I recently attended the PartnershipProjects NVR Accreditation Module. The course is organised around each participant presenting an aspect of their NVR practice to the group. The presentation is followed by reflections and questions from the group facilitators, and then group participants.
For my presentation I shared my NVR practice working with parents of children who self-harm or are suicidal.
My search for NVR literature on this topic located only one article which was by Haim Omer and Dan Dulberger, ‘Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance, Family Process 54:559–575, 2015’. In this blog I share some of the key ideas from this article that struck a chord with me and were used in my NVR practice.
For me the paper presented a view of self-harm and suicide as being relational and having relational impacts. Children and young peoples’ (CYP) self-harm, suicidal acts and threats being, ‘violent communication acts that destroy their own, and their parent’s lives’, and how these acts or threats, implicit and implied, and I would add perceived, can be ‘a unique coercive power, a manipulation, an intimidation, the ultimate last word’.
Viewing self-harm and suicide as being relational communication acts, and not only as an illness or problem within the child, also means there is a shift in focus for the parent not to be seen merely as a treatment agent (for the CYP) but also being a client in their own right. In NVR the parent is the client and focus for change. Having said this Omer & Dulberger do cite a ‘cautionary note’ with NVR not normally being the only aspect of the approach to self-harm and suicide. That CYP would be receiving their own psychological support, family therapy, etc. alongside NVR coaching for parents and supporters. NVR however can be a useful approach where the CYP is declining to be seen.
Whilst NVR is not a manualised approach, ideas from practice can help to form a scaffold or framework from which to help the NVR practitioner begin to organise their thinking, decisions and actions. In the context or working with self and suicide Omer and Dulberger talk of a ‘typical sequence’.
Their sequence encompasses:
- Typically, 15 sessions
- Analyses of suicidal interaction
- An announcement – after the second meeting
- A supporter’s meeting – on third or fourth meeting
They also suggest a focus on Containment and Anchoring – through a shift from
- Helplessness to presence
- Isolation to connection and support
- Escalation to self-control
- Submission and accommodation to resistance
- Distancing and hostility to care and support
Parents also need support to know how to cope with the fear and stress that their child’s actions induce in them, how to support their CYP to resist the threat of self-harm and suicide, and how to manage in a crisis.
I have also found it useful to use NVR Parent Coaching to support parents in finding ways to minimise their own conflict where this is a factor. The aim being this would then improve their communication, and strengthen their parental authority. From an NVR perspective here, authority does not equate to control of the other (the child or spouse), but control of self.
In working with parents in the context of self-harm and suicide by CYP I find there are often issues around blame, feeling hopeless and helpless, frightened parental behaviours, and victim narratives. Parents may blame one another for how things are; they also blame professionals for not doing enough. Concern for their child going too far and the potential for the child to end their life, can lead parents to act from a position of fear, we may then see frightened parental behaviours. Parents may also present with victim narratives; parents feel they are controlled in what they can and can’t do by their child. In all these situations parents may under or over act. They may try to avoid their child experiencing any stress or distress, they may give in or accommodate to their child’s demands and threats. Parents may also oscillate between positions of over and under containment, i.e., implement no rules or boundaries, or have too many rules and boundaries.
Feelings of helplessness connect with ideas about shame. Shame, as stigma due to mental health issues, shame that they feel they are failing as parents. Shame can be managed in unhelpful ways such as not giving in, not backing down, and by being aggressive. Self-harm and suicide can also be ways of managing shame. From an NVR perspective shame is more usefully managed by firstly, recognising and acknowledging the presence of shame. Next, supporting parents to build up the child’s ability to tolerate shame at manageable levels. And also helping parents to avoid the use of comments / feedback that might come across to the child as being critical. Parents need support to develop ways to relate to their child in a non-evaluative way, and to instead increase their presence, and their relationship with their child, through connecting, and reconciliation gestures.
In helping to bring about change it is important that there is transparency about self-harm and suicide. Parents need help to find ways to raise these issues with their child and to formulate this into their announcement, for example to say what they are worried about, what they will be doing and what they want their child to do.
Attending and participating in the NVR Accreditation Module not only helped me reflect on my clinical practice but also has impacted on me personally. For example, reconnecting with systemic ideas I had not used for a while, and being kinder to myself.
Systemic Psychotherapist and Supervisor
NVRA Accredited Practitioner