We think of children as innocent and pure. How could something so delicate and good willingly inflict pain on itself? Self harm involves inflicting physical pain on one’s body. Most often this is done by cutting, burning, or biting. Whether a child learns about self harm from somewhere or someone, or just has the thought one day to try it, it can quickly become addicting.
The act meets some need that is not being met elsewhere. We are innately ritualistic people, particularly when we are young. Routine and ritual creates a sense of safety and stability. What was once unpredictable becomes predictable. What was once chaotic now feels controlled. The more we engage in the behavior, the deeper the pattern and ritual becomes engrained. Thus the harder it can be to break the cycle of addiction.
When we as the clinician, parent, or friend are trying to help a child or adolescent with self harm addiction, it can feel like an uphill battle. We just want them to be healthy and safe. We just want them to stop engaging in the behaviors. We may even say to them, “just stop doing that.” They may be able to abstain temporarily due to motivating factors or a period of stability in mood. However it is often not as easy as “mind over matter.”
Until we look at what is at the root of the behavior, the “why”, we cannot break the cycle.
So why do young people engage in self harm?
What I find most often as a clinician, is the behavior is tied to emotions. “When I’m depressed I don’t feel anything, but when I cut, I feel something.” “I can’t stand feeling anxious, but when I hurt myself the anxiety goes away.” “I feel a sense of relief after I cut.” “I feel guilty, shameful, and embarrassed, I deserve this hurt.”
When we as the support system stop focusing on the “what” and start focusing on the “why”, hope for change is possible.
“When I’m depressed I don’t feel anything, but when I cut, I feel something.”
We can start the process of change by first acknowledging and validating what the child is feeling.
“I hear what you are sharing, it is perfectly okay for you to feel this way, and I am here to help you get through the feeling and/or situation in a healthier, safer way.”
Next we can help the child brainstorm and try out alternative ways of coping with the feelings.
“Instead of cutting when you feel overwhelming anxiety, can we take deep breaths together or go for a walk?”
It is important to help the child differentiate when coping becomes avoidance versus tolerating. If we don’t learn to get through the emotional turmoil, we will continue to avoid or turn back to relying on self harm to stop from experiencing the uncomfortable feeling.
The final part is empowerment.
We empower the child by helping them build a plethora of tools for their coping skill toolbox, and reminding them that they have the power of choice. They can choose to go for a walk, or ask for help, or self harm even if they don’t always feel that they do have the power in the moment.
We cannot control our thoughts and emotions, but we can control what we chose to do in response. When we as the adult can guide and support with patience versus doing for, the child may begin to feel the hope we hold for them that change is possible, and they are worthy of it.
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