Assignment Problem: Julie is a 16 year old girl who has been living in a secure hospital setting for the past two years. She was originally admitted due to concerns about her emotional instability and self-harm behavior. Since she was 12 years old, Julie has been cutting her arms and stomach. On several occasions, she has cut so deep that she has required stitches. She is ashamed of the scars, and always wears clothing that covers them up.
Since being in the treatment centre, Julie has been supervised constantly, which has reduced the cutting behavior. Any attempts to release her, however, have resulted in an escalation of the behavior as soon as she returns to the community. Julie has stated that she does not want to die, but cannot control the impulses to harm herself. Her parents are both actively involved in her life, but have stated that they are unable to care for her at home due to concerns for her safety.
Julie has been described as very smart, charming, easy to connect with and possessing a great sense of humour. She is also lacking a core identity, has low self-esteem, feels persistent shame and hopelessness, and has difficulty regulating her emotions and controlling her impulses.
Her clinical team has decided that Julie has become too institutionalized, and she needs to be placed in a community setting in order for any treatment to be effective. A therapeutic living arrangement is being developed just for her. Julie is very nervous about this move, although she is open to trying it.
You are developing the initial intervention plan for Julie. What areas would you focus on, what kinds of interventions would you attempt to incorporate into the plan, and why?