Help a self harmer

Helping a self harmer

Self-harm is often termed as addictive, both because of the chemical aspects of harming, but also because it can become highly habitual with routines and rituals, and can also become a reflex reaction to emotions that cause anxiety. The upshot of this is that a young person who self harms is likely to feel trapped by the behaviour at the same time as being scared of how they would cope without harming.

When supporting someone who self-harms it is essential to understand the emotional dependency that people place on harming. If the focus is solely placed on helping them to stop harming, or changing their habit, the reality is that they will be no better equipped to handle the emotions that led them to harming in the first place.

One of the first places to start is by exploring the feelings they have immediately before harming and then exploring with them different ways of expressing those emotions. For example if people feel things are out of control at work, they may tidy their desk, if they feel angry, they may go to the gym and pound it out on the treadmill, or, if they feel low they may ring one of their closest friends. They can be very simple, but highly effective and invite young people to think about hope, where before there was only destructive behaviour.

Central to anybody overcoming self-harm, the young person needs to feel they have autonomy and control. What helps along the way is lots of affirmation of their positive choices and encouragement of them as a person.

It is common for people who self-harm to rotate their harming mechanisms to other negative behaviours masking the harming itself. For example stopping cutting, but starting drinking pints of vodka instead, then moving onto having lots of unprotected sex. Although these do not all have the physical effect of harming, the patterns and habitual needs in their lives are similar and something for those supporting harmers to be aware of.

Common questions about self harm

What do I do when a teenager confides in me?

Listen, listen and listen some more, it is likely that this is one of the first times a young person has spoken about the subject. Be aware of how you are responding; gasping and expressing disgust is not going to help. Those who self-harm will have a heightened awareness to the reactions of others so will be very aware of your reaction to them. Be sure to affirm them and express your acceptance of them as a person.

What questions should I ask someone who tells me they self harm?

At the first point of disclosure it is good to ask questions which build a picture of the seriousness of the situation

As time goes on don’t keep going back to practical questions of how much and how often, but focus on things that will increase their understanding and progress them forward, like when they have been feeling low and what have they done that has helped in those times. The key to supporting them is to enable them to think about their coping mechanisms. Any ongoing conversation should have a focus on this and not the harming itself.

How do I stop someone harming?

If a person feels the need to self-harm, the drive is such that they will find a way to harm even if they have nothing available to help them. In one instance, a young person was relieved of their pen knife, their lighter, an elastic band, and a pen only for them to start biting the back of their hand. The reality is it may well be better to let a young person harm and then talk to them afterwards, and not enter into trying to talk them out of an urge, which at that point may be all-consuming.

Should I take their blades away?

In a short answer: no. In self-harm there is often a routine and a security within that routine. In removing their blades you are taking away their ‘safe’ process for harming and run the risk of them harming in ways that are less measured and more risky. Parents sometimes remove every sharp implement in the house, only for the young person to go into the back garden and find a rusty nail to harm with.

Taking the blades from a young person also symbolises you telling them how wrong you think their behaviour is. However negative the coping mechanism of harming is, you do not want to run the risk of a young person hearing that you think that they are wrong or bad in some way.

If a young person offers you their blades and asks you to hold onto these things for them that is a different matter. It represents that person feeling it would be more helpful for someone else to have them, and a commitment to a level of accountability within that. It is recommended that you make it clear that if young person wants them back you will not stand in their way, thus being an extra point in the process but not someone to rile against in a crisis. This continues to give the young person control and choice, which are essential in any supportive relationship.

Should I see them more often now they have told me they self-harm?

Generally the answer is no: they have identified wanting to speak to you about their harming within the context of the contact and relationship you already have. It is important not to cave on the boundaries you already have, so if you do not give your mobile number to young people don’t change that. What you don’t want to do is create situations where the young person can become dependent on you, and where the goal posts for them keep moving. Making a big fuss may make them escalate the issue in their mind. What they really need from you is stability.

What do I do if I think someone is self-harming?

It is always much better if a young person initiates disclosing self-harm, so make yourself available to the young person to do so, giving them opportunities to talk to you if they wish. It may be they don’t want to talk about it. However, if they are obviously showing you cuts and scars it may be that they want you to ask them, that they don’t know how to start the conversation. Don’t avoid self-harm if it is obviously presented before you as this will feed into many of the myths about self-harm being shameful and them not having a right to being understood and supported. If disclosure is handled well it can be a very liberating experience for the young person.

How do I make them stop?

Telling a young person to stop self-harming is never helpful for the young person; they are left feeling misunderstood, isolated and afraid of letting you down. Research suggests that putting expectations and demands on young people like this does very little to help reduce the harming behaviour of the individual, but does have a dramatically negative affect on the ongoing level of sharing in the relationship of the young person and the person who made the demand, usually resulting in future harming episodes being hidden.

A better question to ask is how can you encourage that without taking what is currently a coping mechanism they are relying on away from them.