Self-harming behavior isn’t good, but it’s not 100% bad either. Let me explain.
The idea that there are benefits to self-harming behavior may seem confusing, perhaps even counterintuitive to some. However, people generally do not engage in behaviors of this nature unless there is a payoff. Fortunately, the payoff becomes less reinforcing over time and may last for mere seconds.
When I work with clients who self-harm or who engage in maladaptive coping mechanisms (whether by drinking, drugging, restricting, bingeing, cutting etc.), our work always begins by identifying the purpose these behaviors serve. Typically, my clients report that self-harmful behaviors provide an escape from reality, a temporary feeling of being in control and/or a sense of calm, etc.
Please hear me loud and clear: In no way am I condoning these behaviors! Rather, we need to understand the role they serve so behavioral change can begin to take place. In DBT, we use a skill called “Pros and Cons” that begins to analyze the benefits versus the risks of tolerating distress (i.e. not acting out) versus not tolerating distress (i.e. acting out / self-harming). I encourage my clients to work on this skill when they are in a rational state of mind. Therefore, when an emotional wave hits, they can easily access their pro/con list and hopefully shift the choices they make.
For the most part, when clients enter my office, they are fluctuating between escapist behavior via self-harm and the very negative impacts such behavior has on their day to day functioning. For many, they have been caught in this cycle for quite some time. A crisis or an event (i.e. a relationship ending) leads people to seek professional help. Over time, my clients begin to see that the benefits of self-harmful behavior are extremely short-lived and quickly lead to long term suffering, often with dire consequences. As this awareness builds, clients often report that their self-harmful behavior quickly loses its allure. Giving up self-harming behaviors can be quite scary for clients, so we work on replacing such behavior with DBT skills, aimed to effectively navigate distress and ride emotional waves.
In DBT skills class, we teach a host of emotional regulation and distress tolerance skills to help clients cope with the pain of their reality. During this time period, it is critical for clients to understand that simply because they are not self-harming, does not mean that life suddenly becomes a bed of roses. In fact, they begin to learn to cope with whatever life is dealing them – the good, the bad, and the ugly. We work on radically accepting the pain that life may be bringing in that given moment. They learn that pain is inevitable, but with support and skill usage, they can get through those difficult times without self-harming. They also learn that suffering is self-created when they choose to act out in maladaptive and self-harming ways. As therapy progresses, and as clients increase their window of tolerance to deal with life on life’s terms, they also begin to report a sense of emotional freedom and mastery…. and this is how we begin the process of building a life worth living.
