How Can I Help Myself?

The following suggestions were gathered from my own experience, from the experiences of others who self-harm or have stopped completely, extrapolated from various theories, and from the very limited information on this subject available in the literature. Many thanks to those of you who shared your own techniques. Hawton's (1990) chapter on the prevention of Self-Cutting, Favazza's book Bodies Under Siege (1987), and Miller's book Women Who Hurt Themselves (1994), also provided some useful ideas which I've adapted for self-help purposes.

Suggestions of Things to Do:

1. EVALUATE AND CHANGE YOUR LIFE CIRCUMSTANCES IF NECESSARY. I put this first because as long as you are in a physically or emotionally unsafe environment, it will be much harder (maybe impossible) for you to stop providing yourself with relief through self-injury. Ask yourself how you feel about where you are living....who you are living with....how you spend your days. Are you comfortable with these things? If not, start focusing on changing them. Support groups or therapists can be helpful for this.

2. DECIDE IF YOU WANT TO STOP SELF-INJURING NOW. For some people, the rewards that they get from hurting themselves so far outweigh the negative consequences that they have little desire to stop this behavior immediately and the idea of doing so is very threatening. If this is the case for you, you may want to focus on longer term suggestions for changing your life, rather than focusing on immediate control of your self-injury behavior.

3. IF YOU WANT TO STOP NOW: think about the times that you've hurt yourself and see if you can identify certain kinds of events that provoke the feelings that make you want to hurt yourself, or thoughts that you start thinking before you self-harm. Write these down. Try to recognize these events, or thoughts in the future, when they start to occur, rather than waiting till the feelings are overwhelming.

4. IF YOU FEEL LIKE YOU MIGHT HURT YOURSELF (or recognize events or thoughts that precede self-harm for you):
   1. [These bracketed entries are things that have worked well for me, deb, and are not part of the original list. The 15-minute method. Give yourself permission to do it, but make it a condition that you wait 15 minutes first. When the time is up, reassess. Can you wait another 15? Do it if you can.
   2. Ask what you're feeling. Are you angry? Why? If it involves a possible confrontation with another person, see Linehan's worksheet on [1]dealing with interpersonal conflict for an excellent resource for being cool and competent in dealing with the situation. Are you afraid? Of what? Get together with someone and brainstorm: what's the worst that could happen and how could you respond? What's the best that could happen?
   3. Breathe. Sit comfortably with both feet on the floor. Feel the grounded-ness of your feet. Inhale through your nose for a count of six, eyes closed, mind clear. Hold the breath for a slow count of six. Exhale through your mouth for a count of 6.
   4. Carrol Alvarez, of the University of Washington, explained to me that many times, trauma victims who can talk about their past trauma without obvious affect (emotion) have a fragmented memory of the event(s): the episode has become separated from the feelings that accompanied it. Episodes of free-floating fear, rage, or anxiety that are triggered by something in the present can be thought of as having recalled those emotional memory fragments. To deal with them, Carrol suggests that you think about an episode in the past when you felt as you do now. Write down what happened then and what's happening now. Then make two lists: one of similarities between the two, one of differences. This can help you build perspective.] On to the original list:
   5. Stay in the company of others. People usually injure themselves privately. Spend as much time as possible in public places, stay overnight with a trusted friend or family member if you can.
   6. Try to delay the act in any way you can. Favazza calls the willingness and ability to delay self injury the first step to recovery. You might try distracting yourself by calling a friend, going somewhere, writing in a journal, watching a movie, painting a picture, exercising, etc. Even if you end up hurting yourself, recognize that you made progress by delaying the act and try to delay longer in the future. This is a HARD thing to do. As in substance addictions, some people find that the longer they go without harming themselves, the easier it becomes to resist.
   7. Stay away from the materials that you know you might hurt yourself with, like razors, glass, pins, etc. Many people find it helpful in the short term to remove razor blades or other tempting items from their home.
   8. Some people find that the impulse to injure themselves passes if a loved one holds them tightly when they feel overwhelmed by feelings or out of touch with their bodies. Since many people who self-harm have been abused in some way, this may not work for them, or the choice of who can hold them should be made very carefully. Sometimes having someone hold your hand, or stroke your arm is helpful.
   9. Remind yourself of the long term consequences of self-injury (scars, having to wear long sleeves, and social rejection being a few possibilities);
   10. Some people find it helpful to say "NO!" or "STOP!" out loud to themselves when they think of hurting themselves, and this seems to interrupt the immediacy of their usual self-injury response to stress. In essence, it helps them think before acting and take responsibility for their self-harm.

5. STAY AWAY FROM DRUGS AND ALCOHOL, even caffeine, since these have been linked to self-harm behaviors. Unless your doctor has prescribed a medication (and is aware of your self-injurious behavior), avoid all medications. Even if your doctor has prescribed them, I would recommend staying away from drugs that you know decrease your inhibitions or impulse control (like Valium and other minor tranquilizers) when you feel as though you may hurt yourself. Many people have described them as contraindicated in the immediate prevention of self-injury.

6. IF YOU MUST HURT YOURSELF:
   1. Try to substitute more socially accepted methods such as piercing your ears (again), or better yet get your hair cut or your hair color changed.
   2. Don't beat yourself up about it. That will only make matters worse. This is a VERY hard behavior to change. Try to focus on longer term ways to decrease your stress, finding new ways to communicate and express your feelings, or increasing your control over self-harm instead of on the fact that you hurt yourself again.
   3. NEVER SHARE razors with other people who cut themselves, since this has been identified as a potential new route of HIV transmission. Here's one place where you could cross the line and accidentally turn a non-lethal act into a lethal one. Because many people who self-harm also abuse substances, those who cut might be at higher risk for carrying HIV. [i would add to this "Always clean your razors and your skin to avoid infection. Just wiping them down with alcohol helps."]

7. LIFESTYLE CHANGES TO DECREASE SELF-INJURY OVER THE LONG TERM:
   1. Find new ways to cope with your feelings. Learn new ways to calm, soothe, and comfort yourself. These may not work when you are aroused to the point of feeling overwhelmed, but may be effective if practiced on a regular basis or when you feel tension beginning. Meditation, physical exercise, relaxation exercises, visual imagery, relaxing music, deep breathing, warm baths, and playing a musical instrument are just a few examples of ways that people can soothe themselves.
   2. Several people told me that learning to nurture and protect themselves was an important part of their recovery, as it was in mine. This is not an easy thing to do, and may take many years of work. Try doing things to take care of yourself and make yourself feel pampered and loved. Buy a beautiful journal and write in it. Sit under a big soft quilt and read a good book. Whatever it is that makes you feel loved, do it. Realize what strength it takes to live through what you've lived through. Next time you think of hurting yourself tell yourself that you deserve to be protected.
   3. If you feel a lot of anger, you might try vigorous activities like handball, running, swimming, yard work or martial arts, or squeezing a rubber ball till your hand hurts. Some people told me that it helps them to tear up rags, punch pillows, or paint when they feel anger rising. [I would add here the suggestion, seen on the walkers-in-darkness mailing list, of "slashing" yourself with a red magic marker as an alternative to cutting.]
   4. Practice communicating your feelings instead of engaging in impulsive, addictive behaviors like self-injury or substance abuse to escape them. Find someone safe to communicate your feelings to and try letting someone be there for you. This might be a very close friend, loved one, or therapist. For many of us who have experienced abuse or been raised in households where negative feelings are not expressed verbally, this is not an easy thing to do. Try letting someone you trust comfort you when you are upset. Try expressing your anger directly through words and see what happens. A therapist or counselor can often help you with this.
   5. Assertiveness training groups or self-help book about developing assertiveness skills can also help you learn to get your needs met more directly.
   6. As a general rule, avoid overuse of caffeine, alcohol, and other non-prescribed psychoactive substances. People who self-injure sometimes experience mood swings and these substances can enhance this. If self-injury is an attempt to decrease or increase arousal, these substances might really throw us out of kilter.
   7. Try not to spend time with others who self-injure or engage in self-destructive lifestyles. Self-injury sometime has a "contagious" quality to it, and your behavior might be triggered by the company of others who are harming themselves.
   8. Seek out a therapist to help you make changes in your life. Be a consumer and PROTECT yourself. Victims of abuse or neglect are often highly sensitive to invalidating therapists/approaches to therapy since their earlier abuse or neglect was the ultimate in invalidation. Some therapists place themselves in a superior position to their clients, and act as though their approach is the only one that works, and as though they know more about you than you do. If your therapist doesn't hear you or respect your needs for information, control, feelings of safety, and respect, find another therapist! Ask a prospective therapist (or your current therapist) about his or her views on self-injury: why people do it, how to approach it therapeutically, what to expect in terms of outcome. Make sure the answers are ones that feel comfortable to you. Although there is no shortage of theories about why people hurt themselves, no form of therapy has been shown to work better than any other for helping people to control this behavior. Find a therapist that you can TRUST and work WITH, preferably one who makes you feel empowered rather than sick. Find someone who views this behavior in a way that is comfortable for you, and gives you hope.
   9. Self-help or support groups can be helpful, especially when geared specifically towards people who self-injure. Crisis lines, women's resource centers, and rape or sexual abuse organizations may be sources of information about such groups in your area.

1. How Can I Help my Friend/Child/Loved One Control His/Her Self-Harm?
   1. [To these suggestions, I'd add only this one.] In any situation, but *especially* if your loved one is under a great deal of stress and on the verge of self-harm, try to use the SET model of communicating: Support, Empathy, Truth. First offer a supportive statement: "I'm really concerned about your well-being; I care about you a great deal and you seem very upset." Then, provide empathy -- identify their feelings: "It sounds like you're feeling really awful." Finally, provide truth: "The situation isn't impossible, and we can work together and find a way out." It's extremely important that Support statements not be condescending, Empathy statements not turn into sympathy, and Truth statements not be angry or abusive.
   2. Maintain an accepting, open attitude about the self-injury. Most people who self-harm have problems with low self-esteem and are disgusted by their own self-injury behavior. Try to make him/her feel safe discussing it, and accepted regardless of it. Try not to pay more attention to the self-injury behaviors than the healthier things that this person does.
   3. Recognize the severity of this person's distress and the inability to stop hurting him or herself. Try not to get angry at him/her for self-harm behaviors, since this merely reinforces the self-disgust and discouragement that is already there. If he/she could stop, he/she would. Don't minimize how much distress a person is in, regardless of how insignificant the stressor might appear to you, with statements like "it's not that bad," or "you can't be that upset about it." Acknowledge that the person is under a lot of stress, and that you are there if there's anything that you can do to help. Don't shame the person for failed attempts at controlling self-injury, and praise any success in delaying the act.
   4. If he or she is not already doing so, encourage the person to find a professional therapist that meets her/his needs, preferably one with knowledge and experience with repetitive self-injury. Encourage self-injury support groups if such a thing exists in your area.
   5. If you think this person is in immediate danger of cutting or other superficial or moderate self-injury, stay with him or her until the impulse passes or encourage him or her not to be alone. Physical contact through hand holding or hugging can sometimes be helpful if the relationship is appropriate and trust is sufficient.
   6. Self-injury is an extremely stressful, frustrating, and anxiety-provoking thing for everyone involved. Get support for yourself if you need it, through a counselor or therapist, preferably one with knowledge and experience with self-injury.

If you would like to discuss this further, I can be reached through the anonymous server at: an22340@anon.penet.fi