It is important to remember that there is no quick fix for self injury. There is no one method of treatment that will work for everyone, and each client's experience is their own. Personally, I have found a lot of things that don't work, as well as several things that do. I am sharing with you what I believe to be helpful from my perspective as both a client, and a helping professional. Please use the suggestions below at your own discretion.

Things to remember when treating/working with individuals who self injure (in no particular order):

Educate Yourself

Read a book on self injury to enhance your own knowledge, as well as your comfort level with the subject.

Talk to someone who has injured before and get their perspective.

Knowledge on the subject will also help your client to feel like you are able and capable enough to help them.

Let a client know that you do know about self injury, and that you view it as a coping mechanism. Often clients are afraid of telling a helping professional as they are not sure how the professional will handle the disclosure. Assure them that you have some knowledge of the subject.

Validate

Often self injurers have never had anyone who understood why they do what they do. Let them know that they must have been struggling a lot to resort to such a difficult coping mechanism, and that you acknowledge the sincerity and validity of their problems.

It is also important to let them know that you respect how difficult it was for them to disclose their self injury, and validate how much they must be risking by telling someone about it.

Be Honest

Clients can usually tell when you are lying, or trying to be comfortable with a subject that makes you uncomfortable. Self injurers are already 'on guard' when it comes to disclosing their behaviour, so be honest with them about your reaction.

If it makes you uncomfortable, say so. If it makes you afraid, say so.

If you don't know a lot about it, say so, with a commitment to learn more.

Expect Setbacks

I have yet to find a self injurer who was able to beat self injury on the first try. I am sure they are out there, but the majority of those who self injure will struggle for a long time before quitting for good. Let your client know that this is a step-by-step process, and that it is ok if they have a setback.

It may also be helpful to explain the addictive nature of self injury. This can also validate the clients physical/psychological reluctance to quit.

I advocate a harm reduction approach when dealing with self injury rather than asking the client to abstain from injuring.

Trust

Trust is a very difficult thing for a self injurer to achieve and establish. If they have ever disclosed their self injury before, chances are the person they trusted didn't know how to properly respond, and may have even responded in a damaging way.

With many clients, expect trust to take some time to be established, to be tested, and to be questioned. Understand and expect that this person has likely had previous negative experiences with trust.

Control

Understand that for many self injurers, control is something they struggle to achieve. Often the act of self injury is the only thing in their lives they actually have control over.

Do not attempt to take control over the self injury, or any other aspect of the client's life away, as this will usually backfire.

Try to empower the individual through their own treatment planning, and give them back control over their lives wherever possible

Explore the issue of control with the self injurer, as usually there is more to the story here.

Focus on Feelings

I believe one of the cruxes of self injury is the inability to regulate and tolerate feelings and emotions. One of the keys to reducing and eliminating self injury is to teach a client what feelings are, how they feel in their body, and what they can do to manage them.

Often self injurers do not know how to verbalize their feelings, or they lack the actual words to do so. Try giving your client a list of feelings on paper and have them try to identify how they feel in the moment. Tie this to what they feel in their body at that moment. This will give them the body cues and words they have been missing, and should lead to better and more accurate feeling/emotion identification.

It is also important to help a self injurer understand that they can tolerate feelings. Help them to sit with their feelings, truly feel them, knowing that they can come through them and survive.

Identify The Cycle

I believe that all acts of repetitive self injury have a similar cycle. Once this cycle has been identified, both you and the self injurer can put measures into place to delay or break the cycle.

Click on the image of the cycle for a larger version



Delay and Distract

Encourage any alternatives which may delay self injury, or distract from self injury. Any break you can put between the desire to self injure, and the actual act itself, will lead to breaking the cycle.

Check out the alternatives section for ideas that may help with this.

Plan of Action

One of the problems with self injury is that it is an innately impulsive act. It is hard to think of alternatives when your immediate instinct is to self injure. Client's need something concrete resources they can use when the feeling to self injure arises

Lay out a plan for you client, on paper, which lists things they can try or people they can call before self injuring. Include things like: crisis line numbers, friends/family who are supportive, alternatives to self injury, as well as anything else your client may find helpful.

Another idea you could include with this plan is a list of feelings and a log so your client can begin to identify what triggers their self injury.

They key here is it has to be on paper, accessible and easily reachable in a moment of crisis. Have them put copies of this plan in various places where they can access it quickly when they feel like self injuring. Suggest even having them put it in their 'kit' or near the things they self injure with.

Encourage All Progress

Ending self injury is a step-by-step process. Expect set backs, and with those, encourage and point out even the tiniest areas of progress.

Eg: if a client managed to delay self injuring for even 1 minute, remind them that they were able to delay it, and 1 minute leads to 2 minutes...etc.


Address Deeper Issues

It has been my experience that there is always something at the root of the self injury. Once your client has some new coping mechanisms in place, you can then begin to explore some of these deeper issues.