Responding to Self-Harm

Self-harm is complicated and difficult to understand. If you have not read Understanding Self Harm, I recommend reading it first. This blog is written for those who aim to love hurting people. It is for the individuals who have witnessed the suffering of self-harm in their child, friend, or family member. It is for those who work with hurting individuals. It is not advice on clinical treatment or stopping the behavior. It is to help you stay in compassion and guard your heart so you can continue to love well.

• Be clear about your responsibility. Unless you are a clinician directly working with the individual it is not your job to provide clinical care. Recognize what you are and are not responsible for. You do not have to have the answers. If you take on responsibility that is not yours this may lead to burn out or resentment. We are more apt to feel powerless when we hold things that are not ours to hold—because we are attempting to do a job that is not ours.

• Listen and Refer. In a more practical sense, practice listening, not fixing. Practice being the compassionate witness to the person’s experience. If you are able, listen without words in your head. If you need to respond, decoding is a great tool for this. Decoding means you identify the feeling behind the behavior or words. For example, if the individual says, “I hate you!”, a decoded response would be, “It sounds like you are angry right now”. Do not put pressure on yourself to have the right words. Sometimes decoding might be just acknowledging, “this is really hard right now” or “I can see you are hurting”. After you listen, refer to a professional if it is safe and appropriate. There is work here that is not yours to do.

• Stay curious. We always need to begin from a place of curiosity. Stay present by staying curious. Curiosity inhibits judgment and helps us to stay in compassion. For family and friends, a great script in responding to an alarming behavior is to ask the individual, “how were you hoping I would respond to this?” or “what do you need from me to support you in this?”. Please note that this is different than asking, “what did you expect?”. What I expect may be different than what I hope for. This might give you an indication of the unmet need. Self harm is not something that happens in isolation. There are other factors that need attention and care. Be curious about what those might be.

• Do not take it personally. Do not assume it is about you. Even though self-harm can be a boundary violation, especially when used to elicit care, try not to take the situation personally. We can do this by assuming the individual is doing the best they can (See Assumptions for Compassionate Living).

• Stay engaged and connected. This is especially true for caregivers, and it is a tricky one. Caring for another individual is different than taking responsibility for them. Your responsibility for the individual’s safety is limited. If you suspect an individual is self-harming to meet a need or elicit care, it can be tempting to withdraw care. After all, we do not want to reinforce something unhealthy. However, this approach is likely to result in an increase in symptoms, not a decrease. If the individual has a history of trauma you may unknowingly engage them in a retraumatization cycle (more on this another time) or reinforce unhealthy beliefs about relationship (i.e. “no one cares” or “others will hurt or reject me”).

• Identify and keep your boundaries. To stay connected we need to have boundaries. Boundaries around our own resources and care of self. Boundaries around our time. And boundaries around our responsibility. If an individual is eliciting care, schedule a time to meet. There are emergency resources available and you do not have to be one. If it is a medical or mental health emergency call a local hotline or 911; don’t take it on alone. Allowing your time to be hijacked may lead to resentment, impacting your ability to stay in compassion. For caregivers, a relational regulation schedule is a valuable tool—set aside predictable time to spend together that is NEVER contingent on behavior or crisis. Your energy and time are resources, and you must practice stewardship.

• Grieve. Suffering exists and it is difficult to witness, especially if you are in a helping profession that requires you to bear witness to others’ pain. One of the hardest parts about working with any individual suffering from addictive behaviors or substances is allowing them to choose. An individual who self-harms may choose to continue to self-harm. We do not do anything for no reason. There is a benefit to this behavior and doing something different requires risk. I once worked with an individual whose only healthy relationships were to those in the mental health community. In her mind, getting better meant losing connection. Can you imagine this choice? Even if this is only her assumption, it is devastating. You might say or do all the “right” things and others may not be ready to change. Love them anyway. Identify what you are responsible for and grieve what is not yours.

This is hard stuff. It hurts to see someone we love suffering. Seek professional help and guidance, schedule an assessment for the individual if you are in a care-giving role, manage your responsibility, and grieve what you cannot fix. We are here if you have questions or desire further consultation. Thank you for listening. Take care of you.