Self-Harm. What is it, what it is not, and where to start.

This is a tough one. I’ve spent 10 minutes wondering what to title this particular blog post because I don’t want to strike the wrong tone starting off. But here goes:

Sometimes, people, often teens, hurt themselves, intentionally. Not for fun, or necessarily to prove something-- but because it is what makes sense to make emotional pain stop, or let them feel something when they haven’t found success with other things. To a healthy mind, that wouldn’t make sense. But if someone has begun hurting themselves for relief, they aren’t in a healthy state of mind. I will try to keep this post general to age, because someone can start self-harming at just about any age, however, sometimes I will speak more specifically about how to help a teen.


What is “self-harm”?


The first thing I want to make clear is that self-harm and suicidality are two very different concepts. Someone who is suicidal may or may not engage in self-harm. And someone who self-harms may or may not be suicidal.


Self-harm is when a person causes deliberate harm to their own body intentionally, for the purpose of relieving emotional and psychological distress. Self-harm, also called Non-suicidal Self Injury (NSSI), can take multiple forms: cutting, hitting head/legs/arms, etc with hands or against hard surfaces, burning, scratching, hair pulling.


If you find out someone in your life is harming themselves, let yourself have a few minutes alone to breathe through the feelings (whether anger, fear, sadness, confusion, etcetera). I’m not going to tell you not to feel whatever that emotion is. It’s not helpful, healthy, or realistic.


But after, after is when you can do something.


Where to start


  1. Let them know you’re there for them. You don’t have to be their ‘everything;’ it isn’t your job to fix all that is wrong in their life. No one can do that on their own. BUT you can sit with them, listen to what they have to say, and let them know that they are cared about. That does more than you’d think!

  2. Validate their feelings. Validation does not mean agreeing. You don’t have to know and understand everything that’s going on with them, but if you can take a small leap to either see why they might feel the way they do, you can find the words to validate them.

When we teach loved ones Emotion Focused Family Therapy (EFFT), one of the first skills we teach is validating using emotion coaching. It follows a basic script that you can rely on when you don’t know what else to say. “I can imagine that you feel ________ because _____________, because _______________, and because ___________. I am here for you, and I care about you.” If you can’t come up with three ‘because’ statements, it’s okay. Same with if you have something that feels more genuine in place of the last sentence. The idea is to remind them that they are not alone, and that you care about them. Here is a link to the webinars we send to loved ones for the beginning of EFFT coaching.

Want to know more or get further coaching? Contact Conquer & Bloom Katy Counseling about EFFT coaching.


3. Encourage them or help them get to counseling. This is not something to wait on. “It only happened once!” -- once is already concerning enough to seek help.


For Parents: You can search therapists who work with the age group of your child, or talk to their school counselor for specific referrals (different therapists see different age ranges). For someone who is already seeing a therapist, communicate with that therapist what you’ve learned and work with them and your child to establish safety protocols and how to recognize intensifying symptoms.

For friends, or parents of friends of a teen: Talk to their parents. Suggest they seek therapeutic support.


If you see actively healing or open wounds.


Unfortunately, self-harm wounds aren’t always tended to as they need to be. Again, it isn’t because someone is being careless, but often because they believe they “deserve it” or are in too much shame to take care of their wounds, or even to make sure the instrument they use to hurt themselves is clean. Even if a wound is clean, if it’s the first time you’ve seen the injury, check the cleanliness.


Soap and water is generally all you need to clean basic wounds. I suggest using dish soap. It’s liquid, and typically less perfumed than hand soap or body wash, which reduces irritation. Gently wash with either hands, or a freshly clean soft cloth. If their skin is too irritated for soap and water, saline solution (first aid or basic saline nasal spray, NOT contact solution) can be used as a gentle rinse instead; rinse thoroughly.






The next part of wound care is protecting it while it heals. An antibiotic ointment is helpful, especially if the injuring instrument may not have been clean. Note that if the injury is deep, the cream goes over it, not in the wound. Additionally, for deep cuts (but not so deep that they require stitches), use butterfly closures to pull the sides of the cut back together. Lately, I haven’t seen them in the pharmacies or grocery stores other than HEB and in their brand, so it may be something you need to order online.



If in doubt at all about whether an injury needs stitches, seek medical care immediately.

Urgent care centers can sufficiently help in closing the wounds.


As far as keeping the area covered, standard bandaids are not ideal because of the size of the padded space versus the adhesive tabs. If you’ve ever had a bad scrape from falling off your bike and tried to put basic bandaids on a very large scrape, you probably know how bad it can hurt to pull a bandaid off a scab. Not conducive to healing well. Instead, you can use a large adhesive bandage, which will seal out everything on all four sides. I also recommend using gauze with self-stick wrap (Band-Aid brand calls it “Tough Wrap”) if there is a large number of cuts or cuts over a spread out area because the gauze can be laid out as needed and not risk the painful sticky-on-scab.



Once the wounds are well into healing, using scar cream helps the mark of that experience fade. Many of my teens who struggle with self-harm behaviors worry about other people seeing their scars, and people can be cruel about it. So the scar cream can help reduce that fear that can keep them stuck in that headspace.




_______


Self-harm is a tough topic, but it’s not the end of the world. It’s not uncontrollable chaos. And it isn’t someone’s forever.


If you or someone in your life is struggling with self-harm, and they are open to counseling, I work with those 12 and over who need to recover from self harm.


Peacefully yours,

Elizabeth Bolton, LPC


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