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You are here: Home / All Posts / 5 critical missteps in helping self-harmers

5 critical missteps in helping self-harmers

November 2, 2017 by Dr. Kristin Kellen

When we think about the issue of self-harm, most of us take a step back in confusion. Why would anyone willingly want to inflict pain on themselves? Isn’t that dangerous? What would I do if I encountered someone with that struggle?

A few months ago, I shared about why people engage in self-harm behaviors and how to help them stop. In particular, that article touched on issues such as motivations for harming oneself as well as some practical approaches for ministering to that life struggle. In this article, I share five key mistakes of pastors and counselors as they seek to minister to those engaging in self-harm. In other words, the previous article pointed to things we should do, while this article will solidify what we should not do.

Mistake #1: Listening only to respond, rather than listening to hear and understand

When most of us engage in conversation, in the back of our minds we are formulating a response as the speaker speaks. But the danger in doing so is that we are listening to respond rather than listening to hear.

Consider this: A young woman says to you, “I cut myself because I can’t handle my life situation.” A typical response we may have already formulated is “That’s not the right way to deal with a struggle” or “Life can’t be that bad.” But those responses act as confrontation rather than sympathy and understanding. In her statement, although she may be sharing the motivation for her self-harm, what she is really communicating is “I am so overwhelmed that I do not know any other way to handle these emotions.” The proper response, then, is to acknowledge that struggle and understand her statement. The first response focuses on the hearer, the second on the speaker.

It is important to note here that many who self-harm do so because they believe no one really understands their struggle. Therefore, as pastors and counselors, our first responsibility is to extend empathy before instruction; we must seek to understand before we seek to correct. It is foolish to work toward a solution before understanding the problem. Just as I wouldn’t start tearing away pieces of my car’s engine before understanding the actual problem, so too we shouldn’t seek to “fix” individuals without truly understanding them.

Further, self-harm behaviors always point to something greater, and in order to minister well, we cannot neglect that underlying issue. In the example above, a helpful response might be, “Help me understand what is so overwhelming.” Or, “What makes this more than you can handle?” Essentially, we must seek to understand the reason for the struggle rather than simply fixing the outward expression of that struggle.

Shepherding doesn’t stop when professional counseling begins
by Dr. Jeff Forrey

If you are working with someone who is receiving therapy from a secular perspective, your role as a shepherd doesn’t end. You need to keep in touch with the person because you know that the Scriptures will not be part of addressing the self-harm.

Therefore, pastoral debriefing is critical for the believer in this situation. Here are some thoughts on what the debriefing sessions might entail:

1. Find out what approach to psychotherapy is taken (e.g., with self-harm, Dialectical Behavior Therapy, Emotion Regulation Therapy, or Cognitive Behavioral Therapy might be suggested). The pastor can then do some research to find out what are the general goals for such therapy. This is little different from a pastor learning about medical or surgical treatments as part of ministering to someone in the hospital. Though new psychotherapy models will be created and older models will evolve, one resource that describes some very common secular psychotherapies is Stanton L. Jones and Richard E. Butman, Modern Psychotherapies, 2nd ed. (Downers Grove, IL: IVP, 2011).

2. Ask questions about the counseling conversations to better understand how the therapist is trying to accomplish therapy goals with the person.

3. Think through how the goals of the therapist relate to the Bible’s teaching about what goes on in the “heart” (in terms of how the person’s motivations, desires, and goals compare to God’s design and purposes) and about spiritual growth (in terms of what it means to reflect Christ’s character).

4. Over time, as the therapist identifies goals and offers strategies to the self-harmer, think through:
(a) What does the Bible say about the problem issues identified by the therapist (self-esteem, guilt, etc.)? For example: Suppose the therapist identifies “self-esteem” as an issue to tackle with the person. From a secular perspective, self-esteem revolves around how an individual views himself or herself. Yet, biblically, the way people view themselves is not an end in itself. Instead, people’s self-evaluations must be submitted to what God says in His Word about His relationship with His children and their roles in His kingdom service. Any perceived negative qualities in a person’s life will need to be discussed in the light of these larger biblical themes.

Secular approaches to self-esteem will assume it is a primary motivator for a “well-adjusted life” that precludes self-harm. For the Christian, however, the primary motivation is seeking first the kingdom of God and His righteousness.

Therefore: (b) How does the self-harmer think about God, His Word, His promises, etc., in times of temptations to harm and afterward? The greater the extent to which the person’s thinking and choices are not shaped by the Scriptures, the more vulnerable the person will be to temptations.

Mistake #2: Assuming the counselee can “just stop”

I recently watched a parody of a counseling session in which Bob Newhart was the counselor. As he sought to “help” the counselee, he told her that his two words would fix all of her problems. Waiting for something profound, the counselee was surprised when he yelled “Stop it!” Every problem she shared was met with a loud “Stop it!”

The humor of a counseling session such as that comes from the foolishness of assuming every person can simply “stop” unwanted behaviors. But that is the approach of many pastors and counselors when it comes to the issue of self-harm. We foolishly believe that we can convince counselees to simply stop hurting themselves.

However, the nature of self-harm in many ways mimics the nature of addiction: self-harm behaviors become those that are alluring, they provide an escape, and the behaviors become difficult to break free from. Just as you wouldn’t tell an alcoholic to “just stop” drinking, so too you cannot tell people to “just stop” harming themselves.

In Scripture, particularly in passages such as Colossians 3:5–17 and Ephesians 4:22–24, we see what’s called the “replacement principle.” In these passages, Paul tells believers to put off particular behaviors and characteristics, but also to put on godly behaviors and characteristics. He tells readers to get rid of something sinful and replace it with something godly. In the same way, pastors and counselors cannot instruct counselees to simply put off self-harm behaviors without also replacing them with something greater: a stronger motivation.

Mistake #3: Dealing only with the behavior rather than thoughts and motivations

In Luke 6:45, Luke quotes Jesus, saying, “The good person out of the good treasure of his heart produces good, and the evil person out of his evil treasure produces evil, for out of the abundance of the heart his mouth speaks” (ESV). What is Jesus getting at here? He’s saying that, ultimately, our actions flow from what is in our heart. Therefore, if we want to deal with a person’s external behaviors and actions, we must deal with the heart. While behavior change matters, we must not stop there.

One of the key ways that pastors and counselors can help those engaging in self-harm behaviors is to put practical safeguards in place; perhaps this is removing any objects of harm or maintaining a level of supervision. These are at the level of behavior change. But while these address the action of self-harm, these safeguards are ultimately insufficient. We must deal with underlying thoughts and motivations, rather than just the behavior. Earlier, I noted that self-harm always points to something greater; we have to dig into the underlying thoughts, motivations, or desires that are driving the destructive behaviors.

Mistake #4: Not incorporating help from those professionally trained in this area

Pastors without experience dealing with the issue of self-harm don’t have to enter into the self-harmer’s life alone or blind. Rather, they can come alongside professional counselors or therapists who have been specifically trained in this area. Those professionals will better understand what sorts of questions to ask, potential red flags, and practical strategies for dealing with these harmful behaviors.

Ideally, any professional counsel given would come from a biblical worldview; however, that is not always possible. However, even with secular therapy, a pastor has the opportunity to supplement that counsel. For instance, the pastor can delve into issues like what the Bible has to say about their self-harming behaviors or how the desires of their heart might be motivating their actions. Or, the pastor can bring to light what it means to grow in Christlikeness as it relates to their self-harm. In this way, then, the pastor is able to work as a part of the care team.

Mistake #5: Failing to connect the gospel

The message of the gospel gets at the same thing: heart change. Ezekiel 36:26 tells us that God will give us a new heart. He doesn’t say that He will make us act better. Rather, our hearts change to align with God’s; our desires and motivations change to be like His. That heart change, then, results in behavior change.

Beyond heart change, though, the gospel message also serves as the motivation to end self-harm behaviors. Christ was harmed so that we wouldn’t have to be. Isaiah 53:5 says that “he was pierced for our transgressions; he was crushed for our iniquities; upon him was the chastisement that brought us peace, and with his wounds we are healed” (ESV). Quite literally, Christ’s wounds were inflicted so that ours wouldn’t be. His blood paid for us so that our blood would not have to be shed.

For the young man or woman who engages in self-harm, this message should bring both hope and motivation. Not only did Christ suffer on our behalf, but God’s Word teaches us that He brings us peace. Many who self-harm experience great turmoil in life; they have no peace. But they miss the part of the gospel message that they now have peace with God because of Christ’s suffering, despite our sin. We must not miss that message in our ministry to them.

Finally, the gospel reminds us that we have been bought with a price. Christ’s suffering wasn’t for nothing; He purchased us, including our bodies, on the cross. We are not our own. In many ways, my body is not mine to harm, a truth that holds true for the one who struggles with the tendency to self-harm.

Ministry to those who self-harm can be messy and at times can be confusing and frustrating. But in understanding these pitfalls, and being careful not to fall into them, we are able to walk alongside those who are suffering and lead them to peace. Ultimately, that is what they are searching for. As pastors and counselors, we can lead them to the True Peace, the person Jesus Christ.

Footnotes:

We also encourage you to read Dr. Kellen’s article Why Do People Cut Themselves? And How to Help Them Stop to help you better understand and minister to people who engage in self-harm. CareLeader.org also has a series of articles on listening well.

Kristin
Dr. Kristin Kellen

Dr. Kristin Kellen serves as an assistant professor of biblical counseling at Southeastern Baptist Theological Seminary in Wake Forest, NC. Along with teaching, she specializes in counseling young women and their families.

Filed Under: All Posts, Emotional & mental health Tagged With: Biblical Counseling, counseling mistakes, cutting, Dr. Kristin Kellen, guest post, self-harm

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