it's just it's my name it's lori van lpcs and on facebook there's the van associates facebook page you can also search the nssi and just put that in there and hopefully the group it's a private group you do have to answer three questions to be admitted to it but it's for prevent educate aware and a place for there are some professionals that are on there just trying to better understand the behavior themselves but there are a lot of individuals from literally all over the world i mean so many different countries are part of that facebook group and they are individuals that have family members participating in it or they themselves are participating in it and just a place to be able to vent and be supported and find out resources and i post uh different articles or content on it when i'm able to so hopefully one of those will be a good start and then i have the different books that are available either through the van associates dot com website or through amazon so lots of possibilities that's fantastic well certainly one of those will work for for everybody who wants to connect with you and and i will say i connected with you on linkedin so there's another option um so um thanks so much for for the work that you do and the people that you help and um and the awareness that you bring to this this topic because it's a it's a tough topic and it's an emotional topic so thank you for joining us today well thank you it's it's a pleasure to be able to spread this information and to provide the resources and i i stand by my little hashtag of here to serve yeah which is powerful and i love that and i've learned some things myself today and um you know and i have that interest to go and i want to learn some more um i want to you know i even even i think about when i'm digressing a little bit but i think about my own kids that have come to the table and said look i've got a friend who's you know got some razor blades i need to take away and i need to talk through them and i need to get them some help and i'm like wait wait you're a teenager you don't even know what you're doing and you're helping you know and you this is what you're confronted with and this is the dynamic so so much need for that assistance and and um and then changing our perception so i i really do appreciate your efforts and what you're doing thank you oh thank you thanks laurie