How can I support my friend who self-harms?

Dear Painfully confused, 

Your concern for your friends and your willingness to reach out for support is admirable, so thank you for your question. Discussing self-harm, the act of purposely harming oneself, requires care and sensitivity. People may self-harm for various reasons, ranging from seeking relief to communicating their needs to others. If you feel comfortable, it may be helpful to let your friends know you understand by sharing your own experiences with self-harm and how you stopped. While you may encourage your friends to reach out to a health care provider, you may also choose to seek support for them if the situation is life-threatening.  

Rather than viewing talking to your friends as a confrontation, consider it a conversation. You’re there to show your support and concern, not force or threaten them to stop their behavior. While you may suspect why your friends are self-harming, use active listening skills to hear what your friends have to say. While your own self-harm may have stemmed from one thing, theirs might have come about for an entirely different reason. Some reasons a person may be self-harming include to: 

• Manage or distract from negative emotions. 
• Feel a sense of control. 
• Communicate to others. 
• Punish themselves. 

List adapted from Mayo Clinic 

Listening to your friends and asking them how you can best be there for them may show that you care. It may also be the support that they need; since not all people respond to support in the same way, this may give them the opportunity to explain what they need or how you can help. When approaching a conversation that may be a bit difficult, try using a variety of strategies to make everyone feel more at ease. This could include thinking about things like:  

• Location: Choosing a private location may help make your friend feel safe and comfortable. 
• Body language: If your friend is willing to talk with you, use active listening skills by maintaining eye contact and nodding your head. If you and your friend are comfortable with it, you may offer a hug or to hold their hand. In addition to moderating your own body language, pay attention to your friend’s body language. If they show signs of distress, try reminding them that the conversation can end whenever they want and that you’re not there to push. 
• How much they feel comfortable sharing: If your friend is open to discussing, let them share what they’re comfortable sharing—this may not be much at first. In fact, this conversation may be one of many and it may take them a bit to feel that you’re a safe person to open up to. Try to avoid interrupting them when they speak. If it feels appropriate, ask encouraging but respectful questions.  
• How you can support: Ask your friend what you can do to support them and reassure them that you’re there if they need you. This also means thinking though your capacity to support. Understanding your own history with the same behaviors, it might be helpful to put boundaries on conversations or types of support if you feel yourself being triggered by the experience.  
• External sources of support. Encouraging them to seek help from an external source could also be helpful for your relationship. Consider sharing resources that could offer them more consistent, long-term support or treatment if necessary.  

Some resources you may choose to share with your friends may include: 

• S. A. F. E. Alternatives 
• Cornell University’s Self-injury & Recovery Resources 
• The Trevor Project’s Support for Self-Harm Recovery 
• Crisis Text Line 
• Substance Abuse and Mental Health Services Administration  

You’re showing a lot of kindness and compassion for your friends during this time. While you’re doing that, keep your well-being in mind as well. If discussing self-harm with your friends is distressing or even triggering for you, you may also benefit from reaching out to a mental health professional or utilizing the self-harm resources yourself. 

These conversations can be challenging and upsetting, but reminding your friends that you care about them may bring them more comfort than you know. 

Wishing you and your friends all the best,