Self harm describes any behaviour where you inflict some form of pain or harm upon your own body, usually as a way of coping with difficult or distressing emotions. It is commonly associated with acts such as cutting, burning, pinching or otherwise physically attacking yourself (self injury), but can also include drug and alcohol abuse (self poisoning) and eating disorders. Self harm can be a difficult behaviour to understand, and its causes can be complex.
Hurting yourself may feel like a quick fix, or even positive, solution to difficult situations and emotions in the short-term, but it doesn't address the underlying issues that are causing you to feel distress. The National Institute for Health and Care Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as one of the most effective ways of treating those underlying issues at the root of self harm. We asked RSCPP therapists to explain what CBT is and how it can be used as a treatment for self harm.
The underlying principle of CBT is that your thoughts, your feelings and your behaviours are all strongly interlinked. This means that by changing the way you think about a situation, or the way you act in response to a situation, you can often change the way you feel. It is a very active therapeutic approach, in which you work alongside a therapist to try to jointly gain an understanding of how your way of viewing the world and thinking about things may be influencing the way you feel and behave.
Whilst it can sometimes be helpful to discuss the past, to understand how your past has influenced your life and how problems have arisen, CBT mostly focuses on looking for ways to improve your mental wellbeing in the here and now. CBT says that it's not events that cause your emotions, but how you interpret those events - what you think, or what meaning you give that event or situation. CBT can help you to break your vicious cycles of negative thinking, feelings and behaviour. When you see the parts of this cycle clearly, you can change them - and therefore change the way you feel. It can also be helpful to look at the way your thoughts and feelings affect your body, and the physical sensations you can experience as a result.
Working with self harm, a CBT therapist can help you identify when your stress and anxiety levels are increasing, how to spot the signs or triggers that may cause you to self harm, and how to manage your distress in healthier ways, other than self harm. You can be taught self help techniques and be supported towards a greater understanding of why and when you have chosen self harm as a way to manage your distress.
CBT involves meeting with a therapist to discuss your thoughts and feelings and how these in turn affect you, your behaviour and wellbeing. You may be set specific homework tasks in between sessions to help you and your therapist understand more about the thoughts and behaviours that commonly trigger your self harming. You may be asked to keep diaries and these will be discussed in your sessions in order to help you reduce your self harming behaviour.
There is no easy answer to how many sessions it will take to help you reduce your self harming through CBT, as this depends a lot on why you self harm, how severe your self harm is, whether you have many other coping strategies, and how ready you are to make changes in your life.
Some clients find 6-12 sessions helpful, and after this you may consider concluding therapy or reducing your sessions to every couple of weeks.
Many people find that gaining a better understanding of why they self harm, what triggers the urges, and learning new strategies for coping in different ways, can significantly reduce their need to self harm. However, for many people it is a struggle to give up self harming entirely and therefore there is often a focus in therapy on minimising the frequency at which you self harm, the harm you do to yourself when you self harm, and on helping both you and the people around you to cope more effectively with your urges to self harm.
As with any therapy, the work has to be done by you, the client. There is an expectation that you will be able to carry out homework in between each session, and do bear in mind that any therapy can be difficult and painful. Some clients may drop out of therapy when things become too painful, but stay with it! The eventual hope is that all clients will experience a full recovery from their symptoms.
Any qualified CBT therapist, who is accredited by the British Association of Behavioural and Cognitive Psychotherapists (BABCP), or any qualified clinical psychologist should be well equipped to help you to understand the model of CBT and to look at what underpins your self harming. In particular, look out for therapists who have experience working with self harming.
With any therapist, make sure that they belong to a registered accreditation body, and ask your potential therapist about their experience of working with self-harm. Not all therapists are going to be able to work with all issues and there are no hard and fast rules about finding a therapist who's right for you. Talk to your potential therapist and maybe meet up first to see if you feel comfortable with each other. Remember that this is a person who you're going to be spending a lot of time investing in, so make sure that the fit is right for you both.
Many people starting CBT are worried about giving up their self harming, as it seems to be their only way of coping with difficult situations. Don't worry! A good therapist will help you to learn new ways of coping before asking you to try to give up your old ways of coping.
In addition, many people feel embarrassed, ashamed or guilty about their self harming. You may have met with disgust, and a lack of understanding or intolerance from the people around you - people who self harm are commonly accused of seeking attention. This may be holding you back them from seeking therapy to address your self harming, or from being entirely open and honest with your therapist. Self harming is much more common than you would expect and you won't be judged for dealing with your stresses in this way. Your therapist will understand that you have been doing the best you can with the skills you have, and will focus on providing you with new skills to cope with difficult situations, rather than criticising you for not managing in the past. The more open and honest you can be, the more likely it is that the therapy will be effective.