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Self harming

2010
 
Hi,
 
I'm working with a young girl (15) who is regularly cutting herself. It's quite superficial, normally on her arms. She's had a tough childhood and cutting probably gives her some control. This has been going on for some time.
 
I'm looking for creative ways of working with her - possibly provide avenues to explore control issues.
 
Thanks,
Carlos Kelly
...
 

Depending on how open she is you may want to try some creative story telling and narrative approaches using created stories and fairy tales. Many traditional ones are about control (Rapunzel.....or the Paper Bag Princess). Using them you can get her to re-write her own "story".
 
I often do this with girls in particular using the computer, PowerPoint and lots of pictures.....it is fun as well.
 
A thought....
 
Rick Kelly
... 

Cutting is a complicated issue.  There are themes at play here more than just control.  The pain of cutting releases endorphins which basically makes her feel better for awhile.  The blood reminds her that she is "real."  As I said it's complicated but there is a lot of information on the internet that might be helpful.  One behavioral technique that can be useful to decrease or eliminate the cutting (and the need for dangerous pain) is the use of ice to create a more safe alternative to the pain.  She holds a bag of ice on one location until it begins to be "Painful" -- another is snapping a rubber band on her wrist when she feels the need to hurt.  The DBT model of therapy can be very useful for cutters.  As far as control goes -- allowing her opportunities for choices whenever possible.  In therapy explore internalized pain that she may be "Numbing." 
 
Just a few ideas.  Good luck, and let me know if you need any additional information -- this from a counselor and the mother of a recovered cutter. 
 
Kim Adkins
...
 
Hi Carlos,
 
I took your article to class with me this morning and asked our first year/first semester students how they might respond to your request.  There were a number of responses which I will share with you:  How long have you been working with this girl? Have you had an opportunity to develop a rapport with her to the point of trust or is there anyone else in the setting with whom she has been able to connect?   What are some of her strengths?  Can you encourage her to do more of what she likes and where her strengths lie (activity oriented possibly or from an artistic perspective)? Does she have anyone with whom she can spend one on one time with to help meet some her needs of being important?  We assume you have read her social history from what you said about her tough childhood - someone asked if there  were any issues of mental illness in the family?  Has anyone asked her why she cuts herself?
 
Hope these questions might provide some insight into what you might be able to do or at least offer you a place to start.  We will be interested to watch the threads from this topic.
 
We wish you and the young lady well.
 
Deb Bomek
Winnipeg
...
 
Hi Carlos,
 
My team and I have utilized this tool before with a former youth. We gave the youth a journal to write in anything she felt like writing whether it was just about her day or if she was feeling stressed or upset about anything. When she had finished writing in the journal at the end of the day she handed it in to Youth Care Workers at night and Youth Care Workers would respond back to her with feedback or adding in conversation pieces. This seemed to decrease the cutting behavior in a positive way. I hope this is helpful.
 
Matt Villeneuve
...
 
Kids cut for lots of reasons. My experience is generally it is a coping mechanism to either feel or focus pain. An escape or a grounding.
 
I had one young woman explain that when the adults in her life freaked out about her cutting it made it more serious scary and concerning for her but when they acknowledged the cutting but "did not freak out" about it - it was less of an issue and she was more at ease.
 
I generally ask how it (the coping skill they have chosen at that time) is working for them, what else they have tried for coping how those other things have worked and open the conversation towards some of what is going on behind or underneath the cutting/coping. Many adults, especially parents need assurance and reassurance that their child is not trying to kill themself but just trying to cope with pain or past trauma. In my mind it is a gauge for where in their cycle of happy/sad emotional regulated, how they feel in their various relationships and sense of belonging or how overwhelmed they are at that time/space. What can we as caregivers do differently at times of stress for kids so they have less likelihood of self injuring (because cutting is one form, burning, piercing, pressing, sex, drugs and rock and roll are all other forms).
 
Some of the strongest youth I have met have used self harming at some point in their lives to drown out or focus the pain they feel from our cruel world.
 
Help them accept themselves and to set goals for the future, help them imagine themselves elsewhere doing something other than surviving.
 
Peter DeLong
...
 
Hello,
 
I'm a CYC worker and also a first aid attendant at same or other time. When working with a youth who cuts, I dealt more with the injury and harm reduction, by attending to the cuts, taking the time to be sure of the severity and being sure to clean and or bandage if necesary.  I'm sure that not all youth will let you or I look, or be willing to talk about the behavior or act, but if a staff could build a trusting relationship,  non judgemental way of  dealing with the fact that it's done and the need for safety and self care from here, could be a way to open up discussion around the topic.  I know a thing or two about different people who cut, but probably it's pretty intimate for each person.  Honestly wanting to understand the topics 'around' the act; sensations, thoughts, feelings, is the only way I've ever had youth tell me anything about their cutting.  First aid is something I know though, and small wound aftercare.  Calm and basic guidelines around aftercare is something that all people could learn better, trust me, adults are not so good at cleaning and bandaging their own wounds.  Even if a person doesn't necesarily listen or buy in to the need to care for their body, doesn't stop them from seeing the care of a caregiver.  And it's easy stuff too; soap and water, even better sea salt or epsalm salt baths, dry clean cotton bandages or clothing.
 
I have been told to drop the subject or worse, when checking in about a youths recent cuts.  But when we know that the severity is not a major concern, the answer is the same: Ok, cool, if you think it's gonna be fine, but if you feel we should clean it up, I'm here, and we'll just wash it and maybe put a bandage on it.
 
In the long run, I'm not so worried about cutters.  It's maybe even a pretty good coping mechanism, for them.  There's a technical problem; the cut and infection.  There's room for growth and learning; self care and processing the lead-up and moments of cutting.  And, there's the chance for us to show we're there and open and accepting.
 
Hope this helps, and we can learn from those in our lives who are ready and do take the actions they see necesary for their own wellbeing. Risky youth are the warriors of old.  Respect.  No more prisons.
 
J
...
 
Dear Carlos,
 
As a current cutter, I can tell you that you are on a path saying that it is superficial, there is deep meaning behind this behaviour. Most people that cut are NOT cutting to kill themselves and this is a common misconception.

There really is no means to an end with self-mutilation only understanding. I can say for myself, as with many individuals I've known, that it will never end and it is a consistent entity I face every day. You are valid saying that it is because of control, but there are different reasons for everyone and it could be part of the issue but not all.
 
One thing that I would like to ask: why is it acceptable to pierce and tattoo?
 
I find that in society today there are many things that contradict each other and as a youth I know I was very confused with what is "right" and "wrong". The main point I would like to make is: yes self-mutilation is harm against oneself, but the problem with just stopping or diverting this behaviour is the suppression of self expression. It is my body and I WILL do what I want with it.
 
There is a book that I just recently discovered called, A Bright Red Scream- Self-mutilation and the language of pain by Marilee Strong. This book is a compilation of many people's lives and their experience with self-mutilation.
 
Marilee says "they are more than their disorder, their lives infinitely richer, their stories more complex, than that single label might indicate" (a cutter). Also she says "When people first hear about cutting, discovering sometimes that someone close to them uses knives, razors, or shards of glass to cut their skin and draw blood, there is often a reaction of horror, disgust, or bewilderment. The reasons for such reactions are complex and may reflect a powerful taboo in Western culture about the symbolic use of blood. But a simple explanation is that we are unable to attach an appropriate meaning to the activity of cutting and the only available meaning we grasp at may be that of suicidal behaviour. Cutting, however is not a suicidal act."
 
I would have to say that the only reason that I don't cut as often as I did when I was a youth (and I know many would not like to hear this but) it is because of piercings and tattoos. That is my outlet and even as young as 15 I would say could be an answer maybe not tattoos but piercings. There of course should be some regulation but it is an answer that I can tell you has worked for me and is quite acceptable and accessible in this day and age, I have never had trouble finding jobs or acceptance.
 
I don't want to offend anyone, I'm just passionate about the issues that I had to face as a youth and still as an adult. I hope this helps, sorry if it doesn't.
 
Sincerely,

LB
...

Thanks J
 
Ian Gargan 
...
 
I felt very strongly this morning after reading the replies to speak about my experiences working with youth who cut.
 
In some previous threads I read that " In the long run, I'm not so worried about cutters.  It's maybe even a pretty good coping mechanism, for them" or " There really is no means to an end with self-mutilation only understanding".
 
I'm sorry but cutting IS harmful, and intervention/ change CAN happen. I've seen it myself on a few occasions when working with young women.
 
From what the girls have told me cutting is a way for them to release deep emotional and or traumatic feelings. It is not a call for help necessarily or a place where someone should enter into discussion without some real awareness and compassion/ support.
 
Rapport, coaching, and self awareness activities can make a shift. I run a workshop series for girls through my non profit and I've seen girls who have eaten out of garbage cans due to an eating disorder change, I've seen girls who scratch and cut take their creative energy and make amazing shifts. I've seen girls with such emotional charges from abuse reach out and change their communities.
 
As professionals in this field we know that not every youth can have miracles in a moment sometimes it takes months and sometimes it takes years but we can help if we have the right attitude, energy, and resources!
 
It's also so important not to place judgment or categorize individuals into groups.
 
I found that counselling only went so far for me but coaching can make amazing internal shifts while building positive community strengths and ideas.
 
Loretta A. Cella
...

Hello all,
 
I am currently in my second year of the Child and Youth Care Counsellor program at Mount Royal University in Alberta. I am at a practicum in a group home with at-risk adolescent girls, a few of which self-harm. For someone like me, who is new to the field of child and youth care, and has no experience with self-mutilation, the idea of caring for someone who harms themselves can be quite intimidating. Because I am still new at my practicum placement, I have not yet had to counsel anyone with this issue.

I have found out through discussion with staff and residents though, that self-harm is much more common than I thought. Because it is common in group care, I think that it is key that we all educate ourselves on how to assist physically and emotionally in the event of self-harm trauma.
 
I would like to commend LB for her very candid post about her personal story with self-harm. She has shed some light on the subject, which is such an important one with today's youth. I appreciate that LB reminded us all that this is a life-long battle, and has no quick-fix, band-aid solution.
 
Thanks for reading!
 
Jill Hastings
...

Hi there!
 
A lot of people have mentioned this already, but cutting really is a very complicated coping mechanism. It often gets to a point where it's addictive, since it brings temporary relief and makes the person feel as if they are still 'alive'. Emotions that contribute toward cutting include fear (in terms of loss of control), anger, stress, guilt, 'numbness', helplessness, and failure, to name but a few.
 
To people who have never cut themselves, this coping mechanism is often hard to understand, whilst it makes perfect sense to the person who is engaging in it. Cutting often thrives in secrecy - although it can be a silent visible indicator that help is needed. People generally cut either in total secrecy (as for example people who cut on their legs where it isn’t obvious) or they can cut in places where it may be noticed (for example, on arms). Either way, because of the stigma attached to it many people struggle to ‘confess’ to cutting, which only perpetuates the cycle of secrecy.
 
I give this information because it shows how brave a child is to admit that they are regularly cutting themselves. Cutting is a huge emotional release, and allowing another person into that secret sphere of your life is a huge step towards healing. When a secret is brought out into the light it loses a lot of its power over the person. An open and honest relationship needs to be established where cutting - and the many reasons behind it - can be discussed and worked through. At some point the child is going to hit a brick wall - deciding if she really wants to change or not. This is a tough question, and must be worked through very thoroughly. Giving up cutting - to the child - often feels like giving up a part of your identity and may even be seen as losing a friend. She needs to make up her mind that she wants to change - and she must feel safe enough to engage in honest conversation whenever she wants to cut again, or if she does slip back into it.
 
You might want to encourage her to self reflect a lot (to do creative journaling!), so that she can explore the reasons for the cutting, the emotions that go with it, and the triggers that set it off. Through the journaling she’ll be able to identify which situations, people, places, etc might be risky, and then take a plan of action. Knowledge is a powerful tool when it comes to dealing with emotions and coping. When she has decided she wants to stop, help her to put practical steps in place for her to cope. For example, contacting a friend, or going out to a public area when there are potential triggers at home etc.
 
These practical steps may still seem like a long way off from where she is now, but they may come in handy in the future. Cutting can be overcome!
 
All the best!!
 
Birgitta Nell
...

Hi All,
I have personally not had a lot of experience in the field when it comes to cutting. I am a second year practicum student in the Child and Youth Care Counsellor program, and have completed 100 hours in a residential program. My cottage transitions youth back into the community, ages 12-18, and many clients are known as "cutters", some worse than others. Although I have not had a great deal of experience in dealing with self-harmers, I have quickly realized the importance of compassion and understanding. I find too often, people will refer to self-harmers as youth just looking for attention and not to feed into it. Well yes, I agree they are seeking attention, but attention, love, understanding and respect are things all of these youth have been missing out on for most, if not all of their lives. The reasons they are cutting may be unknown, but the affect it has on them is something we as child and youth care workers need to consider.
 
Self-harming is a coping mechanism for the youth when they are in crisis and/or experiencing stress, flashbacks etc. Whenever a youth decides to self-harm, we need to address the situation individually and with genuine compassion and respect. We have to consider what triggers cause them to self-harm and how it makes them feel. Since this is a coping mechanism, in the moment they feel better, hence why they continue the unhealthy behaviors. As workers we need to take the time to address their feelings at the time, so we can address the triggers and not only the behaviors.
 
Furthermore, we need to be able to work with the youth to find ways they can cope in a healthy manner. Personally, I find that exercise is a great way to relieve stress, but we need to help the youth discover their own healthy coping skills that work for them, as everyone is different. I think the suggestion below of journaling is also a great way for youth to express their emotions, which I think could also help them work through and be more aware of their feelings. Overall I think the most important aspect of working with self-harmers is to remain respectful of the youth and understand that they need guidance to find healthy coping skills.
 
Kayla Caravan
...
 
Hi,
 
I'm currently in my second year of Child and Youth Care Counseling, yet I have been exposed to "cutters" most of my life. Growing up, professionals tell us that those who harm themselves are attention seekers, trying to be noticed or use cutting as a scare tactic implying they want to end their life. however, many youth I have known to be cutters are impulsive when they harm themselves. Often times it's from an emotional experience they are going through and don't know how else to express themselves then by grabbing a sharp blade and adding cuts to their arm. I have often wondered why? What was the reason for physical pain and the answer one young girl gave me, shocked me. She said she would rather suffer all the pain she could cause to herself than bare to suffer from the emotional pain that she couldn't explain. She was hurting and no one took the time to ask why.
 
I find that many professionals only want the behavior to stop, or find an alternate means to self-harm such as drawing or writing in a journal. My concern is that many youth don't know how to express their emotions because they don't understand what it is they feel. The youth I have been involved with often describe intense waves of emotion without being able to identify what emotion they are feeling. Many young people have not developed that level of mental understanding and so they react to stop the pain. From what I have experienced both personally and from the young persons I work with, physical pain is easier to manage than the lasting effects of emotional pain. Cutting is a familiar way for these youth to divert the pain they cannot control with something they can.  (I am not implying that cutting is a great way to solve a young person's emotional pain, but it has been found to be one of the top coping methods used by teens, just like drugs and alcohol).
 
By talking with my clients about cutting and self-harm, I was able to build some strong relationships with them. I found that by just listening, and not always counseling, they were able to explain some of how they were feeling. It also became a preventative measure for times when they felt an urge to cut because they were able to warn me and allow me to give them some one-on-one attention. It didn't have to be talking, it could have been something like building a puzzle to distract them, but by calmly saying "ok let's do something together," instead of making a major deal and over-react, the youth became more open to how they were feeling.
 
I'm not qualified to make psychological assessments like professionals can, and I sometimes don't know how to deal with the situation 100% of the time, but I have enough experience working with youth who self-harm to know that sometimes all they need is just someone to be there. to help them through the mental battle they may be struggling through because they can't do it alone.
 
So my question is this, have youth care workers become so concerned about stopping and preventing the behavior that we have forgotten what it's like to just need a "friend" and be there, wherever that youth is at, instead of finding a quick fix so that it's less for the worker to deal with?
 
I just think too many individuals in this field try to identify the source of a problem, and forget to treat these youth like normal human beings. Sometimes, tossing the textbook out the window and just remembering they are just kids in need of someone does more than using some theory or label we can apply.
 
Caitlyn Pegg
... 

Caitlyn,
 
This is such a thoughtful and deep response. Keep on working and thinking about such issues ... and most of all sharing them with others.
 
Brilliant as a friend of mine would say.
 
Rick Kelly
...
 
I have enjoyed following the conversation and suggestions around working with self-harming youth. Caitlyn, I appreciate the fact that in dealing with such an intense issue it is important to simply be there and be a friend to walk through it with them. Along the same lines dealing with youth who self-harm; I am working in a home where there have been recent intakes of a couple youth who cut. I have recently gone through the completely unexpected suicide of a solid mentor, friend and camp director who I worked alongside for five years. I realize that having not completely dealt with my own emotions regarding this event I would choose to let the youth talk to another staff if they are struggling with suicidal thoughts. However, I would like to get to the place where I have dealt with the suicide enough that I can be a help to those who are going through it. Is there anyone who has suggestions or experience in this area in how to deal with this best? Or perhaps some good resources to deal with suicide so I can be a help in this area to the youth in my group home. Thank you!
 
Christina
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