Supporting Your Loved One
Be present and listen. Someone who is engaging in self-harm is in a significant amount of distress. It is important that they have individuals who they can count on and who will be open to listening to their experience. Tell the person who is self-harming that you are here to listen to them whenever they would like to talk. Show empathy for their current emotional distress and the self-harming behavior, while also relating to them as a whole person. You may say something like: “I know you’re in a lot of pain right now, and I just want you to know I’m here for you in whatever way you need. We can talk if you are ready, or we can do something else you enjoy right now.” EXPERT TIP Liana Georgoulis, PsyD Liana Georgoulis, PsyD Licensed Psychologist Dr. Liana Georgoulis is a Licensed Clinical Psychologist with over 10 years of experience, and is now the Clinical Director at Coast Psychological Services in Los Angeles, California. She received her Doctor of Psychology from Pepperdine University in 2009. Her practice provides cognitive behavioral therapy and other evidence-based therapies for adolescents, adults, and couples. Liana Georgoulis, PsyD Liana Georgoulis, PsyD Licensed Psychologist Talk to your friend, but understand you may not be able to change the problem. Dr. Liana Georgoulis says: "If you have a friend who's engaging in self-harm, try talking to them about it in a kind, caring way. It's normal to worry about seeming intrusive or judgmental, but it's important to let your friend know that you're there for them and you're worried about them. You can offer to help them find resources or mental health assistance, but keep in mind that self-harm is a sign of deep psychological pain, so the person may not be able to stop just because you ask them to."
Ask them how they are feeling. It can mean a lot to a person who is in distress to be able to open up to someone about how they are feeling. Initiating this conversation can also help your friend feel less guilt if they are feeling like they are burdening you for seeking your help. You can say: “I just wanted to check in and see how you’re feeling today. I’m here if you need to talk about something.”
Avoid judgment. The way you react to self-harm is important because it sends a message to the individual about how others perceive them and their current struggles. If you respond in a way that signals judgment, they may be hesitant to reach out to others for help in the future.. Your immediate reaction might be to tell your friend that how they are reacting is dangerous or harmful, but instead say something like: “I don’t know exactly why you’re self-harming, but I can understand that you’re in a lot of pain. I want to better understand what you’re going through.”
Respect your friend’s autonomy. Self-harming may be the only coping mechanism the individual can use currently to alleviate emotional distress and that overcoming self-injury is likely going to be a long and difficult journey. Only the individual can decide when they are ready to stop self-harming.
Do not gossip. It can be overwhelming to find out a friend of yours is self-harming, and you might be tempted to tell other friends. However, self-harming is often a private matter and it is important that your friend has your trust. It should be noted that you should gain additional help if you are worried your friend may be suicidal. If others express their concern or ask you what is going on with your friend, you can say: “I know you want to help and you’re concerned, but it’s probably better if you talk to them yourself. I don’t want to betray their trust.”
Do not set ultimatums. Telling your friend they have to stop or you will tell someone, or you will stop being their friend, will only push your friend away and make them feel more isolated. Rather than setting an ultimatum, tell your friend: “I know you’re in a lot of pain right now, and I would like to see you stop doing this one day. But I know only you can decide when to stop, and I’m not going to force you to do anything.”
Share resources with your friend. There are many free and valuable resources that can help your friend learn more about self-harm as a coping mechanism and also how to learn to cope in different ways. Visit http://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm to debunk myths about self-harm, learn about the dangers of self-harm, and how to cope with emotional stress in different ways. The S.A.F.E. Alternatives Information line available in the U.S. at 1-800-366-8288 is a resource that your friend can call to get support with self-harming behavior and referrals for mental health professionals. You can tell your friend: “I’ve been looking around for different resources to help you. I just wanted to share a couple with you to see if you might want to use them. There is no pressure at all if you don’t find them helpful though.”
Seek additional help when you can’t do it by yourself. While you want to respect your friend’s privacy, there may come a point where you feel like there is nothing more you can do, and you might be worried for your friend’s safety. Encourage your friend to seek professional help, such as a counselor or psychologist, in order to get extra support and to get to the underlying causes of their self-harming behavior. You can even offer to go with your friend to the counselor’s office to show that you care about their well-being. Say something such as: “I know you’re scared right now, but I think getting some extra help might be really good in helping you heal right now. I can even go with you to see the counselor.” If you and your friend are under 18, it will be especially important to tell an adult that can monitor the situation and get extra help as needed. Talk with your friend and see if they can choose an adult who they trust with this information. Call 911 in the United States, or the emergency line in your country, if your friend’s self-injury appears to be medically concerning or life-threatening.
Educating Yourself
Learn about self-harm and how it differs from suicide. When you find out that one of your loved ones is self-harming, you may feel shocked, saddened, and concerned that they want to take their life. Self-harm is actually a coping mechanism used for a variety of reasons to alleviate emotional pain and does not always signal suicidal ideation. A significant difference between suicide and self-harm involves intent. An individual who possesses active suicidal thoughts is seriously considering taking their own life because they see no other escape from their current distress. An individual who is self-harming is likely using this technique as a coping mechanism to alleviate psychological or emotional distress, to affirm they are alive, or to experience a mental rush.
Become aware of local and national resources. There are many local and national resources that can help you be a better friend to someone who is self-harming as well as inform you of the professional resources that might be handy to give your friend. Your Life Your Voice is a national resource in the U.S. that provides a free hotline for kids, teenagers, and young adults to call at any time when they are experiencing distress. They are also open to talking to friends and loved ones about how to better help those who are self-harming. Visit www.yourlifeyourvoice.org to learn more. S.A.F.E. (Self Abuse Finally Ends) is another national educational resource base in the U.S. that provides treatments, outreach programs, and knowledge for those that are self-harming and those who are loved ones trying to help a friend. S.A.F.E. also provides a list of local mental health professionals who specialize in self-harming behavior. Visit http://www.selfinjury.com to get more information.
Explore educational resources. If you are in school or in higher education, reach out to your school counselor or college mental health center to get more information about how to talk to your friend and help your friend who is self-harming. A mental health professional is bound by confidentiality and cannot tell anyone what you discussed unless you reveal imminent risk, such as suicidal or homicidal ideation. However, as a courtesy to your friend, consider telling them that you are going to seek outside resources without using their name. You might start a conversation with a counselor by saying: “I have a good friend who has been using self-harming to cope with their emotional issues. I feel a little over my head and could really use some help in how to help them.”
Taking Care of Yourself
Find a support network. While you do not want to gossip about your friend who is self-harming, it will be important that you find your own support network to help you deal with your own feelings about self-harming and the possible stress and concern that comes with being friends with someone who is self-harming. Getting your own support will alleviate some of your distress and help you be a better friend. Talk to someone in your family whom you trust. If you are really close to one of your parents or one of your siblings, they might be a good support system for you through this time. You might say: “I have a friend who is going through a hard time, and I could really use someone to talk to about it because I’m really worried. I want to make sure I’m helping them the best way I can.”
Seek professional resources. Sometimes people seek out counseling or therapy in order to talk about their relationships with others. It is normal to see a counselor to discuss the worries you have about your friend, to talk about how the situation is affecting you, and to talk about the best strategies to use to help your friend. Your local school or college counselor might be a good resource if you are currently in an educational institution.
Engage in relaxing activities. You might want to be there for your friend whenever you can throughout the day. However, it is important that you take care of your own well-being too since being with your friend might cause you to feel emotionally exhausted. Stay involved with activities that cause you to feel relaxed and happy. Go for a run or walk. Physical activity has many natural health benefits, including improving mood and decreasing stress. Even a quick 20-minute run or jog can help you feel more positive and more energized to talk with your friend again. Listen to music. Music is often therapeutic and allows you to calm yourself while separating yourself from others. Watch a funny movie or television show. Laughter is a powerful tool to help improve mood and increase positive future thinking. If you are feeling hopeless about the situation with your friend, a few laughs could really help you feel enthusiastic about your ability to help them.
Be honest about your boundaries. It is commendable to be supportive, caring, and helpful to your friend who is going through such a difficult time. However, if you start to notice that you are unhappy everyday, tense and anxious, or unable to concentrate on any other commitments, it might be time to tell your friend that you are unable to continue supporting them as much as you did before. If it reaches this point, talk to your friend about reaching out to other people for support. You can say something like: “I really care about you and want to keep being there for you, but I think we need to get other people involved who might really be there to help you. I want you to get the best support possible, and I don’t think that’s always me anymore.”
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