Welcome to this mini blog series on self-harm. It’s by no means intended to cover all aspects of self-harm and the support that can be offered to those who use this particular coping strategy rather than any other. It is intended to dispel just a few of the more common myths surrounding people who self-harm and to provide some very basic pointers for those who work with them.
The mini-series covers:
- Socially acceptable self-harm
- Clinically significant self-harm
- Self-harm as a response to trauma
- Responding to people who harm themselves
Responding to people who harm themselves
Working with people who hurt themselves can be a confusing and bewildering experience. It is often extremely frustrating and distressing for the staff who may well be at a loss to understand why their resident keeps on injuring themselves. Traditional views about ‘manipulation’ or a ‘cry for help’ may bring some limited sense of explanation but they do little or nothing to help prevent future self-harm. This article explores some alternative notions about self-harm and examines ways that workers can make a difference in a genuinely difficult situation.
First of all bear in mind that you are not alone. No single person can do everything. Whilst self-harm does not necessarily lead to suicide these things do happen and it’s always a good idea to liaise with other, specialist professionals. A decent GP, Psychiatrist or community psychiatric nurse will be worth their weight in gold. It is important that you and the resident, together with input from other professionals, perform a thorough risk assessment. Agree how to manage future problems and when to seek outside or emergency help.
All that aside though, there is much that workers can do on their own.
A resident’s ability to manage is greatly enhanced by good support from their surroundings and social group. In supported housing this means that the staff can influence significantly the resident’s coping skills.
Back in the 1950s George Brown began studying the effects of families and social groups on coping and mental health. This research led to the concept of ‘High Expressed Emotion’. A few decades later in the USA Marsha Linehan came up with the concept of the ‘Invalidating Environment’. Both these concepts outline the ways in which certain types of interaction increase stress, reduce coping and lead to the conditions which encourage psychological and behavioural problems including self-harm.
High Expressed Emotion
- Aggression and hostility
- Emotional over-involvement
The Invalidating Environment
- Erratic, inappropriate responses from significant others to the individual’s thoughts, beliefs and emotions.
- Oversimplifying the ease with which problems can be solved.
- Blaming the individual for not solving difficulties with ease.
- A chronic and classical ‘double bind’ scenario in which the individual cannot ‘win’ whatever he or she does.
It clearly would be inappropriate for all workers to undertake full-scale psychotherapy. However, attention to the concepts of expressed emotion and the invalidating environment is appropriate for us all to take on board and can make a huge difference. Remember that befriending is an extremely effective method of supporting people, with or without external therapy.
I hope that by now as we reach the end of this series it is clear that self -harm is likely to represent a coping strategy. For many people it is the only effective strategy they know. Often in training sessions I use the analogy of a small child in a sweet shop. They can have anything they want but there’s a problem. The lights are turned off and all they have is a small ‘pen’ torch – the kind with a very narrow beam that only illuminates a small are of the shop.
Whatever they can see in the torchlight they can have but it’s a very limited choice because most of the sweets on display are in darkness. They’re effectively invisible. Clearly the child will choose from very limited options – not because the other sweets aren’t available but because he doesn’t know about them.
In one sense this is what it’s like for people with limited coping skills. The other coping strategies are available to them but they don’t know about them or they don’t believe that they will work. The coping strategies are the sweets in the shop in other words and your job is to turn the lights on.
Don’t waste time attacking the only coping strategy the service-user knows. That is unlikely to succeed and, quite frankly you wouldn’t want it to. If you remove the only coping skill a person has then they may see no alternative but suicide. It is no coincidence that service-users who harm themselves are around 50 times more likely than the general population to kill themselves.
“About 3 in 100 people who self-harm over 15 years will actually kill themselves. This is more than 50 times the rate for people who don’t self-harm. The risk increases with age, and is much greater for men.”
Royal College of Psychiatrists leaflet: ‘Self Harm’
Instead acknowledge the benefits of self-harm as discussed earlier and then work on discovering and experimenting with other, less injurious methods of dealing with stress. It may well be that to begin with this will amount to nothing more than some slightly less injurious methods of self harming but this is a step in the right direction. Build upon what you can and remember that Rome wasn’t built in a day.
Overt criticism of the service-user is likely to create a barrier
between you that may never come down again.
The chart below outlines some of the things support workers can do to support people who self-harm and suggests responses to likely situations.
You can download a PDF version of the whole four post series here Self Harm mini series by The Care Guy
Filed under: mental health, nursing, Self-harm, Social care | Tagged: coping, criticism, expressed emotion, invalidating environment, invalidation, mentalhealth, self harm, self injury, social care | Leave a comment »