Creating a connection with a young person who self-injures (and where appropriate those involved in their care) that is characterised by an open and honest communication and trust makes it possible to discuss self-injury. Many young people believe that others will either judge them harshly for self-injuring or become over protective. This applies in particular for health and community services practitioners who young people might fear will act to stop them from self-injuring. This could be experienced by a young person as a threat to their control and a restriction on their ability to manage their distress in a way that works for them.
Adopting a stance of curiosity and establishing a respectful dialogue with the young person about their self-injury:
- Demonstrates that they are not being judged
- Has the potential to reduce any feelings of shame
- Indicate that someone is prepared to listen and that it is possible to share their experiences receive support
The following are examples of how not to respond to a young person who self-injures:
- Adopt an authoritarian approach
- Attempt to ‘rescue’ the young person
- Be avoidant of the issue
- View the young person as ‘mad’ or ‘bad’
- Give simplistic explanations about what may be going on for the young person
- Become overly-responsible and/or accountable for the young person’s self-injuring
Some practitioners feel uncomfortable about raising the issue of self-injury with a young person. While questions concerning self-injury should be asked with sensitivity and at the appropriate time, the young person should feel as though they are as a natural part of their story. Young people are more likely to be discouraged from disclosing and discussing their self-injury when practitioners appear anxious about asking or don’t ask when it is obvious that it is appropriate for the question to be asked.
In the preparation for entering residential care questions about self-injury should be asked routinely. So as the young person understands that they are not being personally targeted or victimised, the practitioner should explain that these are standard questions that every client is asked and offer the rationale for why they are being asked; to give the young person the best chance to achieve their goals and complete the program.
Practitioners in clinical settings and outreach roles can also raise the issue of self-injury as a standard part of engaging the young person in treatment and care. When explaining the nature of the service and how it is delivered, the practitioner can mention the range of areas, including self-injury, that they are willing and able to help with. This provides an opening for the young person to raise self-injury as an issue when the time is right for them.
The following practice elements taken from Dialectical Behaviour Therapy and Narrative Therapy can be applied to facilitate of a collaborative relationship (as described above) with a young person who self-injures.
G1i. Validation strategies
To reduce the shame and keep the invitation open for the young person to talk about their self-injuring behaviour, it is essential to validate their feelings and experiences.
E3. Externalising conversations
This provides as a way of ‘stepping back’ from the behaviour, allowing the young person to examine their self-injury with less judgment and more curiosity, and potentially finding out more about the function and outcome of self-injury.