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It can be hard to know how to support someone who self-harms. Being patient and learning about why someone may self-harm can help.

Melissa Prusko, Psy.D.
• March 07, 2022

Self-harm can be so distressing both for the individual engaging in the behavior and for loved ones hearing, seeing, or learning about it happening. 

First, acknowledge how painful self-harm must be for the both of you.

What is self-harm?

Simply put, this is when an instrument (i.e., razors, lighters) is intentionally used to inflict pain and harm to a part of the body, such as arms, legs, and stomach.


Why does someone self-harm?

There is no simple answer. 


There can be so many reasons why an individual turns to self-harm to soothe very deep emotional pain that cannot be expressed and relieved any other way.  For example, someone may self-harm because of fear, shame, rejection, punishment, etc.  What we do know is that something very painful is being communicated to anyone who will listen. 

Our understanding of how our brains respond to deep emotional pain released by self-harm is that of a “shut off switch” for the emotional part of our brain.  Have you ever had an itch in the middle of your back that you couldn't reach?  How irritating!  We would do anything for relief.  And then you pinch yourself on the arm?  Ah, relief!  Self-harm functions similarly as it redirects the focus of the brain from intense emotional pain to something else.

Here are some tips of what to do as well as what not to do when you learn someone is engaging in self-harm:

  1. Do validate.  This can be so hard because many of us often confuse validation with agreement.  We are not saying we agree with self-harm.  We are saying, “I am here for you even if I cannot understand.” 
    1. Validation can be just sitting with someone!

  2. Do express your care, love, and concern.

  3. Be curious.  This, too, can be so hard when all we want to do is stop someone from doing this.  Take a moment to acknowledge how painful this is and be curious – ask the individual what they are feeling.   

  4. Don’t say the self-harm does not make sense, is irrational, or shame the individual.  Self-injury often can be very shameful for the person engaging in it.  The last thing they need is to be judged as they are already judging themselves.
    1. If you cannot understand the pain, then express, “I cannot imagine the pain you’re experiencing.  I am here.” 
  5. Don’t immediately take your loved one to the emergency room.  Not everyone who engages in self-harm is trying to kill themselves.  If you, or the individual engaging in self-harm, is worried about the behavior escalating to suicide, pay attention to the following:
    1. Is the self-harm worsening?  Is the instrument being used becoming more lethal? 
    2. Is the individual, for example, cutting deeper than usual due to being unable to get relief?
    3. Is there a change in location of self-harm to one that is now more lethal?

Remember, everyone is doing the best they can.  Unfortunately, that may look like self-harm.  Be present.  Show care, concern, and love.  It takes a lot of courage for someone to share this, so do not underestimate the trust that was required to share such a vulnerable behavior. 

For the individual, there are options to find alternate ways to regulate very painful emotions.  One suggestion is to seek treatment that utilizes Dialectical Behavior Therapy (DBT).  In 1993, DBT was developed by Marsha Linehan to provide skills training to individuals at high risk for suicide and self-harm.  It has become a leading treatment for individuals with emotional dysregulation, and it can help individuals who self-harm become more aware of their emotions and engage in more effective coping behaviors by helping individuals not act from a place of emotional impulse. 

Another option was developed by Lisa Ferentz, and it is known as the CARESS model, which can be found here.  CARESS stands for Communicate Alternatively, Release Endorphins, and Self-Soothe.  This was developed to help build someone’s coping skills who engage in self-harm and other self-destructive behaviors instead of solely focusing on stopping the self-harm behavior.  This treatment is a nice complement to DBT treatment.  You can read more about the development of this treatment intervention here.

Melissa Prusko, Psy.D.

Dr. Prusko (she/her) strives to provide a compassionate and empathic therapeutic relationship that allows for feeling safe enough to explore and to make sense, together, what may bring someone to therapy. While she practices from a psychodynamic perspective, she is skilled at delivering techniques in a relational manner for those who are seeking new skills for symptom relief.