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I self injure. My psychologist believes I need to improve my self-esteem to reduce my SI.The community nurse thinks I need a strategy in place to help me cope when I want to SI. I don’t know who is right..what is your opinion?

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Both are right. However, I like what the nurse has to say best for the following reason. It is fine and right to say that you need to raise your self-esteem. But how does one go about doing that? Self-esteem is such a nebulous, hard thing to grasp. There is no clear way to make you feel better about yourself. A plan for what to do when you have the impulse to self-injure, on the other hand, is very tangible and real and can be your best friend the next time you find yourself looking for a razor. Work with your nurse and with your psychologist to develop a step by step highly detailed plan for what to do when you want to self-injure. It should go something like this: 1) I’ll know when I’m about to self-injure because I’ll feel like (.. fill in the blanks with how you feel before self-injuring ..) and the following thoughts will be going through my mind (….). When I’m in this sort of danger I’ll do the following .. (………….. step one, step two, step three, etc. ). Get the approval of your clinicians for each of these sorts of steps so that you all agree they are the right things to do. Then – keep this plan with you and use it when you are in danger. With any luck you’ll find that self-esteem goes up while you do this. Good Luck, Dr. Dombeck

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