Working with Self-Harm & Self-Destructive Behaviors

Stacy Ruse, LPC, CIT, CYI on Jan 01, 2019 in Mood and Feelings

Whether you are working with your own self-harming- or self-destructive- behaviors, or with a client’s, it is imperative to validate that the self-harm has a function. Although it may seem contradictory, it is protective in nature. Honoring that the behaviors are protective is an essential step toward healing.

Self-harm is an extreme behavior, and extreme behaviors do not just come from nowhere. They stem from times of being overwhelmed and not having adaptive solutions. In other words, extreme behaviors start when, or after, we have had traumatizing experiences that were not resolved.

Self-harm is a coping skill that gets neurobiologically wired in to bring release, distraction, suppression, and/or escape from internal-conflict and -emotional experiences that are intolerably painful.

No one wants to, or chooses to, hurt themselves when it comes down to it. It is rather a compelling need when someone is triggered. Therefore, I have not found it useful to ask yourself, or your client, to commit to stopping (contracting). It is true that they (or you) would stop if they could; yet, are not able to in moments of dysregulation. So, contracting can illicit shame when someone is not able to uphold a commitment to stopping. De-shaming is a huge part of the healing process. Science supports that shame, whether coming from self or from others, only drives and increases self-destructive behaviors, addictions, and/or compulsions.

It is more about healing the pain that drives the behaviors and finding new and more adaptive coping strategies to replace the function(s) of the self-harm. It is ok, and even helpful, to actually talk about it without judgement. Being curious and open to understanding what led to the extreme behaviors in the first place. Learning more about the function(s) and what leads to, and happens after, the self-harm.

Bringing clarity, sincerity, and compassion to the experiences. De-shaming the behaviors, honoring them as attempts to help and protect self, and exploring what other options might be available that are less consequential. Gently, bringing in small doable practices, of trying something a little different. This may take some time, but small doable steps, even the tiniest changes, help rewire the brain, and lead to big changes over time.

Remembering that validation and compassion are very therapeutic, more so than most of us think, and tend to reduce behaviors. The self-harm is a role, it has a function, and protects and helps in some way.

Some creative questions to ask and explore are:
• What are you concerned would happen if you did not self-harm?
• What is worse, or harder, for you than the self-harm?
• Where is the pain, or what is the pain about?
• What happened to you that led to these behaviors?

As a rule of thumb, working on the trauma(s) that led to the extreme behaviors should be addressed when you, or your client, are more stabilized. When you, or the client, are ready the trauma work can bring deep healing. Eye Movement Desensitization Reprocessing therapy (EMDR), is highly effective for treatment of trauma. Although, please make sure that the therapist you select, whether EMDR or another modality, or if you are a therapist, is well-trained in working with complex trauma.

Stacy Ruse is a Licensed Professional Counselor in Longmont, CO.
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