Like other self-harming behaviors, individuals may turn to self-injury in an attempt to regulate intense emotions, cope with past trauma or relieve anxiety. Self-injury is a coping strategy that people are often using an attempt to try to “feel better.” However, while it might give someone a temporary feeling of relief, it only serves to bury their underlying issues and make them feel even worse in the long run.
As a therapist in private practice in Rockville, Maryland, specializing in helping individuals struggling with body-image issues, eating disorders, anxiety and depression, I have witnessed firsthand the struggle that some people have in terms of trying to break free from using self-injury as a coping strategy.
The following are 3 tips for helping patients who are struggling with self-injury to reclaim their lives.
1.Establish a Safety Plan
If a patient shares that they have been having urges to self-injure, it’s important to start by asking them about the last time that they acted on their self-injury urges. It’s also important to ask them what they typically use to self-harm and whether they have access to these means.
Then, it is crucial to come up with a safety plan. For instance, you might ask that a friend come to their apartment and remove any sharps. Or part of the safety plan could be if they are having self-injury urges, they will reach out to a member of their support network. You can tailor the plan to each individual.
However, it’s also important to note that it’s common to have setbacks on the road to recovery from self-injury. If they do self-injure, it’s important to look at what they can learn moving forward from this experience i.e. avoiding a specific trigger, using a different coping strategy, recognizing the warning signs earlier.
Additionally, it’s important to explore whether they are experiencing any suicidal ideation and if they are, to do a risk assessment for suicide. It’s a common myth that self-injury means that someone is struggling with suicidal ideation. Thus, we cannot assume that everyone who self-injures is also feeling suicidal. However, it is important to ask.
2. Ask Them What Feeling They are Hoping For When They Have the Urge to Self-Injure
It can also be helpful to explore with clients their triggers for self-injury as well as what feelings they are hoping to experience (or to avoid) through self-injury. For example, if a person is looking to feel a sense of “relief,” you could then start to explore with him or her, other more life-affirming coping strategies that could be useful to feel relief, such as journaling, yoga, talking to a friend, crying or drawing.
3. Use Dialectical Behavioral Therapy Skills
I love helping clients to learn DBT skills. DBT is a great treatment modality for a variety of issues, including self-injury. Specific skills that can be helpful for clients struggling with self-injury include the following:
- Urge Surfing:
Just because we feel an urge does not mean that we need to act on it. With urge surfing often I’ll ask clients to try to sit with the urge for five minutes, then extend to 10, then 15, until the urge passes. Studies show that most urges last 30 min to an hour and will naturally start to go down on their own. In sitting with the urge, I also encourage clients to use a healthy coping or distraction strategy.
- Opposite Action:
The first step is to identify and name the emotion that you are experiencing. The next part is to determine whether the emotion (including its intensity and duration) “fits the facts of the situation.” Additionally, a person can ask themselves whether acting on the urge will be effective in the long-term. Then, based on these answers, a person decides whether to act on their urge or to do an action that is opposite to the urge. For instance, if someone feels the urge to self-harm, they might choose to do an opposite action-such as putting scented lotion on their skin or doing something kind for themselves.
Another DBT exercise that I often use with clients is a list of the “pros” and “cons” of acting on crisis urges. I also will have them write next to each “pro” or “con,” whether it is “short term” or “long-term.”
The Bottom Line
It’s also crucial to help patients to begin to practice self-compassion, especially when they are struggling. Through self-compassion we learn how to be kind to ourselves and treat ourselves as we would someone that we love. It’s not their fault that they are struggling with this problem. However, they can work to learn new coping strategies and ways of expressing and mindfully experiencing their emotions.
With access to proper treatment and support, individuals who struggle with self-injury can go on to lead productive and meaningful lives. There is hope! If you know someone who is struggling with self-injury, encourage them to reach out for help. Seeking help when you are struggling is a sign of true strength, not weakness.