Psychotherapy for Victims of Self-Harm: There is Hope
By Gail-Elaine Tinker M.S., NCC, LPC
“That’s when I wanted to cut. I cut to quiet the cacophony. I cut to end this abstracted agony, to reel my selves back to one present and physical whole, whose blood was the proof of her tangibility.”
― Caroline Kettlewell, Skin Game
There are many misconceptions in the popular and professional worlds in understanding self-harm or self-injury. Firstly, self-harm does not necessarily reflect suicidal ideation or attempt, although this must be evaluated. Self-harm is defined as the intentional, direct injuring of body; hurting the body on purpose. The most common form of self-injury is the act of ‘cutting’ – the use of sharp objects to cut the skin – additionally scratching, picking at skin, pulling one’s hair, hitting one’s self, head banging, biting the skin, inserting things into the body, braking one’s own bones, or burning the skin.
Hurting oneself or thinking about intentionally hurting the body is a sign of significant emotional distress. Reporting feelings of emptiness and lack of control over life situations is common in self-harm. These uncomfortable emotions may grow more intense if a person continues to use self-harm as a coping mechanism. Often the use of alcohol and other substances impair judgement, resulting in injury worse than intended. Evaluation for eating disorders is highly recommended for all who self-harm. Injuring oneself can stimulate the body’s endorphins or pain-killing hormones, thus raising the sufferer’s mood. Learning other ways to tolerate the mental pain is necessary and a goal in psychotherapy. The shame and hiding of scars, many which are permanent, can impact social and professional relationships for years to come.
There are over 3.3 million cases of self-harm, in the US as of 2013; the 2018 numbers must be significantly greater. There are no exceptions to self-injury in race, class, sexual identification, religion, or ethnicity. Self-harm is most common between the ages of 12 and 24 – from middle school through college age sufferers. While self-harm is more common in females than males, men and boys are catching up with regards to self-harm statistics. It is not only young people self-injuring; adults and the elderly join the ranks. Self-harming behaviors are often kept very secret by the victims. Captive, unstimulated animals, such as birds, dogs, and monkeys are known to self-harm.
Self-harm may occur with individuals with or without a mental health diagnosis. Self-injury is a behavior developed as a dysfunctional coping mechanism to stress. It is described as a means to better temporarily cope with anxiety, depression, stress, emotional numbness, and a sense of failure. The harm to self must be frowned upon in society; piercing, tattoos, or nail biting do not qualify as self-injury.
Suicide is technically not self-harm. There is a complex relationship with self-harm, as suicide attempt or completion can be an unintentional result of self-injury. Suicide is a 60% risk of those who self-harm, who must be continually monitored for suicidality. Addiction and Eating Disorders are other risk factors. Many sufferers of self-injury do not wish to kill themselves, but to gain control and raise endorphins via pain as a temporary mode of relief.
The therapy goals in self-harming behaviors involve treating the underlying emotions, developing a ‘sense of control,’ and the development of improved emotional and situational coping skills. The psychologist or psychotherapist use Psychodynamic therapy to explore the past, Cognitive Behavioral therapy to recognize harmful patterns and improve coping skills, and Dialectical Behavioral therapy is a more intense, direct means of coping skill development. A psychiatrist can be helpful in prescribing helpful medication to lessen harmful urges. Sometimes treatment within a hospital or partial program is recommended, as it keeps the victim safe from injury and allows times to focus on treatment.
Helping a person whom you suspect engages in self-harm starts with identifying the behaviors. Do you notice a person who suffers frequent bruising, often wears bandages, has frequently broken bones, or wearing long sleeves even in hot weather (covering the injury and scars of self-injury). Be especially aware of statements of worthlessness, hopelessness, and unjustified anger. Problems at home or at school are often co-existing. Anxiety and depression can cause erratic or impulsive behaviors. The next step is to encourage the person to see their doctor and engage in psychotherapy. However, refrain from performing a full-on ‘intervention’ without professional help. Helping the person to find treatment can be effective, as the stress of finding one’s own therapist while in pain is exhausting. Please do not shame the victim and beg them to find the willpower to stop. There is no amount of willpower a sufferer can be expected to hold during stressors. Keep in mind that self-harm is a symptom of greater issues.
Self-harm is far too common, but it can be remediated through psychotherapy and medication. Self-harmers are not necessarily suicidal, but need to be evaluated for suicide, addiction, and eating disorders. A mental health diagnosis may be made. The hope that with therapy and family support, self-injurious individuals may learn to cope with better techniques. The goal is to help people become their best selves.
Gail-Elaine Tinker M.S., NCC, LPC is a psychotherapist in Bethlehem, PA. She specializes in anxiety, depression, grief, and trauma… all possible underlying issues in self-harm. She may be reached directly and confidentially at 610-216-4319.
