1. Show that you see and care about the person in pain behind the self-injury.
2. Show concern for the injuries themselves. Whatever ‘front’ they may put on, a person who has injured herself is usually deeply distressed, ashamed and vulnerable. You have an opportunity to offer compassion and respect – something different from what they are often used to receiving.
3. Make it clear that self-injury is okay to talk about, and can be understood. If you feel upset by the injuries, it may be best to be honest about this, while being clear that you can deal with your own feelings and don’t blame her for them.
4. Convey your respect for the person’s efforts to survive, even though this involves hurting herself. She has done the best she could.
5. Acknowledge how frightening it may be to think of living without self-injury. Reassure the person that you will not try to ‘steal’ her way of coping. (Also reassure yourself you are not responsible for what she does to herself.)
6. Help the person make sense of their self-injury. eg ask when the self-injury started, and what was happening then. Explore how it has helped the person to survive, in the past and now. Retrace with them the steps leading up to self-injury – the events, thoughts and feelings which lead to it.
7. Gently encourage the person to use the urge to self-injure as a signal: – of important but buried experiences, feelings, and needs. When they feel ready, help them learn to express these things in other ways, such as through talking, writing, drawing, shouting, hitting something, etc.
8. Support the person in beginning to take steps to keep themselves safe and to reduce their self-injury – if they wish to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking alcohol if they think they are likely to self-injure); taking better care of injuries; reducing severity or frequency of injuries even a little. In all cases more choice and control are being exercised.
9. Don’t see stopping self-injury as the only, or most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when difficult issues or feelings are being explored, or when old patterns are being changed. It takes a long time for a person to be ready to give up self-injury. Encourage them and yourself by acknowledging each small step as a major achievement.