Understanding the Self-Injurer

Understanding the Self-Injurer

Understanding Self-Injury & Practical Tools to Interrupt the Cycle Shannon Gubser [email protected] 360-894-6016 (W) & 360-481-3830 (C) Video Overview https://www.youtube.com/watch?v=EcFR-7-WzUM Introduction Each of us has special areas weve been called into some sexual abuse, some inner city, some higher ed, others social work, or teaching, my little nitch became self injury back in 2006, would not say that I was an expert, just 10 years of experience on the front lines History- had a dream, met Kara, my general counseling training, love, and faithfulness wasnt enough, saw TV show, attended training at SAFE in Aurora, IL, used tools, found hope/new life when tools were used, expanded the tent pegs, lots of life after stories AS WE BEGIN HOPE: 1. SI is evidence they are letting us see them (can you see my pain)excitingthey

are telling us that something is going on insideits an invitationMs story 2. Best part of my training weekend were the stories at the endworked with many kids who have been free from using self-injury to survive lifethere is freedom from this Todays Journey (SPOILER ALERT) Part 1 (2:30-2:50pm): Taking a closer look at what self-injury is Part 2 (2:50-2:20pm): Practical tools to interrupt the cycle of self-injury Part 3 (2:20-2:30pm):

Picture of hope & Q&A Lets be honestOverview When we are struggling or in pain (birthing contractions for example)we want a way OUT! Or at least a distraction! Sowhat if healthy options to deal with our pain arent known or practiced? And what if self-injury has been learned and now being used to deal with that pain? In a faithful and gentle way, we can teach kids that they dont have to deal with pain in this way any longerthat it is a choiceand that they can choose a new healthy way that will bring healing, bring joy, and bring deeper intimacy in relationships Step 1we must acknowledge/identify that we arent dealing with life in a

healthy manner (dont have to hide any more)Step 2we must be willing/ want to get well (we cant force them)Step 3we can learn and practice new behaviors (thoughts, actions, etc)Step 4we practice our new behaviors until it becomes a part of who we are (faithfulness key here.this can be a VERY long journey to a life without self-injury) SI isnt something to be fearedinstead we meet people where they were atspeak truthteach new behaviorsand be faithful in their livesLOVE changes the worldAND effective tools help a lot as well! Lets learn some of those tools today! Crossing the line (between no SI behavior and SI behavior)the farther over and the longer using it, the longer it often takes to adopted new thoughts and behaviors Part 1 - What is self-injury? Defining Self-Injury (SI-NSSI) SELF INJURY IS Deliberate mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing emotions that seem too painful for words to express

(Lader, 1998). Self abuse, self-injury, self mutilation is seen by the injurer as a form of self care to manage emotions SI is a radical means of emotion management SI communicates emotional pain; translates/communicates emotional pain through physical pain SELF INJURY IS NOT.. Its not a half hearted attempt at suiciderather it is often seen as a way to avoid suicide, seen as a way to get through the moment Its not body modification taken to the extremebody modification is seen as a way to beautify or improve looks Its not demon possessionthis is a gross simplification to treat a very

complex issue Its not just a way to get attention most often times its often the opposite *note* Examples of Self-Injury Cutting Burning Head banging Scratching Biting Interfering with wound healing

Hair pulling Ingesting/injecting sharp objects or toxic substances Breaking bones Facial picking Amputation/blinding Stats A study of 2,875 high school and college aged students showed a lifetime prevalence of SI at 17% (Whitlock, 2006)boys/girls 50% What does this look like? (perhaps an even higher #) Research has show 90% of behavior begins as teenagers, with an average on-set at age 14 with increased severity through late 20s (Penner, 2005)

General Profile of Someone Whos Self-Injuring Has rock bottom self-esteem Is even SELF-LOATHING Often times feels: unloved, ugly, distain, hopeless, trapped, numb Has probably had a lifetime of stuffed emotions Probably has never learned to express emotion in a healthy manner Often times: concurrent eating disorder (80%); history of sexual or other abuse (50%+) Often has feelings of profound abandonment

Often feel they can never be right or good enough And often feel they are damaged goods Usually feels a lot of shame and guilt and therefore keeps this behavior secret Used to think the self-injurer was the emo kidbut found as many who were the perfectionist, jock, straight A student In General, What is the Cycle of SI? 1. Trigge r/ Incide

nt 4. Action Taken 2. Strong Feelin 3. gs Distorte d Though ts (often times attacking identity) In General, What is the Cycle of SI? 1. Generally precipitated by

an incident/trigg er (perceived or real) of loss, abandonment, trauma, disappointmen 4. Action t, etc. is (self-injury) taken to discharge or release the intense feelings, guilt, shame and isolation generally follow 2. Strong feelings

(tension, anger, rage, fear, anxiety, panic, etc.) occur as a result of the incident to an 3. If thealmost uncomfortable overpowering state feelings are not communicated, not integrated, or the individual does not selfsoothe in a healthy manner, then the feelings often provoke distorted/ generalized thoughts, often times attacking

identify and worth, and usually leads to feeling helpless, overwhelmed, and alone. Other Triggers Besides an Incident Someone else talking about SI Seeing SI on TV/computer/books/etc Sight of implements (i.e. scissors, knives, etc) The physical feeling or touching of implements Feeling numb and want to feel again Habitual (location/time/etc)

What does a compassion filled response to life look like? (where are we hoping to lead themwhere do we want to end up?) 1. INCIDENT 2. STRONG FEELINGS ABOUT THE INCIDENT *fully in the moment *identify feelings 4. PROCESS THE EXPERIENCE IN A HEALTHY MANNER BY: GETTING THROUGH THE EXPERIENCE, ASSIMILATING THE EXPERIENCE AND/OR HEALING *for an indefinite period of

time, *truth has been confirmed or adopted (or moving in that direction) and healing has taken place, *identity stands on truth 3. INVITATION TO PROCESS THE EXERIENCE: EXPOSE, BE VULNERABLE, WRESTLE: *internally process with truth about the incident, feelings, thoughts, and possibly identity, if still in a heightened state then *invite and give permission to a trusted accountability person to speak truth about the incident, our feelings, our thoughts, and our

identity Why does SI appear to be more prevalent now? Collapse of the Extended Family (divorce, work, meals, more on own, etc) Emphasis on Quick Fix (technology has shown us no need to wait or selfsooth) Individualized Activities (phone, video games, computer, TV, etc invisibility)dont see the isolated behavior as rude The A-hloic Society (behavior normalized) Body Focused Culture (up to 80% of SIers concurrent eating disorder) Contagion Effect Part 2 - Practical Tools to Interrupt the Cycle What are the Goals When Walking With a SIer? To get through defenses to the root/core issue(s) To help the individual identify and communicate experiences/feelings verbally (not hide) requires vulnerability/intimacy

To challenge irrational/distorted thoughts/beliefs and to replace those with truth To learn the difference between thoughts/feelings/behaviors To increase the window of opportunity between a trigger/impulse/thought(s) and the action/behavior To be able to experience feelings without an a physical act To face fear(s) directly rather than run from/self-medicate with self-injury To experience empathy/compassion as they walk THROUGH the feelings/thoughts/beliefs/healthy actions To mourn the loss of the idealized childhood How to approach or start a conversation if you suspect someone is self-injuring? How do you deal with stuff when it gets really hard? What do you do?

tell me about this while gently touching their arm (if cuts are visible) Everyone has a story to tell. Would you share your story with me? Ive been worried about you because Ive seen Do you want to be well? How can we know? Give a homework assignmentsee if they do it Examples of assignments: lie/truth sheet or log sheet Dont chase after them if they arent ready to get well yet What We Can Teach to Interrupt/Extinguish SI? Life Happens If there is a known triggerget rid of or avoid it At the FIRST sign of a trigger that leads to wanting to self-injurego into 1. Generally

action...dont be the cat playing with a ball of yarn (when theprecipitated pirate ship by is off in the distance, not right next to you) an incident /trigger (perceived or real) of loss, abandonment, trauma, disappointmen 4. Action (if t, etc. We have a choice! self-injury takes place If the individual was not able to do 1-3 alone and still desires to self-injureMUST shame and ASK/SEEK HELP Safe ally will help identify distorted thoughts and beliefs about self/speak isolation with

truth and empathy/compassion generally Hopefully the ending action is that they walked through the experience occur) is taken without self-injurythey know they can do it to discharge or Eventually the truth will become a belief water on top of dry dirt eventually release the sinks/saturates from head to intense Celebrate victories: victories etched in the helmet of soldiers/football feelings If they choose to self-injure: no reason to callrespond in faithfulness, encouragement, what did we learn? How can we use what we learned to help us next time? 2. Strong feelings (tension, anger, rage, fear, anxiety,

panic, etc.) occur as a result of the incident to an 3. If the almost overuncomfortable feelings are not communicated, powering state not integrated or the individual does not selfsooth in a healthy manner, then the feelings often provoke distorted/ generalized thoughts, often times attacking identify and worth and heightening the perception of the incident and feelings

(generally feeling hopeless, overwhelmed, and alone). Be fully presentwhen life is goodenjoy it and be grateful, when it is notPain demands to be felt Fault in Our Stars No feelings are badbut, yes, some are uncomfortable Its OK to be mad, permission to feel any feeling Anger is usually a secondary emotionask why 5X true/deeper feeling(s), what are these feelings and where did they come from? Positive Self-Talk tape playing in head, replace lies with truth (dry plant) Self-Sooth action/tools if needed (breathing, Impulse Control Log w/ 5 alternatives counting, happy place) Positive Self-Talk replace lies with truth Communicate feelings with words if needed

Truth/Lie Worksheet-replace lie/false belief with Ask for helpa safe ally (definesafe accountability) (catch thought and evaluate). What happens can truth reinforce truth of incidentif needed, reach when we water/starve the plant? out/dont isolate CDs that reinforce truth (what we constantly see/ hear we ruminate on) Ask for Helpa safe ally can reinforce truthalso gives us practice being vulnerable

Teach/Learn the difference between truth/lie what they feel like Where did it start? Where did I first learn this? Opportunity to become aware of generational issues (learned behavior) If you know someone is self-injuring, do you Tell Someone? Tell the Parents? Refer to A Counselor? The presenters at SAFE had two differing opinions on this (shows not a clear line) Informed Consent at the beginning of the school yearmay need to remind them School counselors are ethically obligated to keep student reported information confidential unless disclosure is required to prevent clear and imminent danger to the counselee or others. (ASCA, 2004) check school board policy as well ALWAYS tell if suicide seems to be an option (Eisel vs. Montgomery County Board of Education, 1991) ElementaryI would personally say, yes, tell parents (students can choose to do this together or we callthey choose to be present or not, gives them some sense of power/choice in it) Middle/Highcan seek wisdom from other professionals or attorney if there is definite struggle Can allow the individual to tell their parents (with a timeline) OR offer to go with them If SI has become an addictive or habitual behavior, they should be referred to a trained or qualified therapist

Appendix -practical tools- Feelings List MAD GLAD Annoyed Irritated Blissful Proud Furious Frustrated Ecstatic Curious

Enraged Livid Loving Cheerful Angry Aggravated Relaxed Ticked Off Happy ANXIOUS Vulnerable Excited Relieved

SAD DepressedAgonized Startled Frightened ExhaustedTired Terrified Agitated Grieving Shocked Surprised Lonely Miserable Scared

Empty Hurt Lie - Truth

I will never be good enough I am ugly I am stupid Everyone hates me I am unlovable and I dont belong I shouldnt have been born I have to be perfect or they will think __________ I cant do this I need to be punished I am not worthy of real connection I wont be able to live through this If I do this, I might fail If people knew the real me, they wont like me If they know the truth about me, they wont love/like me anymore If I choose ______, I will disappoint _______ To belong, I have to fit in, and be like everybody else Ive done this too many times to be forgiven CD 1 You are Loved, Worthy, Belong, Beautiful Beautiful Mercy Me Beloved Tenth Ave North

By Your Side Tenth Ave North Call Me Beautiful Ginny Owens Come to Me Jamie Grace Dont You Know Ill Always Love YouThird Day Firework Katy Perry Free to Be Me Francesca Battiselli Gold Brit Nicole I Am Your Beloved Vineyard I Believe in You Bethany Dillon I Belong Kathryn Scott I Love You More Matthew West Jesus Loves Me Chris Tomlin Just the Way You Are Bruno Mars Madly in Love With You Sean Mcconnell More Beautiful Than You Jonny Diaz Proud Steven Curtis Chapman Safe Phil Wickham What If Jadon Lavik What Makes You Beautiful One Direction You Love Me Anyway Sidewalk

Prophets Your Love Brandon Heath Hallelujah (Your Love Makes Me Sing)Various CD 2 Child You are Loved Regardless of What You Do (can come out of hiding and leave your shame) Who is This God Alli Rogers Beauty for Ashes Shane & Shane East to West Casting Crowns Empty and Beautiful Matt Maher Field of Grace Big Daddy Weave Forgiven and Loved Jimmy Needham Greater - MercyMe He is Faithful Jesus Culture He Sees WOW Worship Green Healer Hillsong The Hurt & the Healer MercyMe I Am Eddie James I Need You to Love Me BarlowGirl I Turn to You Selah A Little More Jennifer Knapp

More Like Falling in Love Jason Gray New Every Morning Big Daddy Weave Never Let Go David Crowder Ocean Floor Audio Adrenaline The One Thing I Know Sara Groves One Touch Nicole C. Mullen Only Grace Matthew West One Thing Remains Passion Redeemed Bid Baddy Weave Relentless Bethel College Chapel Band Sweet Jesus Selah & Jill Phillips Sweetly Broken Jeremy Riddle Though Im Not Worthy Kari Jobe Undo Rush of Fools Washed By the Water Needtobreathe Wholly Yours David Crowder Band You Are Faithful Jesus Culture You Found Me Big Daddy Weave CD 3 You have Freedom & Victory All Things New Steven Curtis Chapman All This Time Britt Nicole

Born Again Third Day Break Every Chain Jesus Culture Break Free Ariana Grande Free Daria Maclean Hello My Name Is Matthew West How Can it Be Lauren Daigle I Am Free Newsboys I Am New Jason Gray I Wanna Be Free I Will Rise Chris Tomlin Its Not Over Ricardo Sanchez Made New Lincoln Brewster Mighty to Save Hillsong Overcome Jeremy Camp Overcomer Mandisa Redeemed Big Daddy Weave Remind Me Who I Am Jason Gray Rise Shawn McDonald Strong Tower Kutless Stronger Mandisa Stronger Kelly Clarkson Stronger Than the Storm Vicky Beeching

Suitcases Dara Maclean The Sun is Rising Britt Nicole Voice of Truth Casting Crowns Walk on Water Britt Nicole What Faith Can Do Kutless Whom Shall I Fear Chris Tomlin Caution Signs Boys help boysgirls help girls if possible Be a good listenerlisten to their whole story but speak when you hear false beliefs/lies (not crazy) Respond in compassion in your words and actions

Set boundaries (manipulation) AND make allowances (assuring them of your time for them)** Remind them that youll love them and have time for them, even when they dont have a problem** I feared that being well meant being alone again Tori Speak conviction NOT condemnationand teach them to know the difference (heard the FBI studies the original not the fake), condemnation will illicit shame and more hiding Accept them non-judgmentally, love them as a person, not as their behavior they might tell a liebut we dont call them a liar (labels attack identity)

It will require courage for them to reach beyond shame to vulnerability There will be victorybut if they fallit will often be farther in between and less frequentlittle by little...celebrate victories (large and small) It will be worth it! Speak vision and hope for what is to come (phone callTell me what it is gunna be like again.). Freedom is waiting, healing is waiting, deep and authentic relationships are waiting Point out that they can live in peace, doesnt have to be lived in chaosyoull on the Journey Boystacticsside by side with activitystigma to showing emotion Ultimately, SI behavior is a choice, not an addiction over which one is powerless, it can be transformed from a seemingly uncontrollable compulsion to a choice

There is no healthy amount of self-injuryit might be/have been temporarily helpful, but it is ultimately a dangerous coping strategy that interferes with intimacy, productivity, happiness, and abundant life If SI has been the best friend, it is gunna get harder before it gets easier When SI is taken awaysometimes it goes straight to I want/need to die OR replaced with something else (food, exercise, sex, drinking etc)** Consider asking them to give you their chosen instruments Differentiating between suicide and SI (location, intent, methodsone is a coping strategy, one is an escape from life)ask, pin point If theyre calling you after theyve done ityou cant help them Little by littlekeep being faithfulthe journey can take a while, and your faithfulness helps solidify the truths taught along the way while they get stronger as they take more land back They may choose to go back to the dungeonLOVE THEM ANYWAY Rememberwe are the nursenot the doctorour job it to point the way to healing and to walk alongsidewe arent the healer Self-Injury Expert Resource

Bodily Harm (1998) Karen Conterio and Wendy Lader, PhD S.A.F.E. Alternatives www.selfinjury.com Q & A Time: selfinjury.com FAQ Parking Lot

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