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Dr Pooky Knightsmith

Be better at understanding and responding to self-harm

When we take a little time to understand the reasons young people self-harm, it quickly becomes apparent that we need to tailor our response to reflect those reasons. 

If we respond with a one size fits all approach to self-harm, we might help in the short term, but if we want to provide safe, sensitive, sustainable support, we need to dig a little deeper.

Why do young people self-harm?

The answers to this are infinite, and a young person may self-harm for a range of different reasons at different times. To understand the ‘why’ of any specific incident we need to explore what the motivation was to the young person in harming themselves in that way at that time.

Young people presenting with similar looking injuries might have a whole range of different motivations, for example, three young people, when asked about cutting themselves, gave these very different responses:

  • ‘I was really angry after an argument and I needed to let that anger out – I felt like I was going to explode. Instead of shouting or screaming at someone else, I took that anger out on myself.’
  • ‘My depression means that I feel numb all the time. I cut myself just so I could feel something and sort of like remember I was alive I guess.’
  • ‘I was punishing myself because I did badly on a test.’

Encouraging young people to explore the reasons for their behaviour

Many young people won’t initially be able to explain why they self-harmed, either because it was very impulsive, they are too emotional to think, explore and explain rationally or because they simply don’t have the skills needed to communicate what was happening in their head at the time. 

In order to enable young people to begin to explain the reasons for their self-harm we should:

  • be patient and quiet – allow the young person time to order their thoughts without constantly jumping in or prompting
  • never assume – allow the young person to tell their story, never assume you understand what’s happened
  • don’t judge – a young person will most readily open up when they know that their thoughts and behaviour are not being judged
  • consider different modes of communication – some young people struggle discussing emotional issues face to face. You could encourage them to try writing or drawing their issues or have a conversation over email or instant messenger instead of face to face.

Why should we tailor our response?

When we begin to understand the range of motivations that might underlie a behaviour that superficially looks similar, then the need to tailor our response when supporting the young person concerned becomes self-evident.

Taking the young people quoted above for example, the young person who needed to find a way to vent their anger might explore alternatives such as exercising hard, screaming into a pillow or writing a letter about the reason for their anger then tearing it up. These suggestions would make far less sense if posed to the young person with depression or who felt a need to punish themselves. 

Okay, I get it, but how do I put it into practice?

There are a few steps you can follow – it will take practice to get the hang of working in this way, but it really is worthwhile and will help the young person work towards sustainable recovery.

  • Keep a record: encourage the young person to keep a thoughts and feelings journal – this could be written, drawn or filmed, whatever works best for the young person concerned. In this journal they should keep a note of each time they feel the urge to self-harm or follow through with self-harm and share as much detail as they can about what led them to this point and how they are feeling.
  • Look for patterns: very quickly, repeated patterns are likely to emerge in the young person’s journaling. Discuss with them the types of thoughts and feelings they are most often responding to with self-harming behaviours and how and why the self-harm brings some relief.
  • Brainstorm alternatives: think about a whole range of different ideas that they might try in order to bring about a similar feeling or relief or way of coping other than self-harming. (You might find 130 alternatives to self-harm  a good starting point).
  • Trial and error: try a range of different ideas and keep up the feelings journal – discuss regularly what has worked more or less well. Before too long you’ll build a good picture of the most helpful behaviours the young person should try to turn to when they feel an urge to hurt themselves.

Change won’t happen overnight and it’s important to celebrate even minor successes rather than dwell on failures.

As the young person begins to understand their own emotions better and to find healthier ways of coping with them, you will begin to see a steady decrease in their self-harming behaviour. Support will need to continue for some time, even once the self-harming has stopped in order to prevent relapse. 

 

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