1. Reason – I’ll stop cutting when I have a reason to
More often than not, you would be surprised how often when trying to provide help for self harm how many teens say, “I can stop, but I just don’t have a good enough reason to.” I find this comment fascinating and have heard it both from males and females and mentioned in reference to cutting, substance abuse, and addiction in general.
Although this statement sounds a bit defiant, really what they are saying is the cutting is still helping them in some way and until they either have to, or have something better, then they are not going to change.
By saying this however, it communicates that if they did find the right reason to change, they are open to it and I consider this very positive and a doorway to recovery. So the challenge then becomes helping them identify those opportunities that would give them a reason to stop.
In all honesty, the reasons I have discovered are quite varied but important to note. For some, getting in a relationship with someone who does not approve becomes their reason. Sometimes if a parent finds the cutting paraphernalia and take it away, this in turn becomes their reason to stop albeit it forced. For others, it could be getting involved in something that they are passionate about; a cause, a sport, picking up a new sport, starting a new school, starting a new job, etc.
The point is, that one significant factor in helping teens that self injure, is to empower them in finding some sort of change in their routine of self inflicted harm. Many times self injury just keeps them in a rut that is begging to be changed some how and if we can help promote some positive change in their life, then they just might self discover their reason to stop.
2. Ready – I’m not ready to stop
This may be one of the more frustrating factors for those of us who are trying to help someone who self harms although it still demands our respect. No matter how good of a therapist, parent, or caring adult we are if they are not “ready” to change, then they may try to stop temporarily, but for the wrong reasons. Early in my practice, I found myself wanting to fight them on this for all the reasons they “should” be ready. However, at the end of the day the word “should” means very little and is more about me than it is about them, and the truth is this is their battle not mine.
The encouraging thing I have found however is once I let go of this control of my futile efforts to “make them” ready, the sooner they actually become ready and in a very genuine way that usually promotes a longer term stride towards recovery.
I also believe there is some sort of unsaid communication and mutual understanding that is a beautiful paradox in working with teens. The paradox goes something like this. (from the teens point of view) “If you try to make me do something, or disrespect me…then I will fight you.” “If you don’t try to control me, and show me respect, then I will listen to you and consider your suggestions.”
The bottom line is, that for true recovery to take place, the teen who self injures has to be ready for themselves and not for anyone else. We can’t make them be ready, but we certainly can encourage them towards seeing new alternatives and possibilities that involves more productive activity than self destructive behavior.
3. Resources: If I stop cutting what am I supposed to do instead?
Although this question is saturated in addiction mindset, it still is a fair question. You can’t just expect someone to stop an addiction that in their mind has somehow been helping them without providing alternative solutions. I have found in my private practice that although I do have some things cutters can try instead of cutting, that these usually come across as sort of gimmicky, and I only suggest these when pressed.
When trying to find a replacement for self harm, I have found a better approach to be helping the teen discover their internal strengths, passions, and hopes that have most likely been buried from the lies of self injury.
Instead of saying, “Well why don’t you try snapping a rubber band on your wrist instead,” I think a better approach is to ask a question.
“Can you think of a time you wanted to cut but didn’t?” Followed up by, “What did you do and how can we do more of that?”
You see by taking this approach, instead of giving them another gimmick, I am identifying a strength or talent they already had inside of themselves. They might say something like, “I called a friend”, or “I wrote in my journal”, or “I took a hot bath”, or “I went for a walk”. You see the important thing to me as a therapist is to identify these as coping skills that we already KNOW have worked for them and then encouraging these.
Once I have identified a few of these coping strategies that they didn’t realize they had, I then ask, “Instead of cutting this next week, could you at least try one of these before you act on the craving the cut?” More often than not they come back the following week either having not cut, or have cut less.
In summary, these 3 R’s usually go together. Meaning someone can have a “Reason” to cut, but not be “Ready”. Additionally, someone can be ready to cut but not know the “Resources” they have available to them. One final reminder I have discovered is that one of the best resources a teen who self injure can have is a friend who loves them and wants them to stop hurting themselves. Although they usually won’t stop just for this reason, knowing that someone cares for them and wants the best for them who is not a parent or counselor is a very powerful influence.