William ("Dr. Bill") Gaultiere, Ph.D.
Director of New Hope & Psychologist with ChristianSoulCare.com
(714) 971-4213, DrBill@CrystalCathedral.org

WELCOME
I'm glad you're taking this New Hope CE class with me. I pray that it will be an encouragement to you in your service with New Hope, focusing your compassion, improving your skills, and increasing your confidence.
Our subject is self-injury. People who injure themselves are in enormous pain. They need our understanding. And they can be difficult to work with, sometimes trying to manipulate or upset counselors. We need to be prepared on how to respond.
Thank your for your volunteer service and your efforts to learn!

GOALS OF THIS CLASS
1. Understand what self-injurers are experiencing.
2. Learn how to respond to callers/chatter who self-injure.
3. Practice using basic New Hope Counseling skills with callers/chatters who cut themselves.

INTRODUCTION
Self-injury is one of those taboo subjects, yet 1% of Americans (about 2 million) cut or injure themselves. These figures include all ethnic and socioeconomic groups and 40% of these are men.

Princess Diana confessed that she reacted to the strain of her marriage by throwing herself down the staircase and cutting herself with razors, pens, knives, and lemon slicers. "You have so much pain insider yourself," she said in an interview with the BBC, "you try and hurt yourself on the outside because you need help."

WHAT IS SELF-INJURY?
What we're talking about could also be called self-harm, self-inflicted violence, or self-mutilation.
Here's a definition: Self-injury is self-inflicted physical harm that is serious enough to cause bodily damage or to leave marks that last at least two hours.
Note that it's deliberate. And we're not talking about a suicidal act. Instead it's done as a way of coping with unpleasant or overwhelming emotions, thoughts, or situations. Some people obsess about this (can't stop thinking about it) and do it compulsively (like an addiction).

EXAMPLES OF SELF-INJURY
In my research to prepare for this class I came across some statistics on the most common ways that people hurt themselves.
Cutting 68%
Skin picking or scratching 14%
Burning 5%
Hitting 4%
Wound interference (picking off a scab) 2%
Biting (e.g., extreme nail biting) 2%
Head banging 1%

WHY WOULD SOMEONE INJURE THEMSELVES ON PURPOSE?
This whole subject is a shock to many of our New Hope Counselors. And it may be upsetting. It's hard to understand and accept that people would deliberately injure themselves. Even the people who self-injure often say, "I don't know why I'm doing this."
Here's what we know. 50% were abused as children. Most report having experienced emotional abuse or neglect in their past. All, by and large, haven't learned good ways of coping with feelings.
There are four basic immediate reasons for why people cut themselves or purposely injure themselves in another way:
1. To feel alive. They're detached or cut off from their feelings. They may be depressed or feel an emptiness. They be "dissociated."
2. To control feelings or relieve pain. Their emotional pain is unbearable. Their sadness, fear, guilt, or anger feel overwhelming and out of control.
3. To convert emotional pain into physical pain. Because their upsetting feelings are so out of control they convert it into physical pain. The physical pain feels more manageable. They can see the wounds on their bodies. They can see the bleeding stop. They can see the wounds heal.
4. To punish themselves. They feel bad about themselves, about their failings, needs or feelings. They take their anger out on themselves.

HERE'S WHAT THEY SAY
Let's listen to what self-injurers have to say about their experience. This will help to increase your compassion and readiness to be responsive. These are actual quotes posted on the self-injury website.

I want to feel alive (instead of feeling empty, detached, or unreal, which is called "dissociation.")
"My blood voices my pain, like a bright red scream." (This is the title of a book on self-injury).
"To feel real when I feel numb." (38 year-old woman, injuring herself since she was 14)

I have to make the pain go away, to get in control of it
"I cut myself with razors because the pain in my chest is unbearable. Almost anything can set me off. Most of all, the desire to injure myself comes when I feel like I have failed at something or when I feel as though someone close to me is going to leave me. The need for intimacy in my life is great and although I try to keep everyone at arm's length, when I do let someone in I feel as though I will be hurt. Cutting relieves the pain that nothing else can take away." (32 year-old woman, works as an MSW, injuring herself since she was 15)
"Injury gives me focus.....i cannot seem to focus and stop the spinning or emotions/ideas and thoughts (mostly thoughts that i don't want)......si gives me a temporary peace, and it works for any situation." (26 year old man with one year of self-injurious behavior)

"I like the thought that it is ME causing the pain for once, not someone else." (14 year-old girl)
"I injure myself usually when i feel like things aren't in my control. like when i get into a fight with my boyfriend or i feel like noone cares about me, or if i wasn't invited somewhere with my friends that everyone else was invited. i get this feeling where i have so much energy that i could punch through a wall, and my heart is beating so fast i feel like i could have a heart attack and my breathing feels like its being cut short."

I want to put the pain in my body (a form of control called "conversion")
"Because sometimes it hurts so bad on the inside, it's nice to have something tangent to relate to. There is a weird sort of comfort in having an injury on the outside. It is also a whole lot easier to deal with than crud from the past and present. Before [I feel] out of control -- it's like a obsession I can't get rid of. During [I feel] a sense of satisfaction, control, victory. After [I feel] like dirt." (37 year old woman, graduate student, injuring self since age 14)

I have to punish myself
"I'm too needy. Too emotional. I can't handle the pain so I cut."
"I use it as a way of punishing myself for whatever is bad about me."

WHAT SELF-INJURERS FEEL ABOUT STOPPING
Note from the following quotes that self-injury is used as a coping mechanism. Temporarily it works to deny emotional pain and unwanted feelings. Also, it is accompanied by an adrenaline rush. For these reasons it can become addictive.
"I am usually VERY upset during the process and venting of my emotions accompanies the cutting. Most of the time, I do not quit until I am exhausted both emotionally, and physically." (33 year-old woman with a Ph.D.)
"I know it's time to stop when I can realistically see how much I'm going to hate myself for doing this the next day. I also stop when I have so many cuts that I can't possibly continue cutting unless I go over all the marks again." (13 year-old girl)
"The idea of stopping for good terrifies me. I don't know what I would do without that release. I'm afraid I'll go back to abusing alcohol (too messy) food (too shame-filled) or pot (too numbing) so until I can deal with why I am hell bent on my own destruction - the cutting is best coping mechanism I have."
"Sometimes after so many cuts I use sandpaper to scrub away the evidence." (24 year-old woman with 8 years of self-injury since being raped.)
"Sometimes I call hotlines for self-mutilation or suicide, but they can be really mean." (17 year-old girl, injuring herself since age 12)

WHAT HELPS SELF-INJURERS?
There is help for these people. Read the comments from self-injurers who stopped hurting themselves. Their stories show that there is how and the point the way!
"I read a book on the subject, and discovered that the self-mutilation, bulimia, and kleptomania had a fundamental root in sexual abuse I experienced as a child. Once I figured this out, I started working on stopping it. In the most basic sense, I finally stopped when I learned how to love myself again. I do have slight recurrences, and often have to fight the urge when particularly stressed out." (25 year-old woman)
"I stop and think and tell myself to STOP." Remember my teaching tool called "the Feel-Think-Do Triangle?" It teaches a great rule: "Before you speak or act feel and think first." Self-injurers feel overwhelmed or detached and so they cut. Instead, as this person learned, it's best first to stop and think, to "process" feelings, to think about the negative consequences of cutting, to accept your emotional needs as valid, to think about a positive coping resource. Without realizing it you help people do this as a New Hope Counselor when you listen, reflect feelings, ask questions, and engage the person in positive problem solving.
"I haven't injured myself for almost 8 years now but when I get the urge these days I look at the state of my arm and all the awkward moments I've had trying to account for the scars when people ask what happened to my arm..."
"It may sound silly but I find that playing with and talking to my dog helps!" (18 year-old girl, high school valedictorian)
"Prozac! 80 mg./day worked best. 120 made me too jumpy."
"Taking a brisk walk. Shower, eat, scream; hey, I have a ton of lists... "
"I do practical things like eat healthy and get needed rest. Sometimes I write poems, stories, or sketch because they take a lot of concentration and also express the emotions. Sometimes I will do a lot of physical exercise that is really intense."
"I find that calling someone and being able to have the freedom to vent helps. Sometimes I will write my feelings down on paper speaking as I choose without pressure."

WHAT CAN NEW HOPE COUNSELORS DO TO HELP?
1. Remember the ancient Hippocratic Oath: "Physician do no harm!" Particularly with cutters and other self-injurers it's important that you:
Don't panic. This is not a suicide attempt.
Don't react with shock or repulsion. That closes up people emotionally and shames them.
Don't judge or pressure to stop. Never moralize, judge or criticize in your role as a New Hope Counselor! And don't pressure people to do the right thing (unless it's the best way to save a life or protect a child or elder from abuse) because it's likely to activate their resistance.

2. Do LISTEN in order to contain feelings.
Loving, nonjudgmental attitude
Invite deeper self-disclosure with questions. For cutters, ask "How do you feel right now?" (Helps them to feel and to process feelings and to gain self-control over their feelings.) and "How will you feel after you hurt yourself?" (Helps them to see the negative consequences of self-injury, like scars, embarrassment, and that it doesn't solve any problems)
Summarize the main points. ("What I understand is…"
Timely reflection of feelings is the heart of listening! ("It seems that you feel…")
Even-tempered listening is a must (Don't react emotionally! Stay calm!)
Nonverbal cues like "Hmm hm" help

3. Do encourage use of a positive coping resource. They need to develop a new and positive way of dealing with their pain. Later in the conversation, as part of the problem-solving process, you might ask, "What's another way of dealing with your pain?" Or, "Have you ever felt this way and not cut yourself? What did you do instead?"

REFERRAL RESOURCES
Your New Hope Referral guide is a comprehensive, national directory of over 50 pages of phone numbers and websites, all organized according the very same categories that you have on your New Hope Contact Sheet for "Identifying the callers primary problem." (The "New Hope Resources Archive" of my self-help articles uses the same system as does the "CE Manual" of past class notes which is at www.NewHopeNow.org/counselors.) It's in the phone room and on our public website, www.NewHopeNow.org. On the website go to the link "Referrals." Then look under the category "Mental Health & Counseling." There you'll find the following helpful resource:
Self-Injury: Information and resources for those who cause physical injury to themselves, http://crystal.palace.net/~llama/psych/injury.html.

FREE RESOURCES FOR THE PUBLIC
Visit www.NewHopeNow.org for self-help articles by Dr. Bill. (These are free resources for callers and chatters.)

LET'S PRACTICE!
Take the CE Exam which includes a role play. You will receive New Hope CE credit.

Take the CE Exam