What to Say to Someone You Love Who Has Self-Harmed

Last Wednesday I self-harmed for the first time in almost two years, and I noticed a similar thing happened to the last time: a very well meaning and dear friend, in their shock and own pain at what I’d done, inadvertently made me feel more guilty and invalidated than I already felt.

This made me think, what if I could come up with a clear, simple list of things to say and also not to say to a loved one who has just self-harmed.

Self-harm is still a very taboo subject. It is one of the topics that understandably gets the most trigger warnings (see above), so as to not give anyone unhelpful ideas. But also it gets a visceral repulsion from the general population and a fear that comes from a lack of understanding of the intensity and nature of the psychic pain that would lead someone to engage in such an action. In other words, much more understanding of the self-harmer’s experience is urgently needed.

It is understandable that loved ones would be shocked and pained when they are told. The way I told my two friends was very blunt and almost sounded casual, especially in the toneless text format. Generally our loved ones really do love us and want us to prosper, not to be harmed. The best intentions are there, but perhaps what is missing is an understanding of how sometimes the pain is too pervasive, and we feel too attacked or invalidated by our relationships, and often by the world itself. Therefore, the strategies to avoid we’ve used many times before can’t reach us in that moment.

Rather than to go into the specific detail of the triggers that caused my recent self-harm, I can outline some classic borderline personality disorder (BPD) issues that were at play such as interpersonal conflict, rapidly changing emotions, feeling the pain of someone you feel you have pained and not being able to tolerate this distress, the resulting extreme stress which led to dissociation, and of course the big bad wolf of BPD; real and imagined abandonment fears.

Here is what I came up with to share with my friends and for anyone out there who has a loved one who struggles with self-harm. I hope I’ve also done some justice to the varied experience of anyone who self-harms. It is my intention for this to be from a place of love, not criticism.

1. Validate the extreme pain the person is in.

No matter how shocked or horrified you are by the action your friend or loved one has just confessed to, tell them you are sorry for how much pain they are in, even if you don’t understand it and especially if you are disappointed by the capitulation of their action. Acknowledge that the overwhelming problems in their life, the (likely) mental illness they are dealing with, and again the pain they are experiencing as enormous. And don’t tell them that what they did is not OK.

2. Validate how well your friend is doing.

This will be the furthest from where the person in this level of pain feels they are. But it is powerful to hear from someone we trust and love how hard we are fighting.

3. Provide unconditional love and support.

Again, try to push aside any revulsion you are feeling and tell the person how much you love them, and crucially that this love is not in any way lessened. I think the more direct the better.

Try: “I want you to know right now how much I love you and will support you to get better in any way possible.”

When you self-harm you often feel unlovable, defective, hated even and that not a living soul cares for you anymore. Speak into that distortion with love. Also tell them what they specifically mean to you and the difference they make in your life, and the value they have even in the world itself.

4. Communicate your sadness about their pain, rather than disappointment in what they’ve done.

It is understandable and OK that you are upset by what your loved one has done. I want to validate your experience also. But the key is to communicate this more in the sense that you are sad they are in so much pain, rather than disappointed by the self-harm itself. Also remember this pain is overwhelming and excruciating. Your loved one has probably used many skills in the past to avoid self-harm, but this time everything became too much. The act itself has many possible causes and purposes. For me it is always an externalization of internal torment as well as a way of saying enough is enough — the pain and external pressure is more than I can bear. Therefore, realize that even if the act itself may repulse you, there is usually an emotional self-regulation or release purpose to it. We wouldn’t do it if the pain wasn’t unbearable.

5. Ask how they want you to help them and then listen.

This is something that is easily missed especially by fix-it people (and these are many). Surrender this desire to fix the person in pain and instead ask and let them tell you how they would like to be helped. Of course sometimes the person in agony will defer to their friends for advice, and in that case definitely give it. But the person who has self-harmed may already feel really guilty, defective, hopeless and frankly incompetent. Certainly this is how I usually feel. And so it can be empowering to hear, at our very lowest, our friends ask us how we would like them to help us. When you do this you also allow us to tell our story, including potentially what led to this happening. And this can make us feel safe and comfortable to articulate exactly what help we need from this point.

6. Focus on the present and the future, but not on the past.

The thing I probably reacted to the most was when my friends asked what happened to my self-harm avoidance strategies, such as calling people/emergency help lines or dialectical behavior therapy (DBT) distress tolerance skills, the ones I usually use. Of course these are good things in themselves and my friends’ intentions were very noble. But rather than hearing from say a coach who analyzes where their team went wrong in their loss, I simply need some radical acceptance that what happened in the past is past. I imagine this was part of my friends’ processing this harmful act of mine and maybe also their protest against it. But anytime you focus on what could have or should have been done to avoid this act, then there is the potential for us to feel like we are a failure and feel ashamed.

7. Encourage them to plan to seek help if they haven’t already. 

Firstly, you can ask if they need to see a doctor after their self-harm. After this, try questions about support and seeking the professional opinion of a therapist, or ask them sensitively if hospital would be an option. Certainly after my last self-harm I checked myself into hospital where I’m currently writing this from, and I feel much safer and stronger as a result.

8. If the person has chosen tell you, then they trust you.

This trust is very strong, even absolute, with this highly charged and exposing confession. Honor this trust. Feel affirmed yourself that you have been trusted so implicitly and assume the person loves you very much. This is not a pearl that you would cast to swines. Therefore, maybe consider thanking them for their trust in telling you and the privilege bestowed on your friendship.

9. Follow up.

The morning after is often crucial. Just check in with them. Ask again how you can help them and support them in getting help. And keep following up every day until they feel safe again. The period after is a very vulnerable time so the more support, even just through a message, is pivotal.

10. Be the friend you usually are to them.

Keep treating them as if nothing has changed in your friendship. Again, show them their value to you has in no way lessened, in fact it has probably deepened. Remind them again of what a great friend they are. And in everything, love.