I'm a therapist with self-harm scars

"I am a Residential Therapist and a recent graduate. And I have concerns about how to address my self-harm scars to my clients.

I have considered surgery for the major scars and tattoos for the minor scars. Looking for insight from others in the professional or helping field." -R-A Dubbs

We put this question out to other therapists, and their responses were awesome…

I have covered some with tattoos but not all. I don't hide them but I also don't bring them up on my own. If a client asks me in session, depending on client, I would ask what made them curious and potentially use it as a process moment to discuss what it would mean "if they were self-injury scars."

I'm not looking for my clients to ask. I'm merely not hiding them. I've known many people (myself included) that are simply comforted that other people also struggle. I've had people say they feel empowered when they see other professional types show these types of things because it shows they can do it (be a professional after recovery) too.

Out of all my years working as a therapist, I've only had two clients out right ask me. I more often get the question "have you ever done this?" In regards to self-injury than blatantly asking about scars.

-Mo

I work in a psychiatric hospital and I cover all of mine with makeup or tattoos. I'm not sure what your client base is like, but with mine, scars can be extremely triggering to patients and put them back into relapses — so it's not something that can just be explained away. In my experience, the amount that will be triggered is much more than the amount who will feel closer to you because you've been through something similar. For you, your scars may be a symbol of growth, and reminder not to return to your past. But if you're taking that oath to help patients, I do really recommend covering up in some way.

-Tami

Well, as a therapist, using self as an intervention should be used rarely and only to the benefit of the client. So, unless they straight up ask and you feel it's appropriate to address it, do so in a way that will help your client with their own journey. This is my own experience as a therapist and going through ethics courses in grad school that helped me navigate self disclosures to my clients, and when or if I should.

-Lauren

I agree with Lauren… I am a therapist in Drug and Alcohol with my own recovery background and I never use self disclosure to build a relationship with a client. That would allow me to be lax in my use of my actual counseling skills. Any moment we spend talking about ourselves is a moment we are not client-centered. If they ask, kindly redirect attention back to the client; often it's them deflecting away from what they really need to be discussing. Leave them be, but don't explain them. You have to be the stable one in your relationship with your client.

-Lisa

I am a therapist with similar issue, I work with 12-25-year-old people, and many are presenting with self harm in various forms. I haven't had to directly address my scars but I see I'm their presence as a way of helping my clients understand that I can relate.

-Regan

This might sound controversial, but I think you should keep them.

Sometimes a client is helped best when they know their mental health counselor has been through what they have… and gotten to the other side. Think about it — how many addiction support workers are former addicts (drugs, sex, alcohol, love, porn, etc)? Family counselors who have a checkered/spotty family history of their own?

You're, of course, not in any way obligated to speak to your own past struggled with self-harm, depression, obsessive thoughts/behaviors and/or compulsions with anyone, but I think not making an attempt to hide or otherwise get rid of your scars from when you were in that much different place in your own mental health can physically show someone that they can make it out, even if you never make a point to show or discuss them.

Alternately, I don't know where your scars are, but it sounds like somewhere visible in typical professional wear. There's no harm in keeping your office a little chilly and having the excuse to wear longer sleeves or long trousers all year long if you're uncomfortable.

-James

I have covered most of mine with beautiful tattoos.

-LeAnne

Any other mental health professionals in the house? What have you done about mixing your self-harm scars and clients?

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  1. It was really interesting seeing the difference in perspectives from mental health professionals and patients when this was posted on Facebook. It seemed that most mental health professionals felt they should be covered, while patients were much more split.

    Obviously, there's no right answer here since each client you deal with will be different, but here are my two cents: Don't cover them up (unless you really want to), but also don't proactively bring them up. As a patient, I'd notice them and feel a lot more comfortable working with someone who I know understands some of the things I've dealt with. And, having that understanding, I also wouldn't bring them up.

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  2. Although I'm still in grad school and am so close to working with actual clients, I have to say that I would not outright hide mine but that most of my scars are covered by ink. Plus, another person commented that the moment we start taking about ourselves, we have moved away from client centered therapy and that should be the focus. I'm not sure how your scars present on your body but if you feel that it would cause a distraction, I would cover them. Most of mine that were visible, like I said, are now covered by ink. The rest are covered by professional attire. It's about the client and what they need. All the best!

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  3. Your scars are not the reason why people come to see you.
    If someone asks you about them, answer as you see fit. You are a human with experience, one of them is the experience of self harming. You also made the the experience, that this was no longer the thing you needed to do. You do not have to hide, you do not have to address, and you do not have to explain. Just be you and rely on the fact that you lerned what you need to do.
    A therapist is NOT a super hero, just a person who lerned skills to help others help themselves. Wellcome to my absolute dream job! Love, Lola

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  4. I respectfully disagree with Lauren and Lisa regarding the use of self-disclosure. My experience and DBT training have led me to find that self-disclosure can be a vastly helpful tool in the therapeutic environment. Obviously there are limits (for example, I've never disclosed my trauma history) but I do think there's value in clients seeing that therapists are people who have struggled, not Freudian blank slates! I also think that our experience of the client can be reflected back in a way that is helpful and insight-building ("I'm feeling overwhelmed just hearing about it-I can't imagine how you must be feeling!") That said, I would personally cover up self-harm scars in my work environment because it would be triggering for my population. When I self-disclose, I always ask myself why I'm disclosing–is it for me or for the client? Is it for rapport-building ("my vacation was great, thanks for asking") or is it because I just want to talk to them ("my friend is also being annoying"). Again, used appropriately, I don't think that therapists have to completely avoid self-disclosure!

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  5. I think it depends on who you work with and most importantly if you feel acknowledging them will somehow help the client. Since you do not know your clients/their triggers/how you'll build a relationship etc during the first few appointments, I would initially cover up. If you feel comfortable with someone after a while and feel it might help them to see you can relate, I might selectively choose to uncover. This is assuming they are somewhere like your arms, which is visible and also really easy to cover with a vest or chunky jewelry if it's your wrist. Obviously if they are on your thighs or something… Well, no professional should be showing THAT much leg lol.
    If you are comfortable with them, I would definately not be shy around coworkers. It's just that therapy is a delicate balance.

    Ps I'm a nurse, not a therapist.

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  6. I read that one study found 82% of therapists had had significant emotional problems themselves. I think few people who haven't really understand how overwhelming negative emotions can be. How most clients would react to hearing that I don't know tho.

  7. A bit of background for myself: my visible scars are on non-visible parts of my body; I am not a therapist – I am a Certified Peer Specialist – and I have no professional experience as a CPS; I did, however, recently get certified and graduated a program in Massachusetts. I find it very interesting that some of the therapists in the house are stating that patient-centered therapy and non-disclosure is the best plan of action, because a CPS would handle this completely differently. One of the tenants of being a CPS is that you share your story to inspire others when it comes to their own healing. The idea is that you're helping someone because you've been there/done that, rather than helping someone because you have a degree. Granted, someone mentioned that a large portion of therapists have mental health histories themselves… Anywho, a CPS would be encouraged to share a snippet of their story if it was able to help someone in their own healing (hate the term "recovery", but that's another discussion), so if I were helping someone who was cutting, it would likely come up in conversation that I used to cut as well and was able to move past it. I wouldn't necessarily say "this is HOW I moved past it"; maybe brainstorm some ideas with the person I was helping if they wanted me to, in a way that they are taking the reigns and I am not planting ideas in their head. But the idea that you've moved past the desire to self-harm is a beacon of hope for people who might be thinking "I'll never be able to stop cutting/I am a damaged, flawed person because of this/I feel guilty for doing this", etc.

    I did hear during my coursework that CPS's who have history working in other parts of the mental health field tried to adhere to the CPS code of ethics and were terminated from more traditional positions because a lot of people think sharing a history of mental health concerns is unprofessional. So whatever you decide to do, it's probably going to be based primarily on the policies of the organization you work for.

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