Self-Injurious behavior, particularly in adolescents, is a disturbing phenomenon.
However, such behavior is not without valid motivations.
Most all behaviors strive to meet some need and in the case of self-injurious behavior, the need may be related to a sense of self-efficacy.
The most common form of self-injurious behavior is commonly referred to as "cutting" and consists of cutting the skin with a razor, knife, sharp plastic edge, fingernails or just about any sharp object.
The cuts maybe superficial, not even deep enough to draw blood, but will leave marks; or it may be deeper, actually penetrating the layers of skin and drawing blood leaving noticeable scars.
Other forms of self injury include burning the skin, head banging and even more severe forms such as breaking bones.
It is estimated that close to 80% of self-injurious behavior in adolescents is cutting.
In listening to youth who do engage in cutting, one finds that the motivations behind this behavior are functional.
One of the more common motivations is to blunt or redirect awareness from seemingly unbearable emotional pain to objective and captivating physical pain.
Another common functional motivation is to feel some sense of control over the pain in their lives.
That is, if they are going to feel pain, at least let it be pain that they have created.
Cutting as a form of self-punishment is not uncommon.
Another motivation expressed is a more symbolic experience of releasing emotions.
By cutting and releasing blood, they are, in effect, purging their painful emotions.
Bloodletting is a practice not without historical precedent.
Understood in this light, cutting is a coping mechanism.
Cutting is not a suicidal gesture.
In fact, it is just the opposite; it is a functional behavior designed to make living more tolerable.
In this sense, it can be considered a form of self-efficacy rather than any kind of genuine self-destructive behavior.
Self-efficacy is defined as "..
..
capabilities to produce designated levels of performance that exercise influence over events that affect their lives" (Albert Bandura).
Certainly one of the more common themes of cutting is the control it gives a person over their own experience.
The question that arises for mental health providers is how best to respond to a youth exhibiting self-injurious behaviors, specifically cutting.
Despite the functional intention of coping in this way, cutting can be dangerous; and, there are alternative ways to cope which are safer.
If a provider is interested in helping a youth find alternative coping methods besides cutting, they will need the cooperation of the youth.
Despite not being considered an evidence-based intervention, "rapport" is the most important ingredient in getting a client's cooperation.
Without building rapport, the counselor, therapist, or even a parent, will not get the allegiance that will be needed to work together in finding and applying alternatives.
Getting upset, getting mad, making demands and generally being authoritative or coercive will not help; that kind of communication may be partly responsible for the cutting in the first place.
With a supportive and empathetic approach, the youth will disclose not only their pain but also how cutting helps them.
Just talking about it with someone who listens without judgment can itself be transformative.
From there, alternatives can be discussed.
Alternatives that have been successful for some are placing and holding an ice cube where they might normally cut, on the arm or leg; placing a rubber band around the arm or leg and then snapping it can sometimes replace the act of cutting.
Drawing red lines on the arm or leg, or wherever they tend to cut, has been effective for some.
More aggressive alternatives may also work such as using a punching bag, or hitting a mattress, a hard run, skipping rope, or any strenuous physical activity.
Relaxation methods can, for some, be useful, such as listening to soft music, taking a warm bath, going for a walk or doing yoga.
Creative activities such as journaling, painting, playing a musical instrument or working with clay are also viable alternatives to cutting.
If the rapport has been built and there is an alliance, the youth will likely be willing to give some of these alternatives a try.
They may even come up with their own safe and efficacious alternative.