Rage and Client Self-Harm

Rage and Client Self-Harm

An interview with Angela Caldwell, LMFT on cutting and non-suicidal self-injury. Curt and Katie talk with Angela about the causes of self-harm, the mistakes therapists make in addressing self-harm as well as how to identify reasons behind this harmful coping mechanism and how to identify when suicidality is a risk. We also look at how rage within nice families can lead to self-injury.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

Interview with Angela Caldwell, LMFT

Angela Caldwell is a licensed Marriage and Family Therapist and Family Coach. She is the Founder and Director of the Self-Injury Institute, where her practice focuses on the treatment of self-injury from a family systems perspective, as well as the Caldwell Family Institute, where she offers out-of-the-box coaching for families that are looking for something other than therapy to help them reach their growth potential.

Angela is currently on the adjunct faculty for the MFT graduate program at California State University Northridge, where she teaches family systems theories and couples therapy. She has been teaching graduate students for over a decade at four different universities, and previously taught assessment for a large majority of her teaching career. She was selected by Antioch University to design a curriculum for a new Counselor Assessment class, and has offered consultation on assessments for the last eight years.

Angela has served in MFT leadership for much of her career, including holding executive offices in CAMFT and AAMFT. She has worked side by side with Ben Caldwell and other leaders on various advocacy efforts in California, most notably on the passage of SB 1172, which banned reparative therapy for minors in 2012.

In this episode we talk about:

• Angela’s perspective on family systems and champions of families and dinner tables
• The mistakes in treatment planning and way of being related to self-injury
• What not to do when clients disclose self-harm
• The intrusive nature of liability-focused treatment planning and interventions in the room
• The need to render cutting irrelevant
• The role of the family treatment for addressing self-injury
• Non-suicidal self-injury versus suicidal self-injury (the difference is intent)
• “It’s important for therapists to be able to talk about suicide – to use the word suicide with the same emphasis that we use the word hamburger.” Angela Caldwell, LMFT
• It’s important to be direct in asking about intent
• “I’m cautious to link self-injury with suicide in such a short, abrupt way.” Angela Caldwell, LMFT
• Rage in families who are too nice leading to self-injury
• The profiles in non-suicidal self-injury: peer-based and rage-based
• Social media self-injury and mental illness competitions
• How rage is often misunderstood – looking at how rage and anger are very different
• Rage is animalistic and limbic
• Self-injury is rage (when anger is not useful) when you do not want to be a burden
• Rage comes with tactile stimulus seeking, seeking destruction
• Discovery is mortifying
• The problem with group treatment for cutting
• The contagion factor – Barent Walsh
• Co-rumination – looking at adolescent female relationships
• Family Therapy as the most effective treatment for non-
• Rewrite the family constitution around anger and anger expression
• Family assertiveness training, teaching families how to disagree and hurt each other’s feelings
• Angela’s strategy to provoke fights within the families that she sees and conducts repair