As part of my work in an NHS Child and Adolescent Mental Health Service (CAMHS), I frequently work with families where self-harm and self-destructive behaviour are present for the young person. This blog post looks at how Non-Violent Resistance (NVR) ideas can be used to resist harm, increase safety and increase parent/ carer confidence in maintaining presence in the face of self-harm.
The experience of a child self-harming or making attempts on their life is one of the most difficult experiences a parent can face.
“I was so devastated and confused when I found out that my daughter was self-harming. My emotions were all over the place” (quote from parent – source www.charliewaller.org)
Omer and Dolberger (2015) describe that parents are often in deep distress, and are likely to lose confidence in themselves as parents, and in how to respond best. The child’s self-destructive behaviour may be hard for parents to understand, and parents’ reactions may include panic, anger or feeling helpless, which can lead to being passive or dismissing the threat. The parent’s trauma response to self-harm as a threat to someone close to them may lead to an immediate “crisis response”, and if self-harm and/or threats or attempts to end life continue over a long time-period parents may be in a chronic state of hyperarousal and hyper vigilance, which can lead to reactive responses. Parental presence can also be eroded by the involvement of professionals, which in some situations can lead to parents feeling blamed or inadequate and further impact on parents’ ability to maintain presence with their child. Another relational consequence of self-harm can be parents’ experience of “walking on eggshells”– parents feeling organised by fear of self-harm to try to avoid any distress for their young person, out of a natural protective response. Parents may then find themselves unable to resist unreasonable demands, avoiding setting limits, or over accommodating – a pattern of “giving in”. This can then lead to the young person not learning skills to tolerate discomfort, and can lead to parents feeling resentment, which then impacts the parent-child relationship.
Usual interventions working with young people who self-harm may focus on working with the young person to help them develop alternative coping strategies and ways to regulate emotions. Parent involvement may be limited to agreeing on a safety plan/ how to reduce risk, but this may ignore the relational impact on the parent, and their own context, which impacts how they are able to respond to their child. Non-Violent Resistance can provide an intervention to increase parental presence – Omer and Dolberger (2015) highlight NVR principles that move parents/ carers from helplessness to presence, from isolation to support, from submission to resistance, from escalation to self-control, and from distancing and hostility to care and support. These factors can reduce the risk of self-harm or of attempts to end life. As well as the benefits for the young person and family, the use of Non-Violent Resistance methods has the potential economic benefits in reducing the need for attendance at A&E or hospital admissions related to self-harm/ attempts on life. Non-Violent Resistance can also provide an intervention using work with parents as the primary customer when a young person is not managing to access individual therapy themselves.
Omer’s ( 2021) ideas of “vigilant care” provide a helpful framework for working with parents to increase presence and show active resistance to self-destructive behaviours. Using the metaphor of traffic lights – where a child is in the “green zone”, the parent may have eyes and ears open, but the child may be independent much of the time. In the “amber zone”, where there are some concerns, the parent will be supervising closely, with the child knowing this is happening and knowing why. In the “red zone”, where the risk of harm is high, the parent will be taking unilateral action even if the young person resists, to reduce access to sources of harm. This gives a clear message of care and parental presence – that self-harm is so serious, parents must act in any way they can to reduce the risk. Examples are – openly sharing with the child that a parent will check their room and bags for blades or medication, and ensuring key people in the child’s life are aware of the risks and the need for vigilance.
Key NVR skills applied to situations where a young person may use self-harm include:
Self-care to help parents regulate bodily and emotional responses
Reconciliation gestures – often a young person who uses self-harm may find it difficult to talk about their self-harm to immediate family – gestures of care and comfort can provide a way to acknowledge the young person’s distress without the expectation of talking. Reflective comments to name and show curiosity about emotions can lead to the young person feeling their distress is acknowledged and understood.
De-escalation and the idea of “strike when the iron is cold” allows the parent to recognise that their initial distress and panic when discovering self-harm may lead to unhelpful responses and allow the parent to focus on immediate safety and regulate themselves before a later planned response.
The use of support networks, and sensitively sharing the young person’s difficulties with important people in the young person’s and family’s life gives a strong message of presence and belonging – “we all care about you and keeping you safe is so important that we all need to help with this”. I’m reminded of a young person who talked about how his mother and grandmother’s vigilance in remaining with him closely on “suicide watch” at times when he was most distressed helped him to feel safe – a demonstration of presence using the concept of the “sit-with” to show resistance to self-destructive behaviours.
Considering support networks and the principle of a united approach is also important for the worker considering using NVR approaches where self-harm is present. An understanding of the risk to the young person from self-harm and from thoughts of or attempts to end their life is key. Where a young person is accessing therapy or individual support, an individual therapist can share ideas about unmet relational needs that can guide the NVR worker in working with parents to plan responses, conveying validation of distress, and building connection and belonging.
To summarise, NVR resistance principles have much to offer for families where self-harm is present, and can help parents/ carers rebuild their confidence and sense of presence in one of the most difficult situations parents can face.
Written by Clare Spencer,
Family and Systemic Psychotherapist/ Specialist Mental Health Practitioner
NVR Association (NVRA) Accredited Practitioner
Accreditation Module Participant, 2024
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Reference:
Omer H, Dolberger D (2015) Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance. Fam Process. 2015 Sep;54(3):559-75.
