Helping Those Who Self-Injure

Self-injury behaviour is a complex and often misunderstood act. When a person is cutting or burning their own flesh, picking and interfering with the healing of wounds, or hitting themselves, it can be confusing and scary for their loved ones, and even for the professionals who try to help.

It is critical that we attempt to understand the function that self-injury behaviour has in a person’s life. Many of the responses that young people describe as unhelpful involve shock, anger, judgment, and what they perceive as over-reaction on the part of others. In some cases, the reaction of those involved can be described as overly complacent or even dismissive. It is also not helpful when helpers or those close to the person who is self-injuring automatically assume that suicidal intention is present. The person inadvertently feels less understood if the clinical interventions (such as hospitalization) that are undertaken do not match with their intention. This assumption can further drive the behaviour underground, as self-injury often already involves shame and secrecy.

Self-injury behaviour primarily serves one or more of these functions:

• To regulate emotion.
• To relieve feelings of numbness or dissociation.
• To reduce suicidal thoughts.
• To punish oneself for perceived wrong-doing.
• To seek sensation through endorphin release.

Once young people, their families, and support systems are able to understand what purpose the self-injury behaviour is serving, they can begin the process of building new ways of thinking, understanding emotions, and finally, acting with increased self-awareness.

When young people have built the habit of escaping from the present moment when difficulties arise, a safe container needs to be offered where empathy and understanding are present. It can be extremely alarming to contemplate giving up a behaviour that has served to calm us down and help make us feel “normal”. We do this by being intentional about our presence, using compassion, and making sure we convey a sense of trust in the person’s ability to explore what they believe is happening on the inside for themselves. Young people who self-injure have often built up a long history of ignoring or overriding their own needs.

A counsellor must attempt to build a safety net for the person who self-injures so they can express themselves and get their needs met. For young people, it is often necessary to help the family to be an effective part of this. With adult clients, it may be a partner, other family members, or friends who serve as part of the support and safety network. Building on the previous principles, it is important to have a balanced focus between the behavior and the function it serves, without being overly focused on abstinence, especially in the beginning. Safety includes people in the support system coming to understand the positive need for engagement and attention behind the behaviour, rather than misunderstanding it as manipulative attention seeking or an overly dramatic behaviour.

How to Help:

• Do not to respond from fear. Education about our fight or flight instinct helps foster understanding of the powerful impact of remaining calm and fully present when someone else is in distress. The power of being a regulated, solid, and responsive role model cannot be underestimated.
• Teach and practice breathing and other emotion regulation strategies. Breath is one of the most direct routes to calm our nervous system and process our emotions. Some people also benefit from other mindful awareness activities that involve using their senses or guided imagery. Also, activities involving movement, such as walking or martial arts, help people to restore their own emotional equilibrium.
• Coach parents, partners, or family members to be present and notice what is happening for the client. For example, they could show interest in how and what emotions clients are feeling and send a message that those feelings are okay. Reinforce the idea that emotions are separate from behaviours.
• Provide genuine yet respectful feedback on their communication skills. Offer gentle guidance about how to talk to the person and interrupt unhealthy communication patterns that may have developed over time.
• Encourage support people to give less attention to unhealthy or dysfunctional behaviours. Provide examples of how they can validate the person without reinforcing the self-injury behaviour. For example, set a regular time to spend time together and focus on a shared interest or hobby. The need for time and attention from loved ones cannot be underestimated.
• Actively screen for mental health concerns for both the individual who is engaging in self-injury behaviour and their family members whenever possible.
• Collaborate with other professionals in healthcare, the school system, or a work setting when it is appropriate to do so.
  Remember, the functions of self-injury can include restoring calm and comfort, expressing distress, releasing tension, reducing suicidal ideation, and, at times, grounding a person in reality. Effective interventions are accomplished by taking an individualized approach to treatment and a warm, empathic relationship with each person in their support system.

The roadmap to healing is unique for each person. Using these guiding principles will hopefully contribute to understanding the diverse paths for people who have used self-injury behavior as an attempt to temporarily feel better. Many people have been able to discover increased confidence in managing emotions, more hopeful ways to look to the future, and, often, a new way to relate to the important people in their lives. This work is accomplished by all of us increasing our capacity for compassion and understanding.

This blog is a sample from our book, Counselling Insights.

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