Helpful responses to self-injury

Show that you see and care about the person in pain behind the self-injury

Show concern for the injuries themselves. Whatever "front" they may put on, a person who has injured herself is usually deeply distressed, ashamed, frightened and vulnerable. It is cruel and counter-productive to "withhold attention". You have an opportunity to offer compassion and respect; to show them something different from the way they have been treated by most people in their lives.

Make it clear that self-injury is okay to talk about, and can be understood.

Convey your respect for the person's efforts to survive, even though this involves hurting herself.

Help her make sense of her self-injury. For example: ask when the self-injury started, and what was happening then. Explore how self-injury has helped the person to survive (physically and emotionally), in the past and now. Ask how she feels before she hurts herself, and how she feels afterwards. Retrace with her the steps leading up to an incident of self-injury - the events, thoughts and feelings which led to it.

Acknowledge how frightening it may be to think of living without self-injury.

Encourage the person to use the urge to self-injure as signals of buried feelings, memories, needs. (These will be unfamiliar and frightening; go slowly and offer support.) Help her learn to express these in other ways, e.g. talking, writing, drawing, hitting something. Encourage her to ask for support and to care for herself.

Help the person to break down isolation and shame and to build up support networks. (e.g. groups.)

Don't see stopping self-injury as the most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when previously buried issues or feelings are being explored, or when old patterns and ways of living are being changed. This can be frightening but is understandable.

It takes a long time for a person to be ready to give up self-injury. Encourage her and yourself by acknowledging each small step as a major achievement. Examples of very valuable steps might be: taking fewer risks (e.g. avoiding drinking if she thinks she is likely to self-injure); taking better care of the injuries; putting off hurting herself for a day of an hour; reducing the severity or frequency of the injuries even a little. In all cases more choice is being exercised the "hold" of self-injury is being loosened.

Copyright Deb Martinson © 1996-2004   Secret Shame