2. The wide range of problems faced by young people who harm themselves calls for a variety of different treatment strategies, varying from intensive care for those at very high risk of suicide, to brief interventions for the group of patients in whom DSH appears to have been a transient response to temporary difficulties and who have few other problems (Harrington, 2001). One of the most important obstacles to treating DSH patients that may play a role in almost every treatment is compliance (Heard, 2000 in: Hawton and Van Heeringen). Another obstacle in treating DSH patients is the limited availability of research data on effectiveness of therapy for DSH, especially of randomised controlled trials. In the section that follows the most common treatment approaches for DSH will be discussed. Attention will be given to what is known about the effectiveness in terms of reduction of repeated episodes of DSH. Cognitive therapy for DSH patients generally focuses on their tendency to evaluate events and the presence and the future in such a way that this results in the feeling of being entrapped (because of difficulties in coping) and hopelessness (because they have great difficulty in generating positive future events) (Heard, 2000 in: Hawton and van Heeringen). Cognitive and cognitive behavioural therapies directed at cognitive restructuring seem to be promising in successfully treating patients who harm themselves deliberately (Hawton et al., 1998).Given that problem-solving deficits appear to be related to increased risk of self-harm (Orbach et al., 1990), the most commonly used technique for older adolescents is brief problem oriented counselling, which is a form of cognitive therapy. While problem-solving therapy seems to be promising to improve depression, hopelessness and problem-solving skills (Towsend et al., 2001), it is still unclear whether problem-solving therapy can help not only address current problems but also longstanding deficiencies in problem-solving skills. Current research focuses almost exclusively on solving real or hypothetical problems in relationships with other people, yet one of the major issues for suicidal patients is how they can solve the problem of how to gain control over their feelings. Linehan (1993a, 1993b) developed an intensive treatment programme for patients with borderline personality disorder, called Dialectical Behaviour Therapy (DBT). This treatment method focuses on teaching skills that will help people to regulate their emotions and that stress the acceptance of pain and crisis. In a review by Heard (2000 in: Hawton and van Heeringen), in general, a decrease in repeated DSH was found among patients in DBT treatment. Group therapy seems to be promising as a treatment for adolescents who repeatedly harm themselves. However, larger studies are required to assess more accurately the efficacy of this intervention (Wood, Trainor, Rothwell, Moore, Harrington, 2001). No consensus on how to treat DSH medically has been reached yet. As for the psychological treatments, most studies on the efficacy on psychopharmacological treatments are too small to detect significant effects. So far, it appears that the most promising treatments are high doses of Serotonin Specific Reuptake Inhibitors (SSRIs), and, in selected cases atypical neuroleptics. SSRIs are probably the first line medical treatment (Kavoussi et al., 1994). Tricyclics do not seem to be effective for child and adolescent depressions and are toxic in overdose (Harrington, 2001). In conclusion, it can be said that there still remains considerable uncertainty about which type of psychosocial and medical treatments of DSH patients is most effective, inclusion of insufficient numbers of patients in trials being the main limiting factor. However, cognitive-behavioural therapies and problem-solving therapies and DBT seem to be promising. The present study will incorporate elements from cognitive-behavioural therapy, problem-solving interventions and DBT.