Helping Those Who Hurt Themselves
By Tracy Alderman, Ph.D.
The Prevention Researcher,
Volume 7, Number 4, 2000, Pages 5-8
If you work with youth, it?s likely that at some point you will come in contact with someone who self-injures. This article is intended to provide some support, advice, and education to those who have students or clients who engage in activities of self-inflicted violence.
What You May Feel
Shock and Denial
Because self-inflicted violence (SIV) is a secretive behavior, it can be shocking to learn that someone you know is a self-injurer. You may not have noticed many of the signs of SIV, such as a refusal to wear shorts or short sleeved shirts, even on the warmest of days. You probably gave no thought to the frequent "accidents" or the numerous bruises and cuts on the arms and legs of a student which were always accounted for by a logical source. Self-inflicted violence lends itself to secrecy quite well ? it usually takes place in isolation and the results can be concealed with relative ease. Also, most people are often eager to ignore or deny many of the tell-tale signs of this behavior. Thus, when you find out about the self-injurious behavior, it is shocking.
Denial is related to the shock. At times, denial is appropriate, useful and necessary. However, with self-inflicted violence denial is detrimental. People who injure themselves are in a great deal of psychological distress. To deny this distress will communicate that you are not interested, not able to help, or do not understand their SIV behaviors. When you are confronted with the self-injurious behaviors it is important you do not deny the reality and implications of the situation. Although this may be difficult, responding to the SIV, rather than denying its existence, is necessary in order to aid those individuals who are injuring themselves.
Anger and Frustration
Anger is a common response when learning of an individual's self-injurious behaviors. There are many reasons for this. First, anger may stem from the deception which often surrounds SIV. Many individuals who hurt themselves lie about the causes of their injuries. Deception is used as a way of reducing feelings of shame and warding off possible reactions of anger, disgust or rejection from others. However, when the deception is discovered it often produces those very same feared reactions.
Additionally, believing that the self-inflicted violence was not necessary may also anger you. Watching individuals do things to physically damage themselves is frustrating. You may be inclined to scold them or force them to stop hurting themselves. Frustration stems from our inability to control the behaviors of others.
Self-injury, as opposed to many other self-damaging behaviors, usually produces visible, physical evidence. This evidence forces us to realize the extent of our helplessness in changing the individual's behaviors, causing us frustration and anger.
Empathy, Sympathy and Sadness
Empathy is often a mixed blessing. On the one hand, it allows you to be more helpful while also causing you to feel similar sadness and psychological pain as the individual with whom you are dealing. Individuals who engage in self-inflicted violence experience enormous psychological distress. It is essential to understand the immense nature of this distress providing support and assistance. However, by doing so, you run the risk of allowing that person's inner world to penetrate you. The result of our inability to remain detached is that you may feel some of their sadness and pain.
We may also feel sad for the individual who is performing self inflicted violence. However, feeling sympathetic towards others, may cause you to see them as figures worthy of our pity. In many ways, this is condescending. While empathy is helpful, sympathy is not. Individuals who hurt themselves may view their SIV as a positive action, an action which helped them to survive. Being sympathetic, you may see their SIV as a negative and pitiful behavior, an act of desperation. Thus, sympathy is not a particularly useful.
Self inflicted violence often provokes feelings of guilt for those who are close to the individuals performing these behaviors. You may feel as if you did something wrong which caused this person to self-injure. Perhaps you may think you weren't the best teacher, parent, or friend. Guilt can be a useful emotion, but in the case of SIV, it is often not appropriate, necessary, or useful.
It is more helpful to surpass these feelings and focus your energy in a more positive and useful direction. Talk with the self injuring student and find out how you can be helpful at this point in time. Wallowing in your own guilt will keep you immobilized instead of becoming an active and helpful participant.
What You May Think
A variety of thoughts commonly accompany the knowledge that someone you know is performing SIV. Some of the more common are:
* It's all my fault.
* I can fix this.
* You're nuts!
* This changes our whole relationship.
* You're not who I thought you were.
* You're doing this to manipulate me.
Considered objectively, many or all of these thoughts are erroneous and could easily negatively influence your feelings. It is important to be aware of your thoughts so you can prevent them from influencing negative emotional responses which could damage your relationship with the self injurer.
What to Do and Not Do
We don't like to see others in pain. It is almost instinctual that we try to end another's misery. When we see students or clients injuring themselves, we begin to understand the enormity of their psychological pain and it is only natural that we want to help. However, without the proper education and training, helping could do more damage than good. This section will provide some ideas of what you should and should not do when trying to assist those individuals who are injuring themselves.
Talk About Self Inflicted Violence
As mentioned previously, SIV is surrounded by shame and secrecy. SIV exists whether you talk about it or not. Ignoring something does not make it disappear. The same is true with self inflicted violence: it will not go away by pretending it does not exist.
Avoiding SIV has several negative effects. First, it reinforces and strengthens the feelings of shame attached to this behavior. Individuals engaging in SIV may get the idea that the behavior is so shameful that even talking about it is taboo. Thus, the secrecy and feelings of shame surrounding self inflicted violence are strengthened.
When communication is decreased, feelings of isolation and alienation, the same feelings which often precede an act of self injury, are increased. Not talking about SIV, may actually increase the likelihood that the self-injurer will hurt themselves again. Silence makes a very powerful statement.
Talking about self inflicted violence is essential. Openly discussing SIV helps those who are hurting themselves. By addressing the issues of self injury you remove the secrecy which surrounds it and reduce the shame attached. You are encouraging a connection between you and the self injurer. The mere fact that you are willing to discuss SIV helps to create change.
You may not know what to say to the individual who is performing acts of SIV. Fortunately, you don't have to know exactly what to say. By acknowledging that you want to talk, even though you're not sure how to proceed, you are opening the channels of communication.
Here are some questions you might want to use to facilitate the discussion.
* How long have you been hurting yourself?
* Why do you hurt yourself?
* How do you hurt yourself?
* When and where do you usually injure yourself?
* How often do you injure yourself?
* How did you learn to hurt yourself?
* What is it like for you to talk with me about hurting yourself?
* Does it hurt when you injure yourself?
* How open are you about your self injurious behaviors?
* Do you want to change your SIV behaviors?
* How can I help you with your SIV?
It is necessary to talk about SIV so that the person who is engaging in these activities feels more supported, less isolated, and more connected. Simply talking about SIV will help to decrease the individual's need for self injurious behaviors.
Talking is one way to provide support, however, there are numerous other ways to show your support to another. One of the best ways to determine how you can best offer support is to directly ask the self-injurer how you might be helpful. In doing so, you might find that your idea of support is vastly different from how others view it. Knowing what kind, and when to offer support, is necessary.
A key component in being supportive is to keep your negative reactions to yourself. This is not to say that you should not, or will not, have judgments or negative reactions to SIV. However, you must conceal these beliefs and feelings while you are being supportive. Later, when you are not offering assistance, you may release and express these thoughts and emotions.
Most individuals who injure themselves, will not do so in the presence of others. Therefore, the more you are with those individuals who hurt themselves, the less opportunity they will have to inflict self harm. By offering your company and your support, you are actively decreasing the likelihood of SIV.
Many people who hurt themselves have difficulty recognizing or stating their own needs. Therefore, it is helpful for you offer the ways in which you are willing to help. This will allow your students to know when and in what ways they are able to rely on you.
Don't Discourage Self Injury
Typically, when we are told that we can't or shouldn't engage in a given behavior, it is for a good reason. However, these reasons take on much more meaning and relevance if they are self-determined. The consequences of our behaviors help us to determine what we should or should not do. Rules, should?s, shouldn'ts, dos and don'ts, limit us and restrict our freedom. When we maintain the right to choose, our choices are much more powerful and effective.
It is both aversive and condescending to tell an individual to not self-injure. As mentioned previously, SIV is a method of coping, and it is often used as a final attempt to relieve emotional distress. Most individuals would choose to not hurt themselves if they could. Although SIV produces feelings of shame, secrecy, guilt and isolation, it continues to be utilized as a method of coping. Because some individuals engage in self injurious behaviors despite the many negative effects is a clear indication of the necessity of this action to their survival.
When you tell someone to stop something, you are inserting a barrier to communication. This barrier will likely increase the secrecy around self inflicted violence. Even a casual comment indicating that your students should stop hurting themselves, runs the risk of damaging the communication and relationship which exists between you. Self-injurers will continue to injure themselves as long as they need to. Your directives will not change this. However, the amount of secrecy and shame experienced because of these actions might change significantly.
Additionally, some individuals who injure themselves may have an adverse reaction to your demand of cessation. By imposing your limits on others, you are creating an atmosphere for failure. Thus, in order to feel control, some who self injure will increase their SIV behaviors in order to feel as if they have choice and control over these actions.
Although it may be incredibly difficult to witness someone's fresh wounds, it is important that you offer support, and not limits, to that individual.
Recognize the Severity of the Person's Distress
Most people don't self injure because they are curious about what it would be like to hurt themselves. Instead, most SIV is the result of high levels of emotional distress with few available means to cope. Although it may be difficult for you to recognize and tolerate, it is important to realize the extreme level of emotional pain individuals experience surrounding SIV activities.
Open wounds are a fairly direct expression of emotional pain. One of the reasons why individuals injure themselves is so that they transform internal pain into something more tangible, external and treatable. The wound becomes a symbol of both intense suffering and of survival. It is important to acknowledge the messages sent by these scars and injuries. An ability to understand the severity of the self-injurer?s distress and empathize appropriately will enhance your communication and connection. Do not be afraid to raise the subject of emotional pain. Allow the youth to speak about his/her inner turmoil rather than express it through self-damaging methods.
Get Help For Your Own Reactions
At some point in our lives, most of us have had the experience of feeling distressed by our reactions to someone else's behavior. Al Anon and similar self help groups were created to help the friends and families of individuals dealing with problems of addiction and similar behaviors. At this point in time no such organizations exist for those coping with SIV behaviors. However, the basic premise upon which these groups were designed clearly applies to the issue of self inflicted violence. Sometimes the behavior of others affects us in such a profound manner that we need help in dealing with our reactions.
Entering psychotherapy to deal with your responses to SIV is one such way to handle the reactions which you may find to be overwhelming or disturbing. You may also ask friends or colleagues for support or speak with a religious counselor.
In conclusion, dealing with those who self injure can be tremendously difficult. Your own reactions and responses can make all the difference in helping those who are hurting themselves. Remember, you don't need to be perfect ? you just need to be willing to learn, grow, and be honest with yourself and those who you're helping.
Tracy Alderman, Ph.D., is a licensed clinical psychologist in San Diego, California. She is an adjunct instructor at Chapman University and an Educational Research Specialist with San Diego City Schools. Her books include: The Scarred Soul: Understanding and Ending Self-Inflicted Violence and Amongst Ourselves: A Self-Help Guide to Living with Dissociative Identity Disorder.
This article is condensed and adapted from The Scarred Soul: Understanding & Ending Self-Inflicted Violence by Dr. Tracy Alderman. It appears here with permission from the publisher, New Harbinger Publications, Oakland, CA, 800-748-6273, www.newharbinger.com.
This article can be found in the issue:
The Prevention Researcher,
Volume 7, Number 4, 2000
Also called self-mutilation and self-inflicted violence, self-injury is the intentional harming of one's own body without suicidal intent. It typically begins in adolescence, and commonly affects teenaged girls. Volume 7(4) of The Prevention Researcher was one of the first publications to delve into this little known and understood behavior.
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