Understanding self-harm

Before I started working with people who self-harm, I could not reconcile in me the possibility that someone who already suffers greatly emotionally could add to their suffering so directly and physically.

I now work privately with this group of people, and I have also co-facilitated a self-harm support group. These experiences have helped me make sense of this complex and challenging behaviour. I have outlined here some of the thoughts that help me create the kind of therapeutic relationship that a person who self-harms may benefit from.

Understanding self-harm

However people define their self-injury is what matters. Self-harm can take different forms, and each person's experience and relationship with it will be individual.

There are many myths which contribute to an interpretation of self-harm as primarily attention-seeking, tyrannical to others and self-destructive. Other myths include the assumption that only young people self-harm, or mainly young women. In reality, self-harm can affect people of different ages, genders and backgrounds.

People who self-injure often report feeling misunderstood, making it very difficult for them to seek help, even in the midst of a very hard time. Feeling judged or dismissed can make reaching out for support even more difficult.

People who self-harm may have experienced difficult or distressing events in their lives, including loss, abuse, neglect, bullying, illness or difficult relationships. For others, their experiences may be very different. There is no single experience or set of circumstances that explains why someone self-harms.

Some people who self-harm may also experience difficulties with relationships, work, housing or isolation, while others may have jobs, relationships, families and lives that appear settled from the outside. Students who self-harm, for example, can go to great lengths to hide their behaviour and continue to study.

What have I learned about self-harm?

The people I work with describe their actions as a way of coping with, or escaping, hugely intense and overwhelming mental distress. Often the words are difficult to find to describe what is felt. For some, it can feel as though the distress happens suddenly, with little or no recognisable trigger at the time.

Many share that in that moment they find no other way to release their pain. Self-harming can also, for some people, be a way of feeling real or more alive, rather than feeling impossibly cut off from parts of themselves and from the world around them.

For some, taking control of their body in that way can help alleviate a deep sense of powerlessness they experience in significant areas of their life. This may relate to relationships, family, home, work or other experiences.

These feelings of powerlessness can seem impossible to challenge in themselves and in relation to others.

Other people may experience self-punishing thoughts in relation to their self-injury. For some people I have worked with, self-harming has also been a way of communicating distress when expressing difficult feelings in another way has felt impossible or unsafe.

Most of the time, self-harm can serve more than one function, and the stories attached to this kind of coping behaviour are diverse and complex.

Looking beyond the behaviour in therapy

I have learnt to listen to each person's relationship to their self-injury at a deeper level, to be alongside them through past and present experience, sometimes at a very fast and incomprehensible speed, at other times, the silences and pauses are immense.

I have learnt to come close but not too close to each person and their often very painful story.

I am continuing to learn from the individuals I work with, to create a safe and sensitive therapeutic boundary to encourage reflection on the issues behind their self-injury, as little or as much as they need to at a given moment.

This is by no means an exhaustive article on self-harm. Each person's experience is different, and understanding what self-harm means for the individual can be an important part of providing compassionate and appropriate support.