Understanding Self-Injury & Practical Tools to Interrupt the Cycle

1. Understanding Self-Injury & Practical Tools to Interrupt the Cycle Shannon Gubser shannon_gubser@ycs.wednet.edu 360-894-6016 (W) & 360-481-3830 (C)

2. Video Overview • https://www.youtube.com/watch?v=EcFR-7-WzUM

3. Introduction Each of us has special areas we’ve been called into – some sexual abuse, some inner city, some higher ed, others social work, or teaching, my little nitch became self injury back in 2006, would not say that I was an expert, just 10 years of experience on the front lines History- had a dream, met Kara, my general counseling training, love, and faithfulness wasn’t enough, saw TV show, attended training at SAFE in Aurora, IL, used tools, found hope/new life when tools were used, expanded the tent pegs, lots of “life after” stories AS WE BEGIN…HOPE: • SI is evidence they are letting us see them (“can you see my pain”)…exciting…they are telling us that something is going on inside…it’s an invitation…M’s story • Best part of my training weekend were the stories at the end…worked with many kids who have been free from using self-injury to “survive life”…there is freedom from this

4. Today’s Journey (SPOILER ALERT)… • Part 1 (2:30-2:50pm): Taking a closer look at what self-injury is • Part 2 (2:50-2:20pm): Practical tools to interrupt the cycle of self-injury • Part 3 (2:20-2:30pm): Picture of hope & Q&A

5. Let’s be honest…Overview When we are struggling or in pain (birthing contractions for example)…we want a way OUT! Or at least a distraction! So…what if healthy options to deal with our pain aren’t known or practiced? And what if self-injury has been learned and now being used to deal with that pain? In a faithful and gentle way, we can teach kids that they don’t have to deal with pain in this way any longer…that it is a choice…and that they can choose a new healthy way that will bring healing, bring joy, and bring deeper intimacy in relationships Step 1…we must acknowledge/identify that we aren’t dealing with life in a healthy manner (don’t have to hide any more)…Step 2…we must be willing/want to “get well” (we can’t force them)…Step 3…we can learn and practice new behaviors (thoughts, actions, etc)…Step 4…we practice our new behaviors until it becomes a part of who we are (faithfulness key here….this can be a VERY long journey to a life without self-injury) SI isn’t something to be feared…instead we meet people where they were at…speak truth…teach new behaviors…and be faithful in their lives…LOVE changes the world…AND effective tools help a lot as well! Let’s learn some of those tools today! Crossing the line (between no SI behavior and SI behavior)…the farther over and the longer using it, the longer it often takes to adopted new thoughts and behaviors

6. Part 1 - What is self-injury?

7. Defining Self-Injury (SI-NSSI) SELF INJURY IS… “Deliberate mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing emotions that seem too painful for words to express” (Lader, 1998). Self abuse, self-injury, self mutilation is seen by the injurer as a form of self care to manage emotions SI is a radical means of emotion management SI communicates emotional pain; translates/communicates emotional pain through physical pain SELF INJURY IS NOT.. It’s not a half hearted attempt at suicide…rather it is often seen as a way to avoid suicide, seen as a way to get through the moment It’s not body modification taken to the extreme…body modification is seen as a way to beautify or improve looks It’s not demon possession…this is a gross simplification to treat a very complex issue It’s not just a “way to get attention”… most often times it’s often the opposite *note*

8. Examples of Self-Injury • Cutting • Burning • Head banging • Scratching • Biting • Interfering with wound healing • Hair pulling • Ingesting/injecting sharp objects or toxic substances • Breaking bones • Facial picking • Amputation/blinding

9. Stats • A study of 2,875 high school and college aged students showed a lifetime prevalence of SI at 17% (Whitlock, 2006)…boys/girls 50% • What does this look like? (perhaps an even higher #) • Research has show 90% of behavior begins as teenagers, with an average on-set at age 14 with increased severity through late 20’s (Penner, 2005)

10. Has rock bottom self-esteem Is even “SELF-LOATHING” Often times feels: unloved, ugly, distain, hopeless, trapped, numb Has probably had a lifetime of stuffed emotions Probably has never learned to express emotion in a healthy manner Often times: concurrent eating disorder (80%); history of sexual or other abuse (50%+) Often has feelings of profound abandonment Often feel they can never be right or good enough And often feel they are damaged goods Usually feels a lot of shame and guilt and therefore keeps this behavior secret Used to think the self-injurer was the “emo” kid…but found as many who were the perfectionist, jock, straight “A” student General Profile of Someone Who’s Self-Injuring…

11. In General, What is the Cycle of SI?

12. In General, What is the Cycle of SI?

13. Other Triggers Besides an Incident… • Someone else talking about SI • Seeing SI on TV/computer/books/etc • Sight of implements (i.e. scissors, knives, etc) • The physical feeling or touching of implements • Feeling numb and want to “feel” again • Habitual (location/time/etc)

14. What does a compassion filled response to “life” look like?(where are we hoping to lead them…where do we want to end up?)

15. Why does SI appear to be more prevalent now? • Collapse of the Extended Family (divorce, work, meals, more on own, etc) • Emphasis on Quick Fix (technology has shown us no need to wait or self-sooth) • Individualized Activities (phone, video games, computer, TV, etc…invisibility)…don’t see the isolated behavior as rude • The A-hloic Society (behavior normalized) • Body Focused Culture (up to 80% of SI’ers concurrent eating disorder) • Contagion Effect

16. Part 2 - Practical Tools to Interrupt the Cycle

17. What are the Goals When Walking With a SI’er? • To get through defenses to the root/core issue(s) • To help the individual identify and communicate experiences/feelings verbally (not hide) – requires vulnerability/intimacy • To challenge irrational/distorted thoughts/beliefs and to replace those with truth • To learn the difference between thoughts/feelings/behaviors • To increase the window of opportunity between a trigger/impulse/thought(s) and the action/behavior • To be able to experience feelings without an a physical act • To face fear(s) directly rather than run from/self-medicate with self-injury • To experience empathy/compassion as they walk THROUGH the feelings/thoughts/beliefs/healthy actions • To mourn the loss of the idealized childhood

18. How to approach or start a conversation if you suspect someone is self-injuring? • “How do you deal with stuff when it gets really hard? What do you do?” • “…tell me about this” while gently touching their arm (if cuts are visible) • “Everyone has a story to tell. Would you share your story with me?” • “I’ve been worried about you because I’ve seen…”

19. “Do you want to be well?” How can we know? Give a homework assignment…see if they do it Examples of assignments: lie/truth sheet or log sheet Don’t chase after them if they aren’t ready to get well yet

20. What We Can Teach to Interrupt/Extinguish SI?

21. If you know someone is self-injuring, do you… Tell Someone? Tell the Parents? Refer to A Counselor? The presenters at SAFE had two differing opinions on this (shows not a clear line) Informed Consent at the beginning of the school year…may need to remind them “School counselors are ethically obligated to keep student reported information confidential unless disclosure is required to prevent clear and imminent danger to the counselee or others.” (ASCA, 2004)…check school board policy as well ALWAYS tell if suicide seems to be an option (Eisel vs. Montgomery County Board of Education, 1991) Elementary…I would personally say, yes, tell parents (students can choose to do this together or we call…they choose to be present or not, gives them some sense of power/choice in it) Middle/High…can seek wisdom from other professionals or attorney if there is definite struggle Can allow the individual to tell their parents (with a timeline) OR offer to go with them If SI has become an addictive or habitual behavior, they should be referred to a trained or qualified therapist

22. Appendix -practical tools-

23. Feelings List MAD Annoyed Irritated Furious Frustrated Enraged Livid Angry Aggravated Ticked Off GLAD Blissful Proud Ecstatic Curious Loving Cheerful Relaxed Relieved Happy ANXIOUS Vulnerable Excited Startled Frightened Terrified Agitated Shocked Surprised Scared SAD Depressed Agonized Exhausted Tired Grieving Hurt Lonely Miserable Empty

24. Lie - Truth • I will never be good enough • I am ugly • I am stupid • Everyone hates me • I am unlovable and I don’t belong – I shouldn’t have been born • I have to be perfect or they will think __________ • I can’t do this • I need to be punished • I am not worthy of real connection • I won’t be able to live through this • If I do this, I might fail • If people knew the real me, they won’t like me • If they know the truth about me, they won’t love/like me anymore • If I choose ______, I will disappoint _______ • To belong, I have to fit in, and be like everybody else • I’ve done this too many times to be forgiven

27. CD 3 – You have Freedom& Victory All Things New – Steven Curtis Chapman All This Time – Britt Nicole Born Again – Third Day Break Every Chain – Jesus Culture Break Free – Ariana Grande Free – Daria Maclean Hello My Name Is – Matthew West How Can it Be – Lauren Daigle I Am Free – Newsboys I Am New – Jason Gray I Wanna Be Free I Will Rise – Chris Tomlin It’s Not Over – Ricardo Sanchez Made New – Lincoln Brewster Mighty to Save – Hillsong Overcome – Jeremy Camp Overcomer – Mandisa Redeemed – Big Daddy Weave Remind Me Who I Am – Jason Gray Rise – Shawn McDonald Strong Tower – Kutless Stronger – Mandisa Stronger – Kelly Clarkson Stronger Than the Storm – Vicky Beeching Suitcases – Dara Maclean The Sun is Rising – Britt Nicole Voice of Truth – Casting Crowns Walk on Water – Britt Nicole What Faith Can Do – Kutless Whom Shall I Fear – Chris Tomlin CD 1 – You are Loved, Worthy, Belong, Beautiful Beautiful – Mercy Me Beloved – Tenth Ave North By Your Side – Tenth Ave North Call Me Beautiful – Ginny Owens Come to Me – Jamie Grace Don’t You Know I’ll Always Love You-Third Day Firework – Katy Perry Free to Be Me – Francesca Battiselli Gold – Brit Nicole I Am Your Beloved – Vineyard I Believe in You – Bethany Dillon I Belong – Kathryn Scott I Love You More – Matthew West Jesus Loves Me – Chris Tomlin Just the Way You Are – Bruno Mars Madly in Love With You – Sean Mcconnell More Beautiful Than You – Jonny Diaz Proud – Steven Curtis Chapman Safe – Phil Wickham What If – Jadon Lavik What Makes You Beautiful – One Direction You Love Me Anyway – Sidewalk Prophets Your Love – Brandon Heath Hallelujah (Your Love Makes Me Sing)-Various CD 2 – Child You are Loved Regardless of What You Do (can come out of hiding and leave your shame) Who is This God – Alli Rogers Beauty for Ashes – Shane & Shane East to West – Casting Crowns Empty and Beautiful – Matt Maher Field of Grace – Big Daddy Weave Forgiven and Loved – Jimmy Needham Greater - MercyMe He is Faithful – Jesus Culture He Sees – WOW Worship Green Healer – Hillsong The Hurt & the Healer – MercyMe I Am – Eddie James I Need You to Love Me – BarlowGirl I Turn to You – Selah A Little More – Jennifer Knapp More Like Falling in Love – Jason Gray New Every Morning – Big Daddy Weave Never Let Go – David Crowder Ocean Floor – Audio Adrenaline The One Thing I Know – Sara Groves One Touch – Nicole C. Mullen Only Grace – Matthew West One Thing Remains – Passion Redeemed – Bid Baddy Weave Relentless – Bethel College Chapel Band Sweet Jesus – Selah & Jill Phillips Sweetly Broken – Jeremy Riddle Though I’m Not Worthy – Kari Jobe Undo – Rush of Fools Washed By the Water – Needtobreathe Wholly Yours David Crowder Band You Are Faithful – Jesus Culture You Found Me – Big Daddy Weave

35. Caution Signs on the Journey Boys…tactics…side by side with activity…stigma to showing emotion Ultimately, SI behavior is a choice, not an addiction over which one is powerless, it can be transformed from a seemingly uncontrollable compulsion to a choice There is no healthy amount of self-injury…it might be/have been temporarily helpful, but it is ultimately a dangerous coping strategy that interferes with intimacy, productivity, happiness, and abundant life If SI has been the “best friend”, it is gunna get harder before it gets easier When SI is taken away…sometimes it goes straight to “I want/need to die” OR replaced with something else (food, exercise, sex, drinking etc)** Consider asking them to give you their chosen instruments Differentiating between suicide and SI (location, intent, methods…one is a coping strategy, one is an escape from life)…ask, pin point If they’re calling you after they’ve done it…you can’t help them “Little by little”…keep being faithful…the journey can take a while, and your faithfulness helps solidify the truths taught along the way while they get stronger as they take more “land back” They may choose to go back to the dungeon…LOVE THEM ANYWAY Remember…we are the “nurse”…not the doctor…our job it to point the way to healing and to walk alongside…we aren’t the healer • Boys help boys…girls help girls if possible • Be a good listener…listen to their whole story but speak when you hear false beliefs/lies (not crazy) • Respond in compassion in your words and actions… • Set boundaries (manipulation) AND make allowances (assuring them of your time for them)** • Remind them that you’ll love them and have time for them, even when they “don’t have a problem”** “I feared that being well meant being alone again” -Tori • Speak conviction NOT condemnation…and teach them to know the difference (heard the FBI studies the original not the fake), condemnation will illicit shame and more hiding • Accept them non-judgmentally, love them as a person, not as their behavior…they might tell a lie…but we don’t call them a liar (labels attack identity) • It will require courage for them to reach beyond shame to vulnerability • There will be victory…but if they fall…it will often be farther in between and less frequent…little by little...celebrate victories (large and small) • It will be worth it! Speak vision and hope for what is to come (phone call…”Tell me what it is gunna be like again.”). Freedom is waiting, healing is waiting, deep and authentic relationships are waiting • Point out that they can live in peace, doesn’t have to be lived in chaos…you’ll be there either way

36. Self-Injury Expert Resource Bodily Harm(1998) Karen Conterio and Wendy Lader, PhD S.A.F.E. Alternatives www.selfinjury.com

38. Q & A Time: • selfinjury.com – FAQ • Parking Lot