In the aftermath of trauma, some clients turn to self-harm to relieve intense feelings of shame, anxiety, or even emotional numbness.
Over time, these harmful behaviors can become addictive – and helping clients break that cycle can be a challenging process.
So in the video below, Pat Ogden, PhD explains how she helps clients gain insight into both their need to self-harm and the costs of their harmful behaviors. She also provides a surprisingly simple action that clients can take when their urge to self-harm is triggered.
Have a look.
I’m thinking of a client who had a very angry, aggressive, protective, defiant part, and she hated the part of her that was weak and submissive. And these are instinctive defensive responses, right? The angry part of her wanted to kill off that other part. And when she was in a dissociative state, she would cut herself. And as she got insight into those two parts, she was able to help them communicate and eventually help each other, rather than one part of her trying to kill off another part.Sometimes talking about it with a client, finding out the purpose. Clients usually say there’s relief. Often, they’ll say, “There’s relief when I cut myself.” So we’ll say, “Okay. What does the relief feel like? Does it last?” “It doesn’t last.” Those simple questions can be helpful. “Is there any aftermath or any negative repercussions?” “Well, yeah, it hurts afterwards. There’s pain. I have to wear long sleeves. I can’t wear a bathing suit.” They’ll find negative repercussions, and this is just helpful in terms of insight.Sometimes when you’re wanting to help the self-harm stop, but you don’t have the ability yet with your client to work through action, if you think in terms of substitute actions, you can maybe discover the purpose of the self-harm and then find something simple like a Fireball. This I used successfully with quite a few clients. Those super, super hot things that you put in your mouth, that burn your mouth. It’s a similar sensation to cutting, for example. And some clients have been helped by getting inside into their triggers and their impulses to self-harm and then popping a Fireball in their mouth instead. That’s just a little intervention that can sometimes be helpful.”
If you found this video helpful, you can hear more from Pat and other top experts in the field of trauma treatment (like Bessel van der Kolk, MD; Dan Siegel, MD; Stephen Porges, PhD; Peter Levine, PhD; Allan Schore, PhD; and Ruth Lanius, MD, PhD) in the Treating Trauma Master Series.
Now we’d like to hear your thoughts. What are some ways that you help clients manage their self-harm? Let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
Helping Clients Talk About Shame
A Simple Metaphor to De-Shame a Client’s Trauma Response, with Ron Siegel, PsyD
Although I take a professional risk by posting, I feel that it might help someone else for professionals to hear from one who has personally dealt with self-harm and mental illness, and knows, as with addiction, you are never truly cured, only in recovery.
I started cutting because it created relief for me. There is definitely biochemistry involved, in that creating wounds releases adrenalin which brings the body out of homeostasis. Upon the release of the adrenalin, you get a good feeling but an even better feeling occurs when the parasympathetic nervous system kicks in, and releases chemicals that return the body to homeostasis. This is incredibly calming. Not that I recommend it as a method for controlling your emotions. However, when you are brought up believing that stoicism and self-sufficiency are prized attributes, you learn quickly that controlling your emotions is a way to earn love. I simply use the biochemistry to explain that there is a genuine chemical reaction in the body to cutting that makes the action create good feelings and a sense of control for the individual.
Cutting can also be a reflection of how someone who has been molested or sexually abused feels about their body, especially in a society that values women for their image rather than their substance. I know for me I began to hate my body as a result of early sexual abuse and saw cutting as a punishment that fit that hatred. Very similar to an eating disorder in that way, you actually see your body as the enemy and want to make it pay for being “bad”. This poor body image and relationship with the physical self can continue well past the point of the end of the cutting habit.
For some, cutting can become an addiction because of the body’s biological response to the act and the “good” feelings it creates. It became so easy to just take a razor to my arm and get release from the overwhelming emotions that I experienced living in my world. It also gave me a sense of control, as if there were one thing in the world I had control over and that was my own body. I felt I could control when I started cutting and when I stopped cutting. Sometimes, I believed that the cutting actually saved my life because it brought the insanity of my emotional turmoil under my control.
Finally, there is always the communication piece. When I couldn’t figure out what was wrong with me and I couldn’t articulate the mess of my emotional state, cutting left a pretty clear message to those around me. The kind of message I thought I was sending, however, was not always received. When my parents discovered I was cutting several years after the fact, I know they were terrified. Rather than reaching out for help, I was scaring the daylights out of my parents and the professionals. Most had never seen anything like this, even if they might have read an obscure case study. Remember, this was the 1980’s, before the cutting craze had reared its’ ugly head among teenagers. As a result, I created an impossible situation that ended in the removal from my home, bringing about new trauma of its own.
Hopefully, this information will help professionals with their treatment methods. If there is one thing I have learned, each person is unique in what motivates them to start, continue, and stop self-harm or cutting. Until the true motivations behind the act are thoroughly explored and addressed, the individual will continue because there is no other viable option. The feasibility of the treatment, as well as the efficacy, is crucial.
And don’t forget the biological definition of viability: “capable of surviving or living successfully, especially under particular environmental conditions.”
This article is the best description of why I cut and you are right in saying it is always in the background of your mind! Even after stopping cutting for the past 15 years I still feel the urge to start again when I know I have done something even years ago that caused harmful reactions and not understanding the story completely it disturbs the calm I had in stopping and brings it to the surface and makes it much easier to start again! Thank you for the best description ever! Even at 70 I battle with the goodness versus the destructive force inside me!
Very Helpful description! Thank you.
Thank you so very much Jennifer for sharing! I’m a teacher myself, have met many with this problem and I’m also grateful for the nicabm video. I would like to share some of your words Jenny, with others. Would that be okay?
And could you perhaps give me some link/links to read about the this ”biochemistry involved” That is also very helpful. Once again, thank you. to meet each and everyone as an unic individual feels so important.
/All the very best to you
Johanna
Thank you so much, for taking the risk and posting this! It is extremely helpful to me. I’m the mom of a 13 year old daughter who suffers from early childhood attachment issues (we adopted her at 2) and sexual abuse trauma from about 4-7 years (our next door neighbor, her friend’s father)
She is really, really struggling and self harm is only piece of her difficulties. We have many therapists and she has been hospitalized 5 times over the last 6 months. We have have a long road ahead of us, but your honesty and knowledge is valuable to me, in the journey of understanding my daughter. Thank you
Thank you for sharing. I relate to a lot of the things you wrote, especially the part about it being about control. I was born in the 90s so I only had to deal with the ever-looming threat of getting thrown in a mental hospital rather than being taken away from my family for it.
I wouldn’t say I struggle with self-harm, though. I see no real issue with cutting unless it causes permanent nerve damage or something. Everybody self-harms in some way. Smoking, drinking, emotional eating, neglecting adequate sleep… Why single out cutting? For myself, I have some Neosporin on hand and understand how deep is too deep, e.g. avoid reaching subcutaneous tissue.
Brilliant!
Thank you. This is the most practical, honest, factual and helpful explanation I’ve ever found about cutting. It explains something I have been confused about for many years, and have been unable to access real information. It’s yet another subject most people shy away from. I will now have something to offer, the next time the topic or situation occurs. 🌹
Teaching Crises-skills and mindfulness. Chainanalyses after self-harm to understand how the person got in to the chain and how it developed to end up in self harm. Talking about consequences in a short and long term – figuring out what else (less harmful) could give the same kind of reileve, to feel something else or just anything, something that distracts the thing the client can’t handle (intrusive thoughts, strong emotions). I believe that the most helpfulp and gamechanging thing is to increase selfvalidation.
Thank you, very helpful. Especially like the way Pat Ogden asks questions to open up awareness and help insight.
Clearly explained, great examples and ways to engage questions to explore resolve or offering another substitute behaviour which is less harmful.
Insights from Dr. Ogden and people who commented very helpful. Thanks
In addition to what has already been suggested…Anxiety, fear, anger and other similar feelings live in the body. When these emotions become overwhelming I encourage clients to shake it out or jump up and down to release the emotions from the physical self.
When I’m overwhelmed doing that would likely cause me to shut down completely. Might work well with more extraverted types.
My clients who self harm have experienced trauma from sexual molestation or from having family that has not given them permission to feel so the client feels numb and cut, burn, harm themselves to feel again or to hurt in a way that also creates so much pain to quote a client, “the release feels good.” The ponytail band snap on the wrist can be a gentle reminder to return to now instead of the images of yesterday. Also drinking slowly a tall glass of water stimulates the vagus nerve and that can help as a replacement action. Lastly, for a non OCD client hand or face washing with cold water using grounding techniques I have found to be very helpful to many of my self harming clients.
Good description of all the emotions in the mind and feeling the need to cut! I find for myself a cutter that having the someone to talk to changes my emotions and helps prevent cutting! A situation that happened in a hospital years ago has never been resolved and although I talked to the Psychiatrist I had then I am overwhelmed with guilt! He said he would call back but haven’t heard back from him yet! The time is going on where I feel I am being punished by him while I wait to see if he will call back! It brings feelings of wanting to cut or burn to try to figure out what will heal the emotions I have! All the responses have helpful things in them to consider as helpful! Thanks!
Very insightful. I use the two-parts-of-self in my work too. Love the idea of replacement actions.