Self‐injury recovery: A person‐centered framework

Abstract

Growing interest has been paid to the concept of non‐suicidal self‐injury (NSSI) recovery. In research, and sometimes clinical practice, the focus has been on NSSI cessation, with recovery operationalised with reference to the time since someone last self‐injured. Yet, perspectives from people with lived experience of NSSI indicate that recovery is much more complex. Drawing on recent empirical work, and the voices of people with lived experience of NSSI, we outline a new framework for conceptualizing NSSI recovery. We argue that recovery is nonlinear and multifaceted, comprising: Realistic Expectations and Setbacks; Normalizing Thoughts and Urges; Fostering Self‐efficacy; Identifying Strengths; Finding Alternatives; Addressing Underlying Adversities; Addressing and Accepting Scarring; Navigating Disclosures; and Self‐acceptance. In presenting research and clinical implications of this new framework, we propose that this framing offers a more complete understanding of NSSI recovery—one conducive to optimizing wellbeing and promoting resilience among individuals with lived experience.

“What I couldn’t do before, I can do now”: Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence

“…However, our focus on sensing agency does not imply that the participants in this study could have made changes without environmental influences, as the strong association between gaining agency and a pivotal event highlighted its context-dependency (as also theorized by, e.g., Evans, 2007 ). Therefore, when applying a person-centred model of NSSI recovery as proposed by Lewis and Hasking ( 2021 ) that includes domains of self-efficacy, adversity management, and resilience, it is also necessary to consider the current lived context. Besides acknowledging that the discursive framework of recovery might not be relevant to everyone, an individual might want to (or is already taking action integral to) build resilience or thriving, but perceive themselves as impeded by difficult external situations that they cannot control.…”

“…As expected from the positive psychological and social change processes associated with NSSI discontinuation, quantitative research shows that discontinuing NSSI, compared with continuing it, is associated with higher well-being and improved mental health over one- (Hamza & Willoughby, 2014 ; Kiekens et al, 2018 ) and three-year periods (Kiekens et al, 2017 ). However, discontinuing NSSI does not equal psychological recovery or growth per se (Lewis & Hasking, 2021 ). For example, Shaw ( 2006 ) argues in her study of six adult women that “[…] stopping self-injury, in itself, is not a reliable indicator of greater psychological health unless it is accompanied by shifts in other domains of a woman’s life” (p. 171).…”

“…Beyond addressing potential concurrent mental health concerns (e.g., Lewis et al, 2019 ), such shifts include contextual changes such as making life commitments and forging relational ties that longitudinally facilitate positive psychological development (Shaw, 2006 ). This process could partly include building resilience (Lewis & Hasking, 2021 ) and agency. Whereas resilience describes the active process of reframing past adversities and coping with current adversities (Luthar et al, 2000 ), agency, as defined by Bandura ( 2006 ), is the broader process of constructing oneself as someone who can act on their current life circumstances.…”

“…Psychological growth from the perspective of eudaimonic well-being can be narrated temporally as making successive progress by integrating various experiences and events with the self through the larger themes of agency, communion, and learning (Bauer & McAdams, 2004 ). Building on these theories, situating self-injury within one’s agentic capacity might be helpful for understanding when NSSI discontinuation is indicative of psychological growth; from an NSSI recovery framework, it would be helpful in understanding when one can realize their strengths, address different adversities, and feel a strong self of self-efficacy (Lewis & Hasking, 2021 ). This exploration must also consider context, as an individual’s efficacy can be both limited and reinforced by current life circumstances, such as social structures and fortuitous events (Evans, 2007 ).…”

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility

“…Although already employed in depression and substance use research [ 72 , 73 ], these measurement burst designs are currently an untapped resource for NSSI research. For instance, the degree to which NSSI thoughts are self-sustaining in daily life (ie, auto-correlation) could signal a more challenging recovery process [ 74 ] or help explain why some individuals (eg, those with depression) are at risk of a more chronic NSSI course [ 75 ]. Given the relationship between NSSI and suicidal thoughts and behaviors throughout development [ 4 , 76 ], a critical question is clarifying whether a dynamic blueprint of NSSI can help gauge the future risk of suicidal forms of self-injury.…”