Other Influential Factors
Exploring additional influential factors can help you understand what might be sustaining or exacerbating the behaviour. The most common of these are:
- friends who also self-harm or who talk openly about self-harm
- social media
Both have the potential to normalise self-harm as a helpful and appropriate coping strategy and can perpetuate the problem as young people find others who share their feelings. The good news is that a search on Google of how to self-harm produces only helpful and supportive sites, however, there are plenty of more secretive sites and discussion forums which promote a culture of self-harm which young people can access if they know how.
It is helpful to explore what these influences are, help the young person to consider whether these are helping or exacerbating the behaviour. Finally, this can add to the support planning process by facilitating discussion about more helpful influences such as other friends, family members, supportive adults, websites, apps and text or phone lines.
“Who do you talk to about this?”
“Do you have friends who also self-harm/hurt themselves/cut?”
“What do you find helpful about talking to others who self-harm?”
“I wonder if there is anything unhelpful about talking to others who self-harm.”
“Have you looked at any websites about self-harm? What messages do they give you about self-harm?”
“Websites which promote ways to self-harm make you think they want to help. I can understand why you would feel that’s what you need right now. But these sites are not helping you to manage how you are feeling. They are stopping you from getting the best care and support. Can we look at some others that can give you the help you deserve?”
Continuing the Conversation
Once you have established that the person is self-harming you can start to explore with them the reasons for the behaviour which will help you uncover ways you can help.
Acknowledge the young person’s experience by repeating and reflecting back key thoughts and feelings
Use good listening skills to help the young person express how they are feeling. Repeating and reflecting back demonstrates that you are listening, that you care and you value them and their experience. It also prevents you doing too much problem solving and helps you clarify any points you aren’t sure about.
Use the same words as they do about the self-harming behaviours
Again this shows that you are listening and value their unique experience.
Ask them what they find helpful about it
This is a very non-judgemental question which attempts to get to the heart of the function that the behaviour serves for the young person. If you can work out together why or how it is a helpful strategy for them you will have an opportunity to start to identify other safer and more helpful strategies which might produce the same outcome. It may also introduce the idea that there might be unhelpful elements to it which makes them think a bit more deeply about it and again hints at the concept of other things that might achieve the same goal
“It sounds as if self-harming is helpful for you in some ways. Can you tell me how it feels afterwards for you?”
“It sounds as if cutting makes you feel better? Can you tell me more about that – in what ways do you think it helps you?”
State that you understand why the person would self-harm – reflect back the triggers and consequence
This is not colluding, agreeing with or reinforcing self-harm as a solution. It will however help the person to trust and have confidence in you, that you can listen, understand and help them. It is helpful to reflect back the triggers, the consequences and then state your position that it is understandable a person would try to cope in this way.
“so you mentioned there that when you’ve fought with you dad and you’re alone in your room thinking it over you feel guilty, hopeless and overwhelmed and when you cut those feelings goes away. It’s really understandable that you would try to cope in that way.”
Supporting Change
Once you’ve acknowledged how it is helpful for the young person, help them explore the drawbacks, negatives or risks. Highlighting the risks and drawbacks can provide the motivation to make changes.
“I wonder if there are any drawbacks to you cutting” rather than “what are the drawbacks to you cutting?”
Help them identify exceptions, when they use other strategies and introduce the idea of alternatives
“Are there times when you manage to cope without cutting?”
Reassure the young person that you want to help them find other ways of managing difficult times
If the young person can’t find any drawbacks acknowledge how hard it can be to find a reason to stop doing something that helps. Listen carefully to their story – listen for any subtle hints of drawbacks that you can reflect back.
“You mentioned before that you would like to go on the trip but you can’t because of the marks. I wonder if cutting is stopping you doing things you want to do and that could really help you”
Try asking some different questions which hint at the drawbacks and listen closely for any hints of drawbacks raised by the young person.
“If you didn’t self-harm how might things be different for you?”
“If you had other ways of coping with difficult times what would that be like”
