The top ten of helping

“I want people to listen to me. Sometimes I feel as though they think that they know and understand my problems better than I do because they are the professional, but they don’t, not always. So I want to be asked. I want people to ask me what it is like from my point of view, and for me to use my own words to describe what’s happening in my life.”
Self harm can be different things to different people and at different times. It is important to remember that what one person feels is different to another, and what one person does to themselves to cope, is different to another. Don’t assume that you know what is going on for that person, unless you have heard them describe things in their own words. Ask them. Keep asking them. Things change over time and so it is essential to not assume that what was said yesterday is true of today.
People self harm for a variety of reasons and this might be different from one incident to another, and from one time to another, so give people an opportunity to describe this to you.
“Before I got help I didn’t have anyone to talk to. My family kicked me out… the thing that has helped more than anything is being listened to – where people really are interested in what I have got to say!” Dan
Listening to people is such an important skill. Really listening to what someone is telling us requires that we care enough to hear what it is that they are saying, and pay attention to the things that they leave out, or their non-verbal body language even when it might make us worry or feel uncomfortable. It is often hard, with hectic working environments and lives, to create the time and space where we can truly listen to what a person wants to say – but these things are so important.
Individuals repeatedly describe it as one of the most crucial things that is helpful to them and their recoveries. Listening also means that we give that person the chance to describe their difficulties and get to know them. It can help them to understand what is happening to them, and how they feel, and it can help them to make different choices.
Having someone else who can listen to these experiences can validate someone’s experiences. With people that self harm, this is extremely important. Often people that self harm have had numerous experiences where people haven’t been interested in what is going on for them, they have often been dismissed with statements like: “stop being a drama queen”, “you’re overreacting” or “cheer up, things aren’t that bad”.
Talking to you might be the only opportunity they have had in their life to really be heard and can play a pivotal role in them facing their problems so see the privileged position that places you in and make the most of it – there may be no one else better positioned to listen to the person in front of you.
“If I am feeling like self harming, I already feel out of control. If I talk to someone, and then they start telling me what to do, or making decisions for me, it frightens me even more and the urge to self harm gets worse – not better.” Jemma
It is very common for people that self harm to describe feeling out of control and afraid. Self harm is often the one thing that they can do to control how they are feeling, and help them feel in control again. It is important that we try and remember this when we are working with people that self harm.
Self harm is not a suicide attempt. Self harm is the act of harm that an individual engages in to some way attempt to exert control over their emotional state; it is what someone does to try and stay alive and manage what they are feeling. Often we can fall into the trap of making decisions about a person.
If we feel that the person is at risk of suicide then this is a different issue entirely – but don’t assume so – talk to the person; ask them before making decisions. If they are at risk of an attempt on their life, we might speak to their GP about them, or breach confidences, or we might encourage them to seek medical attention. Sometimes these situations are unavoidable, but in each and every case, it is important to remember how frightening this might feel to a person who is probably already feeling out of control. We may end up feeding into the very feelings that lead someone to self harm in the first place. It is helpful to try and keep people as involved as is possible, helping them to feel empowered, and a part of any decisions that are made.
It is so hard to start to talk about self harm and the most damaging thing can be when someone plucks up the courage to ask for help or start talking about their problems and they are met with judgment or hostility. Self harming is not a statement, or a cry for help; they are not doing it as attention-seeking. It is a strategy that people use to try and change how they are feeling inside, just the way you might kick out at something when you are frustrated, or slam your fist on a desk when angry.
Our emotions are a physical experience, and often when we feel something that is uncomfortable we try to escape those feelings. For some people, self harm is one of these ways, and in the short term it can help.
People need your understanding and compassion if they are going to try and change their lives. What people need you to understand is that they are trying to cope with their lives the best way that they can right now. They do not self harm because they want to, or because they are being weak, or because they are looking for attention – they are trying to manage their, often painful, feelings and experiences.
“I don’t self harm so that people know, or see what I am going through; I self harm so that they don’t. I self harm to manage my feelings on my own. I self harm so that no one else has to hear me talk about my day and how bad I am feeling… so to be called an attention seeker hurts, and makes me even more determined not to let anybody in!” Jenny
The way that a person copes is just one aspect of a person – try to see past the self harm to the person beyond this. Try to relate to the person as you would anyone else, and take the focus away from the self harm. If you want to find out how a person is doing, ask them questions about how they are feeling instead of just questions about whether they have or have not self harmed. Without intending to we can often reinforce the behaviour by only giving that person time and care when they have self harmed – to do so is to convey that their distress only matters if they have self harmed and indeed, if they are talking about self harm. Their distress matters regardless of whether they have or haven’t harmed themselves.
“When people found out I self harmed, that is all everyone ever asked me about. That’s all I was to them, the girl that self harmed. They stopped asking me how I was feeling, and started asking me things like had I self harmed this week? I felt like it didn’t matter if I felt bad, it only mattered if I had felt bad enough to hurt myself.” Daniel
Sometimes when people are self harming, or low and depressed it can be very hard to see a way forward for them. It can be hard to know what to do and say to help, or make things better. As a professional, the single most important thing that you can offer someone is hope. People can lose themselves to their lives, and their difficulties and feel exceptionally lost. They can lose hope. As someone who is working with them and getting to know them, it is important that you don’t feel lost too. No matter how bad things get, or how desperate they seem, it is really important that you don’t lose sight of hope. See the potential in a person. If a person cannot see a future, it is very difficult for them to move forwards towards that future. As a professional, sometimes it might be your job to have hope for a person even when they cannot see it themselves; to see a person’s potential even when they cannot.
Also, remember that a person is so much more than their problems. Often it becomes very easy to focus upon the problems that someone is facing, but it can be really helpful to talk about the other aspects of interest and passion in someone’s life – the things that they like to do or things that they have an opinion on. Giving people an opportunity to talk about these parts of themselves also allows them to be known as a real and three dimensional individual and not just a set of problems or difficulties.
“Keep an eye on someone’s mood; if they seem to be down or struggling notice and don’t be afraid to talk to them about it.” Kealey
Often when people are struggling with their mood, or with the urge to self harm they feel completely alone and isolated. Having someone notice that this is happening, and offering them the opportunity to talk about this could be a really helpful intervention.
“I often find it hard to tell someone how I am feeling, but if they notice, and they ask… I am more likely to tell them and talk about it.” Lisa
In the culture of today we have inherited the message that it is ok to not be ok and this concept of it being ok to seek-help. If you are experiencing distress, despair and hopelessness, seeking help can be painfully hard. Instead why don’t we shift the responsibility from the individual and their ability to help-seek to us, as a community, family, friend, co-worker or service and help-offer. Having someone notice that you are suffering and reach into our world can be an absolute lifeline. Don’t be afraid to be that person. Don’t be afraid to talk about self harm and suicide – you won’t make it happen by talking about it – but you might just relieve a lot of suffering if you do.
“If I self harm, I am not a self harmer – I am still a person. If I use drugs I am not an addict, I am still a person. Try to avoid labelling me, I am me, I have other things that I do, and think, and like. I am not just the way that I cope.” Zoe
Often, by labelling people and their problems it means we see them in a certain way and we relate to them in a certain way. It is really important to remember to look beyond the labels that might be applied to the people that we are working with, and think about how they might affect us if those labels were applied to us.
Seeing someone as a self-harmer means they may too adopt that rationale and see something that is a behaviour, instead, as an identity. We can inadvertently reinforce the idea that the presenting behaviour defines a person and who they are – this can then dictate how they are received by others, often stigmatising their experiences of services and interactions.
Self harm is a behaviour. If it is a behaviour it can be present, and it can not. It can be something that we can do, or don’t do. It is not something that we are. Labels and language are important and they’re rarely helpful to anyone.
The single most important thing that anyone says they need in order to start to overcome their difficulties is compassion and understanding. This is such a simple need that is so often left unmet by people who are self harming. The self harm often serves to isolate a person even further because they are ashamed about their difficulties, and anticipate your rejection. Often, whoever we are, when someone is self harming we seek to find an appropriate person to send them to, to get better – we look for someone better than ‘us’ to offer the interventions required to help someone recover. The most effective intervention we each have at our finger tips is the here and now and the very validating offer of compassion. Compassion in a moment of despair can save lives. It is not to be downplayed or overlooked. All each of us have is the here and now and the moment of opportunity right in front of us – always be kind.
When asked what has helped the most, one girl replied:
“When I self harm I feel lost and totally alone… it’s not just the qualified professionals offering me their interventions that have helped, it is the times when they have taken time out to let me know that I matter, or when they have offered me a cup of tea. Those times have helped me to feel that life was worth living, and I was worth bothering with…you can say the wrong thing, in the right way, and if you say it with care and kindness, it will change someone’s life!” Elaine
This is a strong piece of advice. If we become focussed upon intervening with people that self harm, and trying to help we often forget how important the simple things are. It’s also important to remember that you might not always say the right thing, but if you are able to say it with kindness, and be honest with that person, then hopefully they will appreciate your compassion. It is a fundamental need to feel cared about, and something that we can all offer so very easily. Often people fear that in being kind, or in talking about self harm, we might create a dependency or encourage the behaviour. This is unlikely. If we are doing our jobs, and respect and uphold the professional boundaries that are in place, all we are merely doing is letting people know that they matter, and that they count.
Relationships take time to develop and change takes time. Often when people self harm, they find it extremely difficult to trust people, or let anyone help. They may be frightened to talk about their problems for fear of being judged or rejected; they may also fear that you might try and make them stop self harming. Take your time with these relationships. Try and be as consistent as possible, and give things time to develop.
Often, overcoming self harm is a slow and arduous process. You may not see much change in the way a person is coping, and at times, you may see things get worse.
This doesn’t mean that you are doing anything wrong. When people start to open up about their feelings and when they start to face their problems, self harm can often get worse. It is important that you don’t over react about this, and that you give things time to settle.
“When I started to open up about the self harm, I started to think about it more, and do it more. It scared me. I thought I was losing control.” Sarah.
Don’t give up if a person that you are working with doesn’t stop self harming. Don’t measure how effective the work you are doing with a person is, upon whether a person is still self harming or not. Ask the person you are working with how helpful it is and what is and isn’t working; enquire about their levels of distress. Try to measure how well a person is feeling and thinking, as opposed to whether they are self harming.
If you resolve the drivers to the distress and enable someone to feel more resilient in the face of their difficulties, the need for self harm will naturally decrease.
It is also important to note that you, as the person supporting someone that self harms, may not get to see the real progress in their lives. You may not get to see them self harm free and settled, but that does not mean that the time you have with them will not lead to that change. Don’t make the measure of your commitment to the work the need to see the change – just stick with that person and do the right thing. You may not get to see the change – but do the work anyway, with hope, passion and commitment.