Mark Gatland is a trained counselor living and working in Cambridge, England. In 2014, he gained viral-level attention for his post: A Letter to All the Great Dads Out There.
Mark counsels a number of young men and women who cut themselves, often leaving scars for life. In Who I Am: American Scar Stories, I tell the story of a young woman who cut herself for years. Although Cathy now represents those people recovering after years of self-harm, her story reveals a hellish history. The following is Mark’s firsthand experience with people with self-harm and insightful advice on how to help someone who is cutting themselves.
Self-Harming: A Counsellor’s Perspective
Don’t Make Assumptions
“I just want to be heard. I’ve seen loads of professionals and most of them, because it’s their job, think they know me better than I know myself but it’s rare for them to truly understand. All they need to do is ask what it’s like from my point of view and then listen. I’ll tell them but they have to be willing to listen.” Amy, 20
There is no one size fits all. Self-Harm is different for different people. When parents come for counselling invariably the first thing they will ask is “can you explain why my son/daughter cuts themselves?” They always seem very disappointed when I explain I haven’t got a clue, that much like other areas of life you can’t possibly know unless you listen to them.
When addressing the issue it’s important to remember that what one person feels will be completely different to another and equally what one person does to cope will be different to another, no less valid, just different.
I remember asking a father how he coped when he had a stressful day and him responding that he would go home have a cigar and get drunk. Self-harm comes in many forms, we all have our own coping mechanisms and until you understand and accept that each person is different and equally valid then you can’t possibly hope to understand why they do something.
People will self-harm in different ways, for different reasons and as a response to different incidents. Don’t make assumptions. Until you’ve heard someone describe in their own words what’s happening for them you can’t hope to understand.
Make sure you’re listening
“Before I started seeing you I had no one to talk to. My family were so upset that they didn’t want to hear anything I had to say. The most helpful thing has been you listening to me, knowing that when I talk you won’t interrupt, tell me what you think or what I should do.” Mark, 19
Most people think they’re good listeners. I can tell you here and now they’re not. Listening is a skill in itself, it takes practice and involves understanding what it means to actually listen. The saddest thing for me is the number of therapists that actually aren’t very good listeners.
Really listening requires empathy, it means caring about what the other person is saying and being able to recognise what they’re not saying. Listening can often be uncomfortable, that’s why most people will say something or break a silence but true listening doesn’t get uncomfortable, it doesn’t judge, doesn’t offer advice, it just hears.
People have said to me “I don’t really understand your job, all you do is listen to people, surely you must also offer them some advice”. Well this really misses the point, actually listening to someone is one of the most valuable things you can do for them, sadly it isn’t something that happens nearly enough in society and it’s one thing that I believe could genuinely change the world. Don’t believe me, try it for yourself and see the difference it makes in your own relationships.
Young people will overwhelmingly say “the problem is no one listens to me”. Giving a person the chance to describe their problems and tell you how they actually feel gives them self-worth and validates them as a person. With people that self-harm this is of vital importance as often they will have been faced with people that haven’t listened to what they were saying, instead responding with the usual clichés “stop being silly”, “cheer up it will get better” and “don’t overreact”.
Actually being heard can play a massive part in someone facing their problems and making changes.
If there is one thing you can do for someone that self-harms this is it. Listen.
You’re not in control. They are.
“When I think about harming myself I also feel like I am out of control. On the few occasions I’ve told someone what I was thinking of doing they’ve tried to tell me what to do or even worse to make decisions for me. This reduces my control even more and is so scary it makes me more likely to self-harm, not less.” Angel, 16
One of the most common things people talk about when they self-harm is lack of control and how that scares them. Self-harming helps them to gain some control back because they can control how they feel and this in turn makes them feel more in control of situations.
When working with anyone that self-harms it’s vital to remember that removing their control or their perception of it will likely make things a whole lot worse.
People often confuse self-harm with suicide but you couldn’t get further from the truth, self-harm is the exact opposite, a way of trying to stay alive and manage the feelings the person is having.
Some inexperienced therapists have made the mistake of trying to make decisions about self-harmers, assuming that they are a risk to themselves and trying to get help for them be it through breaking confidences and speaking to their GP or encouraging them to get medical help themselves. Of course there will be some circumstances where this is necessary (although I would suggest limited ones) but it is vital in these cases to remember quite how frightening it would be for someone who is already feeling out of control to have decisions either made for or forced upon them. There is every chance that these actions will just exasperate the situation and give even more reasons to actually self-harm.
Whatever course of action is needed the most important aspect is to keep people involved in the actions and to enable them to feel in control of the whole process.
Who are you to judge?
“My parents think I self-harm to get attention. I don’t cut myself so people can see how I’m feeling, I do it so they can’t. I don’t want people to have to listen to me all the time talking about my problems so I cut myself to try and manage my feelings and to save the people around me from having to listen to me. Saying I am seeking attention hurts and makes me want to shut people out just that little bit more.” Rachel, 18
For a self-harmer talking about it is just about the hardest thing they can do. Imagine plucking up the courage to discuss it and being met with anger, judgement or disappointment.
We all have strategies for managing stress and pain, for some people theirs is self-harming. They’re not making a statement, doing it for effect or to gain attention. They are doing it because it is the only way they know of managing their feelings. In the short-term it can actually help and therefore if someone’s struggling and their strategy for dealing with it helps them then who are you to judge?
People don’t make deep, real changes because they’ve been judged. They make them because they’ve been understood and listened to. They need you to show compassion and to recognise that they’re trying to cope the best way they know how.
Change takes time
“Talking about my cutting was really hard. I was really scared. The more I thought about it the less I felt in control and of course the cutting then increased.” Nicola, 15
All relationships take time to develop but when someone is talking to you about their self-harming it can take even longer than usual.
Self-harming is important to the person and their ability to cope. They may be scared you will judge them or worse still try and stop them from doing the only thing that helps.
Relationships have to be built on trust and consistency. You have to be willing to give as much time as is needed and to understand that things could take a long time to get better. In a lot of cases just discussing it means in the short term it will get worse.
It’s very important to realise you can’t measure success against whether the person is still self-harming, there is no magic pill that will suddenly stop it and it isn’t a reflection on you as a counsellor or parent. Try to understand how the person is thinking and feeling and use this as a measure of whether they are moving forward or not.
Stopping self-harming can be a long and slow process, often with significant set-backs along the way, understand this is a necessary journey and support them with compassion and understanding.
Mark lives in Cambridge, England with his wife Joanna and son Harry. When he’s not busy seeing clients or building his business, Mark can be found studying psychology and philosophy, running in the early hours, indulging his passion for cooking or chasing his son around the park. To find out more about Mark or to read his blog, please visit www.thecambridgecounsellor.co.uk