A recent article on the BBC Gloucestershire website highlights the NHS reporting a significant increase in the number of self-harming incidents in the county. The figure is pretty staggering: an 80% increase in 2011-2012 compared to the year before that. Granted, as an NHS spokesperson points out in the article, the definition of self-harm includes many 'low intensity, high frequency acts such as inpatients slapping themselves' as well as its more serious forms such as cutting. Still, does that mean we shouldn't be concerned about it?
Nailbiting, hairpulling, excessive scratching, and cutting are some forms of overt physical self-harm. I have worked with clients who self-harm in these ways, though rarely has that been the issue they've initially come through the door wanting help with. In my experience clients who self-harm often feel ashamed of their behaviour. (Shame is a fascinating subject in itself and deserves its own post at some point!) All the more reason for me or another professional to be accepting, compassionate and even gently curious to find out more, and encourage clients to talk to them about it. Seeking to understand how self-harming fits into the client's world - and getting alongside them - will help them dissolve the vicious cycle of self-criticism and shame, and begin to open up.
Self-harming is one way people sometimes manage their impulses and feelings of anger that they don't feel able to express outwardly. If on some level, expressing anger at someone else seems too dangerous an option, then it can seem safer to release these feelings by causing themselves pain. 'I am angry, I shouldn't feel angry, and I need punishing' is one set of messages I have heard in my practice. Clients have described feeling comforted and relieved when they self-harm. The way forward is to seek to understand the client's experience of it, and to be compassionately forensic in exploring the detail: to develop their awareness of what happens moment-to-moment before they scratch or make that first cut. All of us human beings are challenged when it comes to our impulses: when does it serve me to act on them? when not? Talking about one's destructive impulses and not acting them out directly is a massive step forward. I have heard a client tell me about the moment they really wanted to cut themselves - but didn't. This was a moment of triumph. I was touched and full of admiration for their determination and commitment to find a new and different way of responding to themselves.
It's worth mentioning though that it took months of weekly sessions to get to that point. The rate of change is different for every individual and will depend on their history, how they have formed themselves over the years and how committed they are to the process of their own growth. A teacher in social work quoted in the BBC article says that 'self-harm needs a lot of time-intensive work - there are a lot of deep issues behind the self-harm and that needs a therapeutic approach and that needs money.' How can more of us use our influence and authority, in a culture that often looks for the quick fix, to grow a public awareness of the need to develop a longer-term approach that is responsive to how wonderfully complex we humans are?
Re-reading the article, and seeing the reference to self-harming behaviour being classified as something deliberately inflicted against the self, I've also been reflecting on its more internal forms: being self-critical, creating physical tensions by directing emotions such as anger inwards rather than expressing them, or taking a punitive attitude towards ourselves for who we are. I suspect that many more of us would be able to relate to these examples in our own experience. Working with any kind of self-harm and moving towards self-esteem and self-love can be a lifelong project for any of us.
To read the BBC Gloucestershire article in full see http://www.bbc.co.uk/news/uk-england-gloucestershire-21826571