"Treating Self-harm" is the second article in a series of three about self-harm.
Self-Harm is an increasingly pervasive symptom of emotional distress among adolescent girls. Because it involves physical damage to the sufferer, cutting understandably evokes distress and fear in others. Viewed on a continuum, self-harming behavior can easily—though not always accurately—be interpreted as a precursor to suicidal behavior. Dustin Tibbitts, LMFT, has written a three part series to help parents better understand and address this behavior.
When it comes to most types of adolescent treatment, but especially the treatment of complex issues like self-harm, there is no silver bullet. No magic technique or therapy or adolescent treatment program will automatically provide a cure. Treatment for adolescents with complex issues takes time, commitment and a great deal of patience. Most of all, it requires a positive and trusting relationship or set of relationships.
This kind of relationship is built on compassion rather than judgment. So whether you’re a treatment professional, friend, or parent, the best way to assist someone who is self-harming is not to berate, cajole, punish or threaten. People who self-injure are already very good at doing that to themselves. Instead, the first step toward helping someone who can’t seem to stop harming herself is to engage in a relationship of safety, respect, compassion, and trust.
Regardless of the setting or relationship, effective treatment of adolescent self-harm always starts with the same thing—a genuine relationship of mutual trust. But this trusting relationship is just the beginning…the foundation upon which we build all other aspects of an adolescent treatment program. We must also impart new skills to the sufferer. The dangerous coping skills that she has been using to address her emotional struggles can no longer be options. We have to replace those behaviors with something else that works (more on this in part three of this series). But, again, the relationship must come first.
A client of mine in an adolescent treatment facility told me about her former psychiatrist’s suggestion that she draw a red line on her arm instead of cutting. It didn’t work for her. Another substitution approach— namely submerging her hand in ice until the cold caused pain—yielded similarly dismal results.
In treatment, however, this client stopped pursuing “safer” ways to mimic her self-harm. Instead, she found it more helpful to get involved with caring friends—other adolescents with whom she could build trusting, positive relationships. As she developed an increased understanding of the nature of her struggle, she lived for the moments when she could connect with another human being. Eventually, friendships led her to activities in which she could get her hands doing something creative. Sculpting clay and painting helped. Designing web pages on her laptop seemed to help her resist urges to self-harm too. She allowed her creativity to blossom in the context of these new friendships and was able to move beyond the need to self-harm.
For adolescents whose cutting is especially serious, extended treatment is necessary. Some need external help keeping themselves safe until they can find the courage and self-control it takes to face the emotional pain and heal it. In these cases, the 24/7 supervision and structure of a hospital or residential adolescent treatment center is a critical intervention.
The bottom line is that parents, treatment professionals and friends all need to patiently and respectfully engage in a genuine relationship of trust with someone who self-harms in order to take the next steps. Those next steps include teaching her new tools which will help her to work through her pain and assisting her in replacing the shame she feels with love.