Self harm, and other coping strategies
The best explanation of self harm I have ever heard did not come from reading, research or training. It came from a young person.
“The physical pain distracts me from the emotional pain”.
I thanked them for finding a way to help me understand, for trusting me and sharing this with me. They let me help them.
This was not the first time I had talked openly with a young person about their self harm, I don’t expect it will be the last.
I remember the first time, I was desperate not to get it wrong, to show judgement, fear or shock. I instinctively knew that I needed to listen, to show my concern and to respond in a way that helped that young person and myself feel safe. I explained after we had talked for some time that I had a duty of care, a responsibility towards them. That I was worried about them and wanted to help them. I explained the plan, that they were part of it and therefore still had some control. I told them who we would talk to, together, and what information I had to share. We discussed what the next steps might be, that I was glad they felt they could tell me, that it didn’t matter how much time it took out of my day, they were my priority and I was there for them. I would still be there to support them to cope with this and what would come afterwards.
In any role where you are working to support others, you will recognise and know the ‘limits of your expertise’. There are processes and procedures to follow. Safeguarding, signposting and referrals.
As a parent or carer where can you go to? Do you have a flow chart stuck to your fridge ready for this occasion? A ‘Safeguarding Lead’ to consult? A time where you clock off and walk out of the door to a safe space to process your thoughts?
What is self harm?
Self harm is a coping strategy. We all develop coping strategies to manage stress, some are positive and helpful strategies, some are not. When we think about coping strategies some helpful ones might include exercise, talking to someone you trust, turning your phone off, being able to say no and have healthy boundaries.
Unhelpful coping strategies might include criticising yourself, avoidance, smoking, alcohol or substance use, violence or self harm.
Self harm may be a habit formed that gives a young person a way to
express something that is hard to put into words
turn invisible thoughts or feelings into something visible
change emotional pain into physical pain
reduce overwhelming emotional feelings or thoughts
have a sense of being in control
escape traumatic memories
have something in life that they can rely on
punish themselves for their feelings and experiences
stop feeling numb, disconnected or dissociated
create a reason to physically care for themselves
express suicidal feelings and thoughts without taking their own life
Self harm may offer a short term feeling of release, but the problem does not go away. After self harming then there may be overwhelming feelings of guilt or shame and it is easy to become trapped in a negative cycle. Many people keep self harm private, if it is described as attention seeking and behaviour is judged or misunderstood it is more likely to be hidden.
There are many different forms of self harm or self injury. I attended a training course once and we were asked to list them, the list included cutting, hitting walls, over eating or under eating, picking or hair pulling. These were the obvious forms that we see most often portrayed in the media, or in safeguarding training sessions, or in schools. Other activities on the list surprised me, playing contact sports like rugby, strict exercise routines or diets, binge drinking on a Friday night or clubbing all nighters every weekend.
It’s likely that we will have all practised a form of self harm that has become a habit at some point in our lives. I know what mine are, both the helpful and unhelpful ones. Sometimes changing those habits can be difficult. I found giving up smoking a real challenge, it took several attempts over several years. When I did manage it I rewarded myself with a monthly sock subscription. When you are in your mid 40s that is the ultimate in self care. It’s possible that being hit with a hard cricket ball most weekends throughout the summer is a form of self harm, but the benefits for stress relief far outweigh the negatives.
If you discover someone you love and care about is using self harm to cope, then you might instinctively want to take control over the situation. You might tell them to stop, or be unable to provide an alternative coping strategy that gives them the same release.
Or you could respond by telling them that you understand that this is a coping strategy to manage some form of stress. That it makes you feel sad and worried about them. That you want to help, but you are not sure how. You could be curious about the reasons behind the behaviour, “When you do this I wonder what it is helping you cope with?” Or you can choose to empathise, “I understand what it is like when you feel you can’t cope, I’m sorry you are going through this”. You can talk about your own coping strategies, both the helpful and harmful ones.
Try really hard not to panic or overreact, the way that you respond may be the deciding factor on how they open up to you, or others when they talk about self harm in the future. Remember that they are trying to cope with a situation or feelings that they cannot control.
Try to be non-judgemental
Let the person know that you are there for them
Relate to them as a whole person, not just their self-harm
Try to have empathy and understanding about what they are doing
Let them be in control of their decisions.
Offer to help them find support if they are ready to engage with it
Remind them of their positive qualities and things they do well
Try to have honest communication, where you take responsibility for the fear or worry that you are experiencing
As a parent or carer we can often feel deep empathy with our children, it can feel like our own pain. It is important that you do not try to take over, to force change. Try hard not to act or communicate in a way that threatens to take away control. Find the balance between ignoring and overly focusing upon obvious injuries caused by self harm. Most importantly try not to label it as an act that is attention seeking, wrong, bad or even abnormal behaviour. Ask yourself, what form of self harm have you used to cope in your lifetime?
If you are supporting someone who is self harming, then take care of yourself. Maintain your own personal boundaries in how much support you can offer. Talk to someone you trust, practice self care and seek the advice of professionals.
Self harm does not necessarily mean that someone wants to end their own life. Self harm is common, 10% of young people self harm.
Strategies to reduce or stop self harming to share with children and young people
Talking to someone you trust is the first step to getting better
Talking to someone you trust can help explore why you feel the need to self harm
Talking to someone can help you understand what makes you feel happy or sad, angry or isolated, vulnerable or strong. It can help to develop coping strategies to manage these powerful emotions.
Distraction techniques can help when you feel the need to self harm, they can provide a release for the emotional pressure or they can delay the need to self harm until the intense emotion has passed.
These are all distraction techniques suggested by young people.
Get some play-dough: stretch it or squeeze it to relieve tension.
Hit a pillow or cushion to vent your anger and frustration.
Have a good scream into a pillow or cushion.
Take a minute and breathe or meditate.
Go for a walk to take yourself away from triggers. Being in a public place gives you the time and space to reduce the urge to hurt yourself.
Write down thoughts and feelings that are distressing you; crumple the page up, rip it apart and throw them out as a way to let go of that thought.
Make lots of noise, either with a musical instrument or just banging on pots and pans.
Scribble on a large piece of paper with a red crayon or pen.
Call a friend or family member and talk to them. This doesn’t have to be about self-harm.
Do something creative: make a collage of colours to represent your mood or to remind you of your favourite things.
Listen to music you like or watch a film you enjoy.
Go online and look at self-help websites.
Talk to someone about what is triggering you or seek help from a professional.
Make a calm box or a distraction box with things inside that you know will help you to manage when intense feelings are triggered.
Lots of people self harm, but it is not a healthy or helpful coping strategy. Keep yourself safe by keeping wounds clean and free of infection. With support you can find different ways of coping and get through this.