Self-injury support groups
Guidance for HCPs and organisers
Guidance on running or supporting a real-life group
We are frequently asked for guidance from people wishing to set up and run a real-life support group for people who self-injure. Running such a group is more complex than might be imagined, and in our experience we have found they often fail to continue after an initial flurry.
The guidance we give below may at first feel a little negative, but by being aware of potential problems we hope you can address such issues from the outset and give your group the best possible chance of success.
Things to be concerned about:
- The possible perception that members need to be self-injuring in order to stay a member or get support / attention;
- An active focus on self-injury itself rather than the complex and varying reasons behind self-injury which should really be the focus of attention.
- Consideration of how to completely end the group, or move people out of the group;
- Risk of increasing self-injurious activity due the possible perception that wounds = emotional pain = attention;
- Risk of self-injury becoming a ‘competition’ between members who need to feel their pain is as valid as others.
- Strong relationships between two members may develop into a co-dependent relationship built on continuing self-injury;
- Strong relationships between two members may develop into a co-dependent relationship built on recovery, that could ‘break’ if one person resorts to self-injury during a time for stress;
- Risk of marginalising people who need support, but don’t want to ‘out’ themselves by joining a group;
- The exclusivity of the group may foster feelings within members that ‘outsiders’ “cannot understand what we’re going through”;
- A defined group could possibly label the members, creating a ‘target’ for bullying;
- The exclusivity of a ‘self-harm group’ begs the question as to how people affected by other matters are supported. Bullying? Abuse? Violence? Depression? Anxiety? Mental ill-health? Low self-esteem?
Things to consider:
- Will your group be user-led or ‘expert led’?
- If user-led, what additional support will the leader(s) have?
- If expert led, how will you engage members so that they are involved in the running of the group?
- Who will have access to your group; will it be self-referral or professional referral?
- How will you create, distribute and enforce the rules?
- Will you enforce a ‘no-harm contract’ whereby members are never allowed to hurt themselves while members of the group? (We would suggest no. LifeSIGNS does not feel no-harm contracts are beneficial, and may even be damaging)
- How will you encourage open discussions without allowing some people to dominate the group, and others to remain withdrawn?
- How will you help people focus on emotional processes rather than discussing self-injurious activities and methodologies, which will be triggering?
- How will you discuss triggers? How will members express their discomfort? How will you ensure that calling a topic ‘triggering’ isn’t a method of simply shutting down a topic?
- How will you avoid turning self-injury into a competition? How will you protect members from feeling their self-injury is less valid than others? Will your rules include a ban on visible scars and wounds?
- How will you deal with negative people who aren’t prepared to help themselves?
- If someone becomes overly distressed during a session, how will you provide a safe environment for them to be in until they feel safe to return to the world?
- How will you manage confidentiality issues? What will you do if someone expresses a desire to commit suicide?
- How will you measure success? How will you record lessons learnt?
- How will you introduce new members to an established group so that everyone feels comfortable?
- What will you do if a member has been ‘missing’ for one session? What about two, three?
- How will you manage and work through interpersonal aggression (arguments and dislikes)?
- How will you manage complaints?
- If self-injurious behaviours increase during or after the period that the group exists, what extra support will you offer?
- What records will you make and how long will you keep them, considering the Data Protection Act? Will full names, first names or nick-names be used?
- Is there a framework or methodology that you’ll adhere to?
- What reference materials will you rely on? We would suggest:
How ever you choose to run your group and whatever rules and protective measures you put in place, you will be working with vulnerable people who may be unpredictable. It’s not easy running any support group, whatever the nature, and it can be emotionally draining. It’s important to ensure that those doing so have access to proper care, support and de-briefing for themselves.
If you have any specific questions regarding this guidance, or if you’d like to share your own experiences with us, please firstname.lastname@example.org
Professionals working with people who self-injure might benefit from our Training Package. www.lifesigns.org.uk/services/training