Self-harm from a relationship perspective

Self-harm at first sight appears to be an illogical action. What can be gained by harming yourself?

For some, the act of harming the body has the effect of releasing the build up of tension and the resulting overwhelming emotional pain. For others, experiencing the physical pain allows them to feel something rather than nothing or numbness. Whatever the reason, the solution is short lived and does not provide any long-term relief. 

There is a popular conception that feelings of anger are turned inwards, but this can be an oversimplification. It is true that when young people, who are learning about life and relationships, experience a disappointment or rejection in important relationships, they can begin to feel worthless or that they are no good (David Pocock, 2011). I say young person, as this is often when self-harming starts, but it can occur at any age. Today, there are enormous pressures for young people to conform to cultural standards in order to fit in, but these standards are often difficult to achieve. The pressures often result in relationship difficulties, which in turn can lead to self-harm.

If this behaviour comes to the attention of parents or another supportive relationship, then depending on the responses of these people, the difficulties can be given a space for discussion and in some cases, this is sufficient to provide a different way forward. However, often these practices go on in secret and the person does not seek help, as they have developed a sense of over-responsibility, and do not want to worry or give concern to someone else. Instead they manage the strong feelings through self-harming. On the surface it may seem that everything is fine, but it is like a duck on water, everything is going on underneath.

So what can be done?

If supportive listening or various first aid-type remedies do not make a difference, then it is time to take the next step. If it is accepted that self-harm is a way of managing strong feelings caused by difficulties in relationships, then just removing the self-harm is not a way forward unless a better solution is put in place. By relationships, I include relationships between the person and other people and important relationships from the past, who continue to have a strong influence. The effects of these relationships tend to play out in an internal dialogue, that the person has with themselves that others are right and they are no good or worthless.

Given this picture, it is often very difficult to communicate in any way about what is happening and so a therapist needs to work very hard to gain the person's trust. Once the client does begin to talk it is possible to explore and gently challenge their thought processes, while making connections to their relationships. The next stage of the work is to involve families, partners and significant others to improve communication in these relationships. This needs to be very sensitively negotiated and permission sought at each step, as it is big leap for a person who secretively self-harms to take. 

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