How do I talk to my teen about self-harm and why it is important to get the right help.

Parents are rightly shocked when they discover their child is self-harming. A common response is to avoid the topic because they don’t know what to say, or to take drastic action to try to stop the behaviour immediately. Sometimes self-harm is dismissed as “attention seeking”. These responses are not helpful and may even make the situation worse. As a trauma-informed Family Therapist, I have worked with many self-harming teens over the years. I have come to understand that the dynamics are different for each individual and self-harm is usually an attempt to cope with overwhelming distress and tension. Self-harming adolescents have spoken to me about conflict with their parents, family violence, sexual identity confusion, being bullied, peer group pressure and mental health illnesses like anxiety and depression. Teens who self-harm may also be mimicking others. Most have seen internet content about someone who cuts, and many know a person at school who is doing it. Cutting or hurting yourself stimulates the opioid system in the body, creating a feeling of euphoria. Some teens try it once, get freaked out and decide not to do it again. But others push past these early discomforts and start to crave the euphoric feelings. This can build into a dependence and the behaviour becomes addictive, like binge eating and purging. What is self-harm and what do you look for? 

• Girls and boys are both susceptible to self-harm. Girls are more likely to cut and scratch their skin, while boys are more likely to burn, bang their heads or run into hard objects. Choking or biting oneself and interfering with healing wounds are other forms of self-injury.
• In most cases, tattoos and piercings are not a form of self-harm unless body modification becomes a vehicle for experiencing pain and seeing blood or tissue damage. Nail biting is not a form of self-injury.
• An estimated one in five young people have tried self-injury at some point, but only 3% go on to repeatedly harm themselves. It is rare for self-harm to continue (without significant underlying mental illness or complex trauma) past the mid-30s.
• Self-harm does not necessarily mean your adolescent is also suicidal. Most teens use self-harm to relieve tension and manage distress. They might then become addicted to the release of natural opioids in the body. However, some adolescents who self-harm do also attempt suicide, so it is important to seek professional help, and early.
• Self-injury may be used to prevent or cope with suicidal thoughts and behaviour.
• If someone has a lot of wounds or scars that are similar in shape and clustered in a certain area, particularly on the arms and thighs, self-harm should be explored as a possible cause.
• A wound that is linear or slightly curved, and within easy reach of the person’s dominant hand, may be caused by self-injury. Burns appear as small circular wounds.
• Wounds or scars in places that are unlikely to be caused by an accident, such as the stomach or upper thighs, may be self-injury. Or numerous wounds that are at various stages of healing. It is important to note that most teens choose areas that parents can’t easily see, so don’t assume your child is not self-harming because you can’t see it.
• Remember these signs and symptoms may not indicate self-injury at all, so be careful not to jump to conclusions.

In my experience, teens who self-harm usually have intense feelings of shame and many go to great lengths to hide it. Being confronted by a parent who wants to talk about it is embarrassing and there is a good chance your teen will close down or lie about it. Here are some common questions I receive from parents and how I guide them to support their teens: What do I do if my teen denies self-harm but I believe they are engaged in it?

• Looks for signs they might be hiding injuries by wearing unusual clothing that covers their bodies such as long-sleeve jumpers in summer or refusing to put on a swimsuit.
• I recommend that you query nonchalant explanations for multiple or repeated wounds. Teens may call themselves clumsy, say they keep falling over in sport, or the cat has scratched them.
• If they won’t talk to you about your suspicions, or you notice a wound but they outright refuse to say how it occurred, encourage them to speak to another adult in their immediate circle who they trust. An aunt, uncle or grandparent.
• Make an appointment with your GP and tell your teen it is for a general check-up. This is better than insisting on examining their bodies and violating their privacy.
• Contact the school counsellor and ask them to call your child in for a meeting. Be clear about your concerns so the counsellor can address self-harm in this initial meeting.
• Make an appointment with a family therapist. If you suspect self-harming is occurring, there is a good chance it is. Seeing a family therapist will provide you with instant support and strategies to deal with the problem.

Where do I get help once I have established self-harm is occurring?

• Choose a counsellor who works specifically with adolescents and who understands trauma. A therapist who uses only cognitive behaviour therapy may focus on changing the behaviour but not address the underlying distress. Young people quickly learn how to say what they need to say to get away from CBT therapy.
• Choose a counsellor who your teen actually likes and feels comfortable with. If they don’t feel comfortable, they will never disclose or make progress in overcoming self-harming behaviours.
• If they don’t want to go to counselling of their own accord, again contact the school counsellor and ask them to call your child in for a meeting. Encourage the school counsellor to refer your child to a family therapist or adolescent counsellor who specialises in self-harm.
• Quite often the self-harm can be a symptom of something else going on in the family. Ensure you seek help from a family counsellor who has the skills to unpack what else might be happening that is contributing to stress. If your adolescent refuses to see someone on their own, family counselling is a way to get them to counselling without the teen feeling that they are the “problem”.
• Take disclosures of self-harm seriously and act promptly. If a teen shows you a recent wound that looks deep or infected, seek medical attention.

What do I say to my adolescent who is self-harming? How do I support them?

• First responses are important. If your teen admits to harming themselves, don’t overact by showing shock or anger. And don’t jump straight into fix-it mode. Listen to what they say and speak with a calm voice. Empathize with how hard it must be and how overwhelming their feelings can be.
• Ask yourself why they might feel the need to do it and think about recent events or changes in their lives that might be causing distress. Gently enquire about what is worrying them.
• Ask how you can help and say you will be there to support them in a non-judgemental way. Let them know there are alternatives to self-injury and you will be seeking help with an adolescent and family counsellor.
• Avoid using labels like “attention seeker” or “drama queen” as this dismisses the seriousness of your teen’s distress and can drive the behaviour underground. Anxiously quizzing your teen about the self-harming behaviour will do the same. Remember, adolescents who self-harm are using their bodies to relieve tension or act out impulses, not necessarily to attract attention.
• Self-harm is more about emotional difficulties than illogical thinking, so telling someone to “snap out of it” or “just stop” is not going to help.
• Encourage struggling teens to stay connected to positive social supports such as extended family, friends or sporting teams.
• Consider limiting access to social media which might be causing your teen a great deal of stress. Self-harm can reduce when teens are less exposed to negative social interactions.
• Discourage time with friends who you think may also be self-harming. Some teens are encouraged to self-harm by a friend who is doing it and it becomes a group behaviour.
• Consider a natural supplement.  Research has shown that a supplement of turmeric can produce an antidepressant behavioural response.  You can read more about this here.

A Family Counsellor like me can support parents to make necessary changes that may be contributing to self-harming behaviours in your child. I work with teenagers to break the cycle of self-injury and help them develop healthier responses to stress. In both family counselling and adolescent counselling it is important to also address any mental health concerns or peer group pressure that is fuelling the self-harming behaviour. About Jacqueline Jacqueline has been in private practice for more than two decades, helping individuals, couples and families.  She has extensive experience in couple and family therapy and is considered a specialist in these areas. In her clinical practice, she has helped people deal with complex trauma, affairs, complex mental health issues, eating disorders, adolescent behavioural problems (including self-harm and suicidal ideation), behavioural issues in young children which are impacting parents and families, relationship issues and post-separation work. Jacqueline works with many different dynamics: couples, parents, families with young children, same-sex couples, foster/adopted families, families with teenagers and also adult families.  She is particularly interested in helping parents of children with behavioural issues, or with diagnosed conditions such as anxiety, ADHD, ASD and so on. Although Jacqueline’s work is supportive and friendly, she will challenge her couples and families to make the necessary behavioural changes, to repair relationships and to move towards healthier communication styles in the future. Jacqueline’s style is direct and fast paced and she is known for quickly getting to the heart of the matter.  Clients report that they feel safe and understood with Jacqueline. Qualifications and Professional Membership Jacqueline has a Masters in Couple and Family Therapy (UNSW). She has a Bachelor degree in Counselling and Human Change, and a Diploma in Psychotherapy and Counselling. Jacqueline is a Clinical Supervisor for Counsellors and Therapists. She lectures in couple and family therapy at Masters and Post Graduate level, and is currently Head Lecturer for the Couple and Family Therapy course (Masters) at the Jansen Newman Institute.  She has been a Lecturer at the University of Western Sydney and Sydney University, and continues to guest lecture at other tertiary institutions. Jacqueline is also the Director of the Couple and Family Training Centre where she runs regular professional development workshops and seminars for Therapists, Counsellors, Psychologists, Social Workers and Health Industry Workers who are looking to gain skills in this specialist area. She is a Clinical Member of the Family Therapy Association of Australia and a Clinical Member of PACFA. “Thank you for seeing me today. Your help with all our family issues and all your advice has been invaluable. I don’t know how other families do it, without a Jacqueline in their lives.” – Anna (43) step-mum and mum to four children. If you feel as though you could benefit from talking with a Therapist please contact  The Sydney Couple and Family Specialists on 02 8968 9397 or email info@sydneycoupleandfamily.com.