In the aftermath of trauma, some clients turn to self-harm to relieve intense feelings of shame, anxiety, or even emotional numbness.
Over time, these harmful behaviors can become addictive – and helping clients break that cycle can be a challenging process.
So in the video below, Pat Ogden, PhD explains how she helps clients gain insight into both their need to self-harm and the costs of their harmful behaviors. She also provides a surprisingly simple action that clients can take when their urge to self-harm is triggered.
Have a look.
I’m thinking of a client who had a very angry, aggressive, protective, defiant part, and she hated the part of her that was weak and submissive. And these are instinctive defensive responses, right? The angry part of her wanted to kill off that other part. And when she was in a dissociative state, she would cut herself. And as she got insight into those two parts, she was able to help them communicate and eventually help each other, rather than one part of her trying to kill off another part.Sometimes talking about it with a client, finding out the purpose. Clients usually say there’s relief. Often, they’ll say, “There’s relief when I cut myself.” So we’ll say, “Okay. What does the relief feel like? Does it last?” “It doesn’t last.” Those simple questions can be helpful. “Is there any aftermath or any negative repercussions?” “Well, yeah, it hurts afterwards. There’s pain. I have to wear long sleeves. I can’t wear a bathing suit.” They’ll find negative repercussions, and this is just helpful in terms of insight.Sometimes when you’re wanting to help the self-harm stop, but you don’t have the ability yet with your client to work through action, if you think in terms of substitute actions, you can maybe discover the purpose of the self-harm and then find something simple like a Fireball. This I used successfully with quite a few clients. Those super, super hot things that you put in your mouth, that burn your mouth. It’s a similar sensation to cutting, for example. And some clients have been helped by getting inside into their triggers and their impulses to self-harm and then popping a Fireball in their mouth instead. That’s just a little intervention that can sometimes be helpful.”
If you found this video helpful, you can hear more from Pat and other top experts in the field of trauma treatment (like Bessel van der Kolk, MD; Dan Siegel, MD; Stephen Porges, PhD; Peter Levine, PhD; Allan Schore, PhD; and Ruth Lanius, MD, PhD) in the Treating Trauma Master Series.
Now we’d like to hear your thoughts. What are some ways that you help clients manage their self-harm? Let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
Helping Clients Talk About Shame
A Simple Metaphor to De-Shame a Client’s Trauma Response, with Ron Siegel, PsyD
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