Self-harm is a coping strategy for many people and a way of expressing the emotion they feel trapped inside them. It may offer a sense of release. I have worked with people who self-harm for over thirty years and have learned much from being alongside them. 

In June 2011 I gave a presentation at the Minimising Self-Harm and Suicide Conference in Wales. Following on from this I wrote an article about this experience in the Lapidus Journal 'Working With Women Who Self-Injure: Reflections on A Bristol Experience' Lapidus Journal Spring 2012 Vol..6 II (see below):

Working with Women Who Self-Injure: Reflections on a Bristol experience
by Dawn McHale

Last year I was asked to speak at the ‘Minimising Self-harm, Preventing Suicide’ Conference. This took place on Thursday 30 June 2011 at the All Nations Conference Centre in Cardiff, and was organised by Pavilion Publishing. The request was for wide-ranging information on women’s experience, particularly with reference to statistics for Wales. Although I worked for many years for Mind and other voluntary agencies in North Wales before coming to Bristol, I had no really up-to-date information about Wales, so I offered what I felt was important for people to hear: the human experience of the Self-injury Self-help (SISH) Group in Bristol, with whom I have been involved for nine years, and what it was really like for women attending this regular community of support.
The Conference
Paul Chick opened and chaired the conference. He introduced us to current strategies in Wales and the ambition to link up and develop an all-Wales strategy informed by the joint expertise of voluntary and statutory organisations. This was followed by Dr Ann John discussing the epidemiology of suicide and self-harm, drawing on a range of her own research and other sources. Dr David Williams spoke of the importance of early intervention and Gail Ashton gave a presentation on working therapeutically with students in distress. As a counsellor in a higher education setting, Gail used anonymous examples of clients she had worked with and discussed the techniques and approaches she had used to help support them. Clare Shaw then gave a lively, interactive presentation on how she had developed a professional understanding of self-injury as a trainer for Harm-ed, a service user training agency. The focus of this delivery was on our personal understanding of what self-harm means in terms of our own experience and our coping abilities when things become difficult. Alan Briscoe then gave a talk on supporting the professional, which provided insights into how many workers across a wide range of organisations feel ill-equipped and helpless when faced with supporting people who are actively self-harming.

My presentation opened with an explanation about how I had come to give the talk and what I aimed to bring to the conference: a personal touch, speaking from the heart. I explained that my approach (and that of SISH) was to genuinely work from oneself and consider how we can all join together to support each other. It was important to emphasise that in this approach there is no ‘us’ and ‘them’ – only all of us coming together as a community of women (at this point SISH was a gender-specific service) – and that this has been the secret of its success. Women have expressed how important it is to be able to be themselves in the group, to shed both a sense of being different and the pretence and secrecy that they often have to adopt in their everyday life.

As one woman says in the collection release which was on sale to delegates:

‘For the first time in my life, people looked at me like they thought I was good, like I was worth something, like what I had to say was important.’
I thoroughly enjoyed being asked to take part in this conference and I felt that I stood up for the human factor, for walking alongside women who wanted a safe space just to ‘be themselves’, to share laughs as well as some tears. To quote again from release:
‘Let the work we do continue for our own inspiration and growth and for those of others…’ p 76

Mark Cresswell followed my presentation by talking about self-harm, suicide and men and gave an excellent delivery of statistics and demographics. Simon Hatch then talked about the role of the third sector; and Richard Bundy discussed the role of the Crisis house in supporting people appropriately and positively.
At the end of the conference, suggestions were gathered for further events to continue discussions on this subject. One very positive indication of interest in creative therapies for self-injury was that Gillie Bolton was put forward to give a presentation on writing therapy.
Reflections on practice
During this event I found myself shocked by the fact that the topics under discussion and the concerns being genuinely expressed by participants were similar to those I had been involved in discussing twenty five years earlier when working for Mind in Wales, including a dearth of services for men. This gave me a strange sense of déjà-vu.

In 'Release', Georgina Campbell writes about some of the myths surrounding self-harm: ‘an attempted suicide’; ‘women who self-harm have been abused’; ‘women who self-harm are just trying to get attention’; ‘someone who self-harms can just stop what they’re doing if they really want to’; and ‘once a woman stops self-harming, the problem will go away’. These myths have been around a long time and it is extremely disappointing to find that they have not diminished in the thirty years since I have been involved in work related to mental health.

With the current emphasis on evidenced-based practice, we are all seeking to demonstrate that what we are doing is helpful to the client, that we can meet needs appropriately and positively. In that search it often feels, to me, that the heart of things is diminished by the urgency to find a way forward in funding our work. Even more, in the present financial climate, we are asked to demonstrate continually how we know that what the potential funds will pay for is really needed, that it will do ‘what it says on the tin’, that we regularly monitor, evaluate and provide feedback reports that emphasise that it did do what it said it was going to, if not more.

I am a strong advocate of reflexive practice, of seeking to meet needs by asking clients themselves how it is working for them, as well as looking at ways to improve my practice. But sometimes, in odd moments of paperwork-overwhelm, I do wonder if Powerpoint, statistical graphs and demographics lead us away from the blood pumping through the veins and the heart of the matter. Where is the human factor? Facts are important to keep us informed and to help to raise awareness, to support workers in supporting people, but under such pressure have we become too focused on gathering as much information in as short a time as possible in the hope that this will solve the issues of under-funding and lack of training?

This has led me to develop my own way of working therapeutically with women and men who self-harm. I am not an expert and they are not ‘ill’ – rather we walk together along a path of exploration, including viewing self-harm as a coping strategy, something which for some people has kept them alive, and become a way to express what words may not be able to. Self-harm takes us to the real depths of human experience but also sometimes to places of laughter and shared humour. 

There was an excellent documentary made by the BBC in 2009 in which Meera Syal went in search of information about self-injury and found it was a rich personal journey of discovery. Talking to a wide range of women she learned much about their lives including what one woman writes in 'Release':

‘Self-harm is just a small part of who I am. There is much more to me than just self-harm.’

The SISH (Self-injury Self-help Group) was established in 1999 and endeavoured to hold a facilitated support group every week. The membership of the group has varied – from older women to younger women, from smaller to larger numbers. At one point they asked to have a social event where they enjoyed watching a film whilst sharing a meal. ‘Girl Interrupted’ was chosen and many women were brought to tears by the rawness of the experience depicted in the film, which at times reflected their own lives. SISH also provided monthly well-being workshops that offer a wide range of approaches and techniques to promote good mental health.

SISH is currently on pause while we undertake research into what people in Bristol and its environs feel would meet their needs mostly appropriately. We are talking to people who are actively self-harming, who have had experience of self-harm, and who support people who self-harm. A new course has been developed, by service users and one of the committee members, to help support women and men in finding new ways to manage their self-injury and develop healthy coping strategies.

Release: Women in prison write about self-harm and healing.
Compiled by Leah Thorne. Bar None books, April 2010. ISBN 978-1-905373-30-7
The book can be ordered at a cost of £7 plus p&p from: New Leaf Books, 5 Wardley Road, Walton, Warrington, Cheshire, WA4 6JAA

Dawn McHale is a writer, counsellor and supervisor integrating a range of creative media techniques into her practice. She is also a group worker for several self-help support groups for women suffering trauma. Dawn uses storytelling and therapeutic writing with music to bring myth and story to children and adults. She also runs a wide range of creative writing workshops which integrate meditation, space and movement.
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