Understanding Self Harm. Dr Simon Lewis Clinical Psychologist Alder Hey Fresh CAMHS

Transcription

1 Understanding Self Harm Dr Simon Lewis Clinical Psychologist Alder Hey Fresh CAMHS

2 Exercise: what do you do to cope with big feelings?

3 What is Self Harm Self-harm is a way people cope with overwhelming feelings of pain and distress. By hurting themselves they may feel better for a while and be more able to cope with their lives

4 I feel trapped in my life, Never leave home without a knife. A bad mood, A bad feeling is Just a cut away from healing. For as you see Bleeding is healing for me Running, wet, and red Quiets the voices in my head. Scars and scars galore Each and everyone, I adore. The object of cutting, you see Is to sooth my soul without losing me. To lose me, To lose my head Would surely mean that I'd be dead. So Cut and Cut I continue to do. Until I find another way To save my life each and every day.

5 Myths about Self Harm It is a suicide attempt It is done to get attention People who self harm do not feel pain It is only teenage girls It is only done by people who have a personality disorder or have been abused It is done to be cool If the wounds are not deep it is not serious Self harmers can just stop if they want to It is done to hurt or manipulate others

6 Exercise: How do people self harm?

7 Methods of Self Harm Scratching, scraping or picking Burning or scalding Banging or hitting Hair pulling Scouring or scrubbing using abrasives Misusing medication Inserting things into the body Swallowing things or harmful substances Taking overdoses Tying something around part of the body Cutting

8 There are other things which could also be regarded as self-harm such as drug and alcohol use, under or over eating or risk taking behaviour. Sometimes even more socially acceptable things like smoking or over working. Sometimes, when people are trying to stop self-harming in one way (e.g. cutting) other harmful ways of coping may increase (e.g. drinking). That is why it is important to understand and deal with the problems and feelings behind self harm

9 Feelings that drive Self Harm Emotional pain grief, sadness, anguish or despair Anger angry feelings that people are unable or afraid to express Self-hatred people feel bad about themselves and take it out on themselves Fear and anxiety build up of fear, anxiety, panic or confusion Guilt and shame the burden of guilt or shame no matter how undeserved

10 Feelings that can accompany Self Harm Powerlessness feeling of having no control over things that happen to them Emptiness feeling desperately alone, unheard or without comfort can be unbearable Feeling unreal stress or depression can make a person seem numb and cut off from everything Desperation the result of awful feelings or circumstances feeling trapped in corner with no way out

11 What can lead to these feelings? Abuse or ill-treatment anything that has aroused feelings of fear, distress or discomfort Being witness to the abuse of others Neglect lack of care, love and support Loss through death or separation Bullying or harassment Physical illness especially serious illness/disability Loss of freedom care, hospital, prison Stresses and strains having too much expected of you or too many responsibilities

12 Potential triggers Intrusions Thoughts, memories, feelings, flashbacks Events Conflict, rejection, failure, things going wrong Vulnerable Times anniversaries, tiredness, change, lonely times

13 How does it work? Expressing feelings letting out some of the build up showing the inside on the outside providing a visible sign of the inner pain Distracting from feelings the person can concentrate on the injury, the physical not the emotional pain being out of it for a while Self punishment when there are feelings of guilt or shame

14 How does it work? Taking some control can be the only form of control a person feels they have Trying to communicate seeing and showing how bad things feel A chance for comfort some people find it hard to care for themselves or accept care from others Feeling real when someone is feeling numb, depressed or out of control can be a pain jolt

15 Mental pain Reaction Emotional engulfmen t Feel better/ different Action

16 Fundamental belief system e.g. I am bad I deserve to be hurt Trigger event activating Distressing Memory Facilitating belief e.g. I can only deal with this by hurting myself Fuels Core Belief System Justifies Self Injury Profound distraction and elation Reaction to Self Injury e.g. regret and shame I am weak

17 What helps? Understanding themselves Sorting out issues from the past Changing things in their lives now Finding ways of dealing with feelings Building up self-esteem Learning to take care of themselves Communicating with others Getting support Finding alternatives to self harm

18 Alternatives to Self Harm Surf the urge - mindfulness Let it out physically Try to work out how you are feeling Write letters (to yourself or to others) Talk to someone Get creative Do something comforting Distract yourself Be productive

19 Distress Tolerance Skills (DBT) Wise mind ACCEPTS: Activities Comparisons Contributions Emotions (stimulate opposite ones) Pushing away Thought management Sensations

20 Exercise: Trying out alternatives

21 Responding helpfully Manage your own distress Recognising how hard it may be to talk about giving patient, gentle encouragement Listening and caring Seeing the person behind the self-harm a holistic view Understanding that self-harm is a coping mechanism not judging

22 Responding helpfully Accepting the mixed feelings that the person might have Offering what support you can but aware of your own limitations Helping the person find the help they need Showing concern for the injuries themselves compassion and respect Dealing with current injuries offer the same help as if it were an accidental injury

23 Responding unhelpfully Telling the person off or punishing them in some way Blaming the person for your own shock and upset Jumping in with assumptions about why Ignoring or just not talking about it Trying to make them stop Asking the person to promise they will stop Treating the person as mad or incapable Panicking or over-reacting Passing the buck Judging and disapproving Always treat the person with compassion and help them manage the risk

24 Thoughts to take away? Reflections from today s workshop oh and follow me and the gang on

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