Self Assessment Questions
The following questions were taken from the Bodies Under Siege
website, http://buslist.org/ cgi-binlaf.cgi. They are designed
to be used by individuals who are feeling the urge to self harm.
You can give these questions to your clients and ask them to answer
them before they engage in self harm. Individuals can also go
online and answer them there and then email the answers to themselves.
1. Why do I feel I need to hurt myself? What has brought me to
2. Have I been here before? What did I do to deal with it? How
did I feel then?
3. What have I done to ease this discomfort so far? What else
can I do that won’t hurt me?
4. How do I feel right now?
5. How will I feel when I am hurting myself?
6. How will I feel after hurting myself? How will I feel tomorrow
7. Can I avoid this stressor, or deal with it better in the future?
8. Do I need to hurt myself?
By having an individual go through these questions
it can slow a client down enough to interrupt their impulsivity
as well as make them think about what they are about to do. It
will also help them to identify the feelings that are triggering
the urge to self injure. This can help them to use more appropriate
substitution behaviors in that they can match their feeling to
a substitution behavior.
Alternatives to Self Injury
You can increase the chances that a distraction or substitution
behavior will help calm the urge to self injure by matching the
behavior to how you are feeling at the moment.
Take a minute to look behind the urge. What are
you feeling? Then match the feeling to a substitution behavior
to calm the urge to hurt yourself.
Feeling angry, frustrated, restless.
(These strategies seem to work better if you talk to the object
you are cutting/tearing/hitting. Start off slowly by explaining
why you are feeling hurt and angry. If you end up screaming and
yelling that is okay as it can help you to vent feelings.)
Try something physical and violent, something
NOT directed at a living thing:
• Make a soft cloth doll to represent the things you are
angry at. Cut and tear it instead of yourself.
• Flatten aluminum cans for recycling, seeing how fast you
• Hit a punching bag.
• Use a pillow to hit a wall, pillow-fight style.
• Rip up an old newspaper or phone book.
• On a sketch or photo of yourself, mark in red ink what
you want to do. Cut and tear the picture up then.
• Make Play-Doh or Sculpey or other clay models and smash
• Get a few packages of Silly-Putty or some physical therapy
putty and squeeze it, bounce it off a wall, stretch it and then
• Throw ice into the bathtub or against a brick wall hard
enough to shatter it.
• Break sticks.
• Crank up some music and dance.
• Clean your room (or your whole house).
• Go for a walk/jog/run.
• Stomp around in heavy shoes.
• Play handball or tennis.
Feeling sad, soft, melancholy, depressed
• Do something slow and soothing, like taking a hot bath
with bath oil or bubbles, curling up under a comforter with hot
cocoa and a good book, babying yourself somehow.
• Do whatever makes you feel taken care of and comforted.
• Light sweet-smelling incense.
• Listen to soothing music.
• Smooth nice body lotion into the parts of yourself you
want to hurt.
• Call a friend and just talk about the things you like.
• Make a tray of special treats and tuck yourself in bed
with it and watch TV or read.
• Visit a friend.
Craving sensation, feeling depersonalized,
dissociating, feeling unreal...
Do something that creates a sharp physical sensation:
• Squeeze ice hard. (Note: Putting ice on a spot you want
to burn gives you a strong painful sensation and leaves a red
mark afterward, kind of like burning would. This really hurts.)
• Put a finger into a frozen food (like ice cream) or put
ice, water, and salt in a pitcher and put your hand in it for
a few seconds.
• Bite into a hot pepper or chew a piece of gingerroot.
• Rub liniment under your nose.
• Slap a tabletop hard.
• Snap your wrist with a rubber band.
• Take a cold bath.
• Stomp your feet on the ground.
• Focus on how it feels to breathe. Notice the way our chest
and stomach move with each breath.
Wanting to Focus...
• Do a task (a computer game, writing a computer program,
needlepoint etc.) that is exacting and requires focus and concentration.
• Eat a raisin mindfully. Pick it up, noticing how it feels
in your hand. Look at it carefully; see the asymmetries and think
about the changes the grape went through. Roll the raisin in your
fingers and notice your hand that way. Smell the raisin; what
does it remind you of? How does a raisin smell? Notice that you
are beginning to salivate, and see how that feels. Open your mouth
and put the raisin in, taking time to think about how the raisin
feels to your tongue. Chew slowly, noticing how the texture and
even the taste of the raisin change as you chew it. Are there
little seeds or stems? How is the inside different from the outside?
• Choose an object in the room. Examine it carefully and
then write as detailed a description of it as you can. Include
everything: size, weight, texture, shape, color, possible uses,
• Choose a random object, like a paper clip, and try to
list 30 different uses for it.
• Pick a subject and research it on the web.
Wanting to see blood...
• Draw on yourself with a red felt-tip pen.
• Take a small bottle of liquid red food coloring and warm
it slightly by dropping it into a cup of hot water for a few minutes.
Uncap the bottle and press its tip against the place you want
to cut. Draw the bottle in a cutting motion while squeezing it
slightly to let the food color trickle out.
• Draw on the areas you want to cut using ice that you’ve
made by dropping six or seven drops of red food color into each
of the ice cube tray wells.
• Paint on yourself with red tempura paint or a red lip-liner
Wanting to see scars or pick scabs...
• Get a henna tattoo kit. You put the henna on as a paste
and leave it overnight; the next day you can pick it off as you
would a scab and it leaves an orange-red mark.
Another thing that helps sometimes is the fifteen-minute
game. Tell yourself that if you still want to harm yourself in
fifteen minutes, you can. When time is up, see if you can go another
- Ways to Help Yourself Right Now (n.d.), retrieved 2/22/04 from
Reflection Exercise #11
The preceding section contained information about self-injury
self assessment questions and alternatives for your client. Write
three case study examples regarding how you might use the content
of this section in your practice.
Online Continuing Education QUESTION
What is a benefit of having a client answer the self-assessment
questions? Record the letter of the correct answer the .