SI is an isolated and secretive behavior. Whether or not you discuss it, it exists. Ignoring self-injury does not make it go away. It may actually cause more damage, because, first of all, ignoring SI actually may help reinforce the feeling of shame surrounding the behavior. Many people who self-injure feel that what they do is so shameful that talking about it is taboo. So basically the secrecy and feelings of shame are strengthened. Second, it can add to the factors that lead to self-injury. If you don't talk about SI, there may be an increase in feelings of isolation and alienation - feelings that often precede an act of SI. Therefore, by not talking about SI, you might actually increase the chances of the person hurting him/herself again.
Talking about self-injury is important. That may be a good start to helping a person who hurts him/herself. You can remove the shame and secrecy associated with SI. And by doing so, you encourage communication between you and the SI'er. You help create change just by talking.
Something that might stop you is that you might not know what to say. Even though you might not know what to discuss, just acknowledging that you want to talk opens up communication channels. Here are some questions and topics you might talk about:
- "Do your wounds need immediate care?" The Secret Shame site has practical advice about caring for injuries:
http://www.palace.net/~llama/psych/injury.html (click on "First Aid" in the left column)
- "How do you feel before you SI? How do you feel after you SI?" Retrace the steps leading up to an incident of self-injury - the events, thoughts and feelings which led to it.
- "Did anything specific happen that made you feel you had to hurt yourself?"
- "Why do you hurt yourself?"
- "How did you learn to hurt yourself?"
- "What is it like for you to talk with me about hurting yourself?"
- "How open are you about your self-injurious behaviors?"
- "Do you want to change your SI behaviors?"
- "How can I help you with your SI?"
Talking is one way to show support, but there are many other ways to show it as well. A good way to determine how to offer support is to ask directly. That way, you know what kind of support to offer that is helpful. You might find that your idea of what is helpful is vastly different from how the self-injurer views what is helpful.
Also, an important part of being supportive is to keep your negative reactions to yourself. Making judgments or hurtful responses conflicts with support. To help the SI'er, you must put aside your negative thoughts and feelings for the moment. This is crucial if you want to help the SI'er. I'm not saying that you aren't going to have negative thoughts or emotions, but conceal these beliefs and feelings while you are talking to the person.
Note about Boundaries
Forming boundaries may be necessary for you in any situation with a SI'er. Boundaries are "the limits you place on yourself and others in interpersonal relationships." They help you know what you can expect from others and what others can expect from you. Some SI'ers have trouble with boundaries, possibly due to events such as trauma and abuse. As a result they might break your boundaries. Because of this you might need to set and maintain clear and consistent limits with them. For example, you may tell the person that you are unable to continue talking to them if they SI during your time with them-- "I cannot handle talking to you while you are actually cutting yourself because I care about you greatly and it hurts too much to see you doing that" is a reasonable statement. This way they know what to expect, what help is available to them. (Of course there are exceptions in extreme cases.)
