If I were to ask a group of people (who did not understand) what they think of self-harming, they would probably describe it in terms of cutting, burning, biting and scratching skin, and connect it with teenagers using it to ‘act out’ or follow a ‘copycat’ trend, probably as ‘attention-seeking behaviour’.
Piercing and tattooing, heavy drinking and smoking (not to be confused with addictions) may also been connected with self-harming. But actually, self-harming is far more complicated than these basic typecasts suggest, and it is common across all genders, cultures and ages. Self-harming does not discriminate and is not only common amongst girls, contrary to popular belief.
But what actually is self harming exactly?
Self-harming is the wide ranging things that people do to themselves in a deliberate and often times secretive way to purposely hurt themselves. Most of the time, it is masked from parents, friends, partners or professionals. The self-harmer might therefore self-injure on a part of their body that isn’t readily visible to others. When people do this, they don’t do this because they want to die; they do this, because they want some relief from their unbearable emotional pain of their past experiences.
Self-harming therefore, is a way of numbing that ‘uncontrollable hurting’ by replacing it with another sort of ‘controllable pain’.
It is important to understand non-suicidal self-injury is not, and never has been, listed as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide developed in the US and routinely referred to by medical professionals throughout the UK.
Why do people self-harm?
Self-harming is often associated with attempts to wipe out the painful memories of a trauma a person has had to endure. They might be attempts to control feelings of guilt and rage about things from their past. It is for that reason important to understand that these visible displays are communicating pain that people may be unable to verbalise.
Consequently, it is paramount for clients to understand and appreciate that an ethical Counsellor/ Therapist will never break someone’s confidentiality. However, if I am worried about a client’s safety, I will explain that I might need to talk to someone else about it, but that I will always talk to them first before doing this; i.e.; I will never do it without first discussing it with them.
Moreover, if a client tells me they are self-harming, I will also keep in mind the definition — that the behaviour is ‘a way of coping with difficult emotions’, and that it is different from suicidal intent’.
How can you help someone who self-harms?
I would explore with my client their motivation by asking what they may do and how often they might injure themselves. I would also reassure them that it is not for me to either condemn or condone their behaviour, but that my role, as their Empathic, Supportive, Confidential and Non-judgemental Therapist is to understand what they are doing and why, and to help them work through it with them, and their family – if it’s appropriate — in order to keep them safe.
I have lots of clients – young and old – who self-harm; each of my clients’ has their own reasons for doing this. It is not for me to question them but it is my duty to help them find a better was forward so that they do not feel the need to continue to do so in the future.
It is crucial to reiterate that from my experiences, it is rare that I need to raise self-harm as a serious safeguarding concern. However, it is paramount that we find alternatives to self-harming. For me, risk assessment is not a one-off event; I include an assessment in each session until I am sure that self-harming is not a thing of the present or future for that client.
The NICE guideline on self-harm provides a helpful framework for working with clients safely. For clients who repeatedly self-harm, NICE recommends offering advice on how to treat their own superficial injuries and on harm-minimisation, for example by using clean blades and antiseptic products, rather than trying to stop them from doing it, which is seldom effective.4
Other resources on self-harming
“A helpful guide to harm-minimisation is Kay Inckle’s book, Safe with self-injury, 2017. Safe with self-injury: a practical guide to understanding, responding and harm-reduction. Monmouth: PCCS Books
The book sees self-harm through the lens of a social model of distress. It explains harm-minimisation in the context of an exploration of the meanings of, and reasons for, self-injury, drawing on the words and experiences of people who self-injure. It includes a section on ‘staying safe’, covering harm-reduction practices, self-care and alternatives to self-injury”.
If you are worried about someone who self harms or you, yourself self harms and would like to talk about this in a safe, confidential and non-judgemental please reach out for an ethic therapist whom you will be able to talk to. There are always other alternatives to self-harm and there are strategies that can be taught to help deal with painful memories.