No panacea for self-harming

23rd July 2010 at 01:00
Psychologists examine effective strategies to help children who self-harm

We have tried numerous ways of dealing with children and young people who self-harm, such as the "5 4 3 2 1" technique, which involves asking those who feel the urge to name five things they can see at the moment, four things they can hear, three things they can touchfeel, two things they can tastesmell, and then to name at least one good thing about themselves.

Others include the 15-minute rule, which invites children to see how long they can resist the temptation to self-harm; putting Elastoplasts or bandages on parts of the body he or she wants to injure; and providing lists of emergency telephone numbers.

We used to think these were effective strategies for helping all children, but now we're not so sure. Studies have been done which cast doubt on the value of a one-size-fits-all approach. Some self-harmers tell us that much of what we do to try and help them doesn't work. Here are some examples of what they say: "It doesn't help us if you punish us by being angry with us or taking away support."

"If you panic and think we're always trying to kill ourselves, you're wrong."

"Don't explain away our self-harm by saying that our injuries are superficial or that we're just attention-seeking."

"Don't be scared to talk to us about self-harm, because you think it'll only encourage us to do it more. It won't."

"Don't say we've got to give up self-harming before we're ready."

Without doubt, stress relief and coping are major factors in self-harming. It's a way of relieving the pressure, making it possible to displace the pain elsewhere. One self-harmer put it like this: "It's about control. You're not out of control. In fact, the cutting is, perhaps, the only thing that you have control of." Being in control features strongly with many young people.

Given the serious damage that some children and young people can inflict on themselves, and our patent failure to be of much help, we cannot afford to ignore any potentially beneficial strategy - including harm- minimisation.

While there is no question of actually giving young people sterilised razor blades, we need to consider safer ways in which distressed pupils can hurt themselves. Could there be a less censorious middle road between the dangerous mutilation and insisting that they stop altogether? We know from experience that the very determined, even those under constant observation, still manage to inflict appalling injuries on themselves.

A study by two German psychologists (Stirn amp; Hinz, 2008) suggested that there might be a connection between body-piercing, or tattooing, and self- harm. They got 437 volunteers who regularly read a body-modification magazine to complete an extensive questionnaire on what they did to their bodies and why. The questionnaire also asked about whether or not the respondents had ever deliberately self-harmed.

While only about 1 per cent of the general population will engage in deliberate self-harm, about 27 per cent of this sample had done so. Some even indicated that it was the professional body-piercing itself which caused them to stop. Perhaps we have hit upon yet another treatment strategy that could work, at least for some. There is unlikely to be a panacea.

John Jamieson and Dominique Haggerty are psychologists who work in a residential school for troubled young people.

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