Working with Self-Harm

What is self-harm?

This is when someone deliberately injuries oneself, typically as a manifestation of a psychological or psychiatric disorder.

It is usually a way of coping with or expressing overwhelming emotional distress.

Sometimes when people self-harm they are not the same level as someone who wants to commit suicide. Statistics show that half of people who die by suicide have a history of self-harm.

Intention of self-harm is often to punish oneself or relief oneself of unbearable tension.

Getting help?

Firstly it is important that a client goes to see a GP .

Referrals can be done to other health professionals, private or NHS. 

Normally a therapist will discuss thoughts and feelings and how these affect their behaviour and well-being.

Helping someone who self-harms?

It can be hard to understand why someone self-harms, therefore it is useful to learn why and some strategies to help them

It should be taken seriously: a person who self-harms will describe their behaviour as a way of coping with overwhelming behaviours associated with experiences in the past, which has been difficult or hard for them.

As self-harm is often an expression of internal factors for a person, it is important to ask them about how they are feeling and try to explore what they issue may be.

Self-harm can be very difficult for a person to discuss so allow them time and space illustrating that you are there to support them. Discuss with them ways of reducing harm- known as harm minimisation (meaning to reduce the severity or frequency of incidents).

The important thing is that the person must find alternative way of expressing emotions. Here are a few important things to remember when helping someone who self-harm: 

  • Ask them how they are feeling

  • Do not judge them

  • Let them know you want to listen to them, and how they are feeling really matters to you 

  • Understand and explain to them the journey is long and hard to recover but you will be there to help them

  • Do not let them or make them feel guilty about what they are doing

Alternative and distraction techniques for self-harm

We want to help people delay or avoid self-harming. Different people may find that some techniques will work better than others, but the important message is it is not a failure if you try them and they do not work. 

Here are some ideas that could make a difference to your clients: 

Expressing feelings

Letting the feelings come out physically

  • Screaming as loud as you can

  • Hitting a cushion as hard as you can

  • Kicking a football against the wall

  • Squeezing on an ice cube really hard

  • Squeezing a stress ball

  • Tearing up paper

  • Playing music really loudly 

  • Drawing the place you want to cut in red pen

Letting out feelings

  • Do I feel anxious or angry? And what about? 

  • What would the razor say to you if it could speak?

  • Write a letter to express your feelings

  • Write a list of your achievements

  • Write a gratitude list 

  • Write a wish list

Get creative

  • Draw or paint your feelings

  • Write a song/ poem or joke

  • Keep a diary

  • Write a word down again and again

  • Play an instrument

  • Make a memory box (emergency box)

Comfort yourself

  • Have a new bath or shower

  • Use aromatherapy oils

  • Eat your favourite foods

  • Buy something nice for yourself

  • Go for a massage

  • Give attention to your pet

  • Go to yoga

  • Do mindfulness

  • Have a cup of tea

Get out and about

  • Wash your car

  • Go for a walk/ run/gym

  • Go to the seaside

Be productive

  • Clean the house

  • DIY

  • Volunteer

  • Take up a class

Distract yourself

  • Put the tv or radio on

  • Play the computer

  • Go on the internet

  • Learn a new skill

  • Do a puzzle

  • Look at photographs

  • Make a paper chain

Teaching a client to cut safely

There are many ways people will self-harm. Some will bite, hit, scratch, impact self with objects or cut. If you are working with someone who is cutting it may be important to look at safe ways to do this in order to keep them safe.

Remember to contract and review client safety at every stage of therapy.