Hope this helps a bit

I think you have given too little information for me to have any ideas related to helping the person. The age of 32 and the categories of self-mutilation (skipping the Bulimia for a moment) alone don't come anywhere close to giving me a clinical picture. Apparently, since late teen years she has done something...but then, what type of mutilation, how often, how severe, to what part of the body, does/did it ever change, who knows about it, does she live alone/parents/friend, HOW does she tell about it to you and others, does she care, does she believe she controls doing it, what events does she think initiate it, etc. These are very important to helping her as a unique person. Especially, the HOW she communicates to you (coy, helpless, bold, unaffected, ashamed, easily, guardedly, grandiosely, meekly, softly, slowly, etc.).
Finally, (I use that word tentatively) what was her situation before and at the onset of this behavior? What was her thinking at the time? What has she done to change up to now? Is this the first seeking of help? etc.

Let me contrast VERY briefly 2 of the cases I've had to show what difference this sort of data provides: 1 - the self-mutilator, as a child, was repeatedly raped by her father and then watched (without being able to help) her younger sister grow old enough to become the victim of the raping, and, (get this, ugh)...watched as her father beat and kill her younger brother. For these later events she felt very responsible/guilty...as for the rape, i guess you could say that there are many complications here too, but for one thing, there was much internalized anger...the combination of these and more created the soil for the self-mutilation to grow. 2- the next self-mutilator was leaned upon for emotional support from the mother since birth, apparently. When the father divorced the mother she was 12. Soon, injury and eventually self-inflicted injury was a sure-fire way to get dad and mom together, agreeing, and crying in the same room. He etiology became linked with reducing her anxiety (internally sensing her anxious mother's irrational fears about the divorce) and to make a long story short, her anxiety and mom's was all better if she was injured. Viola, no threat of losing mom (or dad)!

Two entirely different treatment...but both about 32 and self mutilating since teens.

So, you can see where I am going with this. Erickson's approach was truly based on getting 'into' the person's head and trying to figure out as best one can what was/is going on with the person.

Then, using interventions like those usually associated with Erickson's work (paradoxical assignment, skill building assignment, metaphor/suggestion in trance/waking state, asking, reasoning, etc.), to help retrieve the understandings and experiences that would have been necessary to not have/'have had' the problem in the first place for this unique person and history. While there is a bit more to therapy than that, these sorts of interventions are the real turning points that provide the strength to end the problem behavior and shift attitudes.

Hope this helps a bit.
Steve

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