{"id":34934,"date":"2019-07-02T11:58:16","date_gmt":"2019-07-02T10:58:16","guid":{"rendered":"http:\/\/counsellingtu.onpressidium.com\/?p=34934"},"modified":"2022-08-05T16:34:39","modified_gmt":"2022-08-05T15:34:39","slug":"clients-who-self-harm","status":"publish","type":"post","link":"https:\/\/counsellingtutor.com\/clients-who-self-harm\/","title":{"rendered":"Working with Clients Who Self-Harm"},"content":{"rendered":"\n\n\t<h1>Working with Clients Who Self-Harm<\/h1>\n\t<h2>Intervention for Self Harm<\/h2>\n\t<p>In order to start working with clients who self-harm, and to present interventions for self harm, we first need to understand what self harm is.<\/p>\n<p>The <a href=\"https:\/\/www.nhs.uk\/conditions\/self-harm\/\" target=\"_blank\" rel=\"noopener\">NHS defines self-harm<\/a> as follows:<\/p>\n<blockquote><p><em>&#8216;Self-harm is when someone intentionally damages or injures their body. It&#8217;s usually a way of coping with or expressing overwhelming emotional distress.&#8217;<\/em><\/p><\/blockquote>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/counsellingtutor.com\/wp-content\/uploads\/2019\/07\/Working-with-Clients-who-Self-Harm-lecture-summary-featured-image.jpg\" alt=\"Working with Clients who Self Harm lecture summary featured image\" itemprop=\"image\" height=\"300\" width=\"300\" title=\"Working with Clients who Self Harm lecture summary featured image\" onerror=\"this.style.display='none'\"  \/>\n\t<div id=\"cbox-vODZZySnaq10cn4g\"><\/div>\n\t<h3>Prevalence of Self-Harm<\/h3>\n\t<p>Statistics from the <a href=\"https:\/\/www.mentalhealth.org.uk\/\" target=\"_blank\" rel=\"noopener\">Mental Health Foundation<\/a> suggest that the UK has the highest self-harm rate of any country in Europe; it is estimated that at least 400 in 100,000 people here self-harm.<\/p>\n<p>The real figure may well be even higher, since many people who self-harm do not tell anyone about it.<\/p>\n\t<p>Self-harm can affect anyone, but most people who report self-harm are aged between 11 and 25 years. It may be that younger people find it harder to use words to express their difficult feelings.<\/p>\n\t\t\t<h2>Watch this Lecture + Access Hundreds of Hours of CPD <\/h2><h3>Certified CPD for Qualified Counsellors<\/h3>\t\t\t\n\t\t\t\t<ul>\n<li><strong>Hundreds of hours of on-demand CPD lectures<\/strong> to help you stay current with your CPD ethical requirements<\/li>\n<li><strong>Support, and be supported<\/strong>, by thousands of other counsellors as a member of the exclusive online community.<\/li>\n<li><strong>Access your learning anytime you want<\/strong> &#8230; anywhere you choose &#8230; using any device type &#8211; desktop or mobile.<\/li>\n<\/ul>\n\t\t\t<a href=\"https:\/\/counsellingtutor.com\/online-cpd-for-counsellors\/\" target=\"_blank\" rel=\"noopener\" role=\"button\" aria-label=\"Click Here for More Information\">\n\t\t\t\t\t\t\tClick Here for More Information\n\t\t<\/a>\n\t\t\t\t<img decoding=\"async\" src=\"https:\/\/counsellingtutor.com\/wp-content\/uploads\/2021\/05\/Counsellor-CPD-what-is-inside.png\" alt=\"Counsellor CPD Library - computers and mobile phone showing what is inside the CPD library for counsellors\" title=\"Counsellor CPD Library - what is inside\" itemprop=\"image\"\/>\n\t<p>The <a href=\"https:\/\/www.rcpsych.ac.uk\/docs\/default-source\/improving-care\/better-mh-policy\/college-reports\/college-report-cr158.pdf?sfvrsn=fcf95b93_2\" target=\"_blank\" rel=\"noopener\">Royal College of Psychiatrists<\/a> reports that self-harm is more prevalent in:<\/p>\n<ul>\n<li>young women<\/li>\n<li>prisoners<\/li>\n<li>sylum seekers<\/li>\n<li>veterans of the armed forces<\/li>\n<li>gay, lesbian and bisexual people<\/li>\n<\/ul>\n\t<p>This seems to be, at least in part, due to stress from prejudice and discrimination.<\/p>\n<p>People who have experienced physical, emotional or sexual abuse during childhood are also more prone to self-harm.<\/p>\n<p>Sometimes, people may self-harm together: having a friend who self-harms may increase their chances of doing it (especially for girls and female prisoners).<\/p>\n\t<h2>Reasons for Self-Harm<\/h2>\n\t<p>There are many possible reasons why people may self-harm. These include:<\/p>\n<ul>\n<li>pressures at school or work &#8211; leading people to feel that they&#8217;re not good enough or to feel under a lot of pressure<\/li>\n<li>bullying<\/li>\n<li>financial problems<\/li>\n<li>sexual, physical or emotional abuse &#8211; when self-harm may be a way of the person trying to make themselves unattractive to the abuser<\/li>\n<li>loss and bereavement<\/li>\n<li>confusion about sexuality &#8211; when people may feel isolated<\/li>\n<li>relationship breakdown<\/li>\n<li>job loss<\/li>\n<li>health problems<\/li>\n<li>low self-esteem<\/li>\n<li>Increased stress<\/li>\n<li>depression and anxiety<\/li>\n<li>anger or numbness.<\/li>\n<\/ul>\n\t<p>Self-harm can be a way of <em>masking emotional pain with physical pain<\/em>. Sometimes, it&#8217;s easier for someone to feel physical pain than to engage with their emotions.<\/p>\n\t<p><strong>People do not self-harm in order to seek attention<\/strong> &#8211; indeed, much self-harm is hidden or invisible.<\/p>\n<p>Nor are those who self-harm trying to take their own life &#8211; though that could be the unintended consequence. However, according to the <a href=\"https:\/\/www.nhs.uk\/conditions\/self-harm\/\" target=\"_blank\" rel=\"noopener\">NHS<\/a>, more than half of those who die by suicide have a history of self-harm.<\/p>\n\t<h3>Types of Self-Harm<\/h3>\n\t<p>Self-farm can manifest in various ways, including:<\/p>\n<ul>\n<li>medication overdose<\/li>\n<li>cutting yourself<\/li>\n<li>burning yourself<\/li>\n<li>banging your head or throwing yourself against something hard<\/li>\n<li>punching yourself<\/li>\n<li>sticking sharp objects or your own nails into your body<\/li>\n<li>swallowing objects that are not food and generally are not good for you (e.g. broken glass) &#8211; sometimes known as pica<\/li>\n<li>hair or eyelash pulling (known as trichotillomania &#8211; or trich for short)<\/li>\n<li>home-performed tattoos, which may include demeaning words about yourself<\/li>\n<li>putting yourself in harm&#8217;s way on purpose<\/li>\n<li>participating in extreme sports<\/li>\n<li>sadomasochistic practices<\/li>\n<li>substance misuse (with alcohol or drugs)<\/li>\n<li>food misuse (bulimia and anorexia nervosa).<\/li>\n<\/ul>\n\t<hr \/>\n<blockquote><p><em>Self-harm can be a way of masking emotional pain with physical pain. Sometimes, it&#8217;s easier for someone to feel physical pain than to engage with their emotions.<\/em><\/p><\/blockquote>\n<hr \/>\n\t\t<h3>Free Handout Download<\/h3>\t\t\n\t\t\t<p>Working with Clients who Self-Harm<\/p>\n\t\t\t<a href=\"#cb4fb27c56\" target=\"_self\" role=\"button\" rel=\"noopener\">\n\t\t\t\t\t\tClick Here to Download Free Handout\n\t\t\t\t\t<\/a>\n\t\n<h3>Cycle of Self-Harm<\/h3>\n\t<p>Self-harm often <strong>begins with shame or grief<\/strong>.<\/p>\n<p>Sometimes, when a person is suffering emotionally, they become overloaded and &#8211; panicking &#8211; try to avoid that feeling by self-harming.<\/p>\n<p>This may bring temporary relief, but initiates a cycle that becomes really hard to break.<\/p>\n\t<h3>Breaking the Cycle<\/h3>\n\t<p>If you can help the client to break the cycle of self-harm, then it may well slow down, become less intense and even stop altogether.<\/p>\n\t<p>There are three possible intervention points in the cycle of self-harm, but before using any of those, <strong>it is vital to assess risk<\/strong>; this may involve <em>breaking confidentiality<\/em>, depending on the exact nature of the self-harm, the age and vulnerability of the client, and the policy of your organisation.<\/p>\n\t<p>The <strong>first intervention point<\/strong> is working with the shame if the self-harm arises in the room. Here, unconditional positive regard is paramount.<\/p>\n<p>If the client feels they can talk openly about what&#8217;s going on for them without the fear of being judged, then they may be able to examine their behaviour, understand their reasons for this and make changes.<\/p>\n\t<p>The <strong>second intervention point<\/strong> is where the bulk of the therapeutic work takes place: <em>finding the trigger<\/em>.<\/p>\n<p>It can be useful to start by encouraging the client to keep a diary of self-harm, including when it happened and what the trigger seemed to be.<\/p>\n<p>Working on this &#8211; i.e. the difficult situation that is causing the client such emotional pain &#8211; could have a significant impact on how the client feels on a day-to-day basis.<\/p>\n\t<p>Finally, there&#8217;s a <strong>third intervention point<\/strong> when the client feels <em>emotional overload<\/em>. This can be an appropriate place for the use of cognitive behavioural and other techniques.<\/p>\n\t<h2>Useful Techniques<\/h2>\n\t<p>Useful techniques when working with clients who self-harm include:<\/p>\n<ul>\n<li>distraction<\/li>\n<li>finding other, less damaging ways to express emotion (e.g. punching a cushion<\/li>\n<li>changing location\/environment<\/li>\n<li>listening to music (to block out a noisy or difficult environment)<\/li>\n<li>exercising<\/li>\n<li>talking to someone<\/li>\n<li>writing about feelings (through journaling or creative writing)<\/li>\n<li>drawing or colouring in<\/li>\n<li>taking a bath<\/li>\n<li>self-harm swapping (e.g. painting or drawing cuts, using an eyebrow pencil or felt-tip pen; squeezing ice &#8211; possibly in a bowl of red soft drink, if it is important to the person to see blood; flicking an elastic band; and rubbing skin with a toothbrush)<\/li>\n<li>waiting for five minutes before self-harming (perhaps using the countdown timer on a mobile phone).<\/li>\n<\/ul>\n\t<h3>Measuring Progress<\/h3>\n\t<p>It can be useful &#8211; when the client first presents &#8211; to ask: &#8216;How much of your life, if you think of it as a clock or as 100%, does self-harm take up?&#8217;<\/p>\n<p>This then gives an initial benchmark against which clients can track progress &#8211; and perhaps set themselves targets.<\/p>\n<p>Seeing a reduction in this figure &#8211; even if only a gradual one &#8211; can be really encouraging and give them hope for the future.<\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Working with Clients Who Self-Harm Intervention for Self Harm In order to start working with clients who self-harm, and to present interventions for self harm, we first need to understand what self harm is. The NHS defines self-harm as follows: &#8216;Self-harm is when someone intentionally damages or injures their body. It&#8217;s usually a way of [&hellip;]<\/p>\n","protected":false},"author":13127,"featured_media":35244,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[709],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Working with Clients Who Self-Harm &#8226; Counselling Tutor<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/counsellingtutor.com\/clients-who-self-harm\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Working with Clients Who Self-Harm &#8226; Counselling Tutor\" \/>\n<meta property=\"og:description\" content=\"Working with Clients Who Self-Harm Intervention for Self Harm In order to start working with clients who self-harm, and to present interventions for self harm, we first need to understand what self harm is. 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