by Matthew W. Selekman, M.S.W., L.C.S.W.; New York, W. W. Norton, 2006, 223 pages. $21.95, softcover
Dr. Walsh is executive director of The Bridge, Worcester, Massachusetts.
This book is a reissue of Matthew Selekman's 2002 work, entitled Living on the Razor's Edge: Solution-Oriented Brief Family Therapy With Self-Harming Adolescents. The content for the two versions appears to be very similar, but the references have been updated for the 2006 volume.
Although the literature on self-injury is massive, relatively little has been written about the family treatment of adolescent self-injurers. Selekman's work is the only book-length contribution to date; Miller, Linehan, and Rathus's book on dialectical behavior therapy with adolescents and families will be published in late 2006 (1). I have also written a chapter on the family treatment of self-injury (2).
Selekman employs a "solution-oriented brief family therapy" approach in treating self-injury. His assessment uses what he calls a "multisystemic … framework that takes into consideration the complex interplay between the adolescent, family, peer-group, larger-system, cultural, gender, community, and societal factors in the development and maintenance of self-harming behavior." As this description suggests, his multisystemic framework is very inclusive in the scope of its targets.
Selekman's treatment approach is highly eclectic. His recommended therapeutic interventions range from cognitive restructuring, relaxation training, mindfulness, and visualization to "family sculpting and choreography," "Native-American storytelling," and "shamanic healing methods." He also employs such diverse techniques as "family vision quests," "the imaginary feelings x-ray machine," "soul work," and the "family collage mural."
Overall, Selekman's book has a rather evenly balanced scorecard of strengths and weaknesses. The strengths of this work are that the author clearly differentiates self-injury from suicide and that he conveys some very helpful suggestions for families about how they should respond to self-injury in their children. More specifically, he recommends that parents react nonjudgmentally and dispassionately to self-injury and avoid the more typical responses of hysteria, anger, frustration, and condemnation. He also dispels a number of myths about self-injury, such as that it is found only with borderline personality disorder or among people who have been physically or sexually abused.
The limitations of the book have to do with its recommended treatment strategies. Too frequently they are only briefly explained. For example, cognitive restructuring is discussed in a mere two pages. The discussion of meditation—employed as a self-soothing technique—is two paragraphs long, and his review of mindfulness merits only another two paragraphs. These profound topics require extensive discussion if they are going to be raised.
Another concern, albeit a smaller one, is the author's attempt to use adolescent jargon or slang throughout the text. For example, he refers to a recommended quiet room space as "the chilling out room" and to group therapy that teaches self-soothing skills as "stress busters." Although I agree with Selekman's motivation to connect with teens at their own level, using their language in a written text is likely to sound hopelessly outdated soon thereafter.
If you are a family clinician who has a clear direction in providing treatment, Selekman's work can be useful in offering some new ideas for creative work in therapy. If you prefer to work from an evidence-based practice framework, with clearly defined treatment protocols, then you may want to wait for the book on dialectical behavior therapy by Miller and colleagues when it appears in late 2006.
1.Miller AL, Linehan MM, Rathus JH: Dialectical Behavior Therapy With Suicidal Adolescents. New York, Guilford, 20062.Walsh, BW: Treating Self-Injury: A Practical Guide. New York, Guilford, 2006