Sunday 1 March is Self Harm/Injury Awareness Day. Self harm includes a range of behaviours; it is most commonly associated with cutting, burning, pinching or otherwise physically attacking yourself (self injury), but can also include drug and alcohol abuse (self poisoning) and eating disorders.
If you know someone who is self harming - perhaps your son or daughter, a close friend or your partner - it can be difficult to know what to say or do. Even if you understand the underlying causes of their behaviour, you may worry about saying or doing the wrong thing. We asked RSCPP therapists for their advice on how best you can support someone who self harms.
"It's hard to see someone you care about hurt themselves and it can be really difficult to understand," says Registered Psychologist Lindsay Wilkinson. "When we don't understand things, we tend to get frightened, feel helpless and sometimes even get angry - how could they do this to themselves? How could they do this to you? Such strong emotions can make you react really strongly and not always in a way that is helpful. So what can you do?"
The most important thing you can do is try and understand the reasons why your loved one may be self harming. It may be helpful to read our resource on causes of self harm. "Remember that the self harming is a way of coping with a problem for most people, and that it is often helpful to them in the short run, even if that feels counter intuitive to you," Lindsay explains.
Likewise, Registered Psychotherapist Sue Crofton says: "The first response is important - not to be critical or judgmental but curious. I see self harm as a response to an intolerable situation which - as odd as it may seem to non self harmers - works; a survival strategy, if you will."
She adds: "The main thing for friends and relatives is not to panic, but to see your loved one as someone who is trying as best they know right now, to deal with an intolerable situation."
It can be difficult to get the balance right between being there as a supportive listening ear, and coming across as too pushy or domineering. You understandably want to find a way to help your friend or relative to stop self harming, but you may find that what they really need in the first instance is someone to simply listen, not judge them or try to find a solution.
As Registered Counsellor David Hayter explains, "Trying to create a space where the person feels able and encouraged to talk, and where they do not feel criticised, is helpful. Allow them to speak, and to be silent, without commenting on what they say, but acknowledging what they have said. Accept what is being said, even if it is difficult to hear." If they are not ready to talk, he adds, "say that you know they are finding life difficult and that you are there when they want to talk."
Allow them to speak, and to be silent, without commenting on what they say.
Rather than storming in with a solution to the self harm itself, Lindsay says it may be more useful to focus on the underlying issues that are causing them to self harm. "If you can, give the person time and space to talk to you about what is causing them distress, rather than becoming too focused on the act of self harm itself," she says.
"They may not be able to take you up on this straight away, if at all, but knowing that there is someone there who really wants to listen, rather than simply tell them off can make all the difference."
Registered Counsellor Kate Palmer adds: "Just try to support that person with your love and understanding: ask them what would help right now? What might have helped them before they felt they had to self harm?"
Often people who self harm do so in secret and may feel huge shame.
Remember also that your loved one may feel guilty or embarrassed about their behaviour, so tread carefully and avoid criticising them for hurting themselves: "Often people who self harm do so in secret and may feel huge shame," Sue explains. "The most useful advice is to be available as an active listener if they want to talk, without judgment, or advice or pushing."
Rachel Welch, director of organisation Self Harm UK, reiterates this advice, saying: "'If you're concerned about someone then tell them. You may find they have been waiting for someone to ask. Be honest - don't pretend to have answers, and be lead by them: what do they feel they need? What do they want? What do they want you to do? Don't judge, don't panic; but rather listen, be gentle and help them feel as in control as possible."
If they do feel able to open up to you, think carefully about the best steps to ensure their safety, without alienating them or making them withdraw from you. Rather than pushing your loved one to stop their self harming behaviour, it is important to ensure that they are acting as safely as possible and that they have access to appropriate information about accessing help. "If you can, leave leaflets out for counselling organisations or other resources," David advises.
In her experience as a therapist, Sue says, "I have worked with a number of clients who self harm; I do not ask them to stop self harming but get as much information as I can about how and when they do it, and how they feel before, during and after. I do not ask them to stop this behaviour, but ask them to ensure that they use clean implements if they are cutting to avoid infection."
Above all, recognise that you can't solve whatever is causing them to act in this way.
Likewise, Kate says: "Make sure they are physically as safe as possible by either getting them the medical care they may need or making sure the cut or burn is clean and bandaged if needed. Above all, recognise that you can't solve whatever is causing them to act in this way. You can encourage them to find the help they need and you can be there for them. But, however much you care, you can't solve it for them or stop them from self harming."
Self Harm UK has information on staying safe, or you could consult your GP for advice.
Finally, Lindsay says, "Don't forget to take care of yourself too - it will be much easier to talk to the person you love calmly and supportively if you have somewhere to offload your feelings about the situation to."
While it's important to focus on your loved one and their suffering, Kate points out, "Supporting someone who is self harming can feel hugely challenging. You will find yourself coming up against your own feelings - anxiety, disgust, helplessness, anger, wanting to withdraw, just to name a few!" Don't be afraid to find someone else you can talk to, to acknowledge these difficult feelings.