Lessons on Self Harm

Lessons on Self Harm
By: Angela Kuhns, MA, LPC
I would like to explore something that is both heavy and important to talk about. AND nothing is more important than your safety.  If you find discussions of self-harm or references to suicidal ideation activating or overwhelming, do what you need to do to keep yourself safe, including choosing not to read this post.
 
Self-harm refers to deliberately hurting your own body.  This commonly takes the form of, but is not limited to, cutting, bruising, or burning. March is Self-Harm Awareness Month, and I would like to create an opportunity to connect by sharing my own story and what I have learned.
 
By the middle of high school my depression was in full force with all its attendant sadness, confusion, anger, and feelings of worthlessness.  Totally overwhelmed and without access to better tools, I began self-harming.  There were times I self-harmed because it all felt like too much to bear. I have learned we all need to be taught to identify and label our emotions.  We need emotion regulation/tolerance skills that work for us. There were times it was because I felt nothing, trapped in periods of numbness, suppression, and anhedonia.  Self-harm was an attempt to feel something.  I have learned we all need ways to safely feel our feelings, strategies to ride out waves of difficult emotions, and to know that it is okay to get treatment for any underlying issues.  There were times it was out of anger that I didn’t know how to safely hold or communicate.  I have learned we all need to understand that there are no “bad” emotions. Yes, there are painful and difficult emotions, and we need to realize they provide us with valuable information.  We need to learn how sit with, listen to, and communicate our feelings.  There were times it was because the results of physical self-harm were tangible.  I could see it, I knew why it hurt, and I could control how much and when it hurt.  I have learned we all need ways to express ourselves.  We need insight into our pain and suffering. We need to connect to the agency that we do have in our lives.  There were times it was the reflection of the toxic shame that can accompany shoulds, rejection, loss, and disappointment.  I have learned we all need to challenge our avoidance, judgements, and harmful ways of thinking. We need to learn good boundaries, to take responsibility for our own feelings and not the feelings of others. There was even one time that self-harm seemed like the only thing between me and suicide.  I have learned we all need our self-harm, underlying issues, and any co-occurring suicidal ideation treated. We need love, support, belonging, and as many protective factors as possible.  During all this, I would have smiled and told you everything was okay. People around me didn’t know or if they did, they surely didn’t know what to do or say.
 
There are many reasons someone might self-harm and what leads to harm reduction depends on each individual’s needs.  Whatever the reasons, know that THERE ARE THINGS WE CAN DO. 
 
If you have lived experience of self-harm or have thought about self-harming know that you are not alone, you are not inherently flawed, there is help, and it is okay access that help.  If none of that seems believable right now---I hear you, there are reasons those blocks are there, and there are people who can help you work through the blocks, self-harm, and whatever is going on in your life. 
 
If you think someone you care about might be self-harming, please don’t ignore it.  It is equally important to not overreact, which may require you to address your own needs.  A person struggling to manage their emotions doesn’t need high reactivity to also try and manage.  If you’re dysregulated, you cannot help coregulate or model emotion regulation.  Let the person know you care, work with them towards safety, and help them get connected to as many resources as possible including internal strengths, skills building, and professional support. 
 
When a part of self or a loved one self-harms:

• Address immediate safety concerns. 

Is there a wound that needs medical attention?
Self-harm is not a suicide attempt. It is often non-lethal AND behaviors can escalate. Suicidal ideation can also co-occur.  This should be assessed by a professional who will work on a safety plan and harm reduction. 

• Find professional support to address underlying cause(s)

Do not leave self-harm untreated. We can identify the function of the self-harm and work towards meeting underlying needs in more skillful ways.  Also, keep in mind you have the right to directly ask a provider how they address self-harm with clients. 

• Do your best to show up with compassion and a desire to understand.

Criticism, shame, and further non listening will only add more suffering and likely increase self-harm.

• Work to build skills in emotion regulation and tolerance. 

Get support from a therapist. Google search emotion regulation skills -My favorite is R.A.I.N taught by Tara Brach.

• Accept that nothing may work like self-harm. 

It will be different. Skillful coping is going to take more effort, time, and will not feel the same.  This is true of many of the ways we try to find immediate relief.

• Connect to our shared Humanity.

In a moment of pain or overwhelm, we have all engaged in behaviors we weren’t proud of, lacked skillfulness, and that were not in our best interested long term. 

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