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DBT is built around the idea of encouraging the cutters and members of their family to accept the kids as they are while encouraging them to change. "We embrace two seemingly contradictory philosophies," says Hartstein. "That teens are doing the best they can and that they can also do more." With the sense of judgment lifted, children are more receptive to learning a wide range of new coping skills, such as impulse control, distress tolerance and contemplation of consequences.
The treatment at Two Brattle Center is typical of what's offered at most clinics. Cutters start with intensive DBT and coping training, attending sessions from 9 a.m. to 1 p.m., five days a week, for at least four weeks. When they are ready, they graduate to individual and group therapy, once a week each. All the kids have paging privileges, giving them a round-the-clock hotline to their therapists when the urge to cut hits. They are also taught to reach out to family and friends and answer the cutting impulse with some other activity.
"When Melanie wanted to cut, she learned to find something else to do," says the father of a 20-year-old Two Brattle graduate. "She'd be stressed, and the next thing we'd know, she'd be cleaning her closet."
Parents who are worried that their kids are cutting should look for a few red flags. If a teen wears long sleeves and sweatpants in hot weather, there's a chance something is being hidden. Temperamental behavior, intense anger and changes in eating and sleeping patterns may also be warning signals--but they are also part of the ordinary storms of adolescence, so it's wise not to overinterpret. Less ambiguous are sudden shifts in mood. "If a kid is mopey at 5 and much better at 5:30," says Hartstein, "you may want to know what happened in that half-hour." Parents should also keep an eye out for hidden stashes of blades or bandages.
More important than advice for parents is advice for the kids. Almost all former self-mutilators agree that one of the best things cutters can do is come forward--talk about their problems with parents, teachers and friends. It's equally critical for the kids to talk honestly with themselves. "Take a step back," advises Jen, 17, a Two Brattle patient. "Look at the long term. Who's in control of your life, the cutting or you?" Self-mutilation may thrive on secrecy and fear, but as with all wounds, a little fresh air can help speed the healing. --With reporting by Jeffrey Ressner/ Los Angeles