Self-injury behaviour is complex and often misunderstood. 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. In the last several years, helping professionals have begun to understand that these behaviours are not done with suicidal intent, but rather, they have many other functions.
It is our job as helpers to assist the person in understanding the function of the self-injury behaviour and its context. This understanding lays the groundwork for clarity and provides the motivation to engage in treatment. Counsellors should remember that young people may not understand all of the reasons why they self-injure. In the process of exploring their reasons for self-injuring together, we can model and teach new skills along the way.
It is our job as helpers to assist the person in understanding the function of the self-injury behaviour and its context.
Why do people self-injure?
Self-injury behaviour primarily serves to regulate emotion, along with several other potential functions, such as relieving feelings of numbness or dissociation, reducing suicidal thoughts, punishing oneself for perceived wrongdoing, or seeking sensation through endorphin release. Emotional regulation is the most typical function of self-injury in both adolescents and adults. Those who self-injure often describe the feeling of calm that rushes over them after they self-injure.
Here are some common functions of self-injury:
- Influencing emotional regulation; helping to reduce suicidal ideation
- Reinforcing beliefs that lead to self-punishment or self-anger; serving as an anti-dissociation method
- Seeking nurturance and/or pleasant sensations
Once clients, their families, and their 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.
Self-injury behaviour primarily serves to regulate emotion… Those who self-injure often describe the feeling of calm that rushes over them after they self-injure.
A solid therapeutic relationship is a great place to start in order to understand the functions of self-injury behaviour, which you may find out in the process of discovery together. What follows are some steps you can take to strengthen your relationship with the client and determine the function of their self-injury behaviour:
1) Hold a curious, nonjudgmental stance
- Begin the relationship by focusing on getting to know the youth or the adult as a person, rather than initially focusing on the self-injury behaviour.
- Do not respond to revelations of self-injury with shock, anger, aversion, or disgust. Convey a sense of concern without overreacting. Advise about medical attention as needed.
- Do ask about suicide but do not assume that the self-injury behaviour is an indication of a suicide attempt.
2) Start to build awareness of the cycle of self-injury
- Communicate that each person’s experience of the cycle is unique to them.
- Help them to begin the process of separating what they are thinking and how they are feeling before, during, and after the act of self-injury.
- Explore the impact of relationships and environment. For example, when, where, and with whom do they self-injure? What is the impact on their relationships when they self-injure? How do others respond?
3) Invite open discussion of what the client believes is the function of self-injury behaviour
- Ask questions about what the client sees as the benefits of the self-injury behaviour.
- Explore all of the common functions of self-injury behaviour so that the client can consider if any of them are a “fit” in their own situation.
When clients 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 them down and help make them feel “normal.” As counsellors, we can do this by being intentional about our presence, using compassion, and, very importantly, conveying a sense of trust in clients’ abilities to explore what they believe is happening on the inside for themselves.
This is an excerpt from CTRI’s book, Counselling Insights – Practical Strategies for Helping Others with Anxiety, Trauma, Grief, and More.
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