Tag Archives: self-harm and suicide

Working with Self-Harm and Suicidality – CPD with Pete Holloway

Having looked forward to this seminar since it was first mooted, I found that I wanted to take a few days after attending to process the experience. It felt as though it bordered on the transformational and I believed that it was worthwhile to just allow that post-seminar glow to recede if it was going to do so?

A week on, and I have to say that it still feels as though it borders on the transformational. The shifts in perspective it generated for me by examining what self-harm might mean for clients- what and who might be being harmed and who might be doing the harming- by taking a more object relations and existential tack- were truly “lightbulb” moments for me and have already enhanced my clinical practice. The concept that the body becomes the projective tool for what might be going on in the mind; that what is going on in the psyche might be enacted in or on the body sounds simple and yet it was remarkably illuminating.

It was also extremely helpful to address the therapeutic challenges and the “institutional anxiety” that might arise around suicidailty as we work with our clients. Whether we work within an agency as part of a team or whether we are the institution itself as sole practitioners, being able to explore how to work relationally without becoming hamstrung or paralysed by potential consequences around working with such serious issues and behaviours was incredibly valuable.

Looking more closely at risk factors and approaches to risk appraisal when working with the “suicidally contemplative” was also very beneficial in terms of being able to work effectively and appropriately in these areas.

This was an amazing seminar dealing sensitively and helpfully with complex and challenging issues. Pete brought a generosity and warmth to this work which made it accessible and, well, do-able. I am SO glad I attended and have left with the gift of a deeper and more reflective way of “being” with this aspect of therapeutic work and pathways of thinking on this subject theoretically opened to me.

Pete listed some key influences on his thinking and I wonder if it might be helpful to share them:

Felicity de Zulueta: From Pain to Violence

Irvin Yalom: Existential Psychotherapy

Wilfred Bion: A Theory of Thinking

Melanie Klein: Love, Guilt and Reparation

Judith Herman: Trauma and Recovery

I know I’ll be adding these to my reading list!

By: Merri Mayers,
October 2017

We were thrilled with the excellent feedback.  20 out of 21 delegates voted 5 out of 5 on all three questions to give these overall results:

Overall assessment of event: 4.95 out of 5
Speaker: 4.95 out of 5
Value for money: 5 out of 5

Delegates feedback:

  • “You have been highly informative and have re-ignited my interest and passions in this field of mental health and therapeutic interactions.”
  • “What an excellent day – Pete has a breadth of knowledge and a great human, realistic approach to therapy”
  • “I liked the group–size, helpful to promoting an atmosphere where engagement and participation is possible.  Wonderul speaker dealing with a difficult, painful topic in a positive way that affirms the therapist’s competence.”
  • “Excellent speaker, clearly an expert; enjoyable and enlightening about a sombre and disturbing subject”
  • “Pete has been so informative, interesting, engaging and funny – so interesting.  I would definitely attend another of his courses.”

Wendy Bramham
October 2017

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Self-harm: ‘When I hurt, I cut…’

self-harmSelf-harm accounts for over 24,000 hospital admissions every year¹ and it is estimated that 1 in 12 children self-harm². Rates in the UK are some of the highest in Europe³ but – because self-harm is, by its very nature, a private activity and is often kept secret and thus remains unreported – these statistics may be just the tip of the iceberg.

Self-harm is generally thought of to include violent acts to the self – specifically deliberately cutting, hitting, burning, injecting or imbibing potentially dangerous objects or substances, hair pulling, eating disorders etc. Smoking and drinking, over or under-exercising, engaging in risky sporting/driving/sexual behaviour, cosmetic surgery, tattooing and piercing may also be added to the list – although some may not consider many of behaviours in the second list to be harmful. Is eating a doughnut after a difficult meeting at work an act of self-harm or of self-care?

Self-harm is on the increase, and many wonder at the “contagious” aspect of the behavior – is it a way of crying out for help or attention; an act to externally express inner rage; a form of self-punishment; or just a way of “belonging” to a particular group?

Whilst working with a self-harming client can be very distressing, Lynn Martin references many examples of clients who, she feels, were kept alive by their self-harm(4). She refers to “anti-suicide” element of the behaviour, and explains that, for some, self-harm actually allows them to feel that they are in control of their lives. The endorphins, which are released into the blood stream after a puncture to the skin, can serve to somehow “re-boot” the depressed, withdrawn client who has lost touch with her world. Similarly, the pain of the wound can highlight that it hurts “here” rather than just “inside”.

As therapists, it is important that we do not allow any personal shock to spill out when working with a self-harming client. Showing concern for the wounds, and making sure that they are kept clean; ensuring, too, that the client is secure in the fact that you see them behind their pain; communicating that it is alright to talk about the self-harm; respecting the fact that the client is, more often than not, trying to survive and not to die; and reassuring the client that you will not try to steal from them their coping mechanism until they themselves feel safe enough to live without it – all these sort of responses are seen as being the most helpful to the truly distressed and pained client.

Whatever the reasons or the resolutions for the self-harming individual, as therapists we need to be aware of the width and prevalence of this behavior. We need, too, to look after ourselves whilst working with self-harming clients by exploring, in supervision, the myriad of reactions that this particularly violent representation of pain can produce in us.

By: Annabel Murray, Counsellor, June 2015

1 Samaritans & Centre for Suicide, 2002
2 Talking Taboos, 2012
3 NICE 2002
(4) Lynn Martin, Therapy Today, July 2013


Self-help Information about self-harm

What leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  •  developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.


Thoughts from the front-line
We asked a few teenagers to tell us in their own words how they would have liked their parents to support or help them.   The purpose of this exercise was to inform and assist parents/guardians who may be unsure of how to help their child.  Comments remain anonymous to protect identity.
 
Girls aged 14 and 15 told us:
“Further criticism is definitely something NOT to do, because most likely that is what caused the person to self-harm in the first place.”
“Parents shouldn’t pretend they understand, that is one of the most frustrating things for people in this situation. Perhaps saying they are trying to understand would be a better way.”
“Friends can play a large part in preventing further harm… I would get the parents to talk to their child’s friends to see if they have noticed anything.. make it subtle though!”

Girls aged 17 told us:

“For me, my parents couldn’t have really done anything to help me, my mum made me keep my door open at night and took away my razors, making me use hair removal cream instead.  But that didn’t stop me and it wouldn’t stop anyone from doing it.  There’s no way parents can stop it physically in all honesty.   For me it was my own personal feelings of guilt and these weren’t gonna stop no matter how much my mum and dad tried to help.  But the situation would’ve been a lot better if my mum had understood when I told her.  She didn’t say anything and I feel like she didn’t understand why I did it.  Maybe she thought it was some sort of cry for attention, but it wasn’t (I’d been hiding it for one and a half years). If she was more aware of the reasons why people do it, and maybe just gave me a hug, told me I would be okay, comforted me when I was upset about anything, then maybe it would have stopped me doing it sooner.  But instead she never mentioned it to me, only tried to physically prevent me from doing it, not mentally”.  FW

“What might have helped would be if I was not made to feel it was my fault or that I was a drama queen. Guilt is a key contributor to my issues and I was made to feel guilty for self-harming.  I wanted my parents to understand that I wasn’t doing it because I hated them.  I knew they would be heartbroken if I died, but when you’re mentally ‘effed up’ you don’t see it that way, and the selfishness that depression produces isn’t controllable.  Self-harm isn’t always slitting your wrists.  It can be pinching yourself under the table all lesson, or forcing your mind through horrible thoughts (emotional self-harm is a huge thing).  Yes, we know we shouldn’t do it, we know it is bad for us, we know it’s selfish.  Telling us this just makes us feel guilty, which makes us feel crapper which makes us more likely to lose control and do it again.  When you get a cold or even cancer you don’t blame yourself or anyone else; you just look for a way to fix it.  Sometimes we self-harm because it is the only way to feel alive.  Yet, blaming the child for feeling so low is not healthy and will not make them forthcoming with reasons why.”  MA
 
From the above stories, it is clear that it is helpful if parents/carers/relatives can try to understand the emotional distress underlying any self-harm behaviour in their child.    It may be important for the parent to seek their own support, such as counselling, to cope better with this alarming situation.  Wendy Bramham Therapy offers a range of therapists in Newbury & Marlborough who are qualified and experienced in helping with these issues, so please don’t hesitate to contact us.  
Wendy Bramham
July 2015

Self-harm – BBC Wilts, by Wendy Bramham

SELF HARM

What a leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  • developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013
for BBC Radio Wiltshire

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.

Helplines:

Domestic violence 0808 2000247
Bullying 020 8554 9004
Chidline 0800 1111
Homeless: Shelter 0808 800 4444
Samaritans 08457 909090
Drugs: Frank 0800 776600
B-eat (eating) 0845 6341414
Consumer Credit counselling services 0800 1381111
Mind 0300 123 3393