Applying Harm Reduction in Mental Health Therapy

We utilize the principle of harm reduction in our everyday lives without really thinking about it: recycling, driving with a seat belt, donning protective gear to use power tools, putting on a helmet to ride a bike, or using bandaids or heel guards when wearing new shoes. While these actions don’t completely prevent the possibility of something like a car or bike accident, they reduce the likelihood of life-threatening consequences. In a therapy setting, harm reduction is a useful–and proven–approach to treating people who engage in higher risk behaviors. In this post, we explore how and why harm reduction is improving mental health outcomes. 

What is Harm Reduction? 

Harm reduction is an evidence-based therapeutic approach that focuses on reducing harm associated with risky behaviors. Its roots began in communities centered around sex work and substance abuse: in the 1980s as the AIDS epidemic grew alongside heroine and crack cocaine addictions, harm reduction became a useful approach for preventing blood-borne infections and treating substance use disorders. But research has shown that harm reduction can be applied anywhere that behavioral harm or risk can occur, i.e., self harm, eating disorders, relational dynamics, maladaptive coping skills, and more. 

Harm reduction aims to reduce negative effects of a behavior without stopping the behavior completely or even at all, particularly if stopping that behavior would increase an individual’s distress or create unrealistic expectations that they cannot meet given their current mental health condition. Harm reduction theorizes that pressuring individuals to stop certain behaviors can actually escalate feelings of distress, lead to more of the unwanted behavior, and fuel cycles of guilt and shame.

Critics of the movement have vocalized concern since its inception, saying that harm reduction enables and encourages drug use and other risky behaviors, rather than stopping them. However, its practical applications, such as overdose education and naloxone delivery, have proven highly effective in reducing death rates among substance users, and it is emerging as an effective strategy for other mental health conditions such as self-harm.

Harm reduction also recognizes and prioritizes bodily autonomy, choice, sustainability, and safety by centering individual and community needs, as well as working to minimize the harmful effects of risky behaviors instead of simply ignoring or condemning them. 

“Harm reduction holds that society has a responsibility to care for all people, no matter their choices, behaviors, or desires. It views individuals as the sole authority on what happens to their own bodies — and it acknowledges that trying to force an outcome or behavior change on a person who doesn’t want it is not only destined to fail, it’s a violation of their consent and dignity.” – Devon Price, Ph.D., Psychology Today

Because harm reduction centers the person, their needs, and their goals, it is inherently trauma-informed, person-centered, and culturally competent when utilized appropriately.

How Is Harm Reduction Applied in Mental Health Therapy? 

In applying a harm reduction approach to mental health treatment, the therapist aims to meet the client where they're at, and without judgment. This means they will take several things into consideration: 

• The individual's goals: The therapist will not assume that full recovery from a mental health condition such as self-harm, substance use, or an eating disorder is possible or even the client’s own personal goal.

• The complexity of recovery: The therapist also acknowledges that recovery from certain mental health conditions is not linear and that relapses happen for a variety of reasons.

• Unintended consequences: The therapist is aware that abstaining from a certain behavior such as self-harm or disordered eating can have negative consequences that can trigger distress or lead an individual to engage in other unwanted or unsafe behaviors.

• Collaboration: The therapist will prioritize creating a collaborative environment and work with the client to build a treatment plan tailored to their needs and centering their goals.

In harm reduction-based therapy, the goal of treatment is not to stop the individual's behavior but to get curious about what needs those behaviors are meeting for the individual, help them work through those ideas and feelings, and find less harmful ways to live. 

Some practical examples of harm reduction strategies look like: 

• Self-harm: Snapping a rubber band against the wrist whenever the urge to harm becomes overwhelming; learning about proper wound care and safe anatomical positioning.

• Eating disorders: Purging once daily instead of three times daily; opting to eat something small, like an apple, instead of nothing; decrease excessive exercise by 10 minute intervals. 

• High-Risk Sexual Behavior: Get tested regularly; use a condom; use a safeword; use pre-exposure prophylaxis (PrEP).

• Unhealthy Relationship Dynamics: Instead of a cut off, begin to institute small boundaries or limit communication.

• Addiction: Decreasing the amount of a substance consumed but not abstaining; nicotine patches or gum; using syringe exchange programs or safe consumption sites.

What Are The Benefits of Harm Reduction in Mental Health Therapy? 

There are several benefits to harm reduction-based therapy: 

• It reduces stigma of the risky behavior between the therapist and individual, making it more likely for the individual to continue care, because they know they can receive nonjudgmental support, even if they’ve relapsed.

• It makes change more accessible by meeting individuals where they’re at and identifying what is desired or achievable at any given time instead of setting expectations (self, social, familial, cultural) that can’t be met, which can often lead to cycles of shame, disappointment, self deprecation, self hatred, etc. 

• Positive change vs. coerced change: harm reduction also seeks to transform the individual’s relationship to change itself by facilitating positive, self-led change, rather than coercing them into conforming to outside pressure.

• It can help rebuild the individual’s connection to self and open the door to identifying needs by requiring intentionality when engaging with behaviors. 

Finding Harm Reduction Support Near You 

Harm reduction is all about ending the cycles of shame and fear tied to our riskiest impulses and maladaptive coping mechanisms. When you have a nonjudgmental therapist who is committed to your safety and autonomy, you can feel safe enough to get curious about what needs those behaviors are meeting in your life, and begin to forge your own path toward healing. If you're seeking harm reduction support, reach out to us today. We’ll connect you with the therapist and therapeutic approach to help you thrive.

About ECC: 

Empowered Connections Counseling is a practice of licensed therapists providing quality, multidisciplinary counseling for adults, children & teens, relationships, and families in Chicago and across Illinois. Whether by in-person session or via telehealth, we work with clients to find the therapist and treatment methods that best suit their needs. Connect meaningfully with your life by booking an appointment today.

How to Support a Loved One with an Eating Disorder

Eating disorders are serious life threatening illnesses, and they do not discriminate regardless of age, race, gender identity, sexual orientation, or background. Most often you cannot infer from the outside an individual is struggling with an eating disorder. The thought that weight is the only indicator someone is struggling, can perpetuate the secrecy and shame surrounding the struggle. Once you pull back the shade around this stigma, you can then keep an eye out for the warning signs. 

Supporting a loved one who is struggling with an eating disorder can be frightening and overwhelming; however, connection and communal support are key to recovery. Here are some quick tips to consider if you want to provide care for someone struggling with an eating disorder:

Tip #1 Educate yourself and make a plan: It can be difficult to approach your loved one about their eating disorder. There can be a lot of fear and emotions involved, so it is important to feel prepared. Prepare what you want to say and how. Invest in further reading about eating disorders to gain a deeper understanding and compassion for the struggle your loved one is experiencing. Avoid suggestions, and general statements like, “you need to stop.” Map out your key main points, then find a private location and time to talk (How to help a loved one. (2017, February 26).

Tip # 2 Approach with care: The pain your loved one is experiencing can be rooted in deep shame. It is vital to approach from a neutral and loving standpoint. Be sure to use I-statements, like, “I notice you are going to the gym a lot, and I am worried about you. I want to find a way to help you” (Eating disorders: Common warning signs. (2021, June 7).

Tip #3 Don’t give up: Know that they might not initially accept your support, but do not give up. It is important to find the balance between compassion and assertiveness, as getting them the help they need is vital. Allow space for them to express their potential worries, and offer to make the first treatment phone call with them (Eating disorders: Common warning signs. (2021, June 7).

Tip #4 Separate them from their eating disorder: Your loved one is not their eating disorder, and separating the two shows it can be tackled. Find windows where they acknowledge their symptoms, and how it might impact what they want for themselves. For example, if they love the outdoors, but are feeling tired and lethargic. Use that as a chance to express how you want them to gain back their energy in order to go camping and hiking like they’ve wanted to.

Tip # 5 Find support for YOU: Being a supporter to your loved one and their eating disorder can be an emotional journey. Not only does your loved one need to know they are not alone, so do you. Find a family member support group, or seek individual therapy so you have a space to process your experiences.

Sources:

Eating disorders: Common warning signs. (2021, June 7). National Association of Anorexia Nervosa and Associated Disorders. https://anad.org/get-informed/eating-disorders-warning-signs/

How to help a loved one. (2017, February 26). National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/help/caregivers

Additional Resources:

Identity and Eating Disorders

ANAD - Eating Disorder Statistics

Eating Disorder Warning Signs

NEDA- Support Resources