What to Do When You Feel the Urge to Self-Harm and Relapse

March 2, 2021

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Claudia Black Young Adult Center

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By Beau Black

It’s possible to plan ahead to decrease the chances of relapse after you leave treatment. Therapist and author Lisa Ferentz, speaking at The Meadows’ recent conference on trauma and addiction, discussed this challenging part of treatment — and offered a realistic and proactive process that helps patients avoid relapse.

Her talk, titled “Creatively and Compassionately Addressing the Impulse to Self-Harm and Relapse,” explains the process she uses to help patients head off the urge to relapse when it begins. Ferentz uses the acronym CARESS (or simply ‘“CARES” if the word “caress” evokes a negative response) to describe the three steps:

  • Communicate Alternatively
  • Release Endorphins
  • Self-Soothe

To provide some context for these steps, Ferentz says that her approach to treating trauma and the coping strategies that flow from traumatic experience is to “de-pathologize” them. She says, “I remind myself, ‘This person is cutting, this person is picking up and using, this person is bingeing and purging because this is their way of attempting to navigate their thoughts and feelings interpersonal dynamics that feel challenging, stressful, or overwhelming.”

When a patient feels triggered or on the verge of acting out/relapsing, they can use the CARESS process to short-circuit an old, destructive pattern.

Ferentz states that it’s important to give the client some alternatives early on in the process: “Unless we’ve given our clients other ways to [regulate their emotions], the soothing, unless we’ve given them other tools, they’re going to get dysregulated again.” This is why, she says, relapse is such a common occurrence.

“Rather than jumping to ‘we’ve got to get rid of this behavior,’ I began to get curious about what purposes the behavior was serving — why it felt necessary to hold onto the behavior. What did they think they were going to lose if they gave up the behavior?” Rather than focus on what one gains, it’s important to focus on what one will lose — to understand the purpose these behaviors are serving, she says.

Ferentz sees the CARESS process as a way to give patients a way to self-regulate, become more self-reliant, and to “avoid treatment becoming a game of ‘whack-a-mole.’”

So What’s Involved in Preventing Self-Harm and Relapse?

When a patient feels triggered or on the verge of acting out/relapsing, they can use the CARESS process to short-circuit an old, destructive pattern. Ferentz suggests setting a timer for 10-15 minutes for each of the three steps of the process. She also encourages patients to create a box with the materials they need for the process so it’s all in one place and ready to use when it’s needed. Here are some ways to follow through on the three steps:

1. Communicate Alternatively

Draw, make a collage, sculpt clay, write in a journal, create a poem, or record thoughts/feelings. Traumatic experience is encoded on our bodies and minds in ways that can make it difficult to put into words. This step gives the patient room to experiment with different ways of expressing feelings and helps them articulate what is often difficult to say.

2. Release Endorphins

Engaging in physical activity like exercise, hugging, and laughter all trigger the body to release endorphins. Endorphins dull the brain’s pain receptors and create a feeling of euphoria. She suggests using YouTube as an easy source for funny videos; watching a favorite comedy is another option.

3. Self-Soothe

Taking a warm bath, singing, meditating, playing music, using aromatherapy, and coloring something intricate are all ways to comfort and calm ourselves.

Why Use a Timer for the Steps?

“Many people who engage in [self-harm and addiction] behaviors are dissociative,” she says. “Drinking, getting high, bingeing — all have elements of dissociation.” Trade one behavior in which to zone out for another, Ferentz says. That’s why she advises doing 10-15 minutes per step, because this buys the patient 30-45 minutes of time doing something constructive that can meet the same needs as their old self-destructive coping patterns. Because the self-destructive impulse often lasts about 20 minutes, the process can help pass that time productively.

The CARESS process offers a positive, practical way to sidestep old destructive patterns and create new, productive ones that help actually manage trauma and addiction.

She says it’s important to use the process “before I do X – not instead of.” It gives patients ways to achieve what they get from that behavior so that it becomes moot and to release endorphins in ways that do not exacerbate the feelings they’re trying to move them away from.

For many, self-harming is a form of communication. “When a client is in a form of self-harm, they are showing me their pain. There’s a narrative there,” she says. It’s crucial to give them a safe way to communicate what’s happening to and inside them and why they feel the need to give into that impulse.

The CARESS process offers a positive, practical way to sidestep old destructive patterns and create new, productive ones that help actually manage trauma and addiction.

If you or someone you love needs treatment for self-harm or addiction, please contact our team today. We would be glad to help you find the path to healing.