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Therapists' conceptualizations of the function and meaning of "delicate self-cutting" in female adolescent outpatients
Abstract
The "delicate self-cutting syndrome" (Pao, 1969) refers to repetitious non-lethal cutting or scratching traditionally associated with female adolescents. While research and theory have explained the reasons for this behavior in various ways, little attempt has been made to integrate these reasons into broader models. An examination of the literature suggested eight clearly differentiable models that integrated groups of reasons: behavioral, systemic, avoidance of suicide, sexual, expression of affect, control of affect, ending depersonalization and creating boundaries. This study evaluated these models and investigated the relationships between them by surveying therapists about the conceptualizations they use to understand patients who engage in delicate self-cutting. Related developmental issues were also briefly investigated. A pretest was conducted with clinical psychology graduate students and faculty to validate the theoretical associations between specific reasons and the models used to integrate them. The main survey asked a nationwide sample of psychologists and social workers who treat adolescents and adults in individual outpatient therapy to rate a patient on the specific reasons for cutting and the integrative models. Forty-four completed surveys were analyzed. The systemic, suicide, sexual, expression, depersonalization and boundaries models were supported by a factor analysis and the generation of alpha coefficients. Examination of the patterns of relationships between and within models and individual reasons suggested that the behavior model was undifferentiable from the systems model and that the control model addressed the general need to regulate affect and was an issue underlying all other models. The expression model showed a similar patterns of relationships while maintaining its ability to be differentiated. A new structure is hypothesized with control and expression models reflecting basic underlying functions of the self-cutting behavior and the other six models reflecting more subjective meaning assignment. Results also indicated that therapists find the expression, control, depersonalization and boundaries models most useful in understanding and treating their patients. There was little support for the sexual or suicide models. Implications for therapeutic interventions and difficulties are examined in light of the new structure and therapists' preferences for certain models. Directions for future research are proposed.
Subject Area
Psychotherapy|Developmental psychology
Recommended Citation
Suyemoto, Karen L, "Therapists' conceptualizations of the function and meaning of "delicate self-cutting" in female adolescent outpatients" (1994). Doctoral Dissertations Available from Proquest. AAI9434537.
https://scholarworks.umass.edu/dissertations/AAI9434537