Self-Harm (Core Competencies: 1.2; 1.4; 1.6; 1.9; 2.6; 2.7; 3.3; 3.5; 4.4; 4.6; 4.10; 4.19) Self-harm is a difficult topic of conversation. Self-harm includes behaviors such as using substances, cutting, burning, hitting, as well as over-exercising, bingeing, or purging food. Self-harming behaviors do not necessarily indicate a crisis or suicide risk. For many, self-harm is a coping tool that has been developed to manage intense emotions or experiences. It is important that certified peer specialists are aware of their own attitudes and beliefs about peers who engage in self-harming behaviors. The role of the certified peer specialist is not to attempt to stop people. It is to explore what the behavior means to the peer, what purpose the behavior serves, and to offer useful support for developing alternatives if welcome. Harm reduction and self-harm Harm reduction is the practice of mitigating some of the risk for people who engage in self-harming behavior without setting the expectation that they will stop. Many people who engage in self-harming behavior may have been told that recovery can only be achieved by stopping the behavior, but that is not true. Shifting the focus from stopping to harm reduction allows for a more engaging conversation and connection within the peer relationship. A certified peer specialist needs to be able to hold space for the peer to determine when or if they are ready to engage in harm reduction or complete abstinence from a behavior. Supporting a person who is working on harm reduction can be an intimidating and uncomfortable experience for a certified peer specialist who has been trained in an abstinence model of recovery. There is a common misconception that validating someone who is engaged in harm reduction is the same thing as supporting and encouraging the self-harming behavior. This is not the case. There are many ways for a certified peer specialist to support someone who is working on harm reduction, including: • Exploring with that person what the self-harming behavior means to them. • Exploring if the person knows the signs and has a plan for if they reach a point where they need medical intervention. For example: o If a person has used too much of a substance, can they recognize the signs of overdose? o If a person cuts themselves too deep, do they know the signs of shock and have a plan for aftercare?
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