Ok, i know i wrote this a LONG time ago, but i'm hoping for fresh faces and fresh insight into it. I'm looking for a way to add, edit and improve on it and hopefully people here can help.
so please read through and leave me a comment at the end on how it can be improved.
If you cant be bothered to read it, dont leave a comment saying it too long or whatever, i dont want to know and i'll ensure your comment gets removed.
ManicD
**New Section Added**
What Techniques are Available to Help them Stop?
Please read and comment
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TEDI Sticky
The Friends Guide to Understanding and Helping Self Harmers
Version 4.2
The most recent version of this guide can always be found on the LiveWire Peers Support Network's Website at http://www.golivewire.com/forums/topic.cgi?topic=118969
This guide is aimed and written about the form of self harm commonly known as "cutting" but its context can be use for dealing with most forms of Self Harm.
The Definition of Self Injury
Self Injury (S.I.) or Self Harm (S.H.).
S.I. can mean any way in which a person deliberately inflicts harm or injury upon themselves. The most common forms of this are hitting objects, cutting themselves or burning themselves but this is not the limit to the methods of S.I.
Why Write a Guide?
I'm writing this guide to help the friends of people who self harm. People have always concentrated on the people who actually self harm, they forget about the friends and family who have to deal with it on a day to day basis. That is why I am writing this guide, from my own experiences, this is the best way I have discovered of dealing with it. This guide is designed to be a guideline not a set of hard rules; every person the self harms is different and needs to be treated differently. While it is true I have no real qualifications of any sort, I have experience, and that is more valuable than any amount of time in a classroom. I have seen both sides of the fence, I have close friends who self harm and I know the stresses and thoughts that occur. I have also cut myself; I know the point of view of the self harmer and know the difficulties in telling someone about it.
Why do People Self Harm?
There are a million and one reasons on why somebody self harms and I can't possibly list them all. What I can list are the five most common reasons that Self Harmers have said is why they cut.
1.It makes me feel better. It makes my pain physical which can be healed
2.It makes me feel alive, I feel dead/numb on the inside so seeing the blood makes me believe I am still alive
3.I hate myself so much that I feel I need to be punished and cutting punishes me. I feel as if I have caused so many problems that I have to be punished.
4.It just feels so good seeing the bright red blood makes me excited (not sexually) it makes me happy, the throbbing pain and the stinging just makes me free for those few minutes I am free, I have no more pain in me it feels as if it all drained out with the blood.
5. Distraction from current problems/stresses. Like if your pissed as hell you can cut, and you have a new issue, Your bleeding out of your wrist. It takes your mind of everything else for awhile. For a few minutes you have a whole new kind of pain. One that you can do something about. One that can be controlled. That sense of control and sanity is worth all the cuts on my wrist.
What I will also do is provide a link to a website that has asked this question to its members, and you can read what they have replied.
http://www.golivewire.com/forums/topic.cgi?topic=36402
How to recognise the signs of SI
Self harmers are normally not willing to tell people about their self injurious behaviour. Normally they are ashamed of it and work hard to hide the evidence from general sight. The ways in which self harmers hide this evidence can sometimes be the key to discovering people who commit self injurious behaviour.
Things to look for:
•Always wearing long sleeves even in hot weather
•Wearing Bracelets / Sweat bands
•Commonly excuses for wounds like pets / brambles / cooking accident
•Commonly wearing bandages for 'sprains'
Remember not all people who display these signs, so don't go accusing every person who wears a long sleeved top of self harming. Also remember that unless you have the trust of the person in question, it may not even be helpful to bring the subject up. It could cause many problems between you and the self harmer.
Why Cant My Friend Just Stop?
The simple answer to this would be that self harm is addictive. It is addictive on a physical level and a psychological level.
Physically
The physical addiction is not actually a true addiction,at no point does the body require the chemicals produced. Though the effects produced can be desired much like an adrenaline junkie desires more situations that produce adrenaline. Whenever the body gets hurt it releases chemicals called endorphins, these help you to recover from the pain and carry on. These chemicals also have the side effect of cheering you up a bit but there main effect is that they help you to relax. On a normal day the body releases a certain amount of these anyway, which keeps you in a normal mood, but when the body gets hurt it releases a large quantity of these, which make you calm down and not feel the pain as much. These chemicals cause the good feelings that accompany self harm and are the reason that many self harmers keep self harming.
Psychologically
This addiction here is caused the by instant distraction that is caused by the harm. When a self harmer hurts themselves the become almost instantly distracted by the pain and the new feelings that they no longer concentrate on the problems that they were having before hand and start to concentrate on the wound. Most self harmers have an almost ritualistic process from the actually techniques of harming to the dealing with the wound (i.e. covering it up, starting the healing process, etc.) This whole process takes time and causes a distraction from the problems/emotional pain that triggered the depression. The distraction cause by harming is psychologically addictive.
So How Can I Help My friend?
So you just found out your friend self harms, you have a million questions flying in your head, one of the main ones would be 'How do I deal with this?' Well here are a few rules to get you going.
Keeping yourself sane
Remember that this is a difficult to time for your friend, you may wish to help them every second of the day, but to do that is impractical. Nobody can be there 100% of the time. Sometimes you may need your own space and your friend must respect this fact. Sometimes it is necessary to set some limits to the situation, maybe tell your friend something's you are not willing to do e.g. go walking in the middle of the night to meet up with them, as this may put you in danger etc.
You cannot help your friend if you are in trouble yourself, this can have large impact on some people and you may wish to discuss this with someone else to help you with your feelings
You are not a trained councillor or psychiatrist; therefore there are limits to how much you can help. The advice is always to get a self harmer to visit a councillor but sometimes due to the secrecy and shame surrounding self harm they refuse to. As you are not trained to deal with this, you can only help in limited (yet still very valuable) ways. You are not solely responsible for treating their self harm. You cannot expect that you will be able to make all the problems go away, its not your job and not your responsibility. You can be a shoulder for your friend to cry on when they are upset, angry or depressed. A listening ear is something that anyone can provide, and sometime this is what a self harmer needs most, someone who will listen and try their hardest to understand. Someone who they can vent to and release all the frustration and anger.
Just because you have been entrusted by your friend with this information, you have no duty or responsibility to help them, anything you do must be because you want to and because they want you to as well. Talking is the key here; you cannot help your friend if you do not know what help they want. In the end you have no control over what they do so if they continue to harm then you cannot blame yourself. They are their own person and can decide for themselves if they want to. You can only offer your support and be a good friend for them.
How to Behave Around Them
First off, each incident, each time they cut needs to be dealt with as a separate incident. Don't treat it as an ongoing problem, when they haven't cut recently, forget that they do. Don't constantly harass them asking if they have cut etc. Don't think of them any different than a normal person, or how you did before. Self harm is just as much a part of someone as nail biting or thumb sucking. If you think of them differently you will naturally and sub-consciously act different towards them. This will only make them feel isolated and feel that your bond of friendship is weaker, when, if anything, it should be stronger because they have confided in you and trusted you with a deep secret.
Secondly, NEVER get angry at them. By getting angry at them for cutting they are less likely to approach you in future when they have done it or feel they are about to do it.
Also, NEVER tell them off for cutting. This again could lead to them not feeling confident enough to trust you next time.
The Golden rule here is that praise for being good works better than reprimanding for being bad. Reprimanding only leads to the person feeling worse and possible harming themselves again.
A thought that may occur to you is to threaten the self harmer into not doing it again. Things like saying you won't be their friend anymore if they do or you will tell their parents if they do it again. Normally this is a bad idea, most self harmers are not thinking about the rest of the world when they harm, they are normally upset and distraught. Clarity of thought comes after the harm has been done. So, by threatening them they will still end up cutting then when they calm down after they will start to think that they have possible lost a friend or their parents will find out (or whatever the threat was) when they start to think about this they may feel worse and harm themselves again.
Talking to Them
When you find out that your friend has harmed again try to talk to them about it. Ask question about why they cut this time? What triggered it? Remember that the act itself isn't as important as your friend's emotions. It is important that you let the person know you care about them and that you want to understand why they felt so down that they did this. While it is okay to be concerned about the physical injuries, talking about the act itself will sometimes undermine the feelings behind the act, and very often it causes the self harmer to dwell on it. This sometimes leads to harming again. Keep your friend's mind off of the physical side of things for awhile. Another advantage of knowing what triggers there self harm is that you can start to predict it, and when you know they have had a bad day or something you can give them a little phone call or talk to them to try to cheer them up.
Always encourage the person to talk to you, about anything, no matter how little the problem. Encourage them to talk to you or phone you if they ever feel like harming. A good technique to try is to get them to write your name and number on a piece of paper and wrap it around what ever they normally harm with, this is to remind them to call you before hurting themselves. Remind them that what ever may happen you will always support them in any way you can and you will never leave them.
When you talk to them about it, it is important to remember how they are feeling while you're talking to them. It is likely that they will be feeling guilty for doing it, and ashamed that they did. Other feelings may include a feeling of letting you down or that they are somehow worth less than they were. By keeping this in mind you can stop them feeling any worse and reassure the self harmer to make them feel more confident in talking to you.
The next point is a really important point and one of the hardest to actually do. You have to hide your own emotions and thoughts and build strength for their sake.
NEVER let them feel like they have disappointed you or let you down in some way. This only makes you harder to talk to and makes the situation / conversation awquard. It may also make the self harmer feel worse and may even lead to more harm being done. This does not mean that at an appropriate point, (e.g. straight after harm has been done) that you cannot talk to them about your feelings, if you wish to tell them that it hurts you to see them hurt, do so. It will give them more to hold onto and help them stop. Your feelings are important as well.
When talking about an incident it is very easy to allow the conversation to slip into one of those awquard silences which makes everyone feel bad. Try to keep the conversation flowing, some light humour may be appropriate at some point (I can normally do this fairly well), but be careful of what you say, do not demean the incident or the person in any way. If necessary, move onto a completely different topic and forget about it.
What can you say/ask
This is not by far a complete list of what you should ask or what you are limited to asking but rather a set of suggestions on topics they may arise and how to sensitively ask awquard questions.
If your friend tells you he/she has hurt themselves:
Did anything specific happen that made you feel so bad?
How did you feel last night/earlier?
How did you feel when/just after you hurt yourself?
How are you feeling now/today?
How bad are the injuries? (At this point don't push to see the marks if they don't want to show you)
You can always call me if you need to talk.
I'm still your friend whatever happens.
If your friend tells you they have been a period of time without harming: (this can be an achievement that they are proud of)
Congratulations/Well Done
I'm proud of you
Is there anything you have been doing instead e.g. drawing, writing etc.?
Is there anything I can do to help you?
If your friend tells you they want to/feel like self harming:
Has something happened/been happening?
Are you ok now?
Are you in any danger at the moment?
Do you want to meet up?
Can I help you at all?
What's the weather like?
Sometimes a complete change of subject is the best way to go, talk about anything else, something happy and cheerful, add some humour. Distracting attention from the problems and making them feel better is the best and most affective way of preventing S.I. but this needs to follow the showing of concern for the original problem ( in other words this comes after the other questions, when the conversation starts to dry up)
Afterwards
After talking to the person about their latest injury it is important not to go on about it. By all means ask questions, but once the conversation has stopped, let it be. There is more to a person than the injuries that they inflict on themselves, remember that they are still the friends they use to be.
Privacy, Your friend has told you something that is most likely one of their deepest secrets. It is important that it stays that way. If your friend wants to tell someone about it, they will, It is not your place to tell the world about it. If someone else already knows then it is fine to talk to them about it, as long as you are not telling them anything they do not already know. But don't talk to anyone who doesn't already know about it, this includes the persons parents/guardians or teachers etc.
Don't stand staring at old wounds if you can see them, and don't keep asking to see them again. To a self harmer they are not cool, and when people stare it makes them very self conscious.
Now that you know your friend self harms you can help prevent it, you can't prevent it every time but you can help. Anything can help, things like random text messages checking that they are ok in general. Or if you know they have has a stressful day talk to them about it. Give them somewhere to vent their anger and frustration. All you have to do is the listening. Remind them that you care about them and that they can always talk to you. In the end, just be there for them.
The Scars
When you see the marks, scars or wounds that have been caused by the self harming try not to over react, most small marks will fade over time. Larger marks may leave permanent scars but may not be life threatening.
Never start preaching about how they could kill themselves etc. A self harmer has most likely heard this a thousand times. They know they could kill themselves. Self Harmers are normally very careful not to cause injuries that truly risk their lives. Yet they are still aware that accidents do happen. Contrary to popular belief they don't want to die. They self-harm as a way of staying alive, a way of dealing with the unbearable. Most Self harmers are aware that accidents do happen and are prepared to deal with it if it happens, this may include calling doctor/councillor, or even asking a friend for help. Most self harmers will not try to deal with it alone if they feel they are at serious risk. Remember these are still intelligent people.
How do I get them to stop?
In short, you can't!!! Not unless they want to stop. Because the addiction is on a psychological level as much as a physical level stopping needs the harmer to want to stop and have the will power to stop.
What you can do is start to provide alternatives to them cutting. Make sure you are around / easy to call so they can talk to you any time they feel upset.
Don't see stopping self-injury as the only or most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when difficult issues or feelings are being explored, or when old patterns are being changed. It may take a long time for a person to be ready to give up self-injury. Encourage them and yourself by acknowledging each small step as a major achievement.
If they want to stop but are having problems, then try looking in the resources section and find a website with techniques on how to quit self harm.
What Techniques are Available to Help them Stop
The first stage in stopping self harm is to discover its original cause. You will need to talk to them and explore the issues of why they started self harming. Ask questions like, where did the idea come from? What incident triggered it? and how did you feel at the time? From here you can start to understand the personal motivations for that person self harming, until these underlying issues are resolved it may be hard for the self harmer to quit.
The next step involves identifying how, where and why the self harmer currently self harms. Self harm becomes a ritual for many who do it, things like, waiting till night time, laying out the blades, bandages, anti-septic etc, locking doors and so on. Are all part of the lead up to the act and can be just as significant as the act itself. Once you know the ritual used you can start to suggest alternatives, if the self harmer commonly waits till night time(something commonly found in teenage self harm where lack of privacy means night time is better), then good techniques can involve finding ways for them to calm down in the interim. Writing journals/poems, being creative by drawing or painting and phoning a close friend can help. If the self harm is during the day then options such as going for a walk/run, playing loud music and dancing, visiting a friend may be good distractions. In daytime situations the best recommendations normally involve persuading the self harmer to go to places where they cant self harm or don't have the tools. In this way other techniques to help self harmers could be small things such as moving their instruments. If a harmer keeps there knifes in their bedside table, them moving them over the other side of the room could create a more significant step before self harming. If the person can just grab and cut, they are more likely than if they have to get out of bed dig the knifes out from a draw and them return, this action can distract 'the mood'.
Next, encourage and support the self harmer to talk to you after each incident. Even though they may have self harmed, there can still be a lot to gain from the experience, talk to them about why the self harmed and what they feel they could have done instead, set a few small targets such as stopping to write down their thoughts/feelings next time they feel the urge. Review these thoughts with them at a later date.
What help is available to self harmers who want to stop?
Many Self harmers go to therapists and psychiatrists looking for help or to discover answers to their behaviour. This often goes wrong because psychologists often ignore SI because of their own ignorance, inexperience or revulsion of the subject. They try to ignore the behaviour and leave it up to the self harmer to bring up the subject where it may be pushed to the side or incorrectly handled. Often the self harmer will not bring up the subject themselves because most self harmers shroud their actions in secrecy and hide their pain. This means that the problem is not addressed at all.
When the subject of SI is brought up a common reaction is to try to force the harmer into stopping, this may include the threats of sending them to a psychiatric hospital or not seeing them again if they do. As was discussed earlier in the guide, threats do not work as a method of preventing SI, and can often make the situation worse.
This does not mean that there is no help available for self harmers. Many therapists have devoted much time into forming good methods of treating self harmers. With a little research and asking a few questions it is easy to find out whether a clinic/person has the right attitude and ability to help a self harmer. Many clinics have specialised sessions for self harmers and help the self harmer to express their feelings in other ways.
Some questions to ask may include:
•How do you normally deal with self harmers?
•Do you use/what do you think of no harm contracts?
•What do you personally think about self harm?
•Do you have any other self harming clients?
•Do you run group sessions for self harmers?
No Harm Contracts
A no harm contract is a contract between the self harmer and the councillor which states that the self harmer will not harm for a set period of time. This may sound like a good idea at first but when you look into the normal effect that it has on self harmers it can be a bad decision. No harm contracts normally come with consequences if the contract is broken. These may include forced admittance to mental ward, relaying of personal details to parents/relatives/people in a place of respect in the self harmers life. These consequences only serve to install fear and worry into the self harmer's lifestyle. Self harmers use self harm as a method of coping in stressful times, by removing this you are removing the floor from under their feet. Self harm contracts do not provide any other form of support for the self harmer to use in stressful times, this leaves the self harmer at a loss of what to do when stressed. They remove the self harm but do not provide another method of coping. Most people who enter into no harm contracts break them because of this reason, and therefore have to face the consequences of breaking the contract which normally makes the situation worse.
It is advisable to find a councillor that does NOT use no harm contracts.
Resources
http://www.recoveryourlife.com
A website designed as a community that would not judge the people for self-harming. This website offers lots of useful advice on Self harm and includes comments and stories from self harmers that may help you to understand more fully why people self harm.
http://www.golivewire.com
A forum website designed for teens to talk to each other. This was the inspiration for writing this guide. This website has many topics in which many members have asked the question, 'why do people self harm?' by going to the teen forum and doing a quick search in the search box. You can find many topics on why/how teenagers harm themselves. This also provides a place to ask questions yourself about self harm.
http://www.users.zetnet.co.uk/BCSW/leaflets.htm
Bristol Crisis Service for Women is a national voluntary organisation that supports women in emotional distress. The links on this page provide much information on self harm, the causes and how it should be dealt with. Although the help center is designed for women who self harm, it contains much information that is relevant to both genders. http://www.palace.net/~llama/psych/injury.html
By far the best website I have found on self harm. This comprehensive page has everything to do with self harm possible. If you have a question the answer is here.
http://www.palace.net/~llama/psych/quot.html The same site as the last link but this links to the quotes from self harmers. Hundreds of self harmers from every age, gender and background was asked question, here are just some of the most useful quotes that came from there answers.
http://www.lifesigns.org.uk
This is a voluntary organisation that raises awareness about the syndrome of self injury in the UK and beyond.
LifeSIGNS provides much needed information and training to organisations; offering unique services not available from any other voluntary organisations.
http://www.selfharmuk.org
The National Inquiry into Self harm amoung young people's website. this site contains much information from a recent study into self harm amoung young people. To read the full report goto this page on the internet http://www.selfharmuk.org/docs/self%20harm%20report%20lowres.pdf
http://www.selfharm.org.uk
A site espiecally designed for young people in a visually attacive way and contains a good list of resources, espically ones to help people cope or get through self harm.
Thank you for reading.
ManicD
(Author/Editor of The Guide)
Other Accreditations:
Simply no one(Inspiration/Motivation/Best friend I ever had)
tennisg81
WigAOK9
emarkienna
princess purfect
FishyCrossing
antisocialbutterfly
Disclaimer: The author is not and does not claim to be a professional in any areas of depression or self harm. Any action taken as a result of this document is the sole responsibility of the person concerned. This document is in no way affiliated with the Livewire Peer Support Network and is not endorsed by them.
Copyright Ashley Unwin 2005.
This work is licenced under the Creative Commons Attribution-NonCommercial-NoDerivs License. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/2.0/uk/ or send a letter to Creative Commons, 559 Nathan Abbott Way, Stanford, California 94305, USA.
The author may be contacted via Electronic Mail at Slightlydead@hotmail.com or updated email address as specified on the LiveWire Peer Support Networks Website at http://www.golivewire.com/forums/topic.cgi?topic=118969
First Published 2005
Additions/suggestions are welcome. Feel free to write additional paragraphs and post them here and I will amend the guide if I feel it is appropriate. All additions will include your Name/Alias included in the list of accreditations.
ManicD
Post edited at 5:34 pm on June 1, 2008 by ManicD
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