Self-Harm Distractions

Working with teenagers that have experienced trauma, I've come across many that use self-harm as a way to cope with their pain. Some hurt themselves to feel like they have control over their life and body. Some hurt themselves as a cry for help. Some hurt themselves as a way to relieve emotional pain. There are a multitude of reasons why people harm themselves, yet even with all of the information available now explaining self-harm, it's still very misunderstood. Teens are very susceptible to using self-harm to cope, especially if they have experienced trauma, so if that is a population you are interested in working with, I urge you to do research on it.

When working with a teen that self-harms, some of the first steps we take are figuring out together their triggers that lead to self-harm, how self-harm is a tool for coping to them, and how they feel after they self-harm. From there, we are able to move forward to begin finding alternatives. As a helping professional, your first urge may be to tell clients how unhealthy it is and how they need to find alternatives to coping, but you must remain calm. It is not an easy thing for people, let alone teens to share, and doing something like that may lead to feelings of shame and guilt. So please, take a breath, and DON'T panic. It may be shocking, especially if they show you their injuries, but remember that they are sharing their pain for a reason--to get help.

Something I've found to be very successful is this Distractions list, provided by the National Self Harm Network. The list contains a myriad of alternatives to choose from when feeling the urge to self-harm. What I love most is this list is that the distractions are listed into different categories, such as Comforting, Fun, Inspiring, etc., so that there is something of interest to everyone. Some examples of distractions include writing a to do list, popping bubble wrap, sewing, and squeezing ice cubes. The graphics are pretty cute, too :)

Genograms

When working with clients that have a history of abuse or unstable relationships, I find it helpful to do a genogram with them. As Wikipedia explains it, a genogram "...is a pictorial display of a person's family relationships and medical history." It's like a more detailed family tree, that helps clients to observe family relationships and patterns, giving them a better understanding of how those patterns have affected them in the present. The attached image gives basic symbols that are used on a genogram, but I always encourage clients to add their own symbols if they find important patterns or feel like something should be included that's not already listed on the genogram key.

I usually have client's start with their grandparents on each side of the family and work their way down to their immediate family, while also having them include any other family relationships that were a major part of their life. Genograms can be confusing, so it's important to walk through this exercise with your client. I try to have them get down the relationships first, before having them add any symbols.

After the relationships are on paper, the client's add symbols for how the relationships were (i.e. fused, hostile, abusive, etc.) and any important experiences/ailments family members may have experienced (i.e. substance abuse, mental illness, etc.). The paper will get very messy, so I always warn my client's that the genogram is not meant to be pretty.

At the end, I go over the relationships on the paper, any patterns the client observes, and how the family relationships and patterns have affected them in the past and in the present. It allows you to learn more about your clients, and as one client told me, being able to see the patterns of abuse on paper really solidified for her why she tended to enter abusive relationships. If you are looking for genogram examples, you can find some here.