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Helping someone who self-injures
Perhaps someone you care about has honoured you by trusting you with
information about their self injury, or maybe you've inadvertantly discovered
it. Regardless of how you found out, you know about it now and you can't
pretend it away.
Naturally, you may feel upset, shocked or angry when someone you care about
hurts themselves. Try to keep seeing the person in pain behind the injuries.
The most precious things you can offer are acceptance and support. Let them
know you understand that self-injury is helping them cope at the moment. They
are not 'bad' or 'mad' for doing it. You could invite them to talk about their
feelings, or to call you if they are having a difficult time. Only offer as
much as you can cope with, and don't try to take responsibility for stopping
them from hurting themselves.
Don't take it personally
Self-injurious behaviour is more about the person who does it than about the
people around him/her. The person you're concerned about is not cutting,
burning, hitting, or whatever just to make you feel bad or guilty. Even if it
feels like a manipulation, it probably isn't intended as one. People generally
do not SI to be dramatic, to annoy others, or to make a point.
Educate yourself
Get as much information about self-injury in general as you can. There are
plenty of sites on the internet as well as some very informative books. Bodies
Under Seige by A. Favazzo is more scholarly in tone, The Scarred Soul by T.
Alderman is geared towards self-help and A Bright Red Scream by M. Strong lets
you inside the minds of self-injurers, talking about what they do and why.
These all contain valuable information and advice.
Understand your feelings
Be honest with yourself about how this self-injury makes you feel. Don't
pretend to yourself that its okay if its not - many people find it repulsive,
frightening or provoking. If you are having trouble dealing with it, by all
means find yourself a good therapist. Don't try and get secondary treatment for
the person who self-injures and if they are getting treatment, make sure you
see a separate therapist. Another important factor is make sure you don't ask
your therapist to diagnose or treat the person you're concerned with. Your own
therapy should be discussed in the most general terms and never say anything
like "My therapist says you should..." Therapy is a tool for
self-understanding, not for getting others to change.
Be supportive without reinforcing the behaviour
Its important that your friend, lover, child, sibling know that you can
separate who they are from what they do. You need to show them that you love
them no matter what. As much as you can, be available to them. Set aside your
own feelings of fear or revulsion about the behaviour and focus on whats going
on with the person.
Some good ways of showing support include:
• Don't avoid the subject of self-injury. Let it be known you're willing to
talk and then follow the other person's lead. Tell the other person that if you
don't bring up the subject, its because you're respecting their space, not
because of diversion.
• Make the initial approach. "I know that sometimes you hurt yourself and I'd
like to understand, if you could help me do that, I'd be grateful." Don't push
it after that; if the person says they'd rather not talk about it, accept this
gracefully and drop the subject. You could remind them you're willing to listen
if they do ever want to talk about it.
• Be available. You can't be supportive of someone if you can't be reached.
• Set reasonable limits. "I cannot handle talking to you while you are
actually cutting yourself because I care about you greatly and it hurts too
much to see you doing that" is a reasonable statement. "I will stop loving you
if you cut yourself" isn't reasonable if your goal is to keep the relationship
intact.
• Make it clear from your behaviour that the person doesn't need to
self-injure in order to get displays of love and caring from you. Be free with
loving, caring gestures, even if they aren't returned always (or even often).
Don't withdraw your love from the person. The way to avoid reinforcing SI is to
be consistently caring, so that taking care of the person after they injure is
nothing special or extraordinary.
• Provide distractions if necessary. Sometimes just being distracted (taken to
a movie, on a walk, our for an ice-cream: talked to about things that have
nothing to do with self-injury) can work wonders. If someone you care about is
feeling depressed, you can sometimes help by bringing something pleasant and
diverting into their lives. This doesn't mean that you should ignore their
feelings, you can acknowledge that they feel lousy and still do something nice
and distracting. (This is NOT the same thing as trying to cajole them out of a
mood or telling them to just get over it - its an attempt to break a negative
cycle by injecting something positive. It could be as simple as bringing the
person a flower. Don't expect your efforts to be a permanent cure though; this
is a simple improve the moment technique.)
• If you live apart from the person you're concerned about, offer physical
safe space. If you're worried about them ask them to stay over for the night.
Even if the offer is declined, just knowing its there can be comforting.
• Don't ask "Is there anything I can do?" Find things that you can do and ask
"Can I?" People who feel really bad often can't think of anything that might
make them feel better, asking if you can take them to a movie or wash those
(month old) dishes (if done nonjudgementally) can be really helpful.
Spontaneous acts of kindness ("I saw this flower at the store and knew you'd
love to have it") work wonders.
Take care of yourself
Sounds like hard work doesn't it? It is. You can't be completely supportive to
someone else 24/7, if you try to you will only burn out and they won't have any
incentive to change. Find ways to make sure your needs are met.
When you need to, take a break from it. As much as you love someone you're
going to need to get away from them for a while. Let them know that sometimes
you need to recharge and that it doesn't affect your love for him/her. Only
break into this personal time in cases of absolute life-or-death crisis.
Always remember, the balance here is tricky, because if you make yourself more
and more distant, you may get a reaction of increasing levels of crisis from
the other person. If you let them know that they don't have to be about to die
to get love and attention from you, you can take breaks without freaking the
person out. The key here is developing patience. Once you prove that you are
someone who isn't going to go away at the first sign of trouble, you will be
able to go away in non-crisis times without provoking a crisis response.
Ultimatums do NOT work. Ever!!!!
No matter how much you care for someone, you can't force them to change their
behaviour just to suit you. Ultimatums just don't work - well, they do if you
want to drive the behaviour underground. Perhaps the SI is suppressed for a
while, but when it inevitably surfaces its often more destructive and intense
than before. Self-injurers often find more hidden places to cut. Confiscating
tools used for SI is worse than useless - it just encourages the person to be
creative in finding implements. People have been known to cut themselves using
plastic eating utensils.
Punishment just feeds the cycle of self-hatred and unpleasantness that leads to
SI, guilt trips do the same. These are incredibly common and only make things
worse. The major fallacy here is in believing that SI is about you; it almost
invariably isn't (except in the most casual ways)..
Acknowledge the pain of your loved ones
Accepting and acknowledging that someone is in pain doesn't make the pain go
away, but it can make it more bearable. Let them know you understand that SI
isn't an attempt to be willful or to make life hard for you or to be
unpleasant; acknowledge that its caused by genuine pain they can find no other
way to handle. Be hopeful about the possibility of learning other ways to cope
with pain. If they're open to it, discuss possibilities for treatment with
them.
Don't force things
If you make overtures and they're rejected, back off for a few days or weeks.
Don't push it. Some people need time to decide to trust someone else,
particularly if they've received a lot of negative feedback about their SI
before. Be patient.
Adapted from Deb Martinson © 1996-2004
Secret Shame
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