Working with Self-Injury: This week in Intentional Peer Support

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Topic for 6/23/18:  Working with Self-Injury

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Practice Session Study Guide

The following study guide has been personalized and adapted with permission from Intentional Peer Support: An Alternative Approach by Shery Mead.  To purchase the full manual (book, kindle, audiobook), see http://www.intentionalpeersupport.org/store/.  To learn more about Intentional Peer Support and available trainings see http://www.intentionalpeersupport.org/

Self-Injury as a response to trauma/ abuse

There are many reasons that people self-injure.  Here, we’ll talk about it from a trauma framework.
Many of us grow up in families or communities where violence or abuse is normalized. Trauma (particularly abuse) deeply affects everything about one’s life. From relationships, to the way we make sense out of things, to what emotions mean, all of this is influenced by ‘how we know what we know.’ Having our instincts, meaning, and intuition shaped in these ways shapes how we interpret things.

Reflection question

What do people do when they can’t speak about the violence (let alone have language for it), and when everyone’s telling them that they caused it? 

Well, here’s an explanation that makes sense to me:  I pretty much feel like a time bomb ready to explode – my body, my whole being. Releasing that – and getting rid of the discomfort - becomes absolutely essential  to my sense of safety. So I cut, or hurt myself in other ways, to release some of the pressure.

Reflection Question

Think about a time when you had tons of very strong feelings but weren’t in a place where you could talk about them, or even acknowledge them.

• What did it feel like? 
• What happened later?

Seeing the problem differently

How do we think about self-injury in terms of peer support?

Redefining self-injury

One option is to redefine self-injury.  Maybe it is not a disorder, an illness, a bad habit, or something ‘crazy’ I do.  What if, given what I’ve lived through, self-injury is a coping strategy or survival skill that I developed…?

Reflection questions

• Do you have any ‘bad habits’?  (Examples: eat junk food, stay up too late at night, use drugs or alcohol, exercise too much or too little…)
• Are any of them harmful to your health or well-being?  
• What are some reasons you ‘self-injure’ in these ways?  
• In what ways do these ‘harmful’ behaviors ‘help’ you cope or survive…?

Possible explanations:

• Cope with discomfort or uncertainty
• Manage, express or release feelings
• Change my mood
• Give me energy
• Help me stay present and show up for my life

An advantage of redefining ‘self-injury’ as a tool or coping skill is that it gets me past self-blame and out of feeling crazy or irrational.  A limitation is that this view point doesn’t give me much reason to change.  If I keep self-injuring, I may hurt my body and (probably) confuse or scare others.  This generally doesn’t lead to the personal or relational outcomes that I want.

So what’s the alternative?

Re-defining the Problem

A second option is to look even deeper.  Here I start from scratch and question all my assumptions.  The idea is to look at the problem from a fresh vantage point and see if this leads me to any new learning.

I start my new inquiry by asking myself a powerful question:

What really is the problem here?  

This question is powerful because it goes beyond what I’ve been told the problem is by others.  It also goes beyond what my family, therapists, community or culture thinks is the problem.  Instead, it asks me to search my own heart and my own truth and ask myself, deeply:

What really is the main problem here, for me…?

Most people assume that self-injury is the problem. Because of this assumption, their reactions go something like this:

• “You need to stop the self-injury and talk about your feelings.” (not awful)
• “Are you safe? Will you sign a safety contract?” (getting worse)
• “How are you going to stop this behavior?” (whose need is this?)
• “You’re just doing this to get attention!” (the worst of all)

But what if we make a different assumption?

What if, instead, we see the self-injury as an attempt at a solution – and the real problem as being the trauma, abuse or something else that happens?

If I we think about it this way, our inquiry might go something like this:

• “What does cutting (other self-injury) mean for me?”
• “What is the cutting trying to get out?”
• “When I try to put into words what this has been like for me, what do I say?”
• “I wonder what the cutting is trying to say?”

As you can see, very different conversations!

In the first example, we assume my self-injury is bad or irrational.  So the conversation we have is all about how to get me to stop doing it.

In the second example, we see my ‘self-injury’ as a meaningful response.  Because of this, we are free to wonder about it together.  Here, we focus on what I have experienced, why self-injury makes sense to me, and ‘how I came to know what I know’ about life that makes self-injury useful for me.

As you can see, what we talk about is very different, depending on the assumptions we make and the questions we ask.

Creating relational safety

The next task is building in help that goes both ways and works for both people.  In this kind of peer support, both of us share the risks and responsibilities of creating a relationship that is trusting enough to withstand discomfort, uncertainty and differing points of view.

In other words, ‘safety’ is not just about me as the ‘cutter’ (i.e., the person with the identified problem).  It also includes you!  The process of making the relationship safe and trustworthy for both of us is called creating relational safety.

Reflection questions

What are some of the things you might say (or ask for) to begin to build relational safety…

1. ...if you are someone who self-injures?
2. ...if you care about someone who self-injures?

Ok, now go back and take a look at your answers:

• Are you making self-injury the problem to be solved? 
• Are you trying to just control the situation? 
• Are you falling into assessment and evaluation?

Role Play Scenario

Someone you know shows you a deep gash on their leg.  They tell you they were in a really hard place last night and cutting helped them to get out of it.  You’re glad they feel better, but seeing the gash is bringing up really strong feelings for you.

How might you try to make the conversation feel safer for both of you…?

Sample response:

 “It sounds like you’re saying something really powerful! I really want to understand it, but I have to own that it’s (the self injury) difficult to witness from my perspective. Given that we have two different views, is there a way we can communicate so that I can stay in the conversation with you?” 

Going Deeper with Mutual Responsibility

Where might the conversation go from here?

In this kind of peer support, our main focus is on what is good for our relationship.  If it’s not working for both of us, then it’s not working.  That’s what we call mutual responsibility.

With respect to mutual responsibility, the question is whether self-injury is impacting our relationship (and if so, how…?).

Self-injury becomes an issue when it brings up feelings or concerns for either of us.  For example, I might be afraid of how you’ll respond and feel like I have to hide my self-injury from you.  Or you might be afraid that I really want to kill myself or that I’m going to get a bad infection...

The hope is to get both of our needs on the table – and honestly own them as our own needs.  After that, we can look for ways to approach our concerns that work for both of us.

Reflection questions (for both of us) 

1. Is self-injury is our main problem?  
2. Is what happened in the past our main problem?
3. Is something else, beyond either of those, our main problem?
4. Just as important, what, for each of us, would be the solution?
5. What important needs is self-injury meeting for either of us right now?
6. What important needs would stopping self-injury meet for either of us right now?
7. What would have to change (in our lives or relationship) for the concern around self-injury to go away?

Summing up

1. Have you noticed some ways that this kind of peer support different from other kinds of ‘help’ you might be familiar with?
2. What differences do you see?