Self harm is a pattern of behaviour that, like so many addictive patterns and dysfunctional coping mechanisms, can be hidden in plain view, even in those as young as under 10 yrs old. Here are some important early warning signs, behaviours and influences that may help you catch it sooner and in a way that is helpful to you and your child. 

There is always a danger of a child being out of their depth when they are driven by emotion, as the self-regulation function is out of register. So for example when someone is angry they will have elevated levels of adrenaline and noradrenalin in their system, which inhibits the experience of pain. So when they are e.g. cutting themselves they may well cut too deep as they simply do not feel it. Its incredibly important to accept a child’s emotional expression, even if it feels too much or out of order.  A child will earn quickly if you help them manage their experience and expression of these emotions respectfully and with boundaries.

If your child is cutting or burning, seek medical help for the wounds; if you feel out of your depth and that you cannot deal with the way your child is behaving then seek support from a child and adolescent psychotherapist (one with integrative arts training is particularly effective for less invasive intervention and assessment) or an EMDR therapist who specialises in working with children. You can also seek support for yourself from an addiction specialist. Trying to deal with it yourself and failing can generate negative emotions, making the child feel even more hopeless and the parent feel useless. Both will foster resentment, which in turn drives the urge to self-harm – a vicious circle.

Please note a child can also self harm by inviting and provoking physical assault from siblings or parents. It is a way to indirectly ventilate emotion, such as anger or hurt, by making another person responsible. If your child (or indeed any member of your family) is perpetually making you want to rage at them or hit them, then they may be using you as a conduit to express their own pain. The acting out is simply a purging of the overwhelm and will not deal with the problem. So the parent who feels ‘better’ after screaming is describing the feeling of empty before inevitably ‘filling up ‘ again. The answer is to treat the pattern as a clue to a hidden issue that if dealt with appropriately can be treated. Again EMDR is particularly effective as a brief and non-invasive trauma intervention. It works with an ‘unconscious’ part of the brain, and can bring about significant changes for a person in terms of how they manage mood and memories, in a relatively short period of time.  Highly effective for children as they don’t need to be able to talk well to get well.

I think we need to keep in mind how much pressure children are under to perform in today’s globally competitive world. They are competing physically, mentally, socially, practically…. And children are very quick to criticise and shame one another, and have access to multiple ways to put themselves up by putting another person down. (i.e. bullying, cyber bullying). The impact of negative attention can spread widely and quickly, alienating and scapegoating a child almost overnight. Children know this and are keen to remain ‘in’ with one another, placing them on high alert about what they wear, look like – weight, size, fashion sense, ability, image, spots, hair growth, etc.

Constant exams and testing places them under strain to pass but doesn’t introduce a concept of in-depth learning and consideration, so they are culturally encouraged to skim the surface – by implication, this does not teach them how to cope with deeper emotions. I often meet children who think they are ridiculous and over sensitive for having certain emotional needs or experiences, yet on further exploration I will often find they are displaying and experiencing a ‘normal’ level of affect.

I believe that many children are left to their own devices too much and do not have what I would consider to be a consistent model of a ‘good enough parent’ – providing the temporary regulation, a respectful guide, in a consistent way of a parent who is in good shape themselves. Many parents are over stretched and as a result either the child ends up taking care of the parent (not needing or wanting anything from them) or they sadly neglect the child’s core needs believing that to simply feed them, have a laugh and get them to school is enough. Children’s brains are not fully developed until the end of the teen years so until then they require guidance (decreasing as they get older) from someone they can trust and respect – pie in the sky?

I have met countless children in the middle class demographic, who when they experience profound emotion will seek ways to cope with it that are self-sufficient and appear to be short term. (ie hitting self when angry, punching self, banging head against a wall, scratching, cutting, burning, starving) and their families know they do it have not taken it seriously, often coping with it by making a joke of how sensitive the child is, perhaps in the hope that it will simply ‘go away’. But in my experience these things often graduate into eating disorders, codependence (needy giving), and alcohol and drug abuse and misuse. It is a visible part of the addictive cycle that is awash in today’s culture and it should be dealt with seriously at an early age when there is an opportunity for effective and brief intervention.

Pia Mellody and her training team with Mandy, Dita and Victoria from Charter!

Last week I was fortunate enough to attend a week of Post Induction Therapy with Pia Mellody in Arizona.  The model is focused on recovery from the relational trauma that manifests painfully later in life in self-destructive processes such as addiction, codependence and dysfunctional relationships.

As you can see from the photos I am not good at having my picture taken and closed my eyes to the experience!  I also do not have a great reputation for attention in class, with past school days littered with truancy.  (We teach best that which we most need to learn…!) But last week I was captivated.  Not all week I admit as I found the lecturing a bit tiring, but the information itself, the model, is wonderfully human and accessible.  It makes sense, and is interwoven with personal experience, crucially demanding that the therapist also is well!

The genuine integrity of the model was reinforced by the humility of the teachers. Both Pia and Sarah, who was co-facilitating, were keen to teach yet not hungry for applause. In fact Pia regularly yet subtly sidestepped the guru status that was often laid at her feet instead asserting the model as the prize and encouraging personal responsibility.

The PIT model aligns easily with the  therapeutic model at Charter, which is also borne of hard graft and personal experience and it should be relatively easy to integrate the two. This means the clients will experience more bodywork and shame reduction work, paying increased attention to relational childhood trauma and to the 5 core symptoms of codependence Pia describes in her books. We will also provide an intensive 3-day Trauma Reduction Workshop every 6 weeks which is inspired by ‘Survivors’ (The Meadows).

This is not a self-indulgent model it is an operation. It’s all about going home and getting on with your life, which is like a breath of fresh air.

Thank you too to my travel companions and co-trainees, Dita and Vic.  Getting to know you and spend last week with you was really special and enormous fun and I am privileged to have you on the Charter team.

Thus in the early stages of recovery your behaviour may have changed but the filter system remains as it was for a while, offering up ‘stinking thinking’ supported by evidence provided by your brain’s attentional bias. You need to be able to challenge this primed experience and seek out new experiences that are clean and sober, as they do exist.

It is that familiar dichotomy: listen to your feelings, don’t listen to your feelings. This means that you need to be able to have your feelings, but don’t let them dictate your behaviour. Do not believe your own press, instead stick to the plan!

So this New Year’s Eve don’t wait to be hijacked by old thoughts, make plans!

1. Find out if any of your sober friends want to go out and make arrangements to meet and go out together as a crowd
2. Go somewhere familiar – its often tempting to do something different because its NYE, but it often goes wrong
3. Don’t call anyone from your past on a whim: stay in the present with people you are with
4. If you do want to go out in a mixed crowd, make sure someone you trust in onside to help support you to stay sober, and lean on them
5. Know what you will drink – here’s a few of my and friends favourites… ginger beer, cranberry juice, lime and soda, lemonade, elderflower, appletise, Virgin Mary,
6. Remember it’s the build up of feelings (usually resentment) that fuels a relapse – be with people you can talk honestly to, and talk to them!
7. If you decide to stay in on your own make sure you have things to entertain you – DVDs or a good book, with a healthy meal and a couple of friends phone numbers to check in with because that pang of loneliness may come and it’s a powerful adversary to take on alone…channel flicking at midnight is NOT a good idea as you are likely to see the best bits of everyone else’s parties and you will feel its too late to call to chat…
8. If you run into trouble, call the AA/NA helpline – there is always someone to speak to who understands…you are truly not alone: many have gone before you and many will follow, all you have to do is the rest right thing
9. Get to a meeting on NYE and remember the gift that is recovery: share positively
10. Before you take any decision, play the tape forward and call someone

And at the end of the day, remember, its just another night.  So here’s wishing you all a very HAPPY NEW YEAR! I hope that 2013 mark the beginning of a year that you are proud of.

Being ill is always a challenge for people in recovery.  Do you take the meds or not? Should you take ones that make you drowsy or contain codeine? Not a great idea… So where is your bottom line?

Thankfully I have had the good fortune to know an amazing natural healer who has shared many secrets with me over the years, one of which I shall share with you now…

A drink that tastes FAR better than it sounds (it couldn’t taste worse!), this will boost your immune system, and protect many of your main organs including the heart and the liver (it will also get you socially rejected…don’t take it personally!).

Whizz: 3 peeled garlic cloves, 2 unpeeled carrots I stick of celery with leaves, I medium tomato, 1scrubbed sweet potato, unpeeled, & cut into sticks, ½ deseeded Jalepeno pepper, a thumb length of white radish and add water for texture.

Drink twice a day for 3 days!

Good health and happy Christmas!

Thank you for trying though and for being there.

Today I need to tell you how I feel: Its my turn to feel scared that now you will kill yourself with your alcoholism. You and I share the condition of alcoholism/addiction (it’s one and the same) and what I also want to tell you is this: it is soooo possible to have a good quality life without drugs or alcohol!

Though I am the first to understand and the last to judge how you live your life, I am extremely worried for and about you. Frequent drunk driving and destroying our body and health are just two of the many examples of crazy things we both do in active alcoholism/addiction. I can’t continue to stand by and pretend it’s okay, that’s it’s normal and that’s just the way it is- it’s not okay- it’s not normal- and you deserve so much better. You are a beautiful and very special person who deserves a good and happy life.

Before, I couldn’t imagine a life without drink or drugs- what would be left of me?? I was also really scared to stop because then I would have to face my past and my demons and deal with my issues- I thought it would be harder than continuing to use. But nothing is worst than the acute pain of the shame, loneliness and guilt that accompanies active alcoholism/addiction.

Life is not easy but from where I was, I am now generally content and even often happy! And I feel free of that constant shame, guilt, obsession and control- no more lies, I can look people in the eyes (including my family who I adore) and I feel free and hopeful!

THIS IS POSSIBLE FOR YOU TOO!! I believe this 100% and I am so here for you if and when you decide to ask for help. And we can kick this disease in the ass!

I love you and hope to see you soon.”

Outside Edge is the brainchild of Phil Fox who, with the vital support of David Charkham and trustees Simon Woodruffe of Yo! and Led Zepplin’s Jimmy Page, takes productions that are written to mirror the audience’s story, into treatment and prison settings. The way it works is in a way like an extended role-play, so that the audience is encouraged to interact with the actors and affect the process and ending by responding to the script and action as the performance goes along.

Role-play is a fundamental part of the programme at Charter and for my work in schools, so that a person inhabits the other persons skin, walks for a moment in another persons shoes…you could call it momentary other centredness and it works like magic (most of the time!) Outside Edge does this in a structured way on a bigger scale, though it remains simple and personal, and very accessible.

Simon Woodruffe and Mark Rylance spoke with commitment and passion for a society where this kind of resource is available to everyone, and I echo this; access to the resources and benefits of recovery should not be marginalized to the world of severe addiction.

Prevention is better than cure, early intervention is key, and inspiration and education can play a huge part in changing the direction of a young persons life. Outside Edge, like many of us in the recovery community, has a powerful resource at its fingertips with a much wider application than addiction. I am in no doubt that the 12 steps helped me to recover from completely losing hope when I fell foul of severe Rheumatoid Arthritis. There is so much more we can do with what we have if we all join hands and work together…I’m in…

Last weeks press commented on a middle class population drinking themselves into ill health and I believe these are the very same ‘functional alcoholics’. The commuters, workers, mums in the school yard – these are today’s problem drinkers it seems ‘responsible for 10 times the costs of young drinkers’ according to Alcohol Concern, ‘unwitting[ly] …taking serious risks with their health’ and drinking their stresses and exhaustion away. Only it doesn’t go away, it sits there ignited into its own need for more alcohol. To drink alcohol to compensate for emotional need is to make a monster.

And this functional behaviour, is this to appear civilized, all the while arguing and stressing behind the scenes?

I meet children of functional alcoholics who are often scapegoated into addictive behaviour themselves. Mutinous they sit in my rooms, often with a parent wringing their hands, bemoaning their loss of potential. And when these children start talking they are angry. They have often been given money to fix emotional need, as it is the currency that enables the parent to feel functional. They have been placed second to the drinking. The lies and secrets that they have been silently asked to keep so that the alcoholic status quo can rule has left them no alternative but to act out, or act in. Welcome to ACOA – the adult child of an alcoholic: self sufficient yet insecure, these children also often feel guilty about their feelings of anger and sense of neglect as they can see their parent is working ‘so hard’ or is ‘so damaged’ or that the child is ‘given everything’ so wherefore this sense of loss, of anger?

But sadly it does not surprise me. The denial in our society is supreme. Drinking is endorsed, celebrated as a badge of strength – caner’s pride – or brushed under the carpet (again) with bullish denial that shames the concerned into silence: ‘it wasn’t that bad’, ‘everybody does it’, ‘lighten up’, or  ‘do you want me to stop drinking and stay at home every night?’ Or some such variation on a theme that employs tactics that minimize, exaggerate, universalise, generalise – whatever they do they ameliorate the fact and park the issue one more time.

It is so very very hard for a family member to bring a concern about a loved one’s drinking – so hard that most people miss the opportunity for early intervention, coming to someone like me when they are on their knees – can you save my marriage / my job / have I ruined my children? But I need to say that the shame, fear and regret does not have to be such a burden if you get help sooner!

Charter is predominantly designed as a day programme where people can get well in the context of their lives. This is a deliberate design as those addicts I want to work with are not at the critical end of the continuum (though they may feel it) but somewhere in between, where denial still reigns and trouble usually follows. These people, these addicts, are living amongst us, on the tube, at work; they are serving you, picking up the kids, functioning at some level. These are my clients. I work where intervention happens in time for a full and happy life to be possible.

I believe that abstinence is not the goal, but the means, and thus at Charter we work with each client on the core characteristics of addiction rather than necessarily the drug of choice, reducing the risk of devastating relapse and cross addiction.

Addiction is a human condition, it’s relational and it operates on a continuum. Where you are on that continuum plays a huge part in what sort of treatment you will respond best to. The work we do here is extraordinary, consistently turning out sustainable recovery, as evidenced by our thriving aftercare community. It is possible not only to get clean, but also to live a happy and fulfilling life. Aim for the stars…(and don’t stop flapping your wings ‘til you get there!)

One of the reasons I was interested in hosting this event with Montrose was because we need challenging dialogue amongst the thinkers and decision makers who are interested in this incredibly difficult human condition so that addiction is not marginalised to the confines of the extreme cases, but seen in a broader light, often where an opportunity of early intervention lies. (Is this where I mention being able to spot an addict at age 7…?)

Have communications with your adolescent broken down? Do they seem unhappy or anxious?  Are you concerned they may be drinking or using alcohol or other addictive substances? 

Then Charter Adolescents can help.

Research shows that Adolescents are more vulnerable than any other age group to developing, alcohol and other drug addictions in fact drug use is higher among young people than the adult population as a whole[1], yet there are a lack of specialist facilities to help them.

[1] http://www.homeoffice.gov.uk/publications/science-research-statistics/research-statistics/crime-research/drugs-misuse-dec-1112-tabs/extent-young-tabs

Which is why Mandy Saligari, Founder and Director of leading London addiction facility Charter Day Care, Residential and Counselling Centres has joined forces with Stephen Noel-Hill of Alchemy to form Charter Adolescents.

Stephen has extensive experience working with adolescents and young people spanning twelve years working at the Priory Hospital Roehampton and Adolescent Units in Holland.

Mandy has a well-established presence in independent schools lecturing on addiction, parenting for prevention and self-esteem. She has long since wanted to set up a service especially for adolescents addressing the issues that are brought to the surface in these school talks.

“Adolescents are particularly vulnerable to self-defeating coping mechanisms, our main aim with this service is to encourage a valuable sense of self, working with the young person and their parents – many of whom just don’t know how to cope with the issues their children are raising or the behavior they are presenting.”

Both Mandy and Stephen understand that that early intervention and prevention are fundamental to successful outcomes. It is this common vision that led them to merge Alchemy into Charter.

Charter Adolescents is an exciting new service that will do what Charter does best: intensive non-residential treatment and multi-disciplined counselling and therapy. The focus is on early intervention, education, emotional development and appropriate referral to give the adolescent and the family a new lease of life.

With a counselling team who are specialists in this area and experienced in work with young people, alongside Stephen’s expertise and Mandy’s guidance, this service will be dedicated to young people.

Working in groups, individual and family sessions and workshops, after school hours and at weekends, Charter Adolescents is an intensive and brief intervention and counselling service targeted to work with addictive disorders and emotional disturbance.

Charter is well established as a leading London addiction facility offering focused, flexible and effective day care for all addictive disorders at competitive rates.

For more information visit www.charterdaycare.com or call 020 73234970 or email  info@charterdaycare.com

Charter Day Care, 15 Harley Street, London W1G 9QQ

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