
                         Help for families and friends
                                       
   Now what? Perhaps someone you care about has honored you by trusting
   you with information about their self-injury, or maybe you've
   inadvertently discovered it. Regardless of how you found out, you know
   about it now, and you can't pretend it away -- you have to respond in
   some way. Here are some guidelines for dealing with SI in a friend or
   family member.
   
Don't take it personally.

   Self-injurious behavior is more about the person who does it than
   about the people around him/her. The person you're concerned about is
   not cutting, burning, hitting, or whatever just to make you feel bad
   or guilty. Even if it feels like a manipulation, it probably isn't
   intended as one. People generally do not SI to be dramatic, to annoy
   others, or to make a point.
   
Educate yourself.

   Get as much information as you can about self-injury in general. This
   page is a good start; there are also some very informative books out
   there (in particular, [1]Bodies Under Siege by Favazza, [2]The Scarred
   Soul by Alderman, and [3]A Bright Red Scream by Strong). The Favazza
   book is more scholarly in tone, the Alderman book is oriented toward
   self-help, and Strong's book presents the voice of self-injurers
   talking about what they do and why -- it lets you inside the mind of
   people who SI. All contain much valuable information and advice.
   
Understand your feelings.

   Be honest with yourself about how this self-injury makes you feel.
   Don't pretend to yourself that it's okay if it's not -- many people
   find self-injury repulsive, frightening, or provoking (Favazza, 1996;
   Alderman, 1997). If you need help dealing with the feelings aroused in
   you by self-injury, find a good therapist. Be careful, though, that
   you not try to get "surrogate therapy" for your family member/friend
   -- what goes on in your therapy sessions should remain between you and
   your therapist. Don't ask your therapist to try to diagnose or treat
   the person you're concerned about, and if the self-injurer seeks
   treatment, be sure that s/he is seeing a different therapist than you
   are. Don't discuss the content of your therapy sessions in any but the
   most general terms, and never say anything like "My therapist says you
   should..." Therapy is a tool for self-understanding, not for getting
   others to change.
   
Be supportive without reinforcing the behavior.

   It's important that your friend, lover, child, sibling know that you
   can separate who they are from what they do, and that you love them
   independently of whether they self-injure. Be available as much as you
   can be. Set aside your personal feelings of fear or revulsion about
   the behavior and focus on what's going on with the person.
   
   Some good ways of showing support include:
     * Don't avoid the subject of self-injury. Let it be known that
       you're willing to talk, and then follow the other person's lead.
       Tell the person that if you don't bring the subject up, it's
       because you're respecting their space, not because of aversion.
     * Make the initial approach. "I know that sometimes you hurt
       yourself and I'd like to understand it. People do it for so many
       reasons; if you could help me understand yours, I'd be grateful."
       Don't push it after that; if the person says they'd rather not
       talk about it, accept this gracefully and drop the subject,
       perhaps reminding them that you're willing to listen if they ever
       do want to talk about it.
     * Be available. You can't be supportive of someone if you can't be
       reached.
     * Set reasonable limits. "I cannot handle talking to you while you
       are actually cutting yourself because I care about you greatly and
       it hurts too much to see you doing that" is a reasonable
       statement, for example. "I will stop loving you if you cut
       yourself" isn't reasonable if your goal is to keep the
       relationship intact.
     * Make it clear from your behavior that the person doesn't need to
       self-injure in order to get displays of love and caring from you.
       Be free with loving, caring gestures, even if they aren't returned
       always (or even often). Don't withdraw your love from the person.
       The way to avoid reinforcing SIV is to be consistently caring, so
       that taking care of the person after they injure is nothing
       special or extraordinary.
     * Provide distractions if necessary. Sometimes just being distracted
       (taken to a movie, on a walk, out for ice cream; talked to about
       things that have nothing to do with self-injury) can work wonders.
       If someone you care about is feeling depressed, you can sometimes
       help by bringing something pleasant and diverting into their
       lives. This doesn't mean that you should ignore their feelings;
       you can acknowledge that they feel lousy and still do something
       nice and distracting. (This is NOT the same as trying to cajole
       them out of a mood or telling them to just get over it -- it's an
       attempt to break a negative cycle by injecting something positive.
       It could be as simple as bringing the person a flower. Don't
       expect your efforts to be a permanent cure, though; this is a
       simple improve-the-moment technique.)
     * If you live apart from the person you're concerned about, offer
       physical safe space: "I'm worried about you; would you come sleep
       over at my house tonight?" Even if the offer is declined, just
       knowing it's there can be comforting.
     * Don't ask "Is there anything I can do?" Find things that you can
       do and ask "Can I ?" People who feel really bad often can't think
       of anything that might make them feel better; asking if you can
       take them to a movie or wash those (month-old) dishes (if done
       nonjudgmentally) can be really helpful. Spontaneous acts of
       kindness ("I saw this flower at the store and knew you'd love to
       have it") work wonders.
       
Take care of yourself.

   It sounds like hard work, and it is. And if you try to be completely
   supportive to someone else 24/7, you're going to burn out (and they
   won't have any incentive to change). You have to find ways to be sure
   your needs are being met.
   
   Take a break from it when you need to. When setting limits, remember
   that as much as you love someone, sometimes you're going to need to
   get away from them for a while. Tell the person that sometimes you
   need to recharge and that it doesn't affect your love for him/her.
   Only break into this personal time in cases of absolute life-or-death
   crisis.
   
   The balance here is tricky, because if you make yourself more and more
   distant, you might get a reaction of increasing levels of crisis from
   the other person. If you let them know that they don't have to be
   about to die to get love and attention from you, you can take breaks
   without freaking the person out. The key is developing trust, a
   process that will take some time. Once you prove that you are someone
   who isn't going to go away at the first sign of trouble, you will be
   able to go away in non-crisis times without provoking a crisis
   response.
   
Ultimatums do NOT work. Ever.

   Loving someone who injures him/herself is an exercise in knowing your
   limitations. No matter how much you care about someone, you cannot
   force them to behave as you'd prefer them to. In nearly two years of
   running the bodies under siege mailing list, I have yet to hear of a
   single case in which an ultimatum worked. Sometimes SI is suppressed
   for a while, but when it inevitably surfaces it's often more
   destructive and intense than it had been before. Sometimes the
   behavior is just driven underground. One person I know responded to
   periodic strip searches by simply finding more and more hidden places
   to cut. Confiscating tools used for SIV is worse than useless -- it
   just encourages the person to be creative in finding implements.
   People have managed to cut themselves with plastic eating utensils.
   
   Punishments just feed the cycle of self-hatred and unpleasantness that
   leads to SIV. Guilt-tripping does the same. Both of these are
   incredibly common and both make things infinitely worse. The major
   fallacy here is in believing that SIV is about you; it almost
   invariably isn't (except in the most casual ways).
   
   Accept your limitations.
   
Acknowledge the pain of your loved one.

   Accepting and acknowledging that someone is in pain doesn't make the
   pain go away, but it can make it more bearable. Let them know you
   understand that SIV isn't an attempt to be willful or to make life
   hard for you or to be unpleasant; acknowledge that it's caused by
   genuine pain they can find no other way to handle. Be hopeful about
   the possibility of learning other ways to cope with pain. If they're
   open to it, discuss possibilities for treatment with them.
   
Don't force things.

   If you make overtures and they're rejected, back off for a few days or
   weeks. Don't push it. Some people need time to decide to trust someone
   else, particularly if they've received a lot of negative feedback
   about their SI before. Be patient.
   
Other resources

   Bristol Crisis Service for Women publishes a [4]"Responses to
   Self-injury" sheet. Also, I've compiled a [5]list of organizations
   offering help specifically for SIV. Many of them also offer support
   for family and friends of people who self-harm.
   
   [6]Tracy Alderman gives some excellent advice on how to cope when
   someone you love self-injures, as does [7]Kharre. More help can be
   found at [8]What now? [INLINE]
   
  next section: [9]Quotes from self-injurers
  return to [10]SI main page

References

   1. http://www.amazon.com/exec/obidos/ISBN=0801853001/selfinjuryyouare
   2. http://www.amazon.com/exec/obidos/ISBN=1572240792/selfinjuryyouare
   3. http://www.amazon.com/exec/obidos/ASIN/0670877816/selfinjuryyouare
   4. http://www.users.zetnet.co.uk/BCSW/helpful.htm
   5. file://localhost/usr/home/llama/Web/psych/restherp.html
   6. http://www.cybertowers.com/selfhelp/articles/depress/violence.html
   7. http://www.angelfire.com/or/kharreshome/page2.html
   8. http://www.geocities.com/HotSprings/Spa/7171/whatnow.html
   9. file://localhost/usr/home/llama/Web/psych/quot.html
  10. file://localhost/usr/home/llama/Web/psych/injury.html
