Self-Harm :Perspectives From Personal Experience


Multicenter Study on Parasuicides did a 1-year monitoring of suicidal behavior among Ukrainian soldiers based on World Health Organization guidelines. The study revealed— [4]. Ukrainian Government and also different international and national organization take different attempts and initiatives to prevent suicides in Ukraine. There are different associations who provide help and suggestions to those people who are trying to commit suicide. From Wikipedia, the free encyclopedia.

Assessment of risk Crisis hotline list Intervention Prevention Suicide watch. Asphyxiation Hanging Train Cop Seppuku. List of suicides Suicide in antiquity List of suicides in the 21st century. It was a coping mechanism. Everything would build up inside me until I needed some way to release it. Cutting was that release. The tendency to doubt their ability to cope with emotional issues, as well as perceptions of being far more sensitive than others was also highlighted.

For instance, one service user stated:. I feel things more strongly than most people… or at least the bad emotions much more powerfully than the average person. Correspondingly, in a study carried out by HUBAND on women's subjective experience prior to self-harm, the majority of women recalled self-wounding due to an emotional state that intensified over time. It is definitely a quick fix… Welcome to McDonald's society, right where we came from, fast food, anything into a sugar high and then it drops!

Furthermore, the effect of self-harm was described as more powerful than other methods of emotional release, including using a punching bag, writing in a journal and talking to others RAY On the other hand, many interviewees described their experience with self-harm in a manner that suggested it was primarily utilised as a means of avoiding fully processing emotions RAY Many indicated feeling out of control before the self-harm and that subsequent self-harm led them to feel in control of something in their lives even if it was just their pain.

For example, one participant POLK reported:. I self-injure for a feeling of control. If I lose control of a situation, I cut to make myself feel that I still have the power to handle the situation. Self-harm was a means to get support and attention, because of frustration about not receiving support for their illness HARRIS They also reported sometimes feeling a strong desire to be admitted, to escape the overwhelming and often uncontrollable emotions leading to self-harm HARRIS In another study carried out by POLK in the US, self-harm was used by participants as a means to keep from killing themselves or hurting others.

However, it should be noted that only one participant indicated that she used self-harm to keep from hurting others. The influence of cultural factors on self-harm was also highlighted.

Suicide in Ukraine

In particular, participants suggested that the promotion of an individualistic culture can lead to members of that society being more likely to deal with their feelings alone KOKALIARI I am wondering if it says something about our culture's need to deal with something on your own as opposed to deal with something with other people or with healthy means … You can't rely on other people to help you, and sort of like an independent self-sufficient mentality is pretty widespread.

Attempts to justify the behaviour as sanctioned by popular culture and as a behaviour that is practised by numerous other women also emerged RAY ARNOLD found that most women who took part in the study engaged in various other sorts of self-harm in addition to inflicting injuries on themselves.

Most notable was the high occurrence of eating disorders, while overdosing and misuse of alcohol and drugs were also common. Moreover, there were numerous other ways in which women saw themselves as engaging in self-harm. These included overwork, over-exercising, staying in abusive relationships, unnecessary and repeated risk-taking and smoking.

In another study carried out by RAY one participant touched on the notion that certain types of self-harm behaviours may be interchangeable. In discussing the relationship between purging and cutting she admitted she was seeking the same objective in both behaviours, specifically a release through pain. Similarly, SINCLAIR discovered that co-occurring alcohol misuse dominated for four participants and for these people abstaining from alcohol was key to the resolution of their self-harm.

Looking back, they attributed their use of alcohol to an attempt to escape from difficult emotions, but now saw it as precipitating a vicious cycle of low self-esteem and self-loathing. Moreover, refraining from drinking led to an increase in self-pride and individuality, and an immediate end to their acts of self-harm that had required hospital admission. Finally, sleep — or overdose of medication to induce sleep — was cited as an additional alternative release to self-harm HUBAND Many studies reported the physical and psychological consequences in the aftermath of a self-harm episode.

In general, the women expressed mixed feelings about self-harm RAY They spoke of the manner in which self-harm brought relief to their suffering and offered them a sense of satisfaction and empowerment. In particular, concern about disappointing or hurting others through self-harm were frequently expressed RAY They also articulated apprehension about hiding evidence of their injuries and the consequences of others discovering them for example, having to go back to therapy and losing a job. They found that people with more frequent self-harm episodes felt more soothed, relieved, calmer and attentive following their most recent self-harm episode, suggesting that self-harm may become more reinforcing with reoccurrence.

Along with the psychological impact of self-harm, the physical consequences of self-harm were also apparent in the service user literature. One of the most prominent physical consequences of engaging in self-harm was the sensation of physical pain. HORNE examined the experience of pain sensation in adults and young people who self-harm.

Sources of support

Some experienced no pain at all and the remainder felt a reduced level of pain. Others explained that there was a certain pain threshold they needed to reach before they could reconnect with themselves again. The issue of pain was addressed in another study carried out by POLK wherein In a recent study carried out by GORDON , it was found that greater frequency of past self-harm episodes led to more intense feelings of physical pain during their most recent episode.

Another common finding that surfaced from the service user literature was the mixed reactions of others to their self-harm and the stigma and misconceptions about self-harm. Other people's reactions to their self-harm varied, with some women reporting fairly supportive responses while others received quite negative reactions. In a study carried out by BAKER , family, friends and wider society including medical and mental health services were often explicitly characterised as judgmental and lacking understanding.

Moreover, DORER revealed that the most commonly perceived reaction of others was distress — generally expressed by parents and often associated with concern. The second most common response, which was largely articulated by parents, was anger. Many young people also reported being ignored, whilst others felt that people around them had been overprotective since the overdose. On the other hand, BURGESS discovered that reactions of significant others to the young people following the overdose were largely favourable with more people responding with understanding and wishing to help than responding with anger.

Overall, mothers appeared to be more sympathetic than fathers. Participants also spoke about various misconceptions about self-harm. The first misconception that was addressed in the literature was that people self-harm to gain attention from others or as a cry for help. Many of the women expressed anger or annoyance toward people who showed off their injuries or harmed themselves in obvious ways.

Conversely, one participant RAY offered a more sympathetic approach to people who harm themselves for this reason:. If this person is doing it for attention they obviously need it.

☯My Experience in a Pro-Self harm Community

Someone who is going to take it to that extreme has a lot of problems and they just need someone to care. Don't be mean about it. Some women stressed additional misconceptions about self-harm. One participant criticised the tendency to oversimplify the behaviour by attributing it to a single reason, and emphasised the need to recognise the multitude of factors that can simultaneously contribute to this behaviour.

Another participant expressed frustration that so much of what is available to read about self-harm focuses on those who have been sexually abused and stated she does not feel this material applies to her. An additional key topic to come out of the service user experiences was that of ending self-harm and the process of recovery.

Others wanted to quit, but recognised its benefits as a coping mechanism and a means of self-expression. Yet for a small minority, their self-harm subsided after many years, either through therapy or with the help of online peer support and education. Many of these people remained in online communications, helping others, as a way of maintaining their abstinence. KOOL explored people's experiences and motivations for stopping self-harming in a sample of inpatients from a psychiatric intensive treatment centre. The analysis demonstrated that the process of stopping self-harm can be divided into several phases such as: The first phase of connecting and setting limits provided a sense of safety that allowed service users to reach out more to others and themselves and to feel their emotions, such as pain and sadness.

The second phase entailed the heightening of self-esteem with a further deepening of contact with the self. Respondents indicated that their self-esteem increased because they could see and feel that they were recognised by carers and family and friends as full human beings, with all their faults and imperfections. One of the respondents to KOOL stated:. The carers told me they did not disapprove of me as a person, but because of what I did. For me this meant there was nothing wrong with my character, my personality. When I came out of isolation, they saw me as me and I could just start again with a clean slate.

This growing sense of self-esteem allowed service users to discover their own strengths and creative talents, which in turn contributed to a more positive self-image. By putting these talents to use, they succeeded in expressing their emotions in ways other than self-harm. In the third phase service users learned to understand themselves, which allowed them to realise that they could control their own lives. Respondents learned to know themselves better and began to understand their own behaviour. The fourth phase was one of increasing the service user's sense of autonomy.

Self-Harm: Longer-Term Management.

They felt that they gradually became better able to make independent decisions about their lives and act upon those decisions, and thus take responsibility for their own behaviour. In this phase, contact with others changed: They also determined the content and limitations of their contacts with others. As one of the respondents KOOL expressed:. I got control of my life because I realised I could make choices, I could and was allowed to want things for myself and, more importantly, I could stop things. The fifth stage entailed implementing alternative strategies to cope with emotional distress and urges to self-injure and asking for help KOOL Finally, the sixth phase focused on preventing relapse.

Even if they had not engaged in self-harm for a long time, the risk of relapse continued to exist for many. All respondents indicated that they still found it very difficult at certain moments, especially in situations of increasing tension, not to injure themselves KOOL An additional US study SHAW examined how female college students stopped self-injuring and the role if any of professional treatment in this process.

Not all participants expressed an explicit desire to stop or made a conscious decision to stop. Whether women expressed a desire to stop or not, they all stopped cutting when the psychological symptoms giving rise to self-harm, such as alienation or extreme anxiety, discontinued or reduced in number or intensity. Furthermore, all of the women spoke of the importance of self-initiative or taking control of their lives as essential in their journeys toward stopping SHAW It appears that the women's self-harm diminished as increasing involvement in life pursuits — such as intellectual interests, career goals and enlarged social networks — gained prominence in their lives.

Relational ties and support from parents, peers and romantic partners were also of vital significance in helping to stop self-injuring. Participants frequently expressed a desire to satisfy or not concern others as important motivations to stop self-injuring SHAW For others, disclosure was used as a means of reinforcing their commitment to stopping self-injuring and a means of accessing professional treatment. Moreover, the longer women abstained from self-injuring, the easier they found it to resist urges to hurt themselves SHAW Alternative coping strategies played an important role in preventing relapse after stopping self-harm.

For instance, in a study carried out by KOOL almost all participants still felt the urge to self-injure at certain moments and had developed specific strategies to respond to these moments. It is still a daily struggle, but I am taking on the challenge every day. I know what I am doing this for and it is worth it. The respondents identified the following strategies: It was important that these alternative activities should control precisely those emotions for which self-harm was previously adopted as a controlling strategy. However, she could vent her aggression in an acceptable manner by kicking a cushion KOOL However, all participants stated that self-harm was the most effective way to end the agonising experience of alienation.

I think jogging would give me the same relief but cutting is easier and acts much faster and that is what I want in these moments — a prompt relief. On the other hand, it is important to note that the use of alternative coping strategies was not always found to be helpful and some believed that alternatives were only temporary solutions CRAIGEN There were periods where I managed to assuage the need to self-injure by picking up another healthy or acceptable behaviour, at the urging of a counsellor… if that makes sense.

It didn't really last too long because they were terribly simplistic behaviours that were sort of short-term answers. A study carried out on several US students MOYER unveiled some important findings in relation to the origins of self-harm in young people. Most learned of self-harm from their friends; they had asked a friend about it or had a friend recommend self-harm to them.

The expectations and mental stress placed on these young people often became overwhelming, leaving them feeling as though there was no escape — with the exception of self-harm MOYER DORER found that participants had varying reasons for overdosing. The majority of participants reported that when they took the overdose they wanted to die.

Other reasons for overdosing were to escape from painful feelings, to communicate how bad they felt, or for hospital admission to escape difficult family situations. This supports the idea that the motivation behind self-harm is unique to the individual and is fluctuant in nature. Regarding the consequences of self-harm, some young people reported that relationships within their family had improved and others felt that it had led them to develop better coping skills DORER An earlier study by BURGESS found that most young people felt that overall the overdose and its aftermath had resulted in improvements in their lives; whereas others felt that it had made things worse for them.

When asked how they felt in the aftermath of the self-harm behaviour, many reported feeling ashamed about what they had done. However, almost half of the participants felt that they would probably or definitely take an overdose again in similar circumstances. In a study carried out by SINCLAIR , young people with a history of self-harm who no longer harmed themselves talked about their experiences in terms of lack of control over their lives and their uncertainty within their family relationships.

For these participants, the defining difference that led them to stop their self-harm was the resolution of their lack of control within the family structure. Family life was recounted as not only chaotic but also also failing to provide any validation of their experiences at the time. For many of the young people interviewed, the sense of autonomy and independence achieved after breaking away from their family allowed them to separate themselves from their unpredictable family environments, providing them with a sense of purpose and responsibility.

FISH examined the experiences of people with mild to moderate learning disabilities who self-harm. Service users reported that healthcare professionals could make them feel that they did not care when they were slow to respond to their distress, were dismissive of their personal problems or were perceived to be uncaring FISH In the end you just go in your room and do [self-injure], instead of saying I feel like doing it…. Service users also identified a lack of control over their treatment as a negative aspect of the relationship:.

And they said no, clients are not allowed. I think that's badly wrong …. Conversely, service users reported that when healthcare professionals spent time with them one-to-one, demonstrated a caring attitude and, most importantly, recognised their individuality, this had a positive effect.

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Service users and some healthcare professionals agreed that self-injuring should be allowed. Service users viewed it as a right and also explained that it was futile to attempt to stop self-harm behaviour:. I think as a self-harmer you should be entitled to what you do to your body as long as it's hurting no-one else's but your own. I feel that I should be entitled to cut up as much as want and when I want. I do feel there are too many people laying the law down as far as I'm concerned as my self-harming.

The feeling of being punished was also highlighted by service users. They explained that this lowered their self-esteem and, as a consequence, made them more likely to self-harm:.

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Suicide in Ukraine is a common cause of unnatural death and a serious social issue. In , Ukraine ranked 13th in the world by its total suicide per , SELF-HARM. Perspectives from Personal Experience. Edited by Louise Roxanne Pembroke. First Edition, October Reprinted, April Revised and.

Well when I've cut up in the past there's your punishment of putting you on a level three for a few months until things get better. That's what they've always done with me. They punish me by putting me on a higher supervision level, increase my supervision level to level three. I'd feel bad, they didn't trust me, once I'd cut. I'm alright, I wouldn't do it again cos I feel better. With regard to reasons behind self-harm, they were similar to those provided by women, with early childhood experiences such as neglect and abuse, experiences of rejection in adulthood, and as a coping strategy and alternative communication method being frequently reported TAYLOR As well as limiting the degree to which men seek support for their self-harm, this shame may perpetuate the problem by damaging their self-esteem further TAYLOR RUSSELL examined the experience of self-harm in four males and found the inability to maintain satisfaction or contentment was a central theme portrayed by all participants.

Like you were supposed to enjoy a party or you're supposed to enjoy a holiday. I couldn't … separate them, happiness and sadness, erm, so I was out there enjoying it, I was enjoying it, but it wasn't lasting, it was like it was a short term thing…. All participants talked about the differences between men's self-harm and women's, as if men's was somehow more real:.

I think a lot of men do it, whereas a lot of women do it for sympathy, a lot of men do it out of anger and upset and …. Likewise, in a study carried out by TAYLOR the differences between men and women who self-harm was also a prominent theme. Firstly, men tended to injure themselves more severely than women and had less concern about bodily scars. They were more likely to engage in public and violent self-harm, such as punching themselves or a wall or breaking bones.

Whilst they may try to conceal these feelings, they are likely to find expression in some way. Several participants felt it was essential that services be as accessible as possible by being staffed 24 hours a day, providing walk-in services and minimal waiting times for appointments BYWATERS Furthermore, several respondents interviewed explained that they wished they had known about the types of support services available to them before they self-harmed. Finally, it was also suggested that services offer alternatives to clinical support such as having nurses working in the community who can treat self-inflicted wounds BYWATERS Young people, in particular, had a variety of suggestions about how services could be made more accessible for young people who self-harm.

It was suggested that services be centrally located. Walk-in services and telephone access as well as decreased waiting time for appointments were recommended. Others wished that prior to taking the overdose they had access to the type of professional help that they had subsequently received BURGESS Specifically, inadequate sharing of information by healthcare professionals with service users was perceived as an important problem.

Most respondents stated that there was a need for better understanding and more assistance by nurses regarding individual difficulties with problem solving. HARRIS found that participants often felt that they were maltreated because their injuries were self-inflicted. Finally, some people felt that their need for help was not acknowledged, particularly after no aftercare was arranged. Many said they were not given the opportunity to play an active role in their treatment.

In particular, service users perceived that treatments had often been given or forced upon them without any information as to why this was being done. Some respondents explained they had received contact numbers for services at hospital but upon ringing, no one was there to answer their call. One study DOWER provided some insight into the reasons behind early termination of follow-up care.

Some felt they had received as much benefit from treatment as possible, were uncomfortable with the professional providing care or the location of the care, or the care they received was deemed unhelpful. Other young people reported that psychiatrists were often unavailable for continued care because they were too busy or had left the service during the young person's treatment period HOOD KREITMAN recruited individuals attending hospital for the first time after a suicide attempt in Edinburgh and carried out individual, semi-structured, face-to-face interviews to investigate attitudes to help-seeking after completion of formal psychiatric examination.

However, a quarter of participants maintained that seeking help for personal problems was not an acceptable form of behaviour. It must be noted, however, that this study was carried out in the s and the attitudes towards help-seeking and services may have changed since then, placing limitations on the generalisability of the findings reported.

The main reasons given for seeking help were psychological aspects related to self-harm, specifically for self-harm or for an injury relating to self-harm behaviour NADA-RAJA In a study carried out by HUNTER , participants' lack of continuity of aftercare impacted negatively on their attitudes towards future help-seeking and towards themselves.

Stigma also emerged as an important barrier to seeking help and disclosing to others about their self-harm RAY While all women reported trying to hide the fact of their self-harm, some alluded to the hidden wish that others would acknowledge their distress and care enough to reach out to them in a supportive and accepting manner. The women appeared quite inhibited in their ability to reach out to others for fear that others would not understand and for fear that they would be labelled as attention seekers.

Some spoke of a lack of parental understanding in response to their distress. Others expressed the desire to protect their loved ones from their pain RAY Finally, for those who did not seek help, attitudinal barriers such as thinking that they should be strong enough to handle the problem on their own, that the problem would resolve itself and that no one could help, or being too embarrassed to discuss it with anyone, were factors.

Three main categories emerged from the analysis: From the viewpoint of young people, any person who knew about their self-harm could be a helper, while adults were felt to be duty-bound to intervene. According to the young people in this study who self-harmed, there was an insufficient reliable presence of parents at home.

They also felt that school and healthcare personnel could have done more to intervene. Factors that enabled help-seeking were: Other helpful factors were: Factors hindering help-seeking were the following: Additional unhelpful factors were unresponsiveness to self-harm, underestimating or overstating the meaning of self-mutilation, remaining silent about self-harm, negative emotional reactions of adults or over expectations of the capability of young people to fend for themselves.

Knowledge of self-harm as a phenomenon seems to be very important. It emerged in different forms in all three main categories. In fact, knowing facts about self-harm or its existence seems to be a prerequisite for a young person who self-harms to become conscious of the need for help and then to seek help RISSANEN Overall, several participants pointed out the importance of accessibility of services especially for young people and the need for inclusion in planning of their treatment.

Common barriers to accessing treatment or engaging fully in treatment were stigma, communication difficulties, negative attitudes of healthcare professionals and privacy issues. From these four studies it was clear that not all service users received a psychosocial assessment while in hospital, and, for those service users that did, their experience varied across studies. Moreover, the relational aspect of assessment was a key determining factor in service users' appraisal of assessment, highlighting the importance of the therapeutic relationship in the provision of care HUNTER.

Another important aspect of assessment was the opportunity to talk to someone HUNTER , with the majority of participants finding this a valuable experience. However, not all participants felt they were given adequate opportunity and it was not always evaluated as a positive experience. Despite this, most participants expressed a desire to speak to someone about their problems, which gave them an opportunity to start thinking about the reasons behind their self-harm.

Conversely, assessment was experienced negatively when the participant felt devalued by the assessor, was treated in a judgemental manner or they felt they were not understood. Similarly, service users who reported being disappointed with their psychosocial management found fault primarily with their lack of involvement in decisions or when the assessor did not give them sufficient time to talk during the assessment WHITEHEAD And they looked at each other and exchanged nods. It was just very factual. They filled out their little form and that was it.

Likewise, in the study carried out by HUNTER another negative aspect of assessment seemed to be the experience of not being understood, or when healthcare professionals did not seem interested or genuinely engaged in trying to understand the individual reasons behind their self-harm. Furthermore, when participants experienced assessment as invalidating and when assessment seemed to lead nowhere and offer no hope for change it was experienced negatively and could compound the participant's initial feelings of hopelessness, powerlessness and low self-worth.

This study showed that assessments may not have the same salience and importance for users and professionals because assessments are just one single moment in a person's life that is likely to be filled with ongoing difficulties. Individuals admitted to psychiatric wards had mixed reactions to their care. The admission to a psychiatric ward was often described as frightening and led to a sense of diminished control over their lives HUME One year-old male said:.

I speak positively about it now, but back at the time it was terrible. Locked wards, psychopaths; they used straightjackets and straps. In a study carried out by TAYLOR several of the male participants had experienced negative incidences with psychiatrists. The only positive assessment of support from a psychiatrist was a man who said of his second psychiatrist:. She seems to generally care about my wellbeing. I value her opinion and she is quite nice. Service users also explained that while on a psychiatric ward they sometimes felt the need to act in exaggerated ways, and even self-harm, to get the attention of staff BYWATERS In the study carried out by PITULA on suicidal inpatients, service users' initial responses to constant observation ranged from discomfort to surprise or anger.

On the other hand, study participants reported feeling safe because of the physical presence of observers who could prevent them from responding to self-destructive impulses.

Participants reported that the lack of personal privacy was the most distressing aspect of constant observation and service users said that constant observation became almost intolerable after 30 to 36 hours. In a more recent study carried out by CARDELL , the majority of participants expressed positive feelings toward the observers, particularly when they perceived them as friendly and willing to help.

Moreover, a significant proportion of service users reported that their dysphoria, anxiety, and suicidal thoughts were decreased by observers who were optimistic, who provided distraction with activities and conversation and who gave emotional support CARDELL Furthermore, the participants experienced uncomfortable and at times distressing feelings relating to observers' attitudes or behaviour, such as a lack of empathy, a lack of acknowledgement, failure to provide information about constant observation, lack of privacy or personal space and a feeling of confinement.

It is clear from these two studies that the positive attitude of healthcare professionals including empathy and an acknowledgment of the person as a unique individual , providing information about the function of constant observation and an effort to combat privacy issues are essential in improving service user experience of constant observation. However, it should be noted that this study was carried out in the US and the implementation and experiences of constant observation may differ in the UK, thus limiting the generalisability of the findings reported above.

A UK study reported findings concerning management of young people on a psychiatric ward BROPHY , where confiscation by staff of objects that could be used to self-harm increased their feelings of a lack of control and contributed to the desire to self-harm again. Another study carried out on young people and adults BYWATERS echoed these findings in that most felt they were merely being watched and did not receive any sort of therapy for their self-harm. Several young people who presented at hospital after a self-harm episode HOOD said they experienced a sense of relief upon being provided with aftercare at a community mental health service.

Some women communicated a fear of being on a mixed ward while some older young people had negative experiences of being placed on adult wards. However, this was a very small sample size of only ten participants of whom five were female. In contrast to the negative attitudes reported above, DORER found that the majority of young people rated their contact with child and young people's psychiatric services as positive or very positive.

However, almost one third of young people rated their stay as negative or very negative. Despite this positive experience, some service users disliked having to tell their story to several different staff members DORER HUME found that service users' experiences of therapeutic interventions were strikingly diverse. There was a clear preference for specialist community-based interventions that focus on the provision of immediate aftercare and an acknowledgement that the management of self-harm may not necessarily involve its prevention.

In a study carried out by BYWATERS many participants welcomed the opportunity to discuss problems associated with their self-harm with a mental health professional. The drawbacks of psychological treatment were few from the participant's perspective; however, common disadvantages reported were the retelling of their story and opening up to reveal their emotions especially to a stranger.

Others were frightened that telling someone their problems would intensify their distress or bring back memories they were trying to repress. Some respondents BYWATERS appreciated psychological therapy, presumably in a group setting, because it put them in touch with other people like them:. The fact that you talk to other people and there were other people who felt exactly the same as you, no matter what state they were in, no matter what part of life they came from, there were people that felt like you.

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It felt good to feel that you weren't on your own. Conversely, in a study carried out by CROCKWELL the stigma associated with an appointment with a psychologist or psychiatrist for some participants was too much to bear and caused individuals to miss their appointments. That's what I thought: For those interviewed, the most helpful counsellor behaviours were respectful listening, understanding and acting as a friend. Furthermore, the women also discussed behaviours that they viewed to be unhelpful, which included counsellors who failed to demonstrate understanding and counsellors who forced uninvited ideas upon them.

Many of the participants noted that simply talking during sessions was helpful. I won't make a promise unless I can keep it. Or, I try not to. I need to feel a deep sense of obligation to that person and that particular cause to make that promise. So that wouldn't have worked for me.

4.1. INTRODUCTION

Their hard work was matched by my own. As I headed towards adulthood, self-harm was still a part of my life on a daily basis. They also felt that school and healthcare personnel could have done more to intervene. Moreover, professionals who showed compassion and an honest willingness to help were experienced as genuine, reliable and helpful, which made them feel valued, validated them as valuable people in their daughters' lives and allowed parents to see some hope for their daughters. I wish that everyone could take a leaf out of the innocent book of a child's mind. They also articulated apprehension about hiding evidence of their injuries and the consequences of others discovering them for example, having to go back to therapy and losing a job.

Another alluded to the potential dangers of using no-harm contracts. She suggested that counsellors need to provide service users with new improved coping skills before making them stop using their old coping skills. In terms of the focus of treatment, participants did not like counsellors putting too much emphasis on the self-injurious behaviour. Rather, they reflected about the value of counselling that targeted the underlying issues.

Asked what they would tell counsellors working with college-aged women who self-injure, most of the women emphasised that it was important for the counsellor to be nonjudgmental. I think the bottom line is to just try not to alienate them further. Because there is already the knowledge that what you are doing is very bizarre and not normal, and you need to be careful of inadvertently stigmatizing them further.

Suicide in Ukraine - Wikipedia

An additional study carried out by HUBAND found that psychotherapy or counselling was generally experienced as helpful. However, some young people felt that talking did not make a difference to the way they felt:. I've talked and stuff and I still don't really feel a hell of a lot better… Cause you know sometimes even just talking about it doesn't really help, sometimes just a hug or something would be cool, more helpful than sitting here talking about it… The talking and things didn't really help me too much.

I don't feel that it changes anything… It just seems to scare a person, that's about it. Several participants described situations in which they felt that their therapist did not understand them. Reprinted in , Self-Harm remains globally read. A fresh appreciation of Self-Harm is timely. The question for government and psychiatry remains the same as it was more than a decade ago: What makes the book so significant? To this question there is a clear and present reply: I will briefly explain what I mean. To understand why this is the case, consider the following two definitions of self-harm.

Those of us who self-injure carry our emotional scars on our bodies. We are not greatly enlightened to know that self-harm is not the same as suicide and involves self-inflicted harm.