Information for Parents: What You Need to Know About Self-injury. (page 4)
How do I know if my child is self-injuring?
Many adolescents who self-injure do so in secrecy and this secrecy is often the clearest red flag that something is wrong.Although it is normal for adolescents to pull away from parents during times of high involvement with friends or stress, it is not normal for adolescents to be withdrawn, physically and emotionally, for long periods of time. It is also important to note that not all people who self-injure become distant and withdrawn—youth who put on a happy face, even when they do not feel happy,may also be at risk for self-injury or other negative coping behaviors. Some other signs include:
- Cut or burn marks on arms, legs, abdomen
- Discovery of hidden razors, knives, other sharp objects and rubber bands (which may be used to increase blood flow or numb the area)
- Spending long periods of time alone, particularly in the bathroom or bedroom
- Wearing clothing inappropriate for the weather, such as long sleeves or pants in hot weather
What might I feel when I learn that my child is self-injuring, and how do I deal with these feelings?
If you learn your child is self-injuring, you are likely to experience a range of emotions, from shock or anger, to sadness or guilt. All of these are valid feelings.
• Shock and denial
Because self-injury is a secretive behavior, it may be shocking to learn that your child is intentionally hurting him or herself; however, to deny the behavior is to deny your child’s emotional distress.
• Anger and frustration
You may feel angry or frustrated that your child has possibly lied to you about his/her injuries or because you see the behavior as pointless or because it is out of your control. As one parent said, “There is a frustration in terms of that little voice in the back of your mind that is saying ‘just stop it!’ It’s very hard, I think knowing more about the condition and about the underlying factors makes it easier to push that little voice away.” ....…but remember that you can never control another person’s behavior, even your child’s, and trying to do this does not make things better.
• Empathy, sympathy and sadness
Though empathy helps you to understand your child’s situation, sympathy and sadness can sometimes be condescending because they imply that your child needs to be pitied. These feelings may also hinder your ability to understand the behavior.
You may feel as if you did not offer enough love and attention to your child.However, though your actions can influence your child’s behavior, you do not cause their self-injury.
Opening the Lines of Communication
How should I talk to my child about his/her self-injury?
• Address the issue as soon as possible. Don’t presume that your child will simply “outgrow” the behavior and that it will go away on its own. (Though keep in mind this can and does happen for some young people–some do mention “outgrowing” their self-injury. This typically occurs because they learn more adaptive ways of coping).
• Try to use your concern in a constructive way, by helping your child realize the impact of his/her self-injury on themselves and others.
• It ismost important to validate your child’s feelings. Remember that this is different fromvalidating the behavior.
– Parents must first make eye contact and be respectful listeners before offering their opinion
– Speak in calm and comforting tones
– Offer reassurance
– Consider what was helpful to you as an adolescent when experiencing emotional distress
• If your child does not want to talk, do not pressure him/her. Self-injury is a very emotional subject and the behavior itself is often an indication that your child has difficulty verbalizing his/her emotions.
What are some helpful questions I can ask my child to better understand his/her self-injury?
Recognize that direct questions may feel invasive and frightening at first—particularly when coming from someone known and cared for, like you. It is most productive to focus first on helping your child to acknowledge the problem and the need for help. Here are some examples of what you might say:
• “How do you feel before you self-injure? How do you feel after you self-injure?” Retrace the steps leading up to an incident of self-injury—the events, thoughts, and feelings which led to it.
• “How does self-injury help you feel better?”
• “What is it like for you to talk with me about hurting yourself?
• “Is there anything that is really stressing you out right now that I can help you with?”
• “Is there anything missing in our relationship, that if it were present, would make a difference?”
• “If you don’t wish to talk to me about this now, I understand. I just want you to know that I am here for you when you decide you are ready to talk. Is it okay if I check in with you about this or would you prefer to come to me?”
“…internal pain wasn’t real and wasn’t something you that you could heal. And if you make it external, it’s real, you can see it… I needed to have it be in a place other than inside me.” —Interviewee
What are some things I should AVOID saying or doing?
The following behaviors can actually increase your child’s self-injurious behaviors:
- Put downs
- Harsh and lengthy punishments
- Invasions of privacy (i.e., going through your child’s bedroom without his/her presence)
Avoid power struggles. You cannot control another person’s behavior and demanding that your loved one stop the selfinjurious behavior is generally unproductive.
The following statements are examples of unhelpful things to say:
- “I know how you feel.” This can make your child feel as if their problems are trivialized.
- “How can you be so crazy to do this to yourself?”
- “You are doing this to make me feel guilty.”
Take your child seriously. One individual who struggles with self-injury described her disclosure to her parents in the following way: "They freaked and made me promise not to do it again. I said yes just to make them feel better though. That settled everything for them. I felt hurt that they did not take me serious[ly] and get me help.”
How do I know if I am doing or saying the right thing?
• Parents need to ask for feedback from their child about how well they are doing their job as parents.
– This demonstrates that they are truly engaged in improving and strengthening their relationship with their child.
– Parents can identify specifically what they can do to contribute to their child’s success.
Are there any activities I can complete with my child to help them manage their urges to self-injure?
The Nillumbik Community Health Service has developed an activity for identifying who can be helpers and specifically how they can help. There is a worksheet to fill in who is available at different times throughout the day for support. To link to this worksheet, see http://www.nchs.org.au/Docs/SelfHarm_StuInfoPack.pdf. If your child has already developed a list of effective coping strategies for managing distress (for more on this, see http://www.crpsib.com/factsheet_coping_alternatives.asp), this information can be put together to create a “help card,” which includes your child’s top coping strategies and phone numbers of support people, and can be easily carried around in a wallet for whenever the need for support may arise. Go to Appendix M of http://www.sfys.infoxchange.net.au/resources/public/items/2004/12/00131-upload-00001.doc to link to the help card activity.
“Parents, there is hope. If you are facing some of the difficulties we have… don’t give up. You need to fight; many teachers, doctors and counselors may not have the knowledge or ability to help — keep fighting. Don’t give up; there can be a bright light at the end of the tunnel.” — Parent collaborators on CRPSIB team
“I stopped because I developed a sense of worth and, to some extent, love for myself. I also have come to understand that it is painful for those I love to know I cut myself, so I have partially stopped so I would not hurt them. I've learned better coping strategies as well.” — Survey Participant
Understanding the Role of Relationships
Is my child's self-injury my fault?
No, no person causes another person to act in a certain way. Like most negative behaviors, however, self-injury is often a result of two things. That is, a person's belief that he or she cannot handle the stress they feel, and that self-injury is a good way to deal with stress. A history of strained relations with parents and/or peers, high emotional sensitivity, and low ability to manage emotion all contribute to these beliefs. This can lead to the use of self-injury in order to cope. Parentchild relationships strongly influence a child’s (and parents’) emotional state. Youth with high emotion sensitivity and few emotion management skills may be particularly sensitive to stressful dynamics within the relationship, especially if they continue for a long time. For this reason, negative parentchild interactions are often powerful triggers for self-injury. However, they are also powerful in aiding recovery and,most importantly, to the development of positive coping skills. Parents who are willing to understand the powerful role they play, to directly confront painful dynamics within the family, to be fully present for their child, and to help their child see that he or she has a choice in how they cope with life challenges, will be allies in the recovery process. Parents who try to fix their child by taking responsibility for their child’s problems may actually make recovery more difficult.
How might my relationship with my child affect his/her self-injurious behaviors?
• Extremes in the quality of the parents’ attachment (such as a lack of boundaries or too much emotional distance, or extreme overprotective or hovering behavior) are common in today’s society.
– Many adolescents who struggle with self-injury report that their parents are either unavailable to them for emotional support or invalidate their feelings, which has led them to believe that they are worthless or not worthy of being loved.
– Alternatively, parents who cope for their kids by seeking to closely control their behavior, attitudes and/or choices run the risk of undermining their children’s capacity to develop effective ways of handling stress and adversity.
• The importance of secure attachments:
– Adolescents who feel secure and positive attachment bonds with their parents are less likely to gravitate to negative peer groups or be victims of peer pressure.
– Resilient children and adolescents, that is, those who have the ability to quickly rebound from painful life events, say that their secure attachments with their parents or key caretakers have a significant influence on their ability to cope effectively.
According to Selekman (2006), mothers tend to average 8 minutes a day in conversation with their adolescents. Fathers spend only 3 minutes.
How might my child’s peer relationships affect his or her self-injury?
If children feel as if their needs are not being met at home, they may turn to a so-called “second family,” such as a street gang or a negative peer group. This is particularly likely to happen if parents work long hours. Children may turn to this second family because they feel that their parents are too busy to spend time with them.What is particularly troubling is that self-injury may sometimes be a part of the culture of the second family. For example, one adolescent described how she and her friends would play a game called “chicken,” in which the participants superficially wounded themselves, and the winner was the individual who could inflict the most cuts without “chickening out.”
“I think probably one of the most difficult things for people who don’t self injure to understand, what I’ve been asked time and time again, is why do you do it? It’s so many years of depression behind it. You can’t answer ‘I cut because of this and this and this.” And also, how physically addictive it is. It feels so necessary and so right.” — Interviewee
Improving the Home Environment
What aspects of the home environment might be affecting my child’s self-injury?
• Repression and/or mismanagement of emotion
Self-injury is most commonly understood as an emotion regulation technique. This suggests that individuals who practice it have difficulty regulating emotional states healthfully. In some cases, this tendency is a result of a family history of repressing or mismanaging emotion, such as when family members either do not know how to constructively express negative feelings like anger or fear, or when they withhold demonstrations of love and tenderness with their children.
• Family secrets
All families have stories to tell, not all of which are easy to share or hear.When a child or adolescent is directly involved with negative events occurring within the family and then told or chooses not to share what is happening with someone he or she trusts, he/she may suffer— psychologically and physically. Depression, anxiety, and a variety of self-injurious behaviors are all potential consequences of keeping family secrets.
Reprinted with the permission of the Cornell Research Program on Self-Injurious Behavior.
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