Important Topics
Treatment For Adolescent Self-harm
Article two in a series of three about self-harm.
Self-Harm is an increasingly pervasive symptom of emotional distress among adolescent girls. Because it involves physical damage to the sufferer, cutting understandably evokes distress and fear in others. Viewed on a continuum, self-harming behavior can easily—though not always accurately—be interpreted as a precursor to suicidal behavior. Because self-harm is so pervasive and so disturbing, InnerChange program director Dustin Tibbitts, LMFT, has written a three part series to help parents better understand and address this behavior.
One young woman I worked with in an adolescent treatment facility years ago mocked her former psychiatrist for suggesting that she “draw a red line on her arm” instead of cutting. That strategy, she reported with a sneer, didn’t help at all. She also rejected a nurse’s suggestion to submerge her hand under cold water and ice cubes until the cold burned her skin.
Instead of trying to find “safer” ways to mimic her self-harm, she found it more helpful to get involved with caring friends. Over the course of treatment as she developed an increased understanding of her struggle, she began to cherish every opportunity she had to really connect with another human being. In addition to forging positive relationships with the treatment team, she developed friendships with other adolescents. Her peers helped her discover new activities that involved creativity. Sculpting clay with her friends, she discovered, helped her resist urges to cut herself. Painting worked too. Designing web pages on her laptop seemed to help. She allowed her creativity to blossom in the context of these new friendships and was able to move beyond the need to self-harm.
As this adolescent girl discovered, the first step toward helping someone who can’t seem to stop harming herself is to engage in a relationship of safety, respect, compassion, and trust. Berating, cajoling, threatening and shaming are not effective strategies. People who self-injure, after all, are already very good at doing that to themselves.
A positive therapeutic relationship—whether from a therapist, friend, or parent—is really the only soil in which healing can take root and eventually bloom. In the context of adolescent treatment, this kind of relationship is the therapist’s doorway to other important strategies, such as teaching practical coping skills. We have to help the client replace dangerous coping behaviors with other, non-destructive behaviors (more on this in part three of this series). But, in order to teach new skills and strategies, relational context must exist.
The bottom line is that treating self-harming behaviors requires, first, a genuine and trusting relationship. This relationship sets the stage for teaching new coping tools and for replacing shame with love and respect.
