Functions and Alternatives to Self-harm SCOTTISH Personality Disorder Network.

Functions and Alternatives

to Self-harm

SCOTTISHPersonality Disorder Network



Aims of session:

Identify the functions of self-harm

Explore links between functions and

safer alternatives

Clinical interventions; ‘Safety Planning’

Developing practice



“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



“One comes to see that it is not so much the nature of the act that counts but it’s meaning”

Chasseguet-Smirgel, 1990



“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.


AlternativesDistracting techniquesPositive emotional techniquesEmotional focusingAlternative ‘safer’ forms of self-harmComforting techniquesRelaxing techniquesSelf-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 letterslook through old photographslisten to emotional musicwatch funny filmsread joke booksay positive statements to yourselfmake an emergency bundleself voice tape


Emotional Focussing

list emotional triggerswrite poetry/prose about feelingspaint/draw emotionswrite a diarytalkrainy day letter


Alternative ‘Safer’ Forms of Self-harm

hold ice in handsqueeze rubber balllisten to loud musicrubber band on wristthrow things/screampunch cushionsbody paintstand under hot/cold shower


Comforting Techniques

hold a safe objectsit in a safe placelisten to soothing musicsing a favourite songuse perfume/hand creamroom fragrance or pot-pourribuy fresh flowerseat a favourite food


Comforting Techniques

have a soothing drinkhave a bubble bathsoak your feetchange your bedstroke your petwear comfortable clotheshug someone/your teddyput lights onpray


Relaxationguided fantasy ‘dreamtime’focus on breathingcount your breathsfocus on your bodyrelax each muscle individuallylisten to relaxation tapemedicationyogamassage hands, feet, etc


Self-harm Controlhand-in blades, tablets, money etc.lock blades/tablets in cupboardhand in keys/ shoessellotape blades in a boxlock bedroomnegotiate restricted area to damagemedicationgo to beduse 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 faceAlone with self-developed prompt sheetOver the phone with out-of-hours

servicesWith friends or family


Safety Planning Aims

Dispelling secretsCommunicationReducing impulsivenessChoiceEncourages tolerating the feelingResponsibility through self-directionCollaborative workingCreates 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’ ExperienceIt 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 SCOTTISH Personality Disorder Network.

Documents

practice slide

functions of selfharm

favourite food slide

hotcold shower slide

inner world slide

emotional music

action of selfharm

alternatives women