how to help people who self harm

[ellion]

How to help with self-harm

If self-harm has been an important way of coping then it may be very hard to let go, it should be a personal choice, coercing a person into stopping self-harm will not work. Alternative coping strategies and support should be in place before any reduction in self-harm can be hoped for. Don’t expect too much too soon, don’t see stopping s3elf injury as the most important goal, it takes a long time for a person to be ready to give up self injury. A person may make progress in many ways; look for a reduction in intensity or frequency of self-harming behaviour. Give the person who self-harms encouragement and acknowledge each small step they make.

Exploring why people self harm.

The first step is to spend time with the client to understand the reason why that particular individual needs to self-harm and help them to understand why they self in particular circumstances. It is also important to understand from the offset the intention of the self-harm. Did the person intend to die from the self-harming?

Talking

Offering the person support, by gently encouraging them to examine their feelings about why they self harm. The fact that you want to understand will mean great deal.

Ask the person to think about the first time they self harmed, what was going on in their life at that time. What support network did they have around them at the time?

Keeping thought diaries

It is important that the professional and the client understand the circumstances and feelings that trigger the need to self harm. Some people believe that going through this step by step process during the crisis decreases the urge to self injure.

Ask the person to keep a daily record of events and feelings, which should include:

A record of what is going on at the time, what situation were they in when they felt the need to self-harm, what was the trigger.

Identify the unhelpful intrusive thoughts present when they had the urge to hurt themselves

Describe the emotions before, during and after self-harming.

Write down what they did to prevent self-harming, maybe this could be utilised again.

Working through the diary with the person helps them to more closely identify what they were thinking and feeling before the urge to harm themselves, and how the situation that occurred may be connected to the urge. It will also identify  situation in their life when they may be more vulnerable. These are the times when they need extra support to help them cope.

Support is something that everybody needs, by support we mean having contact with people who care and who will help during difficult times. Build up their social network, help them to identify the people that are supportive to them and make them feel good about themselves.

Ask the person to write self-harm (or a word that has the same power for that person i.e. cutting) in the middle of a large piece of paper. Ask them to write words around it that come to mind, these may be feelings or thoughts, things that have happened in the past, people who have significance. Use different colours and draw pictures if this helps. Discuss the information un the paper with the person.

Distraction
Once the patient has identified the feelings that are present when self-harm occurs it may be useful to discuss distraction techniques that can be used as an alternative to self-harm. Most people that self-harm state that the distraction used should fit the emotions they are feeling and the reasons why they want to self-harm.

Angry frustrated
Some of these techniques may help the patient to express their anger, which would otherwise sit inside, making them tense and miserable and self-hating. Using these techniques may help them to acknowledge their feelings.
   
   Do exercises, go for a brisk walk, run or swim.
   Ask the person to line up a set of cushions or pillows to represent people who caused them pain, tell them how much they hurt you, kick and punch the pillow if necessary. It is necessary to have someone present when this occurs to make sure they don’t hurt themselves.
Write negative feelings on a piece of paper and then rip it up.
Tear up rags.
Write a letter to the person or people who are making them angry, get them to express for their own benefit what they would say to that person. Let them decide what they want to do with the letter i.e. rip it up, throw it in the bin, keep it.

Sad, unhappy
Sometimes self-harm is about trying to deal with desperate feelings of emptiness, neediness and lack of comfort.
Pampering, massages, relaxing bath, face masks, nails.
Do something soothing read and listen to music.
Open a window to get some fresh air.
Go for a walk in their favourite place.
 
Craving sensation, feeling depersonalised, unreal
Some people who self harm may use self-harm to help them to feel less panicky, frantic, anxious or numb.

   Squeeze ice cubes or rub ice where cutting would have taken place.
   Take a hot or cold shower.
   Use a red water-soluble felt tip pen to mark instead of cutting.
Scribble on a large piece of paper with a red pen
Put elastic band on the wrist to flick it.
Relaxation techniques.
Ask them to repeat to themselves “oh I am getting those feelings again, its ok, I’m alright, this will pass”.

Help them to start to feel good about themselves, or at the end of everyday write down a list of things that they have achieved, aim for small steps, remember that they may have been receiving messages for years about how stupid and useless they are. Achievements could be just getting out of bed pampering themselves, delaying self-harm, helping somebody else.

Ask the person to write down a list of hopes and dreams; what would they like their life to be like in five years time. Alternatively cut out pictures from magazines to depict hopes. Discuss with the person how these dreams could come be achieved.

[Shell]

Ellion, I know I'm really late at replying to this but still wanted to say that this is a really great read.

I work as a chaplain assistant and am always undergoing crisis intervention, stress management and suicide awareness training.  Sometimes, however, we discuss things like self harm.  I found this information very useful as insight.

Many people have loved ones who self harm and would really benefit from this information.  Thanks very much for this.