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Living on the Razor’s Edge: Solution –Oriented Brief Family Therapy with Self-Harming Adolescents
Book Review

By Gwenelle S. O'Neal
Posted Sunday, March 9, 2003

Living on the Razor's Edge: Solution -Oriented Brief Family Therapy with Self-Harming Adolescents, by Matthew D. Selekman, MSW. W.W.Norton, New York. 223 pages. $32.00.

This book presents an interesting approach to working with self-harming adolescents, their families, and friends. The author uses specific techniques and examples of progress observed often in three to five sessions.

The multi-systemic family assessment framework is presented as the foundation. The macro perspective establishes important factors associated with this approach: strengths within the social network, team work, open dialogue, balanced perspectives, observation of behaviors that maintain the problem environment, and options for transformation. Mr. Selekman identifies a range of methods and techniques that address the adolescents' perspectives, those of the parents, and other family members. He demonstrates how to bring others in and uses innovative and creative conversation to help the multi-system operate effectively. This solution-oriented brief family therapy approach assists the participants in understanding what people feel they can bring and contribute to the work situation. The author makes the social work perspective—person-in-the-environment—come to life in therapy.

The author's research indicates that many of the problems adolescents experience derive from authoritarian parental practices, parents with little time for nurturing their children and adolescents, parents who don't keep their promises, and who don't talk to them. The "longing for connection with and validation from parents and significant others" (p 1) seems to be a consistent theme for many adolescents demonstrating self-harming behaviors seeking to feel better.

He encourages therapists to consider the pitfalls of practicing within limited models and assumptions. He notes he has worked with "far too many adolescents who, pushed by their previous therapists to work through their past traumatic experiences, ended up increasing their self-destructive behaviors or tried to kill themselves." (p 3) He suggests that being therapeutically flexible, adopting a kaleidoscopic view of clients' unique problem stories and interactions, and giving ourselves freedom to traverse model boundaries will help professional growth. (p 15)

The range of methods to select from in designing therapeutic strategies within the systems context is impressive. Primary methods engage the family and significant others through questions, imagination, mood management, cognitive skills development, aerobic exercise, Native American healing methods, connection building practices, and interview techniques—improvisational and creative—that focus on changing the family dance. Internal and external therapeutic experiments are presented.

The control or power dynamic present in families can be addressed through many of the therapeutic options. The Native American talking stick allows opinions to be expressed without penalty. Visualization focuses on observing and experiencing steps to understand what hasn't worked and what can and will occur in the future.

Finally, the author discusses group membership and management. The review of methods to inform collaborative practices with others in the larger helping systems is welcome in its focus on sharing power and leadership to move beyond the resistance of the psychodynamic philosophy meeting the multisystemic. This teamwork requires suspending assumptions about others in order to critically analyze and learn new viewpoints.

This book proposes structure and techniques to enhance the therapeutic process for fluid consumer participation and evaluation. It is useful to social workers, students, educators and clients.

Reviewed by Gwenelle S. O'Neal, DSW, associate professor, West Chester University, Graduate Social Work Department, West Chester, PA.

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