NUMBER 369• 2 OCTOBER 2003 • SELF-INJURY
INDEX OF QUOTESReferences
As child and youth care workers, we care about children. We see troublesome behaviors but not troublesome people. If, as Thom Garfat has suggested, we choose to believe that every behavior serves a purpose, then we need to understand that behavior. But to understand is not to condone. Viewed in this way, self-mutilation is very much like all other behaviors that bring young people to the attention of professionals. While we might see how particular coping mechanisms are harmful or self-defeating, we must also recognize that the youngster is still coping in a way that makes sense to him or her (Bertolino & Thompson, 1999).
If we opt for a competency-based approach, then we need de-romanticize and de-pathologize the behavior by focusing on the act, rather than becoming involved in the confusion of the actor.
This means that we must prepare ourselves to cope with the visual and emotional aspects of physical self-mutilation just as we learn how to deal with any other form of acting out behavior. In all cases, front-line staff require, and deserve, effective professional training and personal support. In the final analysis it is important to ensure that these practitioners feel confident and competent in what they do, not only for the youngsters with whom they work, but for themselves (Krueger, 2000).
On a personal note, I remember vividly my first encounter with a youngster who was physically self-harming. She was sitting in her bedroom in the dark, systematically cutting her forearm with a razor blade. I was horrified and fearful. I was concerned for her safety, but initially I was concerned about my responsibility in allowing her to access a razor blade within the residential unit. I was overwhelmed by the possible consequences and had no idea how to respond to her pain and my confusion.
Following this incident, my supervisor introduced a policy on responding to incidents of physical self-mutilation. In a nutshell, were to stop it — to physically intervene and prevent the youngster from bodily damage. Over the next ten years we were given several different protocols for intervening with youngsters who self-harm. In this evolutionary process, the first step was to move from physical intervention to physical proximity supervision. After a youngster self harmed, she or he would have to remain within arms reach of a youth care staff for a length of time determined by the degree of self-harm and the frequency of the episodes. In fact, this evolution in our thinking and practice was very similar to that currently taking place in hospitals and mental health facilities across North America and Europe (Favazza, 1992).
Shaw, K. (2003). A youth care approach to working with youngsters who self injure. Relational Child and Youth care Practice. Vol.16. No.2 pp 11-12
Favazza, A. (1992). Bodies under siege: Self-mutilation in culture and psychiatry. London: Johns Hopkins University Press.
Krueger, M. (2000) Central themes in child and youth care. retrieved October 25, 2002 from http://www.cyc-net.org/cyc-online/cycol-0100-krueger.html