Q&A: My Child Is Self-Harming. How Can I Help?

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Question: 

I walked in on my teenaged daughter cutting her upper leg with a razor. I have also noticed multiple cuts and what look like cigarette burns on her wrists and torso. She’s always made excuses about them, but now I realize she has been self-harming for a while. She swears she isn’t suicidal. What’s this all about, and what can I do?

Reply from Steve McCrea, MS

Self-harming is a very complex phenomenon. The reasons young people do it vary widely and it is impossible to make a general statement about how a particular individual can be helped. Finding solutions will require a willingness to listen and explore as well as to look at some uncomfortable issues within the family or community—and the discipline not to judge the behavior as being “bad.”

One of the first helpful sayings I learned as a social worker was, “All behavior meets a need.” If we consider behavior to be arbitrary or caused by some biological malfunction, we generally miss the opportunity to consider the meaning of that behavior, often best stated in terms of what need it is meeting for the person choosing to engage in it.

I have dealt with many people who have cut or otherwise hurt themselves intentionally. Their reasons have usually fallen into one of two categories: They either want to overcome emotional numbness and make themselves feel something, or they are in pain and prefer to be the cause, rather than the victim, of their own pain. There is often a strong theme of wanting to regain control of some process or event or of another person’s behavior.

It is also very possible that a person engages in self-harm because it has somehow become “cool” to do so, but in my experience, such folks are unlikely to continue this behavior over time.

Understanding the Why

What I’ve found to be most helpful in dealing with self-harming behavior is to start with the assumption that the person (in this case, your teenager) has a reason for doing it that you don’t understand. Your daughter is willing to endure significant pain to accomplish whatever goal she has in mind, so whatever it is must be of some particular value. Thus, your task is to simply ask her to explain what self-harm does for her. You can say: What’s it like for you? What do you like or find meaningful about cutting or burning? If this direct approach doesn’t help you to understand, ask her what happens when she hurts herself. What effect does it have, positive or negative? Probe for specific answers such as, “I feel very powerful when the blood comes out” or “I know I’m going to be hurt again, but this way, I get to be in charge of the pain.” You will need to ask in a very interested way – there can be no hint that you are critical or want her to stop the behavior; you just want to understand it.

Whatever the reason, be sure to express interest in understanding her explanation for what is happening. If your daughter has ever been to a therapist/counselor/psychiatrist who told her what they thought the cutting meant, listen carefully to make sure she’s not giving a “scripted” response, i.e. the one she thinks adults want to hear. If she does start down that path, an easy question is, “Did someone else explain it to you in that way, or are these your own thoughts on the matter?” 

It’s possible she, like many youths, doesn’t really know why she’s doing it. That’s OK! The point is to express interest in her personal viewpoint and suggest that maybe you can figure it out together. You can ask when she does it, if there are events that tend to happen beforehand, if she’s noticed a particular pattern, and if a particular person is often involved. Whatever makes sense from the conversation you’ve initiated. Stay interested without being too pushy. If this doesn’t work or if it doesn’t make sense for you to be the one to ask these questions, find someone whom your child trusts and see if they can make a breakthrough

This curious, accepting approach accomplishes two things:

  • First, it makes it clear that you are not an opponent who has to be accommodated or fought off. It establishes you (or whoever undertakes this process) as a “safe” person who isn’t interested in controlling her. This opens the door to deeper conversations about what is going on and what your daughter wants to accomplish, is frustrated by, or feeling hopeless about. 
  • Second, it may provide some information that can help you know how best to assist her with the underlying problem(s) that the self-harm is focused on solving. For instance, it may be that a particular person or kind of discussion pushes her in the direction of cutting. You can then talk about better ways to manage that particular situation without even making self-harm the issue. If your child has a viable alternative for dealing with the problem, the cutting may simply diminish or stop altogether. 
Exploring Alternatives

It is important to stress that helping your child stop the behavior comes only after an honest discussion of whether that’s something she really wants to do. Some young people continue to find self-harming to be a helpful coping tool and choose to continue to use it. Getting into a power struggle about trying to stop them is extremely counterproductive! A discussion of less harmful methods of release (like using ice or not puncturing the skin) can be useful for those who have decided to continue, as again the focus is on giving the child options, not controlling her behavior. More options mean more ability to make conscious rather than unconscious decisions, which gives the rational mind a better chance to re-engage. 

If your daughter does share a desire to stop her self-harming behavior, a discussion of alternatives may be in order. For one young adult with whom I worked, I suggested creating a self-harming box containing objects such as spaghetti noodles, a feather, some gummy candies, and any number of other items that can’t actually do much damage. I suggested that we could decide it’s OK for him to self-harm, but he’d have to choose one of the items from the box to do it. This led to uproarious laughter, and the box was never actually needed. Just thinking about it was generally enough to create an awareness that alternatives always exist. We also talked about the type of events that tended to trigger an incident and came up with different approaches to handling his anxiety that didn’t involve hurting himself.

Recognizing Abuse or Suicidality

Self-harming is often associated with abuse earlier in life, particularly sexual abuse. Still, plenty of teenagers self-harm without any specific abuse history, so don’t assume that this is the case. Just be aware of the possibility. If such a revelation comes to light, there will be many other issues you will need to address together that are beyond the scope of this reply. If you already know that abuse history factors into their behavior, don’t push, but don’t be afraid to talk about it. The more OK it is to talk about whatever your daughter is thinking or experiencing, the easier it will be to look at alternatives –or at least convey a solid understanding of her reality. 

Finally, it is essential to differentiate between self-harming behavior, which is generally controlled and focused on anxiety reduction or pain management, and suicidal behavior, which is focused on ending one’s life. Self-harming is just that and has nothing to do with suicidal thinking or actions. When I worked on a suicide hotline, I frequently got calls from people who engaged in self-harm but called us for support rather than talking to their counselor/therapist. Too often, the counselor/therapist would forcibly hospitalize them if they knew what was happening. Clearly, this was a huge impediment to any kind of therapeutic relationship. You can ask your daughter again if she is feeling suicidal if you are legitimately worried about that, but if she again says no, please believe her and deal with the self-harming for what it is: a personal coping measure, not a life-threatening situation.

Entire books have been written on this subject and certainly, some will disagree with what I’ve said here. This is just a distillation of my own experience with what has worked for me and my clients. The most important thing is not to overreact and to be interested in understanding what problem the self-harming behavior is trying to solve. A calm and interested approach will be much more helpful to your child than a panicked attempt to make her stop. Remember, all behavior meets a need. Find out what need is being met by the self-harm (however counterproductive or strange it may seem) and you’re halfway to solving the problem in a way that’s less painful for both of you.

Steve McCrea, MS

Steve McCrea, MS, is a mental health professional, advocate and author who has worked for over 30 years in social services, including over 10 years as a mental health professional. He currently works as an advocate for foster children. He is a member of Portland Rethinking Psychiatry, an educational and advocacy group inspired by the works of Robert Whitaker.