Working with Self-Harm: Underlying Dynamics, Therapeutic Interventions, Using the SASH

Self-harm is a language our clients will speak to us, with their entire being. The prevalence of non-suicidal self-harm is highly correlated with client reports of childhood trauma and abuse, and is often observed to present with PTSD. The goals of injuring or harming one's self include regulating affect, reenacting trauma, preserving the attachment with the abuser and managing annihilation anxiety, among many others. This discussion will explore the ways that self-harm develops in response to trauma, how it is intended to function and "take care of" many of the client's needs, and how it "speaks" in the therapy transference. If the therapist has a no-harm contract but does not know how to talk with the client about the self-harm, this may merely increase client secrecy about it, or the client will simply switch to a different high-risk behavior. We will discuss how to approach these underlying layers of meaning with the client, in a collaborative fashion.

We will be offering training in the use of The System Assessment of Self-Harm (SASH). This tool was designed for the exploration of non-suicidal self-harm, drawing in discussion of related meanings, behaviors, needs and functions. The SASH also aids in the development of co-conscious awareness. These capacities are important aspects of building into stability, a key objective within Phase I of the Tri-Phasal model of treatment for Dissociative Disorders. Originally designed for use with clients who have Dissociative Identity Disorder, The SASH was designed with the development of intra-system communication and analysis in mind, yet is quite easily adapted for use with self-harming clients who do not have DID.

The ability to discuss and process self-harm with your client is an important staple for trauma therapy.

This session was originally presented as a live conference session in April 2021.

Target Audience


Learning Objectives

At the conclusion of this session participants will be able to:

  • List three ways that self-harm is an attempt to cope
  • Discuss self-harm with their clients without arousing feelings of shame
  • Describe self-harm with their clients without encouraging self-harm
  • Utilize the SASH method when working with self-harm
  • Explain how to express thoughts and emotions in ways other than self-harm
Course summary
Available credit: 
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.
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Presenter: Willa R. Wertheimer, PsyD
Presenter Bio: Dr. Willa Wertheimer is a Clinical Psychologist, in Crystal Lake, Illinois. She has served in her community for thirty years, specializing in Trauma, Eating Disorders and Psychodiagnostic Testing. She provides readjustment counseling services for combat veterans, with The U.S. Veterans Administration. She is a frequent presenter internationally, has served as Officers for two ISSTD Component Groups, and is a Faculty member of the ISSTD Professional Training Program. Dr. Wertheimer has served on The Board of Directors for ISSTD. She has contributed a new therapy tool, System Assessment of Self-Harm (S.A.S.H.). Through training therapists to utilize this tool, Willa and her partner Ed Groenendal are working to reduce client shame and open the conversation around self harm. Willa paints, to "keep one foot in the light".

Presenter: Edward Groenendal, MA, LCPC
Presenter Bio: Ed Groenendal, a graduate of The Illinois School of Professional Psychology, has been providing psychotherapy services since 2000. Having joined ISSTD at the start of his career, Ed has been an educator and presenter for both ISSTD and ESTD. His presentations at ISSTD conferences included subjects about:

  • Is There a Host in a Client with a Dissociative Identity Disorder?
  • Second Phase of Treatment of Trauma Disorders and Development of Self Reflection
  • Assessment, Treatment and Underlying Dynamics in Working with Self-Harm

In addition, Ed has also presented on Sexual Issues in Therapy at local county mental health groups. Currently Ed provides consultation to other therapists and is currently serving as President of The Northwest Illinois ISSTD Group. He also provides support and training to other therapists, who treat patients exhibiting complex trauma. Ed Groenendal, along with Dr. Wertheimer are working on a journal article to be published about self-harm related to complex trauma. He enjoys going out on long, cross-country drives and cooking (and eating), along with his wife Willa Wertheimer.

Available Credit

  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.


ISSTD Member cost:
Your Price:
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"Your Price" above reflects your final price based on your membership status and career level. 

  • ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. 
  • ISSTD defines an emerging professional as mental health professionals who have completed an advanced degree and are in the first three years of their career (or first three years after graduation for researchers).
  • If you do not fall into one of the above categories please register as Professional/Retired. 

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