functions and alternatives to self-harm
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Functions and Alternatives
to Self-harm
SCOTTISHPersonality Disorder Network
SCOTTISHPersonality Disorder Network
Functions and Alternatives
Aims of session:
Identify the functions of self-harm
Explore links between functions and
safer alternatives
Clinical interventions; ‘Safety Planning’
Developing practice
SCOTTISHPersonality Disorder Network
Functions and Alternatives
“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
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Functions and Alternatives
“One comes to see that it is not so much the nature of the act that counts but it’s meaning”
Chasseguet-Smirgel, 1990
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Functions and Alternatives
“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
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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
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Functions
Testimony Re-enactment Punish self/others Cleansing Communicate Influence others Connection with inner world
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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.
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AlternativesDistracting techniquesPositive emotional techniquesEmotional focusingAlternative ‘safer’ forms of self-harmComforting techniquesRelaxing techniquesSelf-harm control
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Distracting Techniques
cleaning/tidying washing clothes playing games sports exercise gardening visiting a friend phone someone
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Distracting Techniques
paint or draw
write letters
watch TV/video
listen to music
cinema
shopping
hobbies
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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
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Emotional Focussing
list emotional triggerswrite poetry/prose about feelingspaint/draw emotionswrite a diarytalkrainy day letter
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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
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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
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Comforting Techniques
have a soothing drinkhave a bubble bathsoak your feetchange your bedstroke your petwear comfortable clotheshug someone/your teddyput lights onpray
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Relaxationguided fantasy ‘dreamtime’focus on breathingcount your breathsfocus on your bodyrelax each muscle individuallylisten to relaxation tapemedicationyogamassage hands, feet, etc
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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
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Safety Planning
To assist individuals ‘move away’
from self harm and to search for
alternatives the brief intervention of
“Safety Planning” has been adopted
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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
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Safety Planning Aims
Dispelling secretsCommunicationReducing impulsivenessChoiceEncourages tolerating the feelingResponsibility through self-directionCollaborative workingCreates the third position
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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
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The Third Position
This is how we fulfil the injunction of
the Oracle at Delphi: ‘Know thyself’
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The Third Position
child mother(person) (self harm)
father (other)
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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
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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.
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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.
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