Functions and Alternatives to Self-harm

Functions and Alternatives to Self-harm SCOTTISH Personality Disorder Network

Functions and Alternatives Aims of session: • Identify the functions of self-harm • Explore links between functions and safer alternatives • Clinical interventions; ‘Safety Planning’ • Developing practice

Functions and Alternatives “The action of self-harm prevents and replaces thinking.” Motz, 2001 “The internal drama passes directly from unconscious impulse to action, short-cutting both conscious thought and feeling.” Campbell and Hale (1991) cited in Motz, 2001

Functions and Alternatives “One comes to see that it is not so much the nature of the act that counts but it’s meaning” Chasseguet-Smirgel, 1990

Functions and Alternatives “Women experience a sense of power through being in control of the shape and form their bodies assume as a result of the physical injuries and abuse they inflict upon themselves.” Welldon, 1988

Functions • Destroying body/making it less attractive • Regulation of distress/anxiety • Dealing with or expression of feelings • Distraction • Increased control • To feel real/ownership • Coping, surviving Favazza, 1989

Functions • Testimony • Re-enactment • Punish self/others • Cleansing • Communicate • Influence others • Connection with inner world

The Search for Alternatives Knowing the function behind the self harm can enable the worker to gain a psychological profile that can itself lead the search for alternatives.

Alternatives • Distracting techniques • Positive emotional techniques • Emotional focusing • Alternative ‘safer’ forms of self-harm • Comforting techniques • Relaxing techniques • Self-harm control

Distracting Techniques • cleaning/tidying • washing clothes • playing games • sports • exercise • gardening • visiting a friend • phone someone

Distracting Techniques • paint or draw • write letters • watch TV/video • listen to music • cinema • shopping • hobbies

Positive Emotional Techniques • read old letters • look through old photographs • listen to emotional music • watch funny films • read joke book • say positive statements to yourself • make an emergency bundle • self voice tape

Emotional Focussing • list emotional triggers • write poetry/prose about feelings • paint/draw emotions • write a diary • talk • rainy day letter

Alternative ‘Safer’ Forms of Self-harm • hold ice in hand • squeeze rubber ball • listen to loud music • rubber band on wrist • throw things/scream • punch cushions • body paint • stand under hot/cold shower

Comforting Techniques • hold a safe object • sit in a safe place • listen to soothing music • sing a favourite song • use perfume/hand cream • room fragrance or pot-pourri • buy fresh flowers • eat a favourite food

Comforting Techniques • have a soothing drink • have a bubble bath • soak your feet • change your bed • stroke your pet • wear comfortable clothes • hug someone/your teddy • put lights on • pray

Relaxation • guided fantasy ‘dreamtime’ • focus on breathing • count your breaths • focus on your body • relax each muscle individually • listen to relaxation tape • medication • yoga • massage hands, feet, etc

Self-harm Control • hand-in blades, tablets, money etc. • lock blades/tablets in cupboard • hand in keys/ shoes • sellotape blades in a box • lock bedroom • negotiate restricted area to damage • medication • go to bed • use notes to self

Safety Planning To assist individuals ‘move away’ from self harm and to search for alternatives the brief intervention of “Safety Planning” has been adopted

Safety Planning • Needs practice & individualised to individual (experience, emotions & functions) • Transferable • Face to face • Alone with self-developed prompt sheet • Over the phone with out-of-hours services • With friends or family

Safety Planning Aims • Dispelling secrets • Communication • Reducing impulsiveness • Choice • Encourages tolerating the feeling • Responsibility through self-direction • Collaborative working • Creates the third position

Theory underpinning the third position If the link between the parents is perceived & can be tolerated in the child's mind, it provides a prototype for an object relationship of a third kind in which he is a witness & not a participant. A third position then comes into existence from which object relationships can be observed. Thus we can also envisage being observed. This provides us with a capacity for seeing ourselves in interaction with others & for entertaining another point of view whilst retaining our own, for reflecting on ourselves whilst being ourselves

The Third Position This is how we fulfil the injunction of the Oracle at Delphi: ‘Know thyself’

The Third Position child mother (person) (self harm) father (other)

Clients’ Experience • It helps to feel acknowledged. It’s not helpful to have your experiences ignored • You have to feel that staff can take what you are experiencing without feeling guilty about telling them. • Important to feel heard. • It is helpful when my emotional pain has been acknowledged

Clients’ Experience • Helpful to break the secrecy. • It is helpful if the possibility of self-harm is acknowledged. • It is helpful if it is non-judgemental and accepting. • It is helpful if each positive is recognised; i.e. not just staying safe but asking for help verbally/directly, taking the risk to name thoughts, seeking alternatives/breaking familiar patterns, allowing thinking/feeling space in. • Acknowledgement that I’m feeling bad and finding it hard to cope helps because I feel like people believe me and maybe I won’t need to harm myself to prove it to them.

Staff’s Experience • Feeling that you have been left holding the anxiety and that it is not shared by the resident. • When the boundaries are pushed for the time to be used as a one-to-one. • When clients feel highly aroused and are finding it difficult to think clearly. • Needing to change your position and contain or give responsibility – safety planning, risk assessment and self-harm/suicide. • Feeling unclear as to exactly what is being communicated through the meeting.

Functions and Alternatives to Self-harm