For Parents and Caregivers: Guidelines for Understanding

For Parents: Guidelines for Understanding & Caring

For a Person Who Engages in Self Injurious Behavior

• Recognize that self injury is not the same as a suicide attempt. While it is true that people who are suicidal also may engage in self injurious behavior, the behavior itself is not an attempt to end one’s life. People generally engage in self injury not because they want to die, but because they want to feel better.

• Understand the significant degree of relief that the person obtains from engaging in self injurious behavior. At some level, the behavior “works.” It always “makes sense.” Those who engage in it are not “crazy,” but are attempting to alter an intolerable internal mood state. Self injury is an attempt at a solution.

• Don’t take it personally. People do not generally self-injure to be dramatic, to annoy you, or to make you feel guilty. Educate yourself as much as possible about self injury so that you can learn to respond appropriately.

• Try to suspend your good intentions to stop or fix the problem in favor of moving closer to the person with compassion and understanding. A frontal assault on symptoms alone is rarely effective, and may drive the problem deeper. The better you are able to connect with the person “behind the self injury,” the better you will be able to help the person make the decision to stay safe. People heal as they learn to rely on safe relationships with other human beings rather than relying on self injury to meet their needs.

• At the same time, acknowledge your own emotional reaction to self injury, and discuss your feelings with others who can understand and support you. Many people find self injury frightening and repulsive. It is likely to evoke feelings of disgust and anger. While these feelings are understandable and normal, they can interfere with your ability to be helpful if they lead to distancing, judgmental or controlling behaviors on your part. Common control strategies on the part of caregivers include appeals to logic, threats, groundings, lectures, withdrawing love and support and guilt. Remember that ultimatums do not ever work.

• Understand that limit setting is different than control. For example, saying, “We may need to consider short-term hospitalization to stabilize your pattern of self injury,” or “You will be grounded for coming home an hour after curfew,” are reasonable limits. Saying, “You’ll be grounded if you hurt yourself again” is counterproductive and unreasonable. You can continue to set reasonable limits without crossing the line into trying to control the person’s pattern of self injury.

• Avoid being drawn into a power struggle around the issue of safety in which the person advocates for self injury and you become the spokesperson for safety. The person who self injures must struggle with his or her own ambivalence about wanting to stop versus wanting to continue with the behavior.

• While you cannot stop another person from engaging in self injury, you can help the person make the decision to stay safe by such things as offering love and support, providing distractions (e.g., taking a walk, going to a movie), making time to listen, providing transportation to therapy or support groups, and letting the person know that you love them independently of their behavior. Give the message, “I don’t approve of the behavior, but I always love you.” Make it clear that the person doesn’t need to engage in self injury in order to get displays of caring from you.

• Encourage self injurers to use words to express their pain. Validate their pain. Statements like “You don’t have to hurt yourself to tell me how bad you feel,” can be helpful. Don’t try to talk the person out of his or her painful feelings. For example, instead of saying, “You shouldn’t feel this way,” ask, “What makes you think you are worthless or deserve to be punished?,” or “Tell me more about how you are feeling.”

• Examine your own beliefs and values with regards to conflict, feelings and boundaries. Is conflict dealt with openly and respectfully in your family? Are there certain feelings that you are uncomfortable with or do not allow? Are people allowed privacy and space in your family? How are decisions made? Be open to the possibility of working with a family therapist to help you and your family members establish flexible and respectful ways of communicating and being together.

• Work out with the person the best way to approach the subject of self injury and how you can be the most helpful. Let the person know that you are willing to talk. Some persons who self injure prefer that you bring the subject up from time to time because it is hard for them to initiate a conversation about how they are doing. Others want space, and prefer to talk with you when they are ready to do so. In any case, find out the things that you can do that are helpful, and then do them.

• Recovery entails putting the self injury “out of a job,” identifying the rewards that the self injury provides, and then finding ways to achieve these rewards in safe ways. Rather than seeing yourself as the “self injury police,” looking for ways to “catch” and “stop” the person from engaging in the behavior, imagine yourself as a facilitator, someone who can help the person explore ways that he or she might be able to “act out” in safe ways. The message is, “You’ve found a way to try to take care of yourself by hurting yourself. Let’s see if there are other ways you can meet your needs. Let’s see if we can add to your repertoire of coping responses.”

• Recovery is about the gradual surrender of self injurious behavior in favor of a life worth living. It is not an “all-or-nothing” event, but a process that involves the gradual shifting of trust away from the self injurious behavior toward ever-deepening connections with self, other people and the world.

• Attend to any physical/medical needs a person may have after self injury has occurred, but don’t inadvertently reinforce the behavior by becoming overly concerned. Remain matter-of-fact.

• Use relapse episodes as an opportunity for learning, rather than evidence of inevitable failure. Help the person discover what went wrong, what triggered their self injury, and what they can do differently the next time to stay safe.

• Talk with the person about times they thought about hurting themselves, but didn’t. Ask, “What was different?” “How did you stay safe?” “Do you think you could do this again in the future?”

• People are much more likely to recover from self injury when they are able to find something that makes them “light up,” something that they excel at or feel passionate about, something that makes them want to get up in the morning. Encourage your loved one to take small steps toward strengthening and/or pursuing his or her unique gifts and interests to promote a sense of mastery, recognition and connection to the larger community.

• Remember that there is hope. People can and do recover from self injury.

This information is reprinted with permission from (2006) Shiltz, Thomas J. Self InjurySupport Group Curriculum, RogersMemorialHospital. Call 1-800-767-4411, ext. 566 for information on obtaining the entire curriculum.