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Client who self harms?

2014 

I have a client at work who self-harms. She has scars all over her body. I have found that the scars are a trigger to me. I have never seen it as bad as with this client and I find it very hard to look at the scars because I don't understand why or how she could self harm so much.
I was wondering if anybody knew a) any ways I could assist the client and b) how to prevent the scars being a trigger for me? I am fairly new to the field and I know it comes with time. I was just wondering if anybody had any articles or suggestions?
 
Sincerely

Ashley Gates
Student: Child and Youth Care Worker
...

Hi Ashley,

I hear where you are coming from, as it is a sad sight to see a youth continue the harm they do not deserve.
However as a past self harmer, I have been in her position, and it’s hard to overcome having them, as you can’t really get rid of them unless you pay for surgery. As a past person who used to self harm in my past dark moments, I have learned to look at them as battle wounds towards myself and others, because if I were to go any deeper I would not be here today.

Instead of looking at the client as a person who only self harms, try looking at her as a survivor. It may help, it may not, but generally reading more about self harm really helps, because it gets you in their mindset, and you know exactly why they’re doing it. It’s not a good reason, but when you are so upset, and have those issues, sometimes that’s the only way for a release. It may be part of a diagnosis, not sure, but reading and learning about self harm alone will really help you understand where your client is coming from, and instead of it being a trigger, you can learn from it and put theory into practice.

Leigh B.
...

Please report this ASAP to your supervisor, administrator or child protection services.
She may also need a medical assessment as well, as there could be other scars/injuries you're not seeing.
This needs to be followed up with a clinical interview, team interview, etc., depending on your setting.
Alert as many different professionals as you can.

Gene Cavaliere


See also: Previous discussion threads - Cutting?, Self-mutilation, self-harm , Self harming, Self harm? – Eds.

...

 Hi there,
I think there are two issues here:
1) personal triggers
2) meaning of the behaviour.

Ashley when we as CYC's are feeling triggered by behaviours of the youth we work with (and this is common in the work we do), it is best to seek supervision and your own personal therapy to explore the meaning of these. We need be strong enough to manage what the kids are doing to do effective work.
2) I think it important that we not use evaluative references to describe this behaviour. While it may be intentional, words we use (i.e. sad behavior) can have a detrimental impact in our work and approach we use with the youth. Self harming behaviour is a coping defense youth for dealing with overwhelming emotional pain; while unhealthy and maladaptive as this has the risk to leading to greater harm, it is a means of survival for them.

There are lots of books available on this issue and training too. Check out safeguards training. For now, check out this link for additional information: http://www.selfinjury.bctr.cornell.edu/

Donicka Budd
...

Reading the book Impulse by Ellen Hopkins was a great resource for me. It is written from the perspective of a teen who self-harms, and is intended for a teenage audience as well. (I would not recommend this to the young lady you work with, though she may have read it already!).

There are also a lot of harm reduction techniques out there for cutting, or any form of self harm that ends up harming the skin of an individual. Some of them are replacements (ie. using ice cubes instead of a sharp, snapping elastics on the wrist, writing positive messages with markers on the body part instead of cutting, etc). It could be good to look these up and discuss them with a co-worker to see if they could be useful.

An opinion of mine on why the scars might be triggering for you could be that the scars are a visual reminder of the pain that the young lady has gone through. While many of our youth have experienced immense pain/suffering, not everyone's "scars" are literal or visible. While it is hard to see, know that you have an opportunity to be a positive impact for her right now in her life. The past may be bad, but in the moment things can get better.

Laura Stolte
...

Hi Ashley,

I can relate quite a lot to your dilemma. You mentioned that seeing her scars is a trigger for you - I'm guessing you have had some experience with self harm as well? It is quite a challenge to work with a girl like her when you have your own history, because the dark addictive side of self harm always remains seductive, despite its horror and pain.

I have found two lifelines for myself which I hope might help you as well. Firstly, it's very important to self-reflect. Self harm is not the problem in itself, it is an expression of something deeper. Often people self harm when they feel emotionally overwhelmed, when they feel numb, or when they just don't know how to let the emotions within them out (there are many reasons!) It's addictive because it relieves anxiety. These will probably be good topics to explore with her at some stage.

As a trigger for you, it may be helpful to ask yourself what emotions you feel when you see her scars? What does it stir within you, why does it trigger you? Journaling helps a lot to work through the emotional reason for her scars being a trigger for you. If you have had experience with self harm yourself, it is easy to remember in the moment all the "good" reasons why you did it. Addictions are very good liars! When you have worked through the reason of your own internal response you can be affirmed in yourself, knowing that your own internal struggle is a separate matter from your relationship with her. It is so freeing to draw the boundary line between someone else's pain and the response their pain draws out of us.

The second helpful lifeline which I use is accountability. This of course is if you have battled with self harm yourself (to whatever degree). It is very freeing to be accountable to someone you trust about your own struggles- it is a genuine struggle, and you don't have to battle it out alone! In fact, you shouldn't rely on your own resolve to keep you clean of old behaviours, because the self will is not infinitely strong. When there is someone you can talk to and be honest with it eases the burden a lot. For myself, my husband is my lifesaver. We have a 100% honesty policy, and if I'm struggling I will ask him to take away the sharp objects in the house. Not because I am sick and messed up, but because I am strong enough to know I need practical help and value my own journey enough to humbly ask for protection.

So that would be my advice to you! I hope it helps you a bit. All the best on your journey with this girl. She has come into your life for a reason, and you have exactly what she needs at this point in her journey.

Blessings
Birgitta Nell
...

A GREAT resource for both youth who self harm and caregivers:
http://www.lifesigns.org.uk/

Carol May Watson
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