There are some topics that seem to come up often in DBT skills coaching group (Friday's 4-5pm PST, come join us!) One of them is Self Harm. Content Warning- brief discussion of physical self harm only in next sentence. When most people talk about self harm it typically involves cutting or injuring oneself without the goal of suicide.
I have created my own definition of self harm, as harming oneself in the mental health realm goes far beyond a physical way of harming. Self harm is any behavior that is harmful to one self. Once again this is my own definition, not a diagnosis code, just my own opinion on what I consider self harm when working with clients and students teaching DBT. I have heard similar things referred to as Treatment Interfering Behaviors (TIB) in DBT or self-defeating behaviors. I prefer the latter myself, TIB is a bit outdated and can feel blaming.
So what does this definition include that the original definition does not?
Self Sabotaging: This could include leaving a healthy relationship before the other person you perceive will leave you. Not allowing yourself to grow within a company you work for, getting to a point in a goal and then choosing to not move forward or doing something that gets in the way of your success maliciously. This is the one that comes up in skills coaching that people are like wow, yup that's me!
Choosing Poor Self Care: This isn't forgetting to take meds occasionally, or going through a depressive episode and not having the best hygiene. This is a choose to skip meds that help you, not eating to sabotage a mood or punish yourself for something. Many find they do this when things are going well or the feeling of waiting for "the other shoe to drop" or don't deserve to be happy or healthy.
Denial and Minimizing Issues: We all have things we would rather not talk about or deal with. This refers to knowing but not acknowledging the severity of an issue. By doing this your needs aren't being met.
There are other things that as you read this might "click" as things you may do that interferes with meeting goals as well including procrastination. This isn't to give out labels, or to self-diagnosis (back away from the Facebook "What Mental Health Diagnosis are you?" quizzes please!) but to maybe see another side to behaviors some people blow off or have not yet realized are a problem.
So now what? What can you do to begin working on these behaviors and habits. Recovery isn't linear and takes time.
Here is a mindfulness approach to overcoming this from Dawa Tarchin Phillips on Mindfulness.org (full list in this article) which is fantastic and very much DBT-like.
1) Inquire and identify repetitive thoughts and behaviors.
Use the lamp of awareness. Pay keen attention to the present moment to recognize and acknowledge any negative self-narratives, defeating attitudes or repetitive behavioral patterns. Challenge your negative self-talk. Don’t identify with it or become it. Thoughts are not facts, they can always be changed. The same holds true for attitudes and behaviors. You are not defined by your behaviors. You have the power to change your actions at any time. Choose to empower yourself with clear decisions and commitment.
Thoughts are not facts, they can always be changed. The same holds true for attitudes and behaviors.
Many of us are held back by our lack of wherewithal and clear stance when it comes to habit change. While trying to change exacerbates will power and undermines motivation because of divided efforts to maintain both the current status quo and reach for a new one, committing to change sets free new resources and activates non-linear transformational processes because we have fully released our past modus operandi and are embracing a new way of being altogether. If you want to take the island, burn the boats.
Try This Practice for Committing to Change:
Try it for yourself, write down one habit change you want to make and are willing to fully commit to. Then call up and meet with three people you love and respect and tell them that you are unconditionally and fully committing to the change you are declaring. Repeat your commitment out loud at least three times while looking into your friends’ eyes and shaking their hand with confidence. Observe how your nervous system responds to the experience and commitment you are making. Let the commitment be total with no back door. Examine the effect on your life.
2) Get out of “I – am – ness” thinking.
Most suffering stems from problems that are associated with a limited perception of self, a perception that holds the self as separate from the rest of the world and that generally is occupied with its survival or reification. When we break through self-centered thinking and take a fresh look at problems or situations as a whole, without personal attachment to a single viewpoint or limiting self-associations, we can begin to see solutions more clearly, without the emotional prejudice that can distort or fixate a problem.
Try this simple practice to get out of “I – am – ness” thinking:
Imagine for a moment your friend is the one going through the crisis, not yourself. Imagine listening to your friend explain the problem, and then imagine yourself giving feedback and offering helpful solutions. You are now problem solving from a caring, altruistic and unbiased perspective, and more likely to provide helpful insights and answers to the dilemma. What would your advice be to your friend in a similar situation, what perspectives or solutions would you offer or propose?
3) Maintain focus on your goals and frame them for mastery.
Focusing on your goals will help give perspective on the situation at hand and aid in altering whatever negative self-talk presents itself. A study examining over 2,000 participantsstressed that achievement goals strongly influence positive versus negative self-talk. Goals keep us focused and can emphasize ongoing improvement over perfection. Termed mastery goals, such improvement-focused goals release performance angst and stimulate motivation for personal growth. Remind yourself frequently of your mastery goals to reinforce positive traits that will mature toward your ideal outcomes.