|Preventive Psychotherapy for Self-Harm in Youth
||Overall Rank: 97
For young people who have self-harmed several times, consideration may be given to offering developmental group psychotherapy with other youth who have repeatedly self-harmed. This should include at least six sessions. Extension of the group therapy may also be offered; the precise length of this therapy should be decided jointly by the clinician and the service user.
Young people 12 to 19 years of age and conditions common in this population.
Additional Domain(s) :
Patients with Acute Conditions
Children and young people who self-harm have a number of special needs, given their vulnerability. Physical treatments will follow similar principles as for adults.
For adolescents there is strong evidence suggesting that there is a clinically significant difference favouring group therapy over standard aftercare on reducing the likelihood of repetition, although the numbers were small. For other therapies and outcomes there is insufficient evidence of effectiveness. The evidence reviewed here suggests that there are surprisingly few specific interventions for people who have self-harmed that have any positive effect. The GDG came to the conclusion that, at the present time, there was insufficient evidence to support any recommendation for interventions specifically designed for people who self harm.
While there may be some evidence for the treatment of subgroups of service users, such as those diagnosed with borderline personality disorder, the studies were too small to make recommendations. However, the positive outcome for adolescents who have repeatedly self-harmed receiving group therapy is encouraging; although, because of the rather selective group this was applied to, this approach is in need of further investigation.
Moreover, the GDG came to the conclusion that referral for further treatment after an act of self-harm should be determined by the overall needs of the service user, rather than by the fact that they have self-harmed per se. This draws attention to the reliance on repetition as the primary outcome measure in many studies whereas outcomes relevant to service users such as depression status or quality of life may be more relevant.
The National Institute for Clinical Excellence. Self-harm. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. November 2004. P. 68, Section 188.8.131.52, P. 178, Section 184.108.40.206.
Retrieved on Aug 3, 2006 from: http://www.nice.org.uk/page.aspx?o=cg016niceguideline
Level of Evidence
II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.
- * Primary vs. secondary? I think it’s more like secondary.
- * I am not sure if group-work is always culturally appropriate.
- Possible concern about group dynamic for this population, but this is more anecdotal than related to literature findings.
Variation in Results
Special Group Rank