Existential Therapy

Frankl 1905-1997
Logotherapy
 The essence of being human lies in searching for meaning and purpose
 Love is the highest goal to which humans can aspire and that our salvation
is through love.
 Freud as the depth psych and he as the height psych (Third school of
Viennese Psychoanalysis)
 Human motivation: will meaning vs. will to pleasure (Freud) and
power (Adler)
Kello May (1909-1994)
 Studied with Adler in Vienna, took theology Union Theological Seminary 2
years in sanitorium, read Kierkegaard and recognized the existential
dimensions of anxiety
 Led to The Meaning of Anxiety (1950) and Love and Will (1969) for his
personal
 struggles with love and intimate relationships
 Most influenced by Paul Tillich mentor and friend; May as the main
American spokesman of European existential psychotherapy
 Concerned with the nature of human experience, recognizing and dealing
with power, accepting freedom and responsibility, and discovering one's
identity
 Psychotherapy should be concerned with problems of being flearning to deal
with issues such as sex and intimacy, growing old, facing death, and
taking action in the world).
 Individualism should be balanced by Adler's social interest
 It takes courage to be and our choices determine the kind of person we
become, struggle between the security of dependence and the joys and
pains of growth.
Irvin Yalom (1931)
 parents migrated from Russia after WWI
 Inner city Washington, DC; poor
 neighborhood refuge in reading books from library:
 decided to become a writer
 Professor emeritus of psychiatry, Stanford University School of Medicine:
1970/2005 the Theory and Practice of Group Psychotherapy; Existential
Psychotherapy 1980
 addresses four givens of existence or ultimate human concerns: freedom and
responsibility, existential isolation, meaninglessness, and death
 approached clients with a sense of wonderment; here and now
 believes the therapist must be transparent especially regarding his or her
experience of the client.
  basic philosophy is existential and interpersonal, which he applies to both
individual and group therapy.
 Wrote many stories: Love's Executioner (1987); Staring at the Sun:
Overcoming the Terror of Death (2008); The spirit of a man is constructed
out of his choices.

James Begental (1915-2008)

 coined the term "existential-humanistic psychotherapy"
 away from labeling and diagnosing clients
 emphasized cultivating both client and psychotherapist's presence.
 Assist in deepening inner exploration or searching
 The therapist's primary task involved helping clients to make new discoveries
about themselves in the living moment, as opposed to merely talking
about themselves.
 Viewed resistance as such to being fully present both during the therapy hour
and in life. intellectualizing, being argumentative, always seeking to please,
and other life-limiting pattern. As resistance emerges in the therapy sessions,
the therapist repeatedly notes, or "tags," the resistance so the client
increases his or her awareness and ultimately has an increased range of
choices.
 died at the age of 93.
TheArt of the Psychotherapist (1987); Psychotherapy Isn't What You Think (1999);
Existential Psychotherapy
 Best described as a philosophical approach that influences a counselor's
therapeutic practice
 Asks deep questions about the nature of the human being and of anxiety,
despair, grief, loneliness, isolation, and anomie
 Deals centrally with the questions of meaning, creativity, and love
Common questions/sources of existential angst for clients "Why am I here?"
 "What do I want from life?"
 "What gives my life purpose?"
 "Where is the source of meaning for me in life?"
Banc Dimensions of the Human Condition
 The capacity for self-awareness
 The tension between freedom and responsibility
 The creation of an identity and establishing meaningful relationships
 The search for meaning
 Accepting anxiety as a condition of living
 The awareness of death and nonbeing
The Capacity for Self-Awareness
The greater our awareness, the greater our possibilities for freedom
Awareness is realizing that:
 We are finite-time is limited
 We have the choice to act or not to act
 Meaning is not automatic- we must seek it We are subject to
loneliness, meaninglessness, emptiness, guilt, and isolation

Freedom and Responsibility

 We do not choose the circumstances into which we are born, but we create
our own destiny through our choices
 Freedom implies that we are responsible for our lives, for our actions, and for
our failures to take action
 Freedom and responsibility go hand in hand; assuming responsibility is a
basic condition for change
identity and Relationship
 Identity is "the courage to be"-we must trust ourselves to search within and
find our own answers
 Our great fear is that we will discover that there is no core, no self
 Being existentially "alone" helps us to discover our authentic self Balancing
aloneness and relatedness helps us develop a unique identity and live
authentically in the moment
 At their best our relationships are based on our desire for fulfillment, not
based on deprivation
 Relationships based on deprivation tend to be clinging and symbiotic
The search for meaning
A distinctly human characteristic is the struggle for a sense of significance and
purpose of life
Logotherapy can provide the conceptual framework for helping clients find meaning
in their livesMeaninglessness in life can lead to emptiness and hollowness: an
“existential vacuum
”
Anxiety : A Condition of Living
 Yalom's four givens of existence create anxiety
 Existential anxiety is normal- life cannot be lived, nor can
 death be faced, without anxiety
 Neurotic anxiety, of which we typically are unaware, is anxiety about
concrete things that is out of proportion to the situation
Awareness of Death and Nonliving
 "Death gives significance to living; it is necessary to think about death if we
are to think significantly about life
 Our awareness of death is the source of zest for life and creativity
 We can turn our fear of death into a positive force when we accept the reality
of our mortality
Gaols of Existential Psychotherapy
 Assisting clients in moving toward authenticity and learning to recognize
when they are deceiving themselves
 Helping clients face anxiety and Take full responsibility for your own engage
in action that is based on creating a meaningful existence
 Helping clients to reclaim and re-own their lives; teaching them to listen to
what they already know about themselves
Schneider and Krug (2010) identify four aims of therapy:
 To help clients become more present to themselves and others
 To assist clients in identifying ways they block themselves from fuller
presence
 To challenge clients to assume responsibility for designing their present lives
 To encourage clients to choose more expanded ways of being in their daily
lives
Relationship Between Therapist and Client
 Therapy is a journey taken by therapist and client
 The person-to-person relationship is key
 The relationship demands that therapists be in contact with their own
phenomenological world
 The core of the therapeutic relationship
 Respect and faith in the clients' potential to cope
 Sharing reactions with genuine concern and empathy
Role of Techniques
 Existential psychotherapy is not technique oriented
 Techniques from other models can be used within the context of striving to
understand the subjective world of the client, but they must be used in an
integrated fashion
  when the deepest self of the therapist meets the deepest part of the client,
the counseling process is at its best
Phases of Existential Therapy
Initial phase: Clients are assisted in identifying and clarifying their assumptions
about the world
Middle phase: clients are assisted in more fully examining the source and
authority of their present value system
Final phase: clients are assisted in translating what they have learned about
themselves into action

Strengths from a Diversity Perspective

 "It does not dictate a particular way of viewing or relating to reality
 It has a focus on universality, and on the human experiences that transcend
the boundaries that separate cultures
 It considers the degree to which behavior is influenced by social and
cultural conditioning
Limitations from a Diversity Perspective
 Approach may be excessively individualistic and insensitive to social factors
that cause problems; however, this is beginning to change
 Social injustices may lead clients to feel patronized or misunderstood if the
therapist too quickly conveys that they have choice in improving their lives
 Some clients may prefer more concrete direction
 Existentialists have contributed a new dimension to the understanding of
death, anxiety, guilt, frustration, loneliness, and alienation
 "Its emphasis on the human quality of the therapeutic relationship is a
strength
 The key concepts of the existential approach can be integrated into most
therapeutic schools
Logotherapy
Villes Frankel (1905-1987)
 Born &educated in Vienna
 1930: M.D. University of Vienna
 1949: Ph.D. University of Vienna
 1928 Founded the Youth Advisement Centers in Vienna
 1942-1945: Prisoner in the German concentration camps
 1947: Associate professor at the University of Vienna
 Student of Freud
Villes Frand (1905-1987)
 Began his career in psychiatry with a psychoanalytic orientation
 Distinguished professor in United States International University in San
Diego
 Visiting professor in Harvard, Stanford, & Southern Methodist Universities
 Observed&personally experienced the truths expressed by existential
philosophers &writers
Villes Frankl (1905-1987)
Frankl-quoting Nietzsche's words
 "He who has a why to live for can bear with almost any how"
 guiding motto for his psychotherapeutic practice
 "That which does not kill me, makes me stronger"
 Basic concepts: freedom, responsibility, meaning in life, search for
values
Villes Frankel (1905-1987)
Developed logotherapy
 "Therapy through meaning"
 Central theme-will to meaning
 Dilemma of the modern person: he has the means to live but often has no
meaning to live for
 Malady of our time, "existential vacuum" is experienced when people
don't busy themselves with routine&work
 Aimed at challenging individual to find meaning & purpose through, among
other things, suffering, work, & love
Categorical imperative of logotherapy
“To live as if you were living already for the second time and as if you had acted the
first time as wrongly as you are about to act now..” - Viktor Frankl
Logotherapy views person “as
pushed by drives”.. “”pulled by
meaning and motivated by reason
”
Attitudes in love.
3 Types of attitudes in love correspond to the three levels of human being:
1. Sexual-body
2. Erotic-psychic structure,
temperament, traits
3. Love-core of the other
"Love is living the experience of another person in all his uniqueness and
singularity."

Other Sources of Meaning

 Meaning through work-not just paid work
 Meaning through suffering "There is no predicament that we cannot ennoble
either by doing or enduring"
Meaning through death
Can you imagine living a second time and correcting what we acted wrongly about
the first time?
Seeing life as an uncut movie, a book with kopen ending

"Suffering ceases to be suffering at the moment it finds a meaning."

-Frankl

logotherapy
Focus on responsibility in psychological pain
Emphasizes "decision for rather than "freedom from"
Logotherapy doesn't deal with the symptom, but with the attitude of the client
toward his symptom
Views neurosis/pathology as:
 what is preventing an individual from fulfilling a life task?
 How do you help him/her understand his own life direction?
Basic Principles of Logotherapy
1. Life has meaning under all circumstances, even the most miserable ones.
2. Our main motivation for living is our will to find meaning in life.
3. we have freedom to find meaning in what we do, and what we experience, or at
least in the stand we take when faced with a situation or unchangeable suffering

Two main techniques

Both are based on human qualities of self-detachment and self-transcendence
1. Dereflection
2. Paradoxical Intention: client is encouraged to do, or wish to happen the very
things he fears; a way to handle anticipatory anxiety
Ex. A phobic fights by avoidance and fleeing; but pressure only generates
counterpressure; the more he struggles, the more forceful the symptoms become
Paradoxical Intention
 Breaks the vicious cycle of anticipatory anxiety
 Evokes a sense of humor capacity for self-transcendence one gain's
perspective on one's behavior, puts distance between oneself and the
fear.
 The detachment from one's fears lead to a sense of gaining control
 Warning: Pl is not a panacea; not for endogeneous depression

Dereflection
 Functions to counteract the compulsive propensity for self- reflection and
excessive intention or thought
 Hyperreflection impedes spontaneity, creativity, and activity
 Works well with sexual neuroses: not focusing on the disturbance at hand
with neurotic self-concern, but re- orienting the client's attention toward
pleasing the partner
Socratic Dialogue.
 Socratic dialogue is a tool in Logotherapy that walks a client through a
process of self-discovery in their own words.
 "It is different from Socratic questioning that is often used in CBT.
 Socratic questioning breaks down anxious or negative
 thoughts, while Socratic dialogue is used to find meaning within a
conversation.
 It allows the client to realize they already have the answers to
their purpose, meaning, and freedom.
Therapeutic Goals
 Enabling individual to act & accept the awesome freedom & responsibility for
action because he is alive as a human being
  "Challenge clients' narrow & compulsive trends, which are blocking their
freedom
 Give individuals a sense of release& increased autonomy
 Confront "dizziness"& dread of freedom in order to grow
Client's Experience in Therapy
 encouraged to see their own subjective experience of their world
 Challenged to take responsibility for how they now choose to be in their
world
 Encouraged to take action based on the insights developed
 Must be active in the process-decide what fears, guilt & anxieties they will
explore
 Engaged in opening the doors to themselves
Therapeutic Techniques and Procedures
Capacity for self-awareness: Counseling implications
 They become aware that, in desperately seeking to be loved they really
miss the experience of feeling loved
 They see how they trade the security of dependence for anxieties that
accompany deciding for themselves
Therapeutic Techniques and Procedures
 They begin to see that their identity is anchored in someone else's definition
of them.
 They learn that in many ways they keep themselves prisoner by some of
their past experiences & decisions
 They can learn that they are not condemned to a future similar to the past,
for they can learn from their past & thereby reshape the future
Therapeutic Techniques and Procedures
 They can realize that they are so preoccupied with death & dying that they
fail to appreciate living
 They are able to accept their limitations yet still feel worthwhile, for
they understand that they don't need to be perfect to feel worthy
 Aim-increasing self-awareness, which includes awareness of
alternative/s, motivations, factors influencing the person,&personal goals
Therapeutic Techniques and Procedures
 Freedom&responsibility: Counseling implications
 Therapist assists clients in discovering how they are avoiding
freedom&encourages them to learn to risk using it
 2 central tasks of the therapist
 Inviting clients to recognize how they have failed to choose for themselves
& have allowed others to decide for them
 Encourage clients to take steps toward autonomy
  Anxiety as a condition of living: Counseling implications
 Explore the possibility that, although breaking away from crippling
patterns&building new life- styles will be fraught with anxiety for a while, as
the client experiences more satisfaction with newer ways of being, anxiety
will diminish
 Awareness of death&nonbeing: Counseling implications

Inner Blossoming
An Asian-Transpersonal Approach to Learning, Growth and Healing
Maria Lourdes Llanga-Ramos
 Taught courses in Psychology for more than thirty-five years as an Associate
Professor at the Ateneo de Manila University where she coordinated the M.A.
Counseling Program for fifteen years and the PhD Program in Clinical
Psychology for ten years.
 Clinical Psychologist and Hypnotherapist in private practice, using her
training in both for her counseling and psychotherapy sessions, in the
seminars, workshops, retreats and recollections that she conducts in schools
and universities, corporate and government offices, NGOs, with young
adults, mid-lifers, seminaries and convents for religious clergy.
 M.A. in Social-Industrial Psychology and a PhD in Clinical Psychology from the
Ateneo de Manila University with both courses under government and private
sponsored scholarships
 In college, attained a bachelor's degree in the Behavioral Sciences graduating
as Class Valedictorian and Summa cum Laude
 Mother of two professionals and grandmother to three young ones each with
a distinctive personality that she enjoys being with, caring for, and learning
from.
 Presented in conferences in different parts of the Philippines, as well as
abroad such as in Thailand, Malaysia, India, People's Republic of China, the
United States of America, and Canada.
 Award winning author of "Inner Blossoming: An Asian- Transpersonal
Approach to Learning, Growing, and Healing" which was given the "Gintong
Aklat" award/Golden Book award as Best Book in the Self-Help and
Inspirational Category by the National Book Development Board of the
Philippines.
 Made a textbook for senior highschool students entitled "Personal
Development" used in both public and private schools.
What is Inner Blossoming
 "A way of seeing uncontaminated truth in oneself and others
with compassion
 "A way of cultivating one's ability to go beyond habitual ways of
making sense
 "A way of empowering more healthy, happy and meaningful ways of being.

inner Blossoming Approach

 How do you help blossom a psyche/soul?
 How do we bloom -- that is-grow and heal?
 How do we help others bloom, or grow and heal?
 By providing opportunities for learning objectivity with compassion
The Asian Transpersonal View
 How do we go beyond the illusions of our conditioned habitual ego to the
bigger truth of our authentic being?
 Can we awaken to our sleeping beauties?
QUESTION: which is true of you
You are:
Which is true of you,
A. a human being having a spiritual experience
B. a spiritual being having a human experience

Traditional Western Prayer

We are our personality"
L Psychodynamic/Freudian view: in the unconscious
2. Behavioral/Skinnerian view learned/conditioned from the environment (SR
3. Humanistic/Phenomenological view: in your felt/Subjective experiences
4. Cognitive view: in your chosen mental ideas
(S-O-R)

View from Transpersonal Psychology

 From a traditional body mind paradigm to a bodymindspirit perspective
 Psychology as a study of the psyche (soul; there is a spiritual dimension
to the human being
Transpersonal Psychologists
 Carl Jung-beyond your personal unconscious lie the wider collective
unconscious which lives in you
 Abraham Maslow-to be fully human the highest point is not self
actualization but self transcendence
 Jaime Bulatao, SJ-it is about relationships

Asian Psychology
- There is no such thing as personality. Personality is but an illusion.
"Unless you die to yourself you cannot be born"

What does one awaken to?

The unfolding mystery of one's Self-one's being, one's being with others, in a
world that is part of a larger universe
How do we go beyond the Illusions of our conditioned habitual ego to the bigger
truth of our authentic being? How do we awaken to our sleeping beauties?
Inner Blossoming as a psychospiritual process of awakening to our more Whole Self
The view from inner Blossoming
Inner blossoming is about
recovering one's psyche/soul
one's bigger Truth
inner Brossoming approach 1: INVITING PRESENCE
- Can I be fully present in the There and now"?
- notice how I am co-authoring my experiences from moment to moment
- "give space and time to uncover more the genuine impulse and the inner
longing
- can we all be together in a moment that will never come again?
- "The most precious gift we can offer others is our presence. When
mindfulness embraces those we love, they will bloom like flowers." Thich
Nhat Hanh –

inner blossoming approach 2: OPENNESS

- "create open spaces by being receptive to what is becoming more realistic
- grounded in our bodies
- feeling with our hearts
- understanding with our minds
- awakening to our spirits
OPENNESS
- How do we help someone re-imagine her self and her world? – through more
creative ways of being!
- Through Re-vision-ing
inner blossoming approach 3: AWARENESS
 Am I present in my life?
 If I added 5% more awareness into my daily activities...
 What is one of the greatest gifts/can give?
 What makes my heart sing?
  If I did not have to live up to the expectations of anyone, who would be?
 What I choose to focus on is what I can 'see' and what I look at and can see
becomes reality for me.
Inner Blossoming approach 4: ACCEPTANCE
willingness to embrace our self and our life with respect and compassion
 If I were more accepting of my needs and wants...
 If I no longer deny my fears...
 If I could welcome my dreams more fully..
Unveiling Beams of LOVE
"Perhaps all the dragons in our lives are princesses who are only waiting to see us
act just once with beauty and courage. Perhaps, everything that frightens us, in its
deepest essence, is something helpless that needs our
love."
-Rainier Maria Rilke
Inner Blossoming approach 5: Understanding
Insights – when one accepts, one begins to understand and see
Attuning to the bigger picture of who we are
“Enlightenment or awakening is not the creation of a new state of affairs but the
recognition of what already is ”
- Allan Watts

Inner Blossoming Approach 6: Freedom

The discovery of one’s inherent powers!
“our deepest fear is not that we are inadequate… it is our light not our darkness
that frightens us”
- M. Williamson
“Something we were withholding made us weak, until we found it was ourselves.”
Inner Blossoming Approach 7: Making Choices
Claim one’s power to decide how to meet with changes and crises: test insights by
risking courageous action
“he who has a why to live for can withstand any how ” – Goethe
Swim out of you little pond – rumi
Go beyond borders – fr. Bu
Learn to dance with forever – maria

We are not only dust but also conscious

stardust
Indicators of growth and healing
- Physically reinvigorated
- Emotionally anchored
- Mentally calm and alert
- More connected to what matters most to us- families, friends, significant
others, the world of nature, and God (or a higher force)
- Expressing strength and courage to continue to look at present challenges
- With more loving respect for themselves
- And with resurrected faith and hope

1. Himas (way of affection)

“Gentleness and great love can transform disasters into blessings”
- Chen Yeng
“I did not hear nor understand the words you said, but I heard the love”
2. Gulat (ways of disconnection)
Ex: from the past, false beliefs, false gods, toxic habits
Are you ready for surprises?
3. Tadyak (way of confrontation)
To shake, jolt or startle the other to dare see – a monster or hidden angel around
within
“the flower that blooms in adversity is the rarest and most beautiful of all”
- The emperor of China, Mulan

4. Silbi ( way of service)

“Through altruistic acts we gain true wealth”
“Giving is like drawing water from a well; As water drawn, more flows in, it is by
giving that blessing continue to flow in”
“nurture the habit of giving and our word will become vast”
- Dharma Master Cheng Yen
Ramon Magsaysay Award 1990

“Rx for depression- do something good for someone everyday” – Alfred Adler
 5. Katahimikan ( way of silence and deep waiting)

For the new life or spirit to be born

A quiet heart mind is necessary for enlightenment

Filipino Methods of Awakening in Inner Blossoming

1. Himas
2. Gulat
3. Tadyak
4. Silbi
5. Katahimikan

Here is a scientific answer to our questions!

“We are not human beings having a spiritual experience”

“We are spiritual beings having a human experience”

Fr, Pierre Teilhard de Chardin

Into the blossoming garden of forever

Glimpsing our unity and interconnectedness with others, the universe, and God
“Inside – you are sweet beyond telling”

Experiencing Transformation
Through felt unity, soul connection, and opening to the Garden of Forever.
“how can a drop of water never run dry”
“by becoming a part of the ocean”

“your task is not to seek for love but merely to seek and find all the barriers within
yourself that you have built against it ” - rumi
“God is burning out of you everything which is unlike himself ” -- mother Teresa

Transpersonal Perspective
Part of the experience of being human is our sense of wonder
Who am I?
...yearning for something more

In the Transpersonal Perspective:

The search for identity, felt as a driving thirst to know who we are, is held as a
journey into Being
This is our
psycho-spiritual journey

- Being alive is an invitation to grow from simply being a biological or

physical organism to achieving our personality
- (personal ego who resides in an interpersonal world with others and his own
private intrapersonal world)
To become our Higher Self, or Essence, we are challenged to go beyond anchoring
our self-definition with our ego personality.
While traditional Western Psychology ends with actualizing the ego, or personality,
The Transpersonal Framework points to a Higher Self that is our ultimate and true
nature.
Thus, our so called personality is a very limited way of being, a state of
consciousness which William James says is but one of many other states
of consciousness

Types of ESP
Precognition-the ability to accurately perceive or predict future events
Telepathy-thought transference from one person to another, or mind-to-mind
communication.
Clairvoyance-ability to see things without making use of the sense of sight.

ESP is Hyper-empathy
What is Transpersonal Psychology?
Transpersonal psychology stands at the Interface of psychology and spiritual
experience.
It is the field of psychology which Integrates psychological concepts, theories, and
methods with subject matter and practices of the spiritual disciplines
Its interests include spiritual experiences, mystical states of consciousness,
mindfulness and meditative practices, shamanic states, ritual, the overlap of
spiritual experiences and disturbed states such as psychosis and depression, and
the transpersonal dimensions of relationships, service, encounters with the natural
world, and many other topics.
The central concept in Transpersonal Psychology is sell-transcendence, or a sense of
self-identity which is deeper or higher, broader, and more unified with the whole.
The root of the term, transpersonal or literally "beyond the mask, "refers to this self-
transcendence.
While this self-transcendence recognizes a value to the personal, it also holds
nonduality and the transpersonal as the more fundamental ground of being and
consciousness.

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are
powerful beyond measure. It is our Light not our darkness that frightens us."

A common human condition

We all have experienced existential pains:"" uncertainties, confusion, feeling lost
and direction- less
 overwhelmed by stress, wondering,
 searching for meaning, wanting purpose,
 faced with unwelcome pressures, failures

Three types of suffering,

 desiring pleasant experiences to be permanent/clinging;
 aversion to unpleasant experiences/escaping;
 spinning stressful stories-fantasizing/"if only"
The tragic triad of living
Pain:
Physical -ex, backaches, headaches
socio-emotional -ex. Rejection, betrayal
spiritual ex, need for meaning, relationships belonging to something greater.

Suffering: natural – storms, floods, fire, earthquake

Man-made-ware, ejk, trauma

Death: Loss – favorite pets, dreams, opportunities, friendship, BFF, physical death

DSM-5
 Neurodevelopmental Disorders
 Schizophrenia Spectrum and Other Psychotic Disorders
 Bipolar and Related Disorders
 Depressive Disorders
 Anxiety Disorders
 Obsessive-Compulsive and Related Disorders
 Trauma-and Stressor-Related Disorders
 Dissociative Disorders
 Somatic Symptom and Related Disorders
 Feeding and Eating Disorders
 Elimination Disorders
 Sleep-Wake Disorders
 Sexual Dysfunctions
 Gender Dysphoria
 Disruptive, Impulse-Control, and Conduct Disorders
 Neurocognitive Disorders
 Personality Disorders
 Paraphilic Disorders
 Other Mental Disorders
 Medication-Induced Movement Disorders and Other Adverse Effects of
Medication
 Other Conditions that may be a focus of clinical attention
Additional Notes:
 Internet Gaming Disorder*
 Caffeine Use Disorder*
 Suicidal Behavior Disorder*
 Nonsuicidal Self-Injury*