Show that you see and care about the person in pain behind the
self-injury.
Show concern for the injuries themselves. Encourage the person
to take care of their injury. Whatever
"front" they may put on, a person who has injured herself is usually
deeply distressed, ashamed, frightened and vulnerable. It is cruel and
counter-productive to "withhold attention". You have an opportunity
to offer compassion and respect; to show them something different from the way
they have been treated by most people in their lives.
Make it clear that self-injury is okay to talk about, and can be
understood. Convey your respect for the person's efforts to survive, even
though this involves hurting herself.
Acknowledge how frightening it may be to think of living without
self-injury.
Encourage the person to use the urge to self-injure as signals
of buried feelings, memories, needs. (These will be unfamiliar and frightening;
go slowly and offer support.) Help her learn to express these in other ways,
e.g. talking, writing, drawing, hitting something. Encourage her to ask for
support and to care for herself.
Help the person to break down isolation and shame and to build
up support networks. (e.g. groups.)
Don't see stopping self-injury as the 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 previously buried
issues or feelings are being explored, or when old patterns and ways of living
are being changed. This can be frightening but is understandable.
It takes a long time for a person to be ready to give up
self-injury. Encourage her and yourself by acknowledging each small step as a
major achievement. Examples of very valuable steps might be: taking fewer risks
(e.g. avoiding drinking if she thinks she is likely to self-injure); taking
better care of the injuries; putting off hurting herself for a day or an hour;
reducing the severity or frequency of the injuries even a little. In all cases
more choice is being exercised the "hold" of self-injury is being
loosened.
Ask when the self-injury started, and what was happening then.
Explore how self-injury has helped the person to survive
(physically and emotionally), in the past and now.
Ask how she feels before she hurts herself, and how she feels
afterwards. Retrace with her the steps leading up to an incident of self-injury
- the events, thoughts and feelings that led to it.