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May 23, 2012

Help for families and friends of those that Self Injure

Now what? Perhaps someone you care about has honored you by trusting you with information about their self-injury, or maybe you've inadvertently discovered it. Regardless of how you found out, you know about it now, and you can't pretend it away -- you have to respond in some way. Here are some guidelines for dealing with SI in a friend or family member. You might also find it helpful to post to and read the family and friends section of the bus web board. Some good conversations happen there.

Don't take it personally.

Self-injurious behavior is more about the person who does it than about the people around him/her. The person you're concerned about is not cutting, burning, hitting, or whatever just to make you feel bad or guilty. Even if it feels like a manipulation, it probably isn't intended as one. People generally do not SI to be dramatic, to annoy others, or to make a point.


Educate yourself.

Get as much information as you can about self-injury in general. This page is a good start; there are also some very informative books out there (in particular,Bodies Under Siege by Favazza, The Scarred Soul by Alderman, and A Bright Red Scream by Strong). The Favazza book is more scholarly in tone, the Alderman book is oriented toward self-help, and Strong's book presents the voice of self-injurers talking about what they do and why -- it lets you inside the mind of people who SI. All contain much valuable information and advice.

Understand your feelings.

Be honest with yourself about how this self-injury makes you feel. Don't pretend to yourself that it's okay if it's not -- many people find self-injury repulsive, frightening, or provoking (Favazza, 1996; Alderman, 1997).

If you need help dealing with the feelings aroused in you by self-injury, find a good therapist. Be careful, though, that you not try to get "surrogate therapy" for your family member/friend -- what goes on in your therapy sessions should remain between you and your therapist. Don't ask your therapist to try to diagnose or treat the person you're concerned about, and if the self-injurer seeks treatment, be sure that s/he is seeing a different therapist than you are. Don't discuss the content of your therapy sessions in any but the most general terms, and never say anything like "My therapist says you should..." Therapy is a tool for self-understanding, not for getting others to change.

Be supportive without reinforcing the behavior.

It's important that your friend, lover, child, sibling know that you can separate who they are from what they do, and that you love them independently of whether they self-injure. Be available as much as you can be. Set aside your personal feelings of fear or revulsion about the behavior and focus on what's going on with the person.

Some good ways of showing support include:
  • Don't avoid the subject of self-injury. Let it be known that you're willing to talk, and then follow the other person's lead. Tell the person that if you don't bring the subject up, it's because you're respecting their space, not because of aversion.
  • Make the initial approach. "I know that sometimes you hurt yourself and I'd like to understand it. People do it for so many reasons; if you could help me understand yours, I'd be grateful." Don't push it after that; if the person says they'd rather not talk about it, accept this gracefully and drop the subject, perhaps reminding them that you're willing to listen if they ever do want to talk about it.
  • Be available. You can't be supportive of someone if you can't be reached.
  • Set reasonable limits. "I cannot handle talking to you while you are actually cutting yourself because I care about you greatly and it hurts too much to see you doing that" is a reasonable statement, for example. "I will stop loving you if you cut yourself" isn't reasonable if your goal is to keep the relationship intact.
  • Make it clear from your behavior that the person doesn't need to self-injure in order to get displays of love and caring from you. Be free with loving, caring gestures, even if they aren't returned always (or even often). Don't withdraw your love from the person. The way to avoid reinforcing SIV is to be consistently caring, so that taking care of the person after they injure is nothing special or extraordinary.
  • Provide distractions if necessary. Sometimes just being distracted (taken to a movie, on a walk, out for ice cream; talked to about things that have nothing to do with self-injury) can work wonders. If someone you care about is feeling depressed, you can sometimes help by bringing something pleasant and diverting into their lives. This doesn't mean that you should ignore their feelings; you can acknowledge that they feel lousy and still do something nice and distracting. (This is NOT the same as trying to cajole them out of a mood or telling them to just get over it -- it's an attempt to break a negative cycle by injecting something positive. It could be as simple as bringing the person a flower. Don't expect your efforts to be a permanent cure, though; this is a simple improve-the-moment technique.)
  • If you live apart from the person you're concerned about, offer physical safe space: "I'm worried about you; would you come sleep over at my house tonight?" Even if the offer is declined, just knowing it's there can be comforting.
  • Don't ask "Is there anything I can do?" Find things that you can do and ask "Can I ?" People who feel really bad often can't think of anything that might make them feel better; asking if you can take them to a movie or wash those (month-old) dishes (if done nonjudgmentally) can be really helpful. Spontaneous acts of kindness ("I saw this flower at the store and knew you'd love to have it") work wonders.
Take care of yourself.

It sounds like hard work, and it is. And if you try to be completely supportive to someone else 24/7, you're going to burn out (and they won't have any incentive to change). You have to find ways to be sure your needs are being met.

Take a break from it when you need to. When setting limits, remember that as much as you love someone, sometimes you're going to need to get away from them for a while. Tell the person that sometimes you need to recharge and that it doesn't affect your love for him/her. Only break into this personal time in cases of absolute life-or-death crisis.

The balance here is tricky, because if you make yourself more and more distant, you might get a reaction of increasing levels of crisis from the other person. If you let them know that they don't have to be about to die to get love and attention from you, you can take breaks without freaking the person out. The key is developing trust, a process that will take some time. Once you prove that you are someone who isn't going to go away at the first sign of trouble, you will be able to go away in non-crisis times without provoking a crisis response.

Ultimatums do NOT work. Ever.

Loving someone who injures him/herself is an exercise in knowing your limitations. No matter how much you care about someone, you cannot force them to behave as you'd prefer them to. In nearly two years of running the bodies under siege mailing list, I have yet to hear of a single case in which an ultimatum worked. Sometimes SI is suppressed for a while, but when it inevitably surfaces it's often more destructive and intense than it had been before. Sometimes the behavior is just driven underground. One person I know responded to periodic strip searches by simply finding more and more hidden places to cut. Confiscating tools used for SIV is worse than useless -- it just encourages the person to be creative in finding implements. People have managed to cut themselves with plastic eating utensils.

Punishments just feed the cycle of self-hatred and unpleasantness that leads to SIV. Guilt-tripping does the same. Both of these are incredibly common and both make things infinitely worse. The major fallacy here is in believing that SIV is about you; it almost invariably isn't (except in the most casual ways).

Accept your limitations.

Acknowledge the pain of your loved one.

Accepting and acknowledging that someone is in pain doesn't make the pain go away, but it can make it more bearable. Let them know you understand that SIV isn't an attempt to be willful or to make life hard for you or to be unpleasant; acknowledge that it's caused by genuine pain they can find no other way to handle. Be hopeful about the possibility of learning other ways to cope with pain. If they're open to it, discuss possibilities for treatment with them.

Don't force things.

If you make overtures and they're rejected, back off for a few days or weeks. Don't push it. Some people need time to decide to trust someone else, particularly if they've received a lot of negative feedback about their SI before. Be patient.

Other resources

Bristol Crisis Service for Women publishes a "Responses to Self-injury" sheet. Also, I've compiled a list of organizations offering help specifically for SIV. Many of them also offer support for family and friends of people who self-harm.

Tracy Alderman gives some excellent advice on how to cope when someone you love self-injures, as does Kharre. More help can be found at What now?

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