Treating Self-Injury

Second Edition
A Practical Guide

Barent W. Walsh

HardcoverPaperbacke-bookprint + e-book
July 1, 2012
ISBN 9781462505395
Price: $83.00
413 Pages
Size: 6" x 9"
September 23, 2014
ISBN 9781462518876
Price: $33.00
413 Pages
Size: 6" x 9"
July 2, 2012
ePub and PDF ?
Price: $33.00
413 Pages
print + e-book
Paperback + e-Book (ePub and PDF) ?
Price: $66.00 $36.30
413 Pages

This trusted practitioner resource is acclaimed for its clear, compassionate, and hopeful approach to working with clients who self-injure. Barent Walsh provides current, evidence-based knowledge about the variety and causes of self-injurious behavior, its relationship to suicidality, and how to assess and treat it effectively. Illustrated with detailed case examples, chapters review a wide range of cognitive-behavioral interventions. Essential guidance is provided on tailoring the intensity of intervention to each client's unique needs. Walsh is joined by several colleagues who have contributed chapters in their respective areas of expertise. Reproducible assessment tools and handouts can be downloaded and printed in a convenient 8½“ x 11” size.

New to This Edition

“Those working in the health and education scopes of practice with youth and young people will be well rewarded for the time they spend reading this book. Given the incidence of deliberate self-harm in the community, maybe this book should be added to the list of required reading for all those assessing and helping to manage risk within health services”

Psychology Aotearoa

“Other books on self-injury are available, but none is so comprehensive in approaching treatment in a way that is extremely useful to mental health practitioners....An excellent manual...useful in clinical decision-making—a must-have reference.”

Metapsychology Online Reviews

“This edition is more comprehensive and inclusive and will have an even greater impact than the first edition….Throughout the book, Walsh provides helpful case examples in order to highlight and clarify many of the points and strategies presented. One significant advancement presented in this book is the stepped care model which provides a well mapped out series of strategies of varying levels of therapeutic intensity based upon the assessment and needs of any individual’s difficulties….The book is even more thorough and more comprehensive than its predecessor….This book will be beneficial reading in any advanced graduate course in cognitive behavior therapy, especially focusing on borderline personality and other difficult populations. Anyone dealing with a patient with SIB or specializing in this population will find this book valuable in that it provides a comprehensive overview of accepted treatment strategies and gives valuable advice regarding appropriate ways for therapists to manage themselves when confronted with self-injury in their patients….Integrating the included material with other behavioral, empirically supported strategies and treatments will provide therapists with a full range of skills needed to deal with and cope with this challenging problem.”

Child and Family Behavior Therapy

“[An] extremely practical guide to coping with self-injury. This book anticipates and guides the reader through the complicated multisystemic disasters that this symptom can set off....Reflects the years of experience and wise counsel provided since the 1970s by the Bridge of Central Massachusetts, where Walsh is director.”

Journal of Trauma and Dissociation

“Delivers what it says on the book cover: it is a practical guide....[Makes] a sometimes repellant subject engaging and readable, while never appearing voyeuristic or sensational....This text will be invaluable for any practitioner who works with patients who self-injure.”

Journal of Behavioural and Cognitive Psychotherapy

“Walsh's clear explanations of the therapeutic models enable even beginning clinicians with little exposure to CBT to understand the origins and rationale for his approach, and then be able to apply the techniques in their work with clients.”

Clinical Social Work Journal

“This clearly written and well-referenced book presents state-of-the-art practical information on the assessment and treatment of impulsive nonsuicidal self-injury in multiple settings. The superb use of case histories and examples of treatment make it an indispensable resource for therapists, teachers, and others who are called upon to deal with self-injurers. Highly recommended!”

—Armando Favazza, MD, author of Bodies Under Siege

“The second edition of Treating Self-Injury is the most up-to-date and clinically useful resource on this extremely important public health problem. Walsh and his collaborators are clinical experts who are also versed in the research literature. From topics like the 'choking game' to self-injury in correctional settings to family approaches and beyond, the book is absolutely essential for mental health professionals who treat any form of self-injury.”

—Thomas E. Joiner, PhD, The Robert O. Lawton Distinguished Professor of Psychology, Florida State University

“Walsh combines extensive clinical expertise and knowledge about self-injury with an accessible writing style and careful attention to the latest research. It is clear that Walsh cares genuinely and deeply about the people he seeks to help. Treating Self-Injury, Second Edition, is one of the most important volumes on nonsuicidal self-injury. The book is distinguished by its practical and thoughtful guidance regarding the intricate, often messy clinical realities that treatment professionals encounter every day.”

—E. David Klonsky, PhD, Department of Psychology, University of British Columbia, Canada

“There are a number of books about understanding and treating self-injury. This is by far the best one. Walsh has been a pioneer in the field for decades, and this second edition expertly incorporates recent research advances and translates them into useful assessment and intervention practices. If I could have only one book to guide me in the treatment of self-injury, it would undoubtedly be this one.”

—Matthew K. Nock, PhD, Department of Psychology, Harvard University

“In this second edition, Walsh solidifies his status as one of the foremost experts in the treatment of self-injury. Combining a nonjudgmental and compassionate understanding of self-injury with practical strategies for treating this increasingly common behavior, this book is a 'must' for anyone who works with clients who self-injure.”

—Kim L. Gratz, PhD, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center

“I described the first edition of this book as wise, thoughtful, and sound. Now I need to add 'brilliant' to reasonably describe the second edition. Not only has Walsh incorporated lessons learned from the explosion of research in this area, but he has also woven in the insights of additional well-chosen chapter authors. As the subtitle says, this is a practical guide—but beyond that, it is the definitive treatise on what is known and how to intervene in this most significant of pathologies, and an essential addition to every clinician's resources.”

—Alan L. Berman, PhD, ABPP, Executive Director, American Association of Suicidology

“Walsh has done it again! This is an incredible resource for those supporting individuals who self-injure—and the second edition is even more comprehensive. New content includes updates on psychosocial and pharmacological interventions, which inform clinicians on the most effective supports; a stepped-care model of service delivery that offers targeted strategies to address each client's unique needs; and chapters on issues unique to various treatment settings. I recommend this practical guide to working professionals as well as students preparing to enter the mental health field.”

—Melissa M. Pearrow, PhD, School Psychology Program Director, University of Massachusetts Boston

Table of Contents

I. Definition and Contexts for Self-Injury

1. Definition and Differentiation from Suicide

2. The Relationship between Self-Injury and Suicide

3. An Overview of Direct and Indirect Self-Harm

4. Major Groups in Which Self-Injury Occurs

5. Body Piercings, Tattoos, Brandings, Scarifications, and Other Forms of Body Modification

6. A Biopsychosocial Model for Self-Injury

II. Assessment and Treatment: A Stepped-Care Model

Treatment: Step 1

7. Initial Therapeutic Responses

8. Formal Assessment of Self-Injury, Jennifer J. Muehlenkamp

9. Cognitive-Behavioral Assessment

10. Contingency Management

Treatment: Step 2

11. Replacement Skills Training

12. Cognitive Treatment

13. Family Therapy, Michael Hollander

14. Psychopharmacological Treatment, Gordon P. Harper

Treatment: Step 3

15. Body Image Work

16. Prolonged Exposure or Cognitive Restructuring for Treating PTSD and Related Self-Injury

Treatment: Step 4

17. Treating Persons with Multiple Self-Harm Behaviors

18. Residential Treatment Targeting Self-Injury and Suicidal Behavior in Adolescents, with Leonard A. Doerfler and Ariana Perry

III. Specialized Topics

19. Managing Reactions to Self-Injury: A Guide for Therapists and Other Caregivers

20. Social Contagion and Self-Injury

21. A Protocol for Managing Self-Injury in School Settings

22. Asphyxial Risk Taking (the Choking Game), Amy M. Brausch

23. Understanding, Managing, and Treating Foreign-Body Ingestion, with Ariana Perry

24. Self-Injury in Correctional Settings, Kenneth L. Appelbaum

25. Treating Major Self-Injury


Appendix A: Breathing Manual

Appendix B: Body Attitudes Scale (BAS)

Appendix C: Clinical Scales to Assess Self-Injury

Appendix D: Helpful Websites Related to Self-Injury

Appendix E: Bill of Rights for People Who Self-Harm

About the Author

Barent W. Walsh, PhD, is Executive Director of The Bridge of Central Massachusetts in Worcester and Teaching Associate in Psychiatry at Harvard Medical School. The Bridge specializes in implementing evidence-based practice models according to protocol in public-sector settings. It comprises over 40 programs serving persons with mental health or developmental disability challenges, including special education; residential treatment; wraparound services; supported housing services; a drop-in center for gay, lesbian, bisexual, and transgender teens; and a program for homeless people. A recipient of the Lifetime Achievement Award from the Massachusetts chapter of the National Association of Social Workers, Dr. Walsh has worked with self-injuring persons for over 40 years and has conducted research, written extensively, and presented internationally on self-injury. He has consulted on this topic at numerous schools, outpatient clinics, group homes, psychiatric hospitals, and correctional facilities, and has also served on the clinical and research faculties of the Simmons and Boston College Schools of Social Work.


Kenneth L. Appelbaum, MD, Professor of Clinical Psychiatry, and Director, Correctional Mental Health Policy and Research, Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, Massachusetts

Amy M. Brausch, PhD, Assistant Professor of Psychology, Western Kentucky University, Bowling Green, Kentucky

Leonard A. Doerfler, PhD, Professor and Director, Counseling Psychology Program, Assumption College, and Adjunct Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts

Gordon P. Harper, MD, Associate Professor of Psychiatry, Harvard Medical School, and Medical Director, Child/Adolescent Services, Massachusetts Department of Mental Health, Chestnut Hill, Massachusetts

Michael Hollander, PhD, Director of Training and Consultation Service, 3 East DBT Service, McLean Hospital, Harvard Medical School, Belmont, Massachusetts

Jennifer J. Muehlenkamp, PhD, Assistant Professor of Psychology, University of Wisconsin–Eau Claire, Eau Claire, Wisconsin

Ariana Perry, BA, Outcomes Manager, The Bridge, Worcester, Massachusetts


Mental health practitioners working with adolescents and adults, including clinical psychologists, psychiatrists, counselors, and clinical social workers.

Course Use

Serves as a supplemental text in graduate-level courses.
Previous editions published by Guilford:

First Edition, © 2006
ISBN: 9781593859817
New to this edition: