hi--my suggestions are:
1. don't assume "child abuse."
2. consider medication for depression &/or PTSD.
3. make a clear contract with the patient about what she can expect from you (eg, when can she call you? where?), and what you expect from her.
4. discuss some reasonable long-term and short-term goals for the therapy, and get her buy-in. tell her you'll evaluate your progress together in, say, 5 weeks, and then do it.
5. emphasize that the two of you are a team, and reinforce your connection in a wide variety of ways (eg, "i used to wear my hair the same way," "i'm planning to see that movie also," "i don't like it when it rains either").
6. give her homework, even if it is extremely simple.
7. have her write about wanting to self-mutilate when she feels like self-mutilating. if she still wants to do it after she's written about it, for now that's, well, acceptable (a difficult word to use here, i know), because she's slowed herself down and you get some information about the experience.
8. for that matter, ask her what the cutting (or whatever it is) means to her, as well as what the experience is like.
9. again, consider medication for depression.
10. evaluate her for suicide.
11. get a consult from an MD
12. keep really good records.
13. schedule a break after your appointments with her.
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