Self-Harm as Purposeful

In February 2025 I invited ‘unanswered questions’ about self-harm and throughout March 2025 and beyond I will be responding to these questions in a series of blogs. In these blogs I draw on my personal and professional experience, as well as survivor and academic literature. The purpose of these blogs is to bring together a range of perspectives and pose ideas and questions for further reflection. I welcome feedback and questions – thanks for reading!

The Unanswered Question(s): Should you tell someone to stop self-harming?

About 10 years’ ago I was taking part in a national conference of grassroots self-harm support services. Those of us running and using self-harm support services spent two days together talking about innovation, best practice and the glue that holds our services together – turns out it’s tea, biscuits, dark humour and transparency.

Towards the end of the event, someone from another service came up to me and said,

‘You know what the best thing about this event is? – I don’t have to start every conversation with a justification of our approach, because everyone here is on the same page.’

The approach they were talking about was one that was very familiar to me, as was the experience of having to explain it, justify it and defend it.

Just Say No

It’s a common assumption when you tell people you run self-harm support services that your focus is on getting people to stop self-harming. It also really brings people up short when you say no.

No, we don’t have that expectation.

No, we don’t set the agenda when people are looking for support.

As a society when we see someone doing something that makes us uncomfortable, or seems harmful or even antisocial, or, if we’re willing to admit it, makes us angry or seems too difficult to deal with; we tell them to stop.

And in the moment, if something is imminently dangerous, then stop is an appropriate immediate response. But the thing about stop is that it shuts things down, it’s the end of a sentence, the end of a conversation. There’s no space in stop for what or why.

And truthfully, what do any of us feel when we’re told to stop doing something that’s meaningful to us? Do we think oh yes, good point, I won’t do that again? Or do we feel that we’re doing something unwanted, that we’re being a nuisance, misunderstood, unseen, unheard, shamed and ashamed?

The Risks of Being Vulnerable

When someone approaches a person or service for support around self-harm, they’re really making themselves vulnerable. Unfortunately, it’s still that case that in many places there’s no guarantee of a positive, constructive response and reaching out for support might result in dismissal, ridicule, hostility or even inadequate or punitive delivery of medical treatment.

Everyone’s self-harm exists in a context, with a person, a life, hopes, dreams, struggles and all the rest of behind any attempt to connect. When someone reaches out for help around self-harm and is dismissed, it’s not just their self-harm that’s dismissed, but their vulnerability, their context and their humanity. Reaching out for help is risky, regardless of whether it’s the first or thousandth time.

When someone reaches out to make that connection and the response is ‘stop’, it’s not self-harm that stops. What stops is the hope of making a meaningful connection and of being met and accepted where you are. What stops is the opportunity to be one of the many steps along the way to something different, that many people seeking support around self-harm are looking for.

What is Support For?

Research shows and my own personal and professional experience certainly back this up, that feeling heard and validated, and being able to form a supportive relationship are key for people who want to better understand their self-harm. And for these things to happen, they need to be fostered in an environment that offers, but does not demand, trust, acceptance and no judgement.

Support that focuses only on stopping misses the mark in every way if you are trying to provide any of these things. Support that focuses only on stopping has already made a huge judgement about the validity, meaning and purpose of someone’s self-harm and their wider context before even meeting them. Support that focuses only on stopping centres the aims and needs of the service. Support that focuses only on stopping doesn’t have space for curiosity, learning and the power of other potential positive outcomes.

It’s hard to think about stopping if you don’t feel seen, heard, validated.

It’s hard to think about stopping if the agenda has already been set before you’ve walked in the door.

It’s hard to think about stopping if you’re confident you’d fail at the first hurdle.

Carrying On With Life

For many people I’ve worked with, self-harm has been not solely a negative experience or a problem, but something that has helped them to cope with unbearable experiences, function when overwhelmed and keep them alive.

The fact that there are so many theories about the functions of self-harm only serve to underscore the fact that it’s a multi-faceted, complex experience and any one size fits all approach such as ‘just stop’ is very unlikely to facilitate meaningful change. What it might mean is that people hide what they are doing, stop seeking out support or change the way they self-harm so it’s less obvious.

A focus on ‘making people stop’, without acknowledging and honouring the role of self-harm in their lives, risks not only alienating people from support, but removing something that is preventing them falling into a crisis or keeping them alive. In the same way that it’s clearly established that making someone who is alcohol dependent suddenly stop drinking is highly dangerous, it’s important to acknowledge that requiring someone to suddenly stop self-harm can also have serious consequences.

Self-harm as a way to refrain from acting on suicidal urges comes up frequently in self-harm peer support spaces. Bristol Crisis Service for Women’s seminal research found ‘it was often a means of carrying on with life ’ and the Cornell Research Programme on Self Injury and Recovery points out that self-harm is often used as a coping strategy for preserving and enhancing life.

Other Ways to Offer Support

I want to be clear that I am not saying there is no place for supporting people to stop using self-harm, because there absolutely is, and for many people that is their goal. What I am saying is that for some people, the idea of stopping is challenging, or scary, or impossible, that a service which has that as the key goal has excluded them already. There are many other life-changing ways to support people around self-harm which do not involve ‘making them stop’.

You can offer support to feel less distressed or more in control; to better understand personal triggers, patterns and cycles of self-harm, ways to delay self-harm, distractions from self-harm, activities that offer displacement from self-harm, alternatives to self-harm, reducing damage from self-harm, self-advocacy when seeking treatment, damage limitation following self-harm and first aid.

People can and do live fulfilling lives whilst also self-harming, and research shows that focusing purely on stopping self-harm can set people up to fail and actually stand in the way of positive changes and therapeutic progress.

Moving Away From Moralising

In the introduction to ‘Hurt Yourself Less ’, a self-help guide focused on self-harm management written by people with personal experience, psychiatrist and researcher Phil Thomas reflects on the way professionalised responses to self-harm. He points out that the approach of seeing self-harm as unacceptable and something to be stopped as ‘disguises a set of moral judgements about the nature of the act.’

The guide goes on to outline a range of exercises that the people writing it have found helpful in understanding their self-harm, as well as clarifying (p58-59) that people in support roles shouldn’t ‘try to stop us and “save us from ourselves”’.

What do they say is helpful?

‘LISTEN and CARE.

Respect us and treat us with dignity.’

It’s easy to focus on stopping as the main or only goal without pausing to think about what that means and who that will serve. If someone is seeking your support around self-harm and your first instinct is to tell them to stop, take a step back and consider:

Why are you telling them to stop?

What does stopping mean for them?