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‘For Sam’

Some professional experiences are so profound they have the power to shift perception in a moment. Our clients are so often our teachers.

Many years ago, as a trainee person centred counsellor, I came to understand self harm at a much deeper level when I met Sam.

He had been living rough for several years, pitching a tent in local woodland or sleeping in shop doorways from time to time. His adult life had been tough, so had his childhood. I can see him now, grinning at me across the Formica table that separated us.

Sam didn't have many teeth left. They fell out, or were punched out, over a lifetime of struggle.

Glancing to one side in the glass partitioned cubicle, there were other inmates in conversation with their legal advisers and social workers. Like many of the men I encountered while working in this category A prison, Sam was a victim. He had a traumatic story that went back to when he was a small boy.

Neglected by his mother, abused by his father, Sam had opted to leave home as early as possible and took to the streets. A life of petty crime followed.

But my heart went out to him when he rolled up his sleeve to show me the many cuts that criss-crossed his arms. Mostly they were healed with raised, bluish, keloid scars but, worryingly, some marks looked fresher, brighter, redder than the others.

'Do you want to say something about the cutting Sam?' I asked, and listened attentively as he tried to explain why he did it, how it felt and the purpose it served.

The experience, for me, by the end of the session, was so intense that, when he left the cubicle and I waited for the patrolling officer to open up my door, I hurriedly wrote down all the thoughts and feelings which came to me in that moment. Those words I would later construct into a piece of poetry to try to capture, as best I could, the essence of what Sam had tried so hard to convey to me.

Self harm; latest figures Self harm is in the news again. The UK has the highest self-harm rate of any country in Europe with estimates of 400 in 100,000 people self-harm. High rates of self-harm are reported by individuals who also have borderline personality disorder, depression and eating disorders. It's also been highlighted as a growing problem in our schools.

There has been a threefold increase in the number of teenagers who self-harm in England in the last decade, according to a World Health Organisation collaborative study. However this is unlikely to be the full picture as many more youngsters who harm themselves do not end up in hospital.

So why is self harm on the increase and why does it now seem to affect younger and younger children? Looking at the issue through the 'SAFE SPACE' emotional needs lens can be a very helpful starting point.

Self harm and SAFE SPACE The SAFE SPACE 'recipe' for emotional well-being includes Security, Attention, Fun family and friendship, Emotional intimacy, Status, Privacy, Achievement, Control and Engagement. When these universal human needs are being met, we feel our life is worth living. We feel positive, motivated and engaged with a world which has meaning and purpose for us.

And we have a kind of internal SATNAV which is always trying to push us towards getting these needs met, with a range of 'towards' or 'away from' instincts and emotions, some of which can very uncomfortable.

Along the way, we can develop complex mechanisms for 'affect regulation' or emotional management, as we try to keep emotions within a comfortable range. Drink, drugs and addictions become the props and crutches we might use as adults to get us through.

But, for children, so much of their life is outside their control. As they try to construct their personal identity, outside pressures, stresses and strains can materialise in behaviours which might begin as a coping mechanism but can soon develop into a pattern, a conditioned response..... an addiction.

At first, cutting or self harm can give an illusion of getting needs met, just as with other addictive behaviours:

  • As a way of avoiding uncomfortable emotion and staying Safe.

  • As a way of communicating distress and drawing Attention.

  • As a covert act in Private

  • As a way of exercising Control.

If, like me, you have been in the presence of someone who is cutting, you would notice a trance-like Engagement as the cutter becomes totally absorbed in the act. The dopamine rush offers its own reward. So, it seems clear that self harm is best viewed and treated as an addiction, as should anorexia and bulimia.

For young people who get caught up in a 'peer culture' of self harm, the act itself can become a bonding experience and also tick the boxes for Emotional intimacy, Friendship, Status and Achievement.

Helping Sam Sam's self harm began in childhood too. When we had our encounter all those years ago, I offered him everything I had in my counselling toolbox at that time. I listened respectfully and without judgement. I tried as hard as I could, with empathy, to see through his eyes, to feel some of his immense pain.

To my former self, I would now say 'You did what you could with what you had........but it was not enough.' My professional evolution to therapeutic coach has seen the acquisition of many more skills and tools along the way, which would have been very helpful for Sam:

  • Normalisation of the mechanism of distress through psycho education

  • Resolution of trauma with imaginal exposure techniques such a EMDR or Rewind

  • Behavioural pattern breaking

  • Dealing with cognitive distortions

  • Establishing helpful behaviours through positive mental rehearsal

  • Restoration of hope and motivation with metaphor and therapeutic story

  • Counselling and holistic life coaching

  • Goal setting

There is so much more I could do now but, back then, with enormous good will and good intentions, I listened respectfully as he told his story and wrote for him a poem that he would never actually see.


For Sam For all the crap, for all the hurt, I cut. For all the tears, rejection, fears, I cut. For the man who was no father to me The mother who I lost. For all the doors slammed in my face, I cut. The pressure builds. Internal screams. A thousand voices rise. Orgasmic rush explodes in pain. The razor is my only friend.

See my blood. I’m drenched in blame. Can you feel the toxic shame? Consign it to an unmarked grave, Conceal it if you must. They call me weak. Yet I am strong They see victim. I survive. The look of pity in your eyes Betrays the truth, deflects the guilt. For I am you and you are me. The screaming of your inner child Connects us in a bond of pain. Where do I stop and you begin? Coagulation seals the vein


Frances Masters is an experienced psychotherapist, trainer and author.

Her professional journey has seen her evolve from counsellor to coach, developing along the way, a unique new mental health model, test bedded for 5 years in a therapeutic coaching charity she founded in 2009.

The Fusion therapeutic life coach training has since been accredited by the National College of Further Education (NCFE) as a fast track diploma and distance learner skills certificate.

Frances is passionate about getting effective mind management into our schools.

Frances' belief is that learning these skills early will help young people develop the emotional resilience to feel their best, be their best and create their very best lives.

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