In an article published in 2021, Self-injury recovery: A person-centered framework, Stephen P. Lewis and Penelope A. Hasking argue that recovery is a complex and non-linear process that varies from one individual to another and cannot be reduced to cessation of self-harm only. “Indeed, NSSI recovery is not a one‐shoe‐fits‐all process” they explain. They suggest a model of recovery that is person-centered. Their Person-Centered Model of Self-Injury Recovery involves 9 key concepts.

Realistic expectations and stepbacks

It is important to understand that recovery does not mean total cessation of self-harm along with the absence of self-harm thoughts and urges. Recovery is non-linear and many people self-harm during the recovery process. “[R]elapses are a normal part of the recovery process” explain Lewis and Hasking.

Normalizing thoughts and urges

Individuals need to accept that thoughts and urges about self-harm may never disappear completely but their frequency and intensity will likely diminish over time.

Fostering self-efficacy

By accepting that urges may never fully go away, individuals can develop self-efficacy in order to resist urges.

Identifying strengths

By reflecting about a time when they managed to resist the urge, individuals can understand what enabled them to resist the urge and identify their strengths, such as relationships, creativity, sense of purpose, hobbies etc.

Finding alternatives

What alternatives worked in the past? Finding alternatives is not easy and varies from person to person. Individuals need to try alternatives and accept that some may not work until they find the one that suits them best. Lewis and Hasking recommend however to avoid replacement behaviors that mimic aspects of SH, such as drawing on skin with a red marker or holding ice cubes as they have not been proven to be effective and they can lead to the persistence of urges.

Addressing underlying adversities

Addressing underlying difficulties are essential in the recovery of self-harm as they often contribute to self-injury. Such difficulties can be (among others) self-loathing, history of bullying or abuse, depression, anxiety, PTSD, BPD or eating disorders.

Addressing and accepting scarring

For people who have scars, scarring can make recovery more difficult due to shame. Scars should be made a part of the recovery by accepting that they might be permanent and seeing them in a self-compassionate way. Some individuals see them as a symbol of strength and resilience for example.

Navigating disclosures

Due to the stigma surrounding self-harm, many individuals do not want to tell others about their self-injury. Yet, in many cases, disclosing self-harm is important in recovery and can lead to seeking help. They should also think about unwanted disclosures (someone noticing scars for example) and be prepared for such situations.

Self-acceptance

Recovery can help people accept themselves and find meaning and resilience for self-harm and future adversities they might face.

Reference:

Lewis, S. P., & Hasking, P. A. (2021). Self-injury recovery: A person-centered framework. In Journal of Clinical Psychology (Vol. 77, Issue 4, pp. 884–895).