What to do when someone you care about self-harms


Not a week goes by that a therapist doesn’t hear about a client or a client’s friend self-harming. This is particularly true of therapists who work with teenagers – lately it feels like something of an epidemic.

After first hearing about self-harming behaviour – which usually takes the form of cutting, scraping, hitting or otherwise causing injury to the self – parents and friends usually react in one of two ways:

Shock and disbelief followed quickly by panic or anger / irritation that this this might be “just” attention seeking and therefore a type of manipulation.

Both reactions are valid.

Here’s what you can do if someone you know/love is self-harming:

1. Understand that regardless of all else, there is a reason, and it’s real

2. Listen to the person without judging, and accept that they themselves may not know why they are doing what they are doing (keeping no.1 in mind).

3. Encourage the person to seek professional help besides yours. You are not a mental health professional, and you may find it very difficult to contain your own emotions around this, and therefore may not be able to be effective help.(if you are a mental health professional I’ll say this word which you’ll have heard over and over and over: boundaries 😉Your skills are not in quesiton, you may even be the best fit for the job! But it’s still important to refer onwards, and it’s not a failing on your part).

4. If they say they are suicidal, believe them, and talk to them about getting immediate professional help. Ideally don’t do anything behind their backs – this might add to feelings of mistrust and insecurity they may already have. It also reduces the chance that they end up in a situation talking to someone you trust, but they don’t.. If the person is under 18, then feel better about going behind their backs and report what they’ve done to their parents/ GP/ or teacher. They might be cross and accuse you of betraying them, but are doing the right thing out of genuine concern. Guilt does not apply here!

5. Let them know how you feel if you are frightened and upset (which you probably will be!). This in itself will be experienced as helpful to them – they may not realise how much you value them and their experience.

6. Get support yourself. Hearing that someone you care about or love is harming themselves is a very big deal and can be extremely upsetting and traumatic, particularly if you have previous experience of self harm yourself, or if you have lost someone to suicide. You do not have to contain this all by yourself. There are many people out there who will know how to support you as well as the person you care about.

7. In rare occasions, someone will deliberately and consciously self harm to punish or control the people they are involved with. If you suspect this is the case 1-6 still apply. And again there is a reason for this dysfunctional behavior. However, you are not responsible for someone else’s actions. Professional intervention will help the person to become aware of their behavior, accept responsibility for it and learn to manage their emotions and relationships in a healthier way.

Do your best to avoid:

1: Asking for the gory details. You may feel the need to know so that you can feel like you know what you’re dealing with here – but this is your need, and will not be helpful. They will already be feeling vulnerable and shamed, and exhausted from telling you as much as they did. Now is not the time to push for more.

2: Jumping to the conclusion that this is ‘just’ for attention. Let’s be clear: it IS for attention – we need to leave the word ‘just’ out. And it’s a pretty dramatic way of getting it, isn’t it?! Instead, we need to consider ‘Why is this person going to such lengths?’ Be aware that something bigger than simply “just” looking for attention is definitely going on here. Even if it’s that they have not yet learned how to ask for support or acknowledgment. Again, there is always a reason.

3: Assuming that they are suicidal. While it looks violent and extreme, it is not necessarily a sign of suicidality, but it is serious, and deserves to be treated as such. Feel free to ask though, it might be a relief to them to be asked, and ay well take the power out of it for them. Back to points 3 and 4 above!

4: Insisting that they stop for your sake. This might be experienced as blackmail or that you are more concerned about your own upset than you are about theirs. They are already vulnerable and will see and hear everything through that lens, for now.

5: (Repeat) Dealing with this by yourself. If the person is self-harming due to a crisis, outside help will be effective. If they are self harming to punish you or control you in some way, outside help will take the power out of that – either way, outside help is the way to go!

Remember to mind yourself – we cannot effectively support anyone if we are not supported ourselves.

*Originally posted on sister site TwoWiseChicks

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