One day two parents bring a fragile soul to your office and tell you she has been caught cutting. They want you to help their daughter stop. But as you look at the daughter all you see is painful detachment. She has no real desire to stop cutting as long as the pain within haunts her soul and entices her to seek relief from a razor blade.

She knows the cutting is wrong, but she is beyond caring about right and wrong. She will take whatever relief she can get, even if it is only for a few moments, as she is distracted by the pain of the razor and the resulting rush of endorphins. For her, the bottom line is that, for a moment, she is distracted, free from her relational pain. 

Self-injury, in its various forms—such as cutting—is an attempt at self-healing. Does that sound like an oxymoron? It should, because it is. But the cutter has a rationale for cutting. Deep within the soul of the cutter, pain and emptiness reign. She feels alone and embittered by the unfairness of life and her own hurt. The cutter is persuaded that no one understands. If God is acknowledged at all, he is viewed as distant and unable to stop the gnawing pain within.

Self-injury knows no social or economic bounds. From the lonely, hurting teenager to the empty world of Princess Diana, self-injury offers a momentary escape from relational agony. Here is one way to define the sin of self-injury:

Self-injury is a form of self-inflicted physical injury performed in order to assuage the relational hurt resulting from broken relationships with God and others. Thus, self-injury is not primarily a cry for help, but a desperate attempt at self-healing when relationships with others have seemingly failed.

The underlying sin of self-injury is turning to self for relief rather than to God. The cutter tries to accomplish for herself something that only God can do. Sin’s deceitfulness lures the self-injurer on. The razor continues to promise what it cannot deliver. The song “Numb,” by Linkin Park, describes the pain of a cutter, a teenage daughter alienated from her mother, this way:

I've become so numb, I can't feel you there,
Become so tired, so much more aware I'm becoming this, all I want to do
Is be more like me and be less like you.
And I know I may end up failing too.
But I know
You were just like me with someone disappointed in you.

So what can you do to help self-injurers that God brings to you? Both Mark Shaw and Ed Welch have written helpful booklets that anyone counseling self-injurers should read. You, of course, will do a thorough job of data-gathering, looking for the underlying issues that brought things to this point. In addition, allow me to suggest adding Psalms 23 to your resources in dealing with self-injurers. This psalm describes with amazing insight the world of the self-injurer. Let’s take a brief look at each verse and how it applies. I will make the comments specific to cutting, but the principles apply to all forms of self-injury.

1 The LORD is my shepherd, I lack nothing.

This strikes right at the center of the pain of the cutter. From a relational perspective, the cutter believes that she lacks everything. She believes that if God is indeed her shepherd, then he must be doing a terrible job. Functionally, she knows little of the care of God. He is not a loving shepherd, but a tyrant. She may not voice these words directly to you or to her parents, but that is where she is functionally. Your task, counselor, is to bring her back to God’s reality. This verse connects to reality from God’s perspective.

“How do I begin to explain God’s reality?” you may ask. That is an excellent and fundamental question. The answer to that question is often referred to as one’s worldview, although we are looking only at the “short version” here.

We are here on the planet to do what he has called us to do. Thus, through the promises and work of Christ we do, in fact, have all that we need. We lack nothing. Our cutter is viewing life from her own perspective, from her perception of her needs. This way of thinking is always a recipe for disaster. Some people embark on a lifelong quest to meet their own needs. They chase the illusive dream; to achieve it they may become workaholics or engage in some other vain pursuit. Cutters don’t wait that long. Their pain drives them to seek relief NOW. The goal of your counseling should be to bring the self-injurer to embrace the reality of this first verse of Psalms 1.

 2 He makes me lie down in green pastures,
he leads me beside quiet waters,
 3 he refreshes my soul.
He guides me along the right paths
  for his name’s sake.

These two verses speak of the blessed reality that verse one proclaims. If God is our shepherd, then he does indeed refresh our souls. He does guide well. In his care we indeed are surrounded by green pastures. But the cutter denies this reality and sees life only from her own lonely perspective. She is living by sight and not be faith. So, as you work through the pain of her life, you have this blessed hope to set before her: salvation, true rest, is found in coming to Christ (Matthew 11). Christ alone, through his word alone, can make sense of this young girl’s life. To be healed, she needs to see with eyes of faith. Inner healing must begin for the physical wounds to heal fully; otherwise the wounds will beckon to be opened again.

4 Even though I walk
  through the darkest valley,
I will fear no evil,
  for you are with me;
your rod and your staff,
  they comfort me.

This is where you can begin; this is where your cutter can identify deeply with the written word. She knows all about the dark valley of her life. The psalmist does not gloss over this dark reality. The self-injurer lives in this valley. The only light she sees is the brief reprieve of the razor blade. Start here, and help her see that her view of reality is at odds with God’s reality. Christ was tempted at every point that she was tempted, but he never reached for the sharp edge of the blade. Instead, he turned to the joy of submitting to his heavenly Father. Because of his death, your cutter can do this as well. She no longer has to fear the dark evils of her life. God can bring comfort to her darkest fears.

5 You prepare a table before me
  in the presence of my enemies.
You anoint my head with oil;
  my cup overflows.
6 Surely your goodness and love will follow me
  all the days of my life,
and I will dwell in the house of the LORD forever.

This is the reality that awaits your counselee as she turns away from her fears—fears driven by a flawed, sinful perspective that says she is alone and there is no one to help with her hurt, pain and fear. As she is able to embrace the truth of these last two verses, she will be able to rest in the truth that God is her Shepherd, and she has all that she needs in him.

As many commentators have said, Psalms 23 is for the living, not the dead. Using compassion, skillful listening, insightful questions, diligent prayer, and courageously proclamation of God’s sufficient Word, you can bring hope and healing to the cutter.