You might believe that it is impossible to stop self-harming if you have been doing it for a while. This isn't true. It can take time, effort and determination to stop, but lots of people have managed to do it.
Sometimes, you may need to get outside support to help you make positive changes. You may find that you need to try a few different things to find what works for you, and combine self-help techniques with professional support. (See ‘How can I help myself?’)
There is light at the end of this tunnel. It’s possible to change certain thought processes and to learn how to deal with things in a different way. The most important thing is to have a strong support network in place for when you’re ready.
It takes courage to ask for support. It is understandable that you may have concerns that you won't be understood or that you will be pressured to make changes faster than you want to. However, it’s important to remember you have the right to receive support that is both empowering and respectful. Any health professional, such as your GP or psychiatrist, should discuss all your options with you, and your views and preferences should be taken into account when making decisions about your treatment.
If you receive treatment on the NHS, it should be in line with National Institute for Health and Care Excellence (NICE) guidelines.
These say that:
- any health professionals should treat you in a way that is sensitive and non-judgemental
- ideally, health professionals should be trained in communicating sensitively with people who self-harm and be aware of potential stigma
- any treatment you are given should be tailored to your individual needs
- treatments offered may include structured sessions of talking treatments, such as cognitive behavioural therapy (CBT), psychodynamic therapy or problem-solving approaches.
If you are concerned about your treatment or care, or find it hard to access the support you need, it may be helpful to get an advocate to support you. This could be a friend, family member or professional.
If you want to seek professional help, the first step would usually be to visit your GP. Your GP can discuss your self-harm with you in confidence. They may assess you and let you know about available treatment options, or they may refer you to a specialist.
If your GP is concerned that your self-harm is a threat to your life, or if you need medical treatment for injuries resulting from your self-harm, they may suggest that you spend some time in hospital for treatment and care. (See Civil admission to hospital.)
Talking treatments can be short- or long-term and involve talking with someone who is trained to listen with empathy and acceptance – usually a counsellor or therapist. They do not aim to give advice, but offer you the chance to explore your feelings and find your own solutions to any difficulties you are having. Talking things through with another person can help you understand your feelings and behaviour, and start to make positive changes. It can also help you feel supported to have someone else accept and understand your experiences.
Talking treatments are free on the NHS, and some local organisations, including some local Minds, provide therapy and counselling free of charge or at low cost. To find out what support you can get in your area, ask your GP or contact Mind Infoline (see ‘Useful contacts’). If you can afford it, you could also consider seeing a private therapist. Check that they are appropriately trained and accredited before you start. (See BABCP, BACP and UKCP.)
Talking treatments that might be useful include:
- Psychodynamic therapy – This focuses on how past experiences contribute to current experiences and feelings. It can be short- or long-term. It can be more intensive than some other therapies, because it involves talking about your childhood, your relationships, and how these things might relate to your self-harm.
- Cognitive behavioural therapy (CBT) – CBT aims to identify connections between thoughts, feelings and behaviour, and to help develop practical skills to manage them. A CBT therapist may support you to look at what happens just before you self-harm, to keep a diary of self-harming episodes and find other channels for your feelings. CBT does not usually explore the underlying causes of self-harming.
- Dialectical behaviour therapy (DBT) – This therapy was designed for people with borderline personality disorder (BPD). It combines techniques from CBT that help to change thoughts and feelings, along with techniques that strengthen self-acceptance. If you have been diagnosed with BPD and your self-harm is part of this condition, DBT might be something that would help you.
I can't recommend CBT enough. I've found that spotting my triggers and stress indicators is vital. I've learned to deal with the stress and anxiety before it gets bad enough that I self-harm.
I was taught DBT skills. It was the best thing ever to happened to me. I have my bad days but my skills help get me through.
Your relationship with your therapist
One of the most important things about talking treatments is the relationship you have with your therapist. You may not always agree with each other, but you must both be committed to working together in spite of any difficulties.
Sometimes a counsellor may ask you to commit to not self-harming during a course of counselling. It’s important that you don’t feel pressured into making decisions about this, and that anything you decide is realistic for you at the time. If your counsellor is not specifically trained in self-harm, it might be useful to ask them to find out more, for example by reading information, such as this booklet, or by talking to organisations for people that self-harm. (See ‘Useful contacts’ .)
In a support group, people with similar experiences meet to discuss their feelings and experiences, and share tips for coping. Support groups can be run by a group leader or by group members. They may focus on specific issues, such as self-harm, or be more general. You can find out about support groups in your area by contacting Mind Infoline, or a self-harm organisation such as the Bristol Crisis Service for Women (BCSW).
If you do not feel ready to talk face-to-face with someone, you might find online support useful. Several self-harm services offer confidential email or text support, and there are also forums where people who self-harm share their experiences and offer support to each other. Mind’s online community Elefriends may also be a good source of support, to help you discuss the difficult feelings and emotions that cause you to self-harm in a way that is safe and supportive for others. (See ‘Useful contacts’.)
It's important to use caution when using online support, as the content on some sites can be overwhelming and may trigger your urges. Make sure that the websites you use are moderated, and that you know how to protect yourself and other people online. When talking about self-harm online, it’s important to think sensitively about how what you write can affect your own, and other people’s, feelings. Some people find that talking about feelings, rather than behaviours, is the best way to express yourself safely. (See How to stay safe online.)
Having this space to be able to talk about my problems, with being anonymous and having that trust that you won’t be judged, really got me through some of my darkest moments. Online support became my building bridge into getting offline support.