What Is Self-Harm, and How I Can Help You.
Self-harm or self-injury can be a positive action for those who self-harm. This does sound a little controversial, and I can imagine that you are asking, ‘how so?!’ Surely this is a negative action with negative consequences.
I am not for one moment condoning or permitting this action, although what is important to understand is why people self-harm and have suicidal ideations.
Deliberate self-harm (DSH) is a lot more common than suicide. Some report that self-cutting is a way of preserving their life and ameliorating any suicidal thoughts, ideals, or further actions (Klonsky 2009).
The most common way of attempting suicide is taking an overdose, but there are many methods of self-harm people engage in such as cutting, biting, burning, and asphyxiation to name a few.
Evidence suggests there is a link between psychiatric illness that can also be co-existing with personality disorder.
What is self-harm?
Self-harm is when you inflict harm/injuries on yourself, such as cutting, as a way of dealing with challenging memories, pain, feelings, and overwhelming situations and experiences. It is also used as a means to ‘feel something’ by those who ‘feel nothing.’ Some people have described self-harm as a way to:
Change emotional pain into physical pain.
Having a sense of being in control.
Punish themselves for their feelings and experiences.
Express something hard to put into words.
Escape traumatic memories.
Turn invisible thoughts and feelings into something visible.
Create a reason to physically care for themselves.
Having something in life that they can rely on.
Reduce overwhelming emotional feelings or thoughts.
Have something in life that they can rely on.
Stop feeling numb, disconnected, or dissociated.
Express suicidal thoughts and feelings without taking their own life.
You may feel a short-term sense of release after self-harm, but the cause of your distress is not going to go away. Self-harm can also make you feel worse by bringing up very difficult emotions.
You may have your reasons for self-harming, but it is important to know that it does carry risks. Once you have started to depend on self-harm, it can take a long time to stop.
Not all those who self-harm have an intent of ending their lives or attempting suicide. For some, it is a form of controlled action and decision, especially when using ‘cutting’ to self-harm.
Deliberate self-harm may be used to interrupt sequences of events or thoughts that the self-harmer finds undesirable or uncomfortable. Hence many clients I have worked with say they experience relief, either physical or psychological, from engaging in that harm.
Self-harm may be used to communicate with others without having to verbalise how they are feeling or what their thoughts are. As someone working with self-harmers, we need to make sense of the message behind the behaviour of self-harm, to effectively support them and reduce, if not cease, the repetition of this maladaptive behaviour.
Some self-harmers do have underlying suicidal thoughts. They may express this by:
Indicating a continued sense of hopelessness.
Continued determination to die.
Frequent suicidal ideations.
Evidence of psychiatric illness.
Precaution taken against discovery.
The risk of deliberate death is higher amongst men than women. Social and cultural factors are also indicators for therapists, such as myself, to look out for as well as social-economic factors and age.
Medication, pre-disposed, precipitating, perpetuating factors, psychiatric history, family history, past therapies, and treatments are all considered when working with someone with suicidal intent or self-harm.
Why do people self-harm?
There is not fixed reason as to why people self-harm. It can be different for everyone. For example, for some, it is linked to specific experiences and is a way of dealing with something that is happening or has already occurred in the past. For some, the reasons may be less clear and more complex to make sense of.
Sometimes you may not know why you self-harm, but that does not mean you can’t get help.
Common reasons for self-harming include:
Loss of a job.
Homophobia, biphobia, transphobia.
Sexual, physical, and emotional abuse.
Breakdown of a relationship.
Pressure at school or work.
An illness or health problem.
An increase in stress
Difficult feelings such as numbness, anxiety, depression, or anger.
Some people find that substance abuse increases the likelihood of self-harm or that self-harm is more likely to happen at certain times, like the night.
How I work with someone who is self-harming
I assess the risk and look at how the risk can be managed; can it be changed? In my own practice, if a suicidal client or self-harmer seeks therapy as part of the contract, the client agrees to not engage in any suicidal activity or self-harm activity at any cost during their therapy.
A safety plan is agreed with the client, led by the client and they agree to take all the steps in that pan. Each plan will be different for each client.
The two key questions I ask when working with a self-harmer or someone with suicidal thoughts or intent are:
How does self-harm help you?
Do you want to end your life? Or do you want to end whatever is causing your distress, pain, or problematical situation?
I use an integrative approach, Cognitive Behavioural Therapy, and Dialectical Behavioural therapy in an effective way of working with self-harmers. This is done in an individual therapeutic setting.
Compassion Focus Therapy and Acceptance and Commitment therapy are integral to my working with these clients.
Distraction skills are crucial to progression as well and coping and managing tools needed to reduce behaviours in self-harm and suicidal attempts.
I hope you can gain some insight into self-harm, are able to empathise, and be able to assist them in getting support. If you can signpost a self-harmer to get the appropriate support, this can be the most important step and initiative implemented.
Young Minds: https://youngminds.org.uk/
A&E (Accident & Emergency department)
NHS111 or 999
Samaritans- Tel no: 116 123
Short Video by Marsha Linehan- DBT: https://www.youtube.com/watch?v=j_6j43zKNFw
If you know someone who self-harms or if you self-harm, know that you are not alone in trauma. Reach out to our therapist for a consultation.