Junk mail piles up at our door, asking us to bag up our old toys and clothes (as if we have old clothes *every two weeks*!) and leaflets ask us to sign up for Direct Debits to support the homeless in London, the hungry in Africa.

We all care, but we don’t all have the money or the emotional strength to take all these requests seriously do we? Do we? If I read every word of every request that came through my door I think I’d end up crying on the kitchen floor, unable to go to work before I’d signed the 18th Direct Debit agreeement…

I feel like a heartless ******** putting them in the recycling tub, or on top of the fridge for ‘when I get home’…

I know I give what I can each and every month; I have my favourite causes, voluntary orgs and charities that I donate to every payday, but we’re all asked to donate more and more aren’t we?

Are we being asked for too much? Do we hope our parents give more then us, or do we give more than our parents?

Would you like to take our mini-survey? If you’d like to share more of your thoughts please leave an anonymous comment below the post.

Cheers,

Wedge

Self-injury can be seen as a compulsion, but it is not something that just ‘happens to’ a person or is out of their control.

Self-injury is a choice; the person is choosing to cope as best they can. Although self-injury is a chronic syndrome, people can be directly helped to move away from it as a coping tool and make new and better choices. The results, which may not be dramatic, can be life changing.

The following distraction techniques may help.

The 15-minute rule

A professional can explain to a client that they have the choice to hurt themselves, and that their choice is not going to be taken away. The client needs to be encouraged to recognise their own power and then make a decision to put off the self-injury for just 15 minutes. After 15 minutes, they can choose to hurt themselves, or they can assess how their feelings are progressing and choose to wait another 15 minutes.

Surfing the urge

If a professional discusses with their client how it feels to have an emotion (like anger, love, or anxiety) build and grow to intolerable levels, it can be agreed that just as a wave of emotion builds, so it declines. Accepting that emotions (of all types) develop like waves can be a powerful meditation, especially when we focus on how we feel, say two per cent ‘better’ after reflection (perhaps during the 15-minute game).

State change

How we treat our body affects our thoughts and feelings; for example a person who is feeling afraid may make him or herself smaller by hunching their shoulders or hiding behind their hair. By changing their physical behaviour a person may thereby be able to break free from the cycle that leads to self-injury. Standing, breathing from the diaphragm and lifting the head and eyes will change one’s physical state. Washing up is another good activity when there is a need to break cyclical thoughts.
More alternatives and distraction techniques are available from www.firstsigns.org.uk/help/

However we tackle the behaviours around self-harm, we should always approach a person with compassion and respect. They are doing the best they can, and as professionals and carers we can help them to make real changes in their lives.

Other posts from this series:

Introduction

What is self-injury?

Not just a girl thing

Not so irrational

Hard to stop

Taking care of yourself and your clients

People who work with clients who self-injure need to be prepared to give up their preconceptions and accept that self-injury has a purpose, a function and that it is a ‘valid’ way to cope for those who feel they have no other way.

The work requires patience, setting aside judgement, and effective use of supervision and/or debriefing in order to help and empower clients.

Before considering how to provide new choices for people whose self-injure, professionals working with such clients should reflect on how they may feel throughout the process. Self-injury is such an emotive subject that it will affect anyone working with people who self-injure on an emotional level, and they may end up feeling uncomfortable and less than confident in their treatment and support services. Ensuring that you have colleagues with whom to discuss your observations and feelings, and that you make use of supervision and/or team debriefing sessions is very important.

When I am delivering training to carers, doctors and welfare officers, we often talk about how frustrating it is to be able to help a person for only a few weeks. We talk about feelings of inadequacy, and even anger at some clients’ lack of progress. Thus I am hoping that the majority of professionals work within a close team, and that they have excellent debriefing processes whereby they have chance to express themselves and seek counsel from others who are experienced in regard to working with clients who may self-harm.

There is also a need for professionals and professional teams to recognise that self-injury is often a long-term entrenched behaviour. There is no quick fix, drug, or therapy that offers a solution for all. Moreover, people often self-injure for years before disclosing their behaviour to a professional. This professional’s reaction may set the scene for any help the person may seek and receive in future. It is therefore vital that anyone working with a client who self-injures be open, non-judgemental and fairly non-directional, as any hint of exasperation or dismissiveness may switch the client off to receiving help that is offered.

It follows that anyone working with a client who self-injures should not expect a change overnight. A person does not move away from self-injury just because they have professional help and support, however excellent that support may be. Professionals should be prepared for the long haul: even with a client who responds well and acts on everything they have put before them there may be multiple relapses. A person may have an absolute understanding of their self-injury and the advice given, yet still return to self-injury when they feel crushed by life.

Professional should not berate themselves for being just a small part of a larger chain of support. They may not see the full value of their part in therapy come to fruition, but the seeds they plant in their time working with a client can be life-changing for that person later on. They should not discount their impact, even if it is a smaller contribution than they would like.

It can be helpful for professionals to talk about self-injury in a frank and practical manner with clients who self-injure. However, the focus should be on the emotional drivers behind the behaviour, rather than behaviour itself or its physical effects. ’Scar checks’ are inappropriate except in the case of physicians who need to physically treat a patient. A person’s emotional distress cannot be judged by their wounds. Self-injury may tell a story that is written on the body, but only the person involved can read it. Body checks invade a person’s personal privacy and destroy the trust and honesty required in a therapeutic relationship.

It is also important to avoid ‘no-harm contracts’ or any attempt to impose one’s will as a professional upon the client. A person may well be in a powerless situation at home or work, and self-injury may feel like their only way of retaining some authority over their lives – this should not be taken away. Instead, a client should be reassured that they are not being asked to ‘stop’, but to develop new ways of coping so that they have more choices. To empower people they must be provided with more, not fewer, choices. The choice to self-injure is always the client’s.

Coming next: Distraction and alternatives.

Finally, a professional working with a young client should explain their confidentiality policy in a clear and open manner, and inform the young person of exactly how the professional means to work with their parents or guardians. The parents of young clients can often need managing, and professionals should dissuade them from over-reacting. Removing all the knives from the kitchen does nothing but force shame upon a child, and they will become even more secretive about their self-injury. If their bedrooms are raided and ‘tools’ and items (like bandages) are taken away, they may be forced to use alternative methods of self-injury they are not familiar with. Broken glass and lighter flames can be more dangerous than razor blades and safety pins.

SIAD is important because it’s a global event, and an opportunity for people to come together so that many voices may be heard. We’ve had a super response to our efforts this year, particularly on Twitter where so many of our friends have contacted us, re-tweeted us and engaged with us. And that’s what it’s all about isn’t it – engaging with people and sharing our thoughts, ideas and resources.

But what has SIAD really meant? What has today achieved on a national and global level? How many people across the world have learnt something about self-injury today? Will the media continue to focus on teenage girls for yet another year? Will  people continue to be judged, invalidated and labelled as attention seekers? How many people are still suffering in silence? How can we reach them? These are the questions  swimming around my head as I endeavour to shut down for the night and focus on more trivial things such as feeding my cats and cooking the dinner.

What’s going through your mind? What questions do you have? What would you like to know about self-injury? In which direction should our awareness raising efforts focus over the coming year?

So many questions…

…one day we’ll have all the answers, and our job will be done!

In the meantime, thanks ever so much for all your support today and throughout the year. We work *for* you, but we couldn’t do it without you.

I, also, would like to personally thank Wedge. It’s Wedge who has worked so hard on our website, updated our SIAD page and created our wonderful posters, together with all our other content around the web. Thank you Wedge.

Wedge has worked hard on our SIAD page and spent a great deal of time giving quotes to the media (it’s fantastic that each year the media show increasingly more interest in SIAD!)

Of course we can only do so much – I’m confident we provide more information and resources for SIAD than any other organisation, but it’s down to our members and visitors to make use of everything we provide and do their bit to help raise awareness about self-injury.

So please do print our posters and stick them up wherever you can today. It’s not too late to email your local media or MP, or to slip a letter or factsheet through the door of your GP, school or workplace. You can find a template letter on our SIAD page and all our Factsheets on our publications page.

We’d love to know what you’re doing today for SIAD so please do leave us a comment, post on our Facebook Group or Page, Bebo, Myspace or our Message Board, or send us a reply on Twitter.

Thank you to all our members, supporters and visitors – have a great SIAD.

Because self-injury is experienced as a coping mechanism, it is a mistake for carers or professionals to push for a cessation of the self-harming behaviour.

Those who are trapped in the cycle of self-injury or self-harm feel under a great deal of pressure to ‘stop’. They know it is not ‘normal’ to hurt themselves, and because they worry a lot about how people perceive them, they will go to lengths to hide their self-injury and keep their emotional difficulties to themselves. Even those of us who can talk about self-injury do not want to become a burden to our friends and carers, so we play down our distress. The pressure to ‘quit’ is intense, and people frequently go through a Herculean struggle to resist the impulse to self-injure, often for the sake of others.

Parents, teachers and friends may feel that if the self-injury goes away, everything will be all right. However, focusing on ‘stopping’ self-injury, as if this is all that is wrong with a person’s world, is counter-productive. Such preconceptions drive self-injury underground, and people will be unable either to be honest or to discuss their secret hurt. Counsellors and psychotherapists, who rely on the therapeutic relationship with clients, may be better placed than most to know that trust and honesty are critical to understanding and healing.

With all the will in the world, resisting the compulsion to self-injure can be impossible over the long-term. In the short-term, people can consider distraction techniques and alternative activities, as described below. However, in terms of helping people to break away from a chronic reliance on self-injury as a coping mechanism, it is counterproductive for professionals to put pressure on people to ‘just stop’.

Rather than talking about ‘stopping’, I would suggest that counsellors discuss the idea of ‘moving away from self-injury and self-harm’ and replacing self-injurious behaviour with other, more adaptive coping strategies. If a person has new ways of dealing with upset, stress, mental ill-health and difficulties in their life, they have new choices and options regarding how to behave. If a person learns to seek health and happiness, and to be in control of their own life, they may then be able to leave self-injury behind them.

Coming next: Care for yourself and your clients.

At first glance it may be hard to see how hurting oneself can make one feel better.

Is there a ‘high’? Some kind of ‘rush’? On the surface, it is hard to see what is good about self-injury, especially when the person hurting themselves is ashamed of their action, and/or feels terrible at the distress they may be causing their worried partner or parents.

Talking with a client who relies on self-injury as a coping mechanism may not enlighten a professional, since not everyone can explain what self-injury does for them. It is hard to find the right words; few people are fantastic at talking about their emotions, and fewer still have the emotional vocabulary to discuss their distress and self-injury. It is therefore easier to divine the purpose of self-injury from observation rather than feelings.

Our observations at FirstSigns are that self-injury may have different functions, depending on the situation:

1. Intrapersonal communication / self-expression
2. Making intangible emotions tangible
3. Release and relief from intolerable distress
4. Calm the mind, removing repetitive thoughts
5. Calm the body, physiological reduction in tension
6. A sense of control over one’s emotions and environment
7. Communication to other people
8. Demonstrating a need for help
9. Manipulating other (powerful) people.

With regard to the last point, we should bear in mind that any channel of communication can be used to manipulate people. It is not uncommon for vulnerable people to feel powerless, and within healthcare systems it is quite possible for a client to feel as though the support is being ‘done to them’ rather than provided for them, so it is little wonder that some people feel compelled to play power games.

The majority of people who self-injure tell me that it helps them to cope with overwhelming levels of distress and get on with what they have to do. The release and relief from emotional turbulence is therefore the primary function of self-injury. When a person is upset, breaking down, panicking, or falling into despair, they can rely on self-injury as a way to sublimate or bypass these debilitating feelings. Self-injury therefore provides some control of emotions that would otherwise cripple and arrest a person.

Self-injury is not ‘acting out’ or ‘attention seeking’, though it may sometimes be considered to be ‘attention needing’. If a person feels unheard or invalidated in their home, school or work environments and they rely on self-injury to help them cope with their distress, then by showing their injuries they may perhaps be able to make other people ‘see’ what they have been unable or unwilling to ‘hear’.

So there is method in the madness, and in reality self-injury is a valid coping mechanism because it works. Stressed and vulnerable people are making a logical choice; they are aiming to care for themselves as best as they can, considering their often limited options.

Coming next: Hard to stop.

As always, FirstSigns (LifeSIGNS) has produced a fantastic self-injury awareness day web page to help you with your own awareness raising, with guidance as to what you might like to do and information to aid you. Our Factsheets are always popular, this time of year in particular, and there’s one for everyone – whether you’re a friend or family member of someone who hurts themselves, a teacher or a healthcare worker. There’s even one specifically for guys. We also have a detailed guidance document to help schools who wish to create and maintain a self-injury policy.

Of course we have posters for you to download too, and Wedge has worked incredibly hard updating them for you, so I hope you’ll make good use of them and post them up wherever you can.  And our awareness wristbands are still available to purchase either for yourself, or for others.

I’m sure we’ll be keeping you well reminded about SIAD over the next couple of weeks, and we wish you all well with your awareness raising activities. Do let us know what you’re planning!

Please spread the word about SIAD and our page – perhaps you could promote the SIAD address on Twitter, Buzz, Facebook, Bebo, MySpace and your favorite networks? Just send people to www.firstsigns.org.uk/siad or http://firstsigns.org.uk/siad

Thank you,

The media tend to focus on young girls who cut themselves. Women’s magazines and teen magazines for girls reflect their audiences, so naturally stay focused on girls who self-injure.

By contrast, men’s magazines hardly touch the subject –perhaps a reflection of the fact that men do not want to talk about things they perceive as weakness. When I started looking for information about self-injury in 2000, I searched the web and found some informative sites, run by girls, for girls. As far as I could tell, they were all American. I soon decided that as a male in the UK, I could provide a perspective, so I started writing and web publishing. Since founding LifeSIGNS (aka FirstSigns), I have been in contact with many men and women who want to see the media redress the imbalance in reporting.

Self-injury is definitely not a girl thing in our experience. FirstSigns has always suspected that a bias in published research may be responsible for the apparent predominance of females who self-injure, and a report by M.J. Marchettoi suggests that this is indeed the case:

’No gender differences were observed among skin-cutters, most of whom reported experiences of trauma. BPD [borderline personality disorder] was recorded for a minority of those skin-cutters without a history of trauma… although these results provide further confirmation of a potential association between prior trauma and repetitive skin-cutting, they rigorously challenge the validity of reported gender differences for this behaviour. Further, this study has identified that repetitive skin-cutting can arise independently of BPD and prior trauma.’

For further information about male self-injury see: http://men.firstsigns.org.uk

Professionals working with clients who self-injure should endeavour to drop any preconceived ideas about gender differences and accept that, whatever the (obviously incomplete) statistics tell them, self-injury can affect boys, girls, men and women from all backgrounds and of all ages.

The statistics on self-injury are obviously incomplete for several reasons. First, they tend to be collated from Emergency departments, where ‘self-injury’ has often been included in ‘suicidal behaviour’ tick-boxes. Second, research that directly polls people misses men because there is no agreed definition of ‘self-injury’, and also because men are unlikely to discuss weakness no matter how anonymous the questionnaire. Third, the vast majority of people who hurt themselves do not seek help either from A&E departments or their GP, so it is impossible to have reliable, relevant statistics when self-injury is hidden as it is.

Self-injury is the hidden affliction; it is a difficult subject, and even harder to talk about from a personal point of view. People who self-injure worry about other people’s reactions, including the reactions of healthcare professionals. Will they be thought of as weak? Will they be considered stupid? Attention seekers? Acting out? Childish? A waste of time? Only through understanding and by providing accessible routes into care can professionals begin to reach people who would otherwise never talk about their self-injurious impulses.

i Marchetto MJ. Repetitive skin-cutting: parental bonding, personality and gender.
Psychology and Psychotherapy 2006; 79: 445-60.

Coming next: Not so irrational.

At FirstSigns (LifeSIGNS) we define self-injury as a coping mechanism – something a person learns to rely on to help them deal with intolerable distress.

We do not focus on the self-injurious behaviour or method of wounding, but rather consider the emotional drivers behind the behaviour and the emotional state that self-injury brings about.

We have learned that a great many different behaviours that cause pain or damage to a person in an immediate sense come under the heading ‘self-injury’, and we know that self-injury is a very personal behaviour and that people come to it in their own, indirect ways. We have also learned that there are some activities and behaviours that are better described under the umbrella term, ‘self-harm’. The reason for the distinction is that the media throw around the term ‘self-harm’, and yet people mean a great many different things by this.

Self-injury and self-harm: definitions

Self-injury is a coping mechanism. An individual harms their physical self to deal with emotional pain or to break feelings of numbness by arousing sensation.

Self-harm is an umbrella term, an overarching definition that includes eating disorders, food-related issues, drug and alcohol misuse, risk-taking behaviours and self-injury.

A professional should never assume they know what other people mean when they say ‘self-injury’ or ‘self-harm’ – nobody can know what methods or feelings a client may be referring to with these two almost interchangeable words.

Self-harming behaviours

• Self-harm:
  • Food related:
    • Controlled / restricted eating
    • Overeating
    • Bulimia
    • Anorexia
  • Drug and alcohol misuse
    • Alcoholicism
    • Binge drinking
    • Drug addiction; chronic or acure drug misuse
  • Risk taking
    • Sexual
    • Physically dangerous
    • Illegal / anti-authority
  • Self-injury
    • Cutting
    • Burning
    • Chemical
    • Branding
    • Scalding
    • Hair pulling
    • Banging / bruising, including bone breaking
    • Pricking
    • Biting
    • Ingesting, including chronic self-medicating, overdosing (chronic or acute), self-poisoning, swalling objects

We have a whole section of our website dedicated to explaining self-injury and self-harm, alongside an easier to view diagram which is more comprehensive – see ‘What SI is‘.

Coming next: Not just a girl thing.