Category Archives: Red List

Red List: What to do if I feel like self-injuring

When I ask my clients to create a Wellness Journal to help treat their mood disorder, I often ask them to include a “Red List.”  The red list is different dependent upon the client.   For individuals who have anger issues, the red list is things to do when they are angry.  Likewise for anxiety.   However for many of my client’s the red list is what to do when they feel urges for self-inflicted violence, most commonly cutting.

I worked in the Emergency Department of a local hospital for five years during which time I learned that many professionals do not understand the urge for self-injury.   The advice they give is frequently horrendous.   Often well-meaning medical staff treat “cutters” with cruelty.   They can be cold and distant when treating self-inflicted cuts.   I unfortunately have seen physicians staple or stitch up cuts before the numbing shots fully are in effect.  Worse than the physical pain they cause is the emotional pain, making the individual who has inflicted self-violence to feel belittled.  I have also been fortunate to see that with a little education these same professionals can be kind and understanding to “cutters.”

My experience in working with individuals with urges for self-inflicted violence or cutting is that more than anything they need love and understanding.   The first step is to plan in advance.   I encourage the creation of a red list, or a list of what kinds of coping strategies can they implement when they feel overwhelmed and want to self-injure.   I remind them that cutting is a coping strategy…. not one that I encourage, but indeed a coping strategy.   Instead of putting down their coping strategy I want them to find better ones.

Many times the urge for self-inflicted violence is paired with depression and anxiety.   Unfortunately depression seems to cause memory loss and we completely forget our coping strategies.   This is why a red list is so valuable.   In the list we have written down advance instructions for ourselves.   Unfortunately there is no “one size fits all” list.  Each person must create their own list.   Also unfortunately we usually discover what strategies work and what strategies do not work through trial and error.  This is why it is so imperative that when someone we work with, love or care about does self injure, that we do not put them down.   They did not fail, but just found another coping strategy that didn’t work, and now it is time to work on finding some new, better ones.

So…  What is on your red list?

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