In this blog, Senior Clinical Therapist Kirsten Bolt, MEd, LMFT addresses some of the most common myths regarding self-injury, the underlying reasons for it, and the treatment approach Open Sky takes to support students who struggle with this behavior.
Self-injury, also known as “self-harm,” is derived from the more formal term “non-suicidal self-injury,” and it refers to intentionally injuring one’s body, without suicidal intent, in a manner that is not socially sanctioned. Forms of self-injury can include, but are not limited to: cutting, scratching, burning, or carving the skin; hitting or punching oneself; pulling hair; picking one’s skin; or preventing wounds from healing. Some people may use the same form of self-injury all the time, while others may hurt themselves in different ways at different times.
Myth #1: Self-injury is an attempt at suicide.
Self-injury can be alarming, and many parents may not distinguish self-injurious behaviors from actions meant to end one’s life. In reality, individuals who self-injure usually do so as a coping mechanism to support, rather than end, living. While self-injury is not intended to be deadly, people who harm themselves are at higher risk for suicide and should receive help immediately. And there is always risk of accidentally injuring oneself more severely than intended, potentially even lethally.
Myth #2: Only girls self-injure.
Some people see self-injury as a teen fad especially prevalent among young girls, and particularly of the “emo” culture. While self-injury does often begin in adolescence, people across all genders, ages, races, sexual orientations, and socioeconomic statuses engage self-injurious behaviors.
Myth #3: People self-injure to manipulate others or get attention.
Self-injury is not inherently manipulative, and it can be pejorative to label self-injurious behavior as “attention-seeking.” Most people engage this coping strategy to regulate their emotions, or to feel their emotions. Individuals who self-injure need support for their emotional or mental needs, and for some people this behavior is the only way they know how to communicate those needs. In these cases, it can be helpful instead to think of this behavior as “connection seeking” or “communication.”
Myth #4: Self-injury isn’t a big deal if the person isn’t hurting themself severely.
The severity of one’s physical pain is not necessarily indicative of the severity of their emotional pain. As noted above, sometimes self-injury is the only way people know to express their need for help. In addition, different people have different levels of pain tolerance. Therefore, all self-injurious behaviors should be taken seriously and addressed.
There are three primary reasons people self-injure. The most common is to moderate overwhelming emotions. Creating a focus on physical pain distracts from emotional pain.
The second reason is the flipside of the first. Some people feel numb as their status quo, and physical injury helps them to feel more alive.
The third primary reason people use self-injury is to communicate their level of internal distress to others when they don’t know how to do so verbally or in a healthier manner.
By considering self-injury through the lens of Glasser’s choice theory, we find that self-injury is typically used to satisfy two of the five categories of needs: love and belonging, and power and control. When someone feels a lack of love and belonging, they may turn to self-injury as a way to connect with friends, communicate distress, or temporarily decrease the shame they might feel. Or perhaps a person feels out of control and powerless to regulate and manage their emotions. They may start to use self-injury as a way to feel more in control internally. In some cases, self-injury might also be used to meet a third need, survival, as it can help one cope and stay alive.
Self-injury may alleviate the problem in the moment but ultimately it leads to long-term problems that reinforce the person’s inability to cope emotionally. Until a person learns how to manage emotions effectively, they are susceptible to taking on other unhealthy coping strategies, such as substance use, promiscuity, disordered eating, aggression, etc. These unhealthy behaviors tend to leave individuals feeling hopeless, shameful, guilty, and stuck in a cycle that is increasingly difficult to interrupt.
The physical safety of Open Sky students is always the first priority for guides, therapists, and the entire Field and Clinical teams. We continuously monitor and check for signs of self-injury and attend to them medically as needed and in ways that are humanizing, rather than shaming, to the individual.
The first step in treating self-injury is to complete a thorough assessment by gathering information from the student, their parents, and our field guides. With assessment (and constant reassessment), we begin to understand the history, severity, circumstances, and intentions surrounding the behavior. Though self-injury does not inherently correlate with suicidal thoughts, we also assess for suicidal ideation. Throughout assessment, we maintain focus on the most significant issue at hand: the underlying emotional challenges that led to self-injury. Focusing too much on the behavior itself can reinforce it and keep the individual from meeting their needs in healthier ways.
Assessment and reassessment inform the treatment plan, which brings us to the second step: intervention. This step is individualized, based on the information gathered in the assessment and the individual’s progress. When the student is stable, we focus on deeper work, such as understanding Glasser’s choice theory and the core needs met by the behavior, reflecting on the effectiveness and dangers of the behavior, and discovering how the self-injurious behaviors actually inhibit meeting one’s needs long-term. We help students develop skills to regulate emotions, interrupt ritualized patterns, and communicate their needs assertively to others. This is particularly effective in wilderness therapy due to our 24/7 supervision and monitoring by staff and the continuous ability to intervene amid challenges.
Peers can be a source of support to individuals who self-injure, which is one of the ways wilderness therapy can be highly effective and unique. There is usually someone else who has experienced the cycle of self-injury, thereby helping individuals feel less alone and able to hold each other accountable. The peer group is an emotionally safe and structured space for everyone to share their emotions. Field guides are trained to monitor conversations and intervene if discussions go in unhealthy directions about self-injury (or other concerning coping strategies) as opposed to discussion about the emotions beneath the actions. In addition, the level of connection and intimacy students find with their peers at Open Sky is truly unique and supportive for students who struggle with a sense of belonging.
The entire process of self-injury treatment at Open Sky is intentional and individualized. What one person needs might not be what another person needs. In every situation, our team is compassionate and empathetic. We strive to understand rather than judge those who self-injure and to validate the emotions a student is feeling without reinforcing the behavior.
Involving the family in the treatment of self-injury is an important component of the healing process. The child may inform their parents for the first time about the behavior, acknowledge the severity of it, talk about why they do it, and express their intentions for how to better manage overwhelming emotions in the future. We work with parents to understand the motives and risks of self-injury, intervention strategies, and how to do their own personal and family therapy to support their child.
We also work with parents regarding how to support their child during the transition after Open Sky. We know there will be transitional challenges in adapting to an environment with less containment than wilderness therapy. Fortunately, the work that both the student and the family do during their Open Sky experience prepares them to face these challenges without self-judgment, as well as equips them with the skills to overcome the challenges.
Article originally published December 2017.