Self-Injury Stigma and Language, with Dr. Penelope Hasking

What is your initial reaction when you hear the term self-injury or self-harm? Or hear about someone intentionally cutting themselves or even scratching themselves or burning themselves? I've heard some call it "crazy" attention seeking, irrational or even manipulative, and describing people as cutters or self-harmers as if they're defined by their behavior. These are examples of stigmatizing language, and stigma often stands in the way of people seeking care or professional help when they need it. But what is the relationship between stigma and describing non-suicidal self-injury or NSSI for short as contagious or talking about self-injury in terms of recovery? And do clinicians and researchers use terms that those who self-injure deem appropriate? To answer these questions and to talk about stigma and NSSI, I am joined today all the way from Australia by Dr. Penelope Haskene. Welcome to the Psychology of Self-Injury Podcast, a resource for parents, professionals, and people with lived experience. I'm your host, Dr. Nicholas Westers, Clinical Psychologist at Children's Health, Associate Professor at UT Southwestern Medical Center in Dallas, Texas, and Chair of the Media and Communications Committee of the International Society for the Study of Self-Injury, or I-S-S-S, or simply I-Triple S. It's hard to research self-injury without coming across the work of Dr. Penelope Haskene. I remember having dinner with Dr. Haskene and a small group at the hotel restaurant during the 11th annual I-Triple S conference in Eau Claire, Wisconsin in 2016, and talking about how prolific she'd become in the field of self-injury. She's now the president of I-Triple S. She's also the co-founder of the International Consortium on Self-Injury in Educational Context. She has led the development of international guidelines for addressing self-injury in schools and universities, and has worked with international colleagues to promote advocacy and outreach for people who self-injure and those who care for them. Her primary interests are in the social and cognitive factors that initiate and maintain self-injury among youth. Thank you, Dr. Haskene for joining us today. Thank you for having me and inviting me to do this. So that we and our listeners are on the same page, how would you define stigma? That is, what is stigma? I think stigma is really about people thinking differently about somebody else because of a particular characteristic. So, usually this is a negative view of somebody, which can lead to people being treated differently or potentially discriminated against because of that characteristic. So in the case of NSSI, someone might think a person with the history of self-injury is weak or attention seeking or that it's just a fad that they're going through a phase. And the problem with that is these attitudes can then lead to people thinking that those who self-injure maybe don't deserve help or that there are waste of time taking up space and emergency departments, for example, or potentially that they could be about influence on others if we're talking about something like contagion. And this can then make someone who does self-injure feel even worse about themselves if these stigmatizing views are being expressed and enacted and can present a barrier to seeking support even if somebody needs it. How did you become interested in stigma as a topic, especially as it relates to self-injury? I think there are a number of different parts to that answer. I've always been aware of the stigma associated with self-injury and of people being labeled as attention seeking of clinicians and emergency nurses talking about frequent lives, people who repeatedly present to emergency. And one of the reasons I got into the field was to try to educate and inform and minimise some of that stigma. More recently though, I was involved in a project with a PhD student of mine and somebody talked about NSSI recovery. And I had this kind of visceral reaction to the word recovery. And what I was thinking, they recovery from what? NSSI is a behaviour, it's a coping strategy. And we don't usually talk about recovery from coping strategies. So it just kind of sat in my brain and didn't quite make sense. And then I started bouncing off other words. So words like maladaptive and started thinking about, we're talking about being maladaptive because somebody likely to internalise that and perceive themselves as maladaptive. Contagions another one that comes up a lot. So these all started to swim together in my head. And I wondered about the impact on somebody who hears themselves being described as someone who's engaging in a maladaptive behaviour that is attention seeking, contagious and shouldn't be talking to other people and it's not recovered. And I felt like individually these words might seem harmless, but when you put them all together, they present a very invalidating picture that I think can have quite a profound impact on a person who's hearing themselves described in that way. So that really kicked off my interest in language and how that made the petuate stigma. And I definitely want to touch up on some of those comments you mentioned related to read the term recovery, contagious. And I know also I've heard stories about individuals going to the emergency department at their local hospitals seeking services for non-suicidal self-injurious behaviours and wounds and being treated differently and being stigmatized like you had mentioned. And I think a lot of times the perpetrators of stigma are us as mental health professionals and clinicians and researchers. So I'm very appreciative of your work and what you're doing in our talk today. And what are some common ways that we talk about self-injury that may inadvertently perpetuate this stigma about the behaviour and individuals who engage in it? I think there are a number of different words that when you use unconsciously that people aren't really aware, are likely to be stigmatising. And I mentioned clinicians and emergency nurses before using language that may not be appropriate. And I know where you think that people are doing this on purpose. So I think that's the first thing to take on board is that we're not sort of seemingly pulling people out and saying, you know, you're being malicious about this. That's not the issue at all. But I think we can reflect on the fact that language really shapes how we do the world. It's how we communicate meaning and value to the things around us. So the language we use is really important. I think one of the most important things we can do is try to use person-centered language so we don't refer to people as self-injuries or cutters because that's really diminishing them to just one behaviour they engage in and really ignores the person as a whole and the other things that are going on in their lives. Avoiding labeling language. So anything that gives the impression that something is good or bad, as I kind of inferred before, it's possible that someone can internalise that message and start to see themselves as good or bad. So we want to try to avoid that. So the example I gave before was talking about self-injuries being maladaptive. And while people might talk about the behaviour as being maladaptive, if somebody then starts to internalise that message and think they are maladaptive, that's when it becomes a problem. So that has been not in the perpetuates that stigma but has that impact on somebody's self-worth and their own self-view of themselves. Yes, so you mentioned a couple things. One, making sure that we don't label people by their behaviour. So we separate the person from their behaviour because none of us is a direct result of our behaviours. We engage in behaviours. We do things that may or may not be helpful for us, but we are more than what we do in a given moment. So I think that's a huge thing for us to consider is refraining from language that calls people self-injurer, self-harmers, cutters, however the word might be. And then another thing you mentioned is how individuals may start to internalise that. And I know there's some research out there on self-stigma and how individuals will start to believe the public stigma that's out there that maybe they are their behaviours. And so what kind of effect might that have particularly maybe a young person that is engaging in self-injury? I think it can have quite a significant effect. People don't usually self-interface because they feel good about themselves. So if we're putting messages out there that are saying somebody is maladaptive or hopeless or a waste of time, then that's just continually hitting more of these negative points and potentially making somebody feel even worse about themselves and reducing the chance of a likelihood that they would seek support or ask for help if they felt they needed it. One of my PhD students has just published a paper looking at different kinds of stigma and looking at public stigma, that self-stigma, that internalisation of that public stigma, but also looking at anticipated and enacted stigma. So what do people expect to happen? What do they, if they disclose their self-injury, what do they expect other people will do or how they react and then they're enacted stigma. So what are they experienced in terms of stigma? And there's definitely a lot of that anticipated stigma that people very much view others are going to have a very negative view of themselves and going to treat them differently because of their self-injury, which then reduces the chance that they're going to tell anyone about it. So there are a lot of different kinds of stigma. We just mentioned public stigma, self-stigma, professional stigma, and here enacted or anticipated stigma. What are some common myths that perpetuate stigma about self-injury? I think the ones that come to mind are kind of those stereotypes that people still seem to hold on to. And I'm thinking of things like only teenage girls self-injure, that they're doing it for attention or to fit in with others or that it's a fact that they'll grow out of. And I think like with the language, when you put all of those together, you've got only teenage girls doing it for attention and not just grow out of it, it compounds that myth and it compounds that stereotype and feeds those negative attitudes and that stigma towards self-injury. And as we know, all of those are untrue. Anyone of any age can self-injure girls and boys, women and men self-injure and it's not confined to adolescents. Some people will self-injure, will pass that into self-adulthood. So perpetuating those myths likely reinforces those negative attitudes and that stigma and potentially may lead to that in that kind of stigma. So if somebody thinks somebody's just attention-seeking, it's just a fact that they'll grow out of, we don't need to worry about it, we don't need to take it seriously. And then that's going to feed into how somebody who self-injures is treated. And you mentioned how the myth that is more of something that girls or females may engage in. And so I'm thinking even as a male, this stigma might be that it's not a guy's problem. And so there's not, it's not okay to ask for help because if I self-injure and people think that only girls do it, then my chances of seeking help, I couldn't suspect, would be a little bit lower. I think you're absolutely right. That's a really interesting question. It's not one that we've explored to date, but we certainly have some interview data with men and women. And it would be really interesting to have a look at some of that data and see how that anticipated stigma in particular may impact help seeking differently for women and men. People often wonder if self-injury is contagious. So first, what is the link between stigma and use of the word contagious when referencing self-injury? Well, to go back a step, the idea of contagion comes from the suicide literature, where people know that somebody who knows someone who's died by suicide is at greater risk of engaging in suicide or behavior themselves, or that glamourizing and publicizing suicides of public figures tends to increase rates of suicide. So the contagion word has been in that suicide field for a very long time. And I think we've just stolen it and applied it to an SSI. The concern I have with the word is that it's really grounded in infectious disease models. So we talk about viruses, for example, being contagious. So it implicitly suggests that somebody who's self-injures has this infectious disease that can be spread to other people just by being around them, which obviously isn't true. And to me, that disease-based model just comes with this notion of disease and being diseased, which I think is not helpful in describing self-injury or somebody who's self-injures and feeds into some of those implicit negative attitudes around what self-injury is, why somebody might engage in self-injury and what impact that might have on other people. It also, again, ties into that help seeking or support seeking idea. So people are very afraid to talk about self-injury because they're worried that talking about it might increase risk among vulnerable youths usually. So it's a big concern in schools. How do we address self-injuring schools without creating this epidemic of self-injury? And I think if we take that contagion idea out of it and look at, you know, people do talk about self-injury, people are self-injuring. So it's not helpful to ignore it and say, let's not talk about it. The better question is to ask, how can we talk about it safely? How can we talk about it in a way that doesn't increase risk for other people? And in terms of the language, I tend to suggest changing the words, just not using the word contagion. So we might talk about selection effects where like-minded people tend to hang out together. So the fact that two people in a group might self-injure isn't about contagion, it's about that they may have similar underlying concerns and a similar way to cope with that. There may be socialisation effects where somebody does get the idea to self-injure from somebody else. So I'm not saying that doesn't happen, but taking out that word contagion, I think sort of takes some of the emotion out of it. And then I think the other thing to think about is in terms of peer effects, there are peer influences on self-injury and peer consequences of self-injury. So we can look at an array of different factors that feed into self-injury and the following effect, not just within peer groups, but at a societal level as well and broadened the conversation to social attitudes, social knowledge awareness, stigma, broadly. I like what you said earlier about, with schools, we don't want to simply not talk about it, but bringing awareness is more than simply talking about it. And you mentioned using the correct language and I think when it comes to just mental health in general, I do see a lot of people, including a lot of mental health clinicians arguing that we need to talk about mental health more, or mental health disorders or suicide prevention or suicide awareness or non-suicidal self-injury awareness more. And I think one of my criticisms to an extent is I think a lot of people are aware, it's just they just don't know how to talk about it and not knowing how to talk about it could perpetuate stigma and cause more harm. So we need to make sure we're not just talking about mental health concerns or even self-injury more. We need to make sure that we're talking about it correctly. I think that's a really good point and I get the impression that people want to talk about it, but they're very afraid of making things worse. So particularly in that suicide prevention space that you mentioned, people are very afraid of how to, you know, I don't want to make things worse, so I just want to talk about it at all. Let's talk about recovery next. You had mentioned earlier the term recovery as related to self-injury has been met with some criticism, particularly your own about maybe some of that reaction initially that you had felt or had to hearing that word. For instance, how long must someone go without self-injuring to be considered, quote, recovered? Was it six months, 12 months, years? So recovery can mean different things to different people, such as cessation of both the behavior and urges to engage in the behavior or some take it even further to the presence of wellness. So not only the behavior absent, the urges absent, there's also has to be a step further where they want to be overall well. Is there a relationship between self-injury stigma and using the term recovery and any of the research that you have done? We haven't yet looked specifically at stigma and use of recovery. We do have that data, but many people who self-inja use the term recovery themselves. That's a concept that they feel comfortable with and we'll talk about. But I would caution anyone against conceptualising recovery in terms of a time since somebody self-injaed. And that's the way we usually see it presented in the literature, as you said, is at the last six months, is at the last 12 months. And we know from the data that we have, when you talk to people who self-inja, they will talk about experiencing ongoing urges, ongoing thoughts of self-injury long after they last self-injaed. And they will define recovery as no longer having those urges or no longer having those thoughts. And to me, one of the things that concerns me about that is people may have those thoughts or urges for years. And if somebody defines recovery as not having them, then they're going to view themselves as not recovered even if they haven't self-injaed for a very long time. So I think the first part of that recovery process is normalising ongoing thoughts and urges and allowing people to realise that that doesn't mean somebody hasn't recovered. It just means that this is part of their life. That's just the natural thing and the important thing and then is how they address or deal with those ongoing thoughts or urges. So it's not like this fatalistic, you know, you're never going to be recovered because you always have these urges. But saying, yep, that's part of it. The important thing is how you deal with those. I think another part of recovery is this sense of self-efficacy. So the belief and the ability to resist any of those urges or to accept those thoughts and just sort of let them pass through. And the belief and your ability to engage alternative coping strategies. And we've written about how clinicians in particular can work with people who self-injaed to recognise times when they've had an urge to self-inja and didn't act on that. And saying, look, you know, if this is your goal, this is what you did, you've done it before, you can do it again and working with someone to build that self-confidence that they can lead with those thoughts or urges. And obviously the salient or the strength of those thoughts or urges and the frequency of them is likely to diminish over time. But I think accepting that that's normal is an important thing. I think some of the other things around recovery, it's broader than just the behaviour. So people who self-inja may have visible scarring that other people can see and that's going to be with them for quite some time. So part of that broader recovery process is deciding what to do about that. Do they decide to conceal those scars, not conceal those scars. What are the consequences of that? How might they deal with somebody staring at the scars or asking about them? So it's an ongoing thing. It's not just stop the behaviour. There's a lot more to it that goes into that. And I like what you said before about that sort of sense of well-being. So we would talk about recovery ultimately having this self-acceptance and that includes, you know, any, how do we deal with disclosure? Who went what, where, how do we deal with scarring? How do you deal with those ongoing urges? And that self-acceptance kind of transcending that as a final kind of recovery point? This might be the beyond the scope of our conversation or interview today, but as you were talking and as I was thinking about separating the person from the behaviour as well as the term recovery and what that means, I think about other models, you had mentioned disease model or in some areas addiction, where alcoholics anonymous, for instance, they identify as that and then identifying as the behaviour enables them to overcome the behaviour that they want to overcome to an extent. Do you have any thoughts about how that might apply to self-injury? I haven't thought about the addiction stuff a lot, but not really in the sense of whether taking on that identity could be helpful in that recovery process. But I think there's some more work we need to do in that space around how people conceptualise their own recovery and what that looks like over time. So I could definitely be a next step that I'd be curious to hear about and read about. We know that the diagnostic and statistical manual mental disorders, the fifth edition, so for our listeners, the DSM, which is the basically diagnostic manual that mental health clinicians use to identify mental health disorders based on set criteria. The DSM has proposed a non-suicidal self-injury disorder in its most recent edition, and it's not a formal diagnosis, but it looks to be a possible diagnosis in the future. There's a lot of arguments I think on both sides, is it beneficial or not? But what a formal diagnosis of non-suicidal self-injury disorder decrease or increase stigma, do you think? I think I can go both ways. I think having it formalised who would mean that self-injury is actually taken seriously in the inverted commas, I think it's not dismissed as attention-seeking that people recognise this is actually a thing that we need to address that we need to talk about, and that could be validating for somebody who self-injures. That could be validating if clinicians start to take them seriously, family, and friends, sort of recognise that this is something of concern. But we also know that self-injury tends to be bundled together with mental illness as well, so not only does self-injury come with its own stigma, it usually comes along with mental illness stigma. So codifying an SSI as a mental disorder may exacerbate that mental illness stigma as well as the stigma associated with engaging in the behaviour. I know that Stephen Lewis has done some research who's actually asked people with lived experience what they think about, including an SSI in the DSM, and his findings were exactly that, that some people said yes, this could be a really validating thing, and that may well tie in with that AA kind of idea of identifying with the behaviour. But he also had people saying actually I think it's going to perpetuate stigma. It's going to be interesting to see what happens and what the pull-out from them is actually going to be. That's such a great response yet, because I think there's just different ways to look at it. There are probably advantages and disadvantages in having to weigh that out, but we know obviously right now that criteria is quite imperfect in a work in progress. You just mentioned Stephen Lewis and you and Stephen and Dr. Boyas had just co-authored a paper that's going to be coming out about stigma and language related to self-injury. Can you tell us a little bit about this paper that you guys have written? What we did is we put out a survey to clinicians, researchers, and people with lived experience of self-injury and gave them a list of words and phrases that are used to describe an individual who's self-injus, the behaviour itself, and the course of self-injury, sort of that onset, maintenance recovery timeline. And we asked them to indicate on a scale how appropriate they thought those terms were or how appropriate those phrases were. And we see some differences in what people think is appropriate terminology. With the second part of that study, we asked them the clinicians and the researchers only how often they tend to use those words or phrases in their work, in their clinical work, or in their research work. And there's a bit of discrepancy between what people consider to be appropriate terminology and what they were actually saying they were using in their research or in their clinical practice. So researchers tend to rely on words that are epidemiological in nature, so they describe the onset of the sort of the rates of self-injury, whereas clinicians are focused on things like getting better and recovery and those clinical kind of things. I think probably the most striking was words and phrases that pretty much everyone agree to were most appropriate to describe people with lived experience were someone with lived experience of self-injury or someone with the history of self-injury. But clinicians and researchers reported underusing those terms in their practice. So they recognise and said these are the most appropriate things, but that's not what they were using themselves. To me, that was just a little bit of a wake-up call to say, you know, just take a minute to think about the language you're using and is it even consistent with your own values, let alone what people with lived experience would like to be hearing. Someone with a history of non-suicidal self-injury or someone with lived experience, we've been using a lot of that terminology throughout our conversation here. You also mentioned interestingly, while researchers and clinicians tend not to use phrases that they themselves consider most inappropriate. That's good news, so there are some really inappropriate terms that most clinicians and researchers recognise such as self-injury as being manipulative or attention-seeking. I'm fascinated by the statistic in your paper talking about up to 15% of researchers and clinicians reported using terms that people with lived experience of self-injury consider inappropriate, at least sometimes having reported using those terms such as hopeless, cutter, borderline, some quite pejorative words in terms. In 15%, that's 1 in 7. Basically, 1 in 7 researchers and clinicians using that, and that's fascinating to me as a clinician, primarily, in my second role being more of a researcher. Is there anything else you want to tell us about that paper that really challenged the way you thought or that we should be, that should challenge our thoughts about how we use language? Yeah, I think the statistics that 15% sometimes use those words that we'd consider most appropriate, I don't think we need to oversell that. I think overall people are doing well. Great. The message is paper is by and large clinicians and researchers are doing okay. There are a couple of times people are using words that maybe they shouldn't be, and again, it was at least sometimes. It's not like they're using them all the time, but overall people are doing okay, but there are probably, there's probably some room to be a little bit more respectful. And as I said before, this hate home for me is really, you know, take five minutes just to think about what words are we using. And I've come back to what I said right at the beginning. I don't think people are being malicious in the language that they're not deliberately using terms that are likely to be stigmatising. Taking some time just to think about what comments are being put out there and what impacts that might have on people may be helpful. I like that very empathic approach there in response, because I know I had mentioned earlier about professional or provider stigma. And I think part of that stems because a lot of mental health clinicians see people that are struggling whether it's with something unrelated, but when just talking about mental health in general, mental health disorders in hospital settings, for instance, or the emergency department, clinicians are seeing families and individuals in crisis. And so it's easy to get overwhelmed by that. And I think it is a learning process. And I'm reminded of one of the mental health stigma writers, researchers, authors, Patrick Corrigan, who talks about not necessarily being the word police, because I know there is power in our words in changing how we talk about things like you had mentioned earlier, but at the same time, simply not allowing someone to use a specific word may not change their stigma, their beliefs, their negative beliefs about the behavior about those who engage in it. But there can be at least a start. So yeah, we're not talking about being the word police here. We're talking about more building that empathy, knowing that we're all at work in progress. We all mess up at times. And I think even myself as a psychologist in engaging in self-awareness, making sure that I am remaining humble in knowing that I even I mess up and I'm sure I've messed up. And you said earlier, we don't intentionally judge people or behaviors, but sometimes it can come across that way and think and come across as stigmatizing. So I think that is important for us to make sure that we stay stay on our toes. I think that's a really good way of putting it. And I think it's important to recognize that things change as well. So I've absolutely used these words and phrases in my early papers. And I look at them now with dread going on. But it's that self-reflective process. And we learn as we go. Yes, it's very humbling. Well, based on our conversation today, what would you recommend to parents, professionals, and people with lived experience? So we'll start with with parents of those children who have self-injured related to our conversation about self-injury and stigma language. For parents and I think for professionals as well, the starting point is to realize that people self-injure for a reason. Self-injury doesn't happen in a vacuum and that it serves a purpose for them. So it's important to think about what is that function that it is serving. And depending on what that function is, that may mean that stopping self-injury is actually quite difficult. Criticizing people or punishing them or diminishing their efforts in NSSI recovery, which I use in inverted commons isn't going to help. Coming back to that idea that ongoing thoughts and urges are common, that life's as a common, and again not getting frustrated with people or thinking they're deliberately not trying to change or deliberately trying to hurt you or manipulate you, this is an ongoing struggle and it can be really difficult. And I think understanding that will help foster that relationship between parents and their children and help them understand each other and understand what's going on in that process. And how about people with lived experience? Again, I come back to this idea of self-acceptance. And one of the things that we're sort of writing a paper recently around this idea of that AA kind of model that I'm not going to be recovered into all the thoughts in an urges go away, I think there's some scope there for people with lived experience to realize that that's not necessarily true, that just because they're still having thoughts or urges doesn't mean that they haven't recovered or that they haven't progressed in some way. And that baby steps are important, that it's important to reward any positive change, no matter how small that might be. And I think that's also true for parents and professionals as well. It may be that the behaviour itself hasn't necessarily changed but people feel more confident in their ability to resist urges. I would see that as a positive step that we can nurture and grow, that's great. Why do you feel more confident in that? What's changed? What's different? How can we work on that and foster that? Recognising strengths. We talk a lot within these kind of disease-based models and focusing on the self-injury and focusing on times in somebody's last self-injured, it's all the negative stuff. People with lived experience of self-injury are also often highly resilient and strong and capable and have strengths in lots of other areas of their lives. So reducing someone to that one behaviour, I think as I said before, ignores the potential for all of these positive effects and positive self-worth as well. I love that self-acceptance piece because I think about a lot of people may keep track of how many days it has been since they've self-injured and then just psychologically beat themselves up if they slip and have an urge and act on an urge when their goal has been cessation all along. And I think rarely does berating ourselves or beating ourselves up psychologically lead to lasting change. And so when you're talking about self-acceptance, I think that's that self-compassion piece knowing that being human. There's room for that, mistakes or slip-ups and it's part about learning about ourselves and accepting ourselves. And I think again, borrowing from the drug and alcohol literature, we talk about the difference between life's sense, life's sense and relapses. And I think we can take the same kind of model that, okay, ongoing thoughts and urges in normal slip-ups will happen. It's what you do with that, you know, do you then say, okay, well, I've slipped up that seed, it's all over. Or do you pick yourself back up and go, okay, that was one mistake. Let's keep moving forward. Is there anything else that you'd like to share with us about self-injury stigma and the language we use, anything that we may have missed or any final thoughts? I think it's kind of like what you're saying before in terms of for clinicians and researchers to be a little bit more self-reflective on how they talk about self-injury broadly, how they interact with people who do self-inja and almost just taking a time to put yourself in somebody else's shoes and think about what impact might this have on somebody who's probably not feeling so great about themselves already and is the potential to exacerbate that and inadvertently make them feel even worse. And if we take that time to go hang on, what impact is this going to have on someone else? Maybe that will help us rein in some of that stigma? Yeah, in that self-reflective piece, it's hard to change and stop stigmatization if we're unaware when we're perpetuating it and making sure that we're being very cautious with how we speak. So if someone wanted to learn more about your work or your lab over there in Australia, where can people go to learn more about your work? That's a really good question. We probably need to have a bigger presence in the world. The easiest thing would be to email me directly and then I can put people in touch with some of our research. There's also the website self-injury.org.au and that has some information there for researchers, clinicians, parents, teachers, people who've lived experience some basic psychoeducation and some resources for people as well. And people can also find you at the the IEEE, the International Society for the Study of Self-Indry web page as president. It's the letter i-t-r-i-p-l-e-s.org, and so there's a lot of great information there. Any listener can also get a hold of Dr. Haske in that way with any questions. Well, thank you very much for joining us. Hopefully this is going to be a helpful podcast interview for our listeners for parents, professionals, and people who lived experience. Thank you Dr. Haske and really appreciate you being here today. Thank you. We hope you enjoyed this episode of the Psychology of Self-Indry podcast. It is not considered therapy or meant to be a replacement for therapy, so if you or someone you love is in crisis and needs to talk to someone, you can reach out to the crisis text line, a global not-for-profit organization providing free mental health texting service through Confidential Crisis Intervention by texting home to 741-741. If you found this podcast helpful, please subscribe, give us a rating, and tell your friends. For all things psychology, follow me on Instagram and Twitter at DocWesters for all things self-indulatory, follow IEEE on Facebook and Twitter at i-t-r-i-p-l-e-s. I'm Dr. Nicholas Westers. Thank you for listening to the Psychology of Self-Indry.