Finding out your teenager is engaging in self harm is often shocking, confusing & scary for parents. There is a lot of misinformation about self harm around, & confusion about how best to address it. This guide will help you decide what course of action to take, & how to help your teen.
Defining Self Harm
Self harm is defined as any intentional self-injury or intentional physical pain inflicted in the context of high emotional distress, but is not aimed to end one's life.
Other terms for self harm are;
- deliberate self harm
- non-suicidal self injury (NSSI)
Examples of self harm include:
- cutting
- scratching
- burning
- hitting head
- punching self
- hair pulling
- pinching
The purpose of self harm is to reduce or avoid emotional distress with the use of physical pain & injury. This is different from suicidal actions, where the goal is to end one's life.
Self harming behaviours & suicidal behaviours are different, but they often coexist. People who engage in self harm are more likely to engage in suicidal behaviours, & is therefor an important risk factor to recognise & treat early.
Myths About Self Harm
There are many myths about self harm in our society. Understanding the true nature of self harm is vital to accessing effective treatment & having a helpful family response.
Myth: Self harm is done for attention
Fact: Self harm is an expression of high distress & a lack of skills in managing that distress. People who self harm often feel shame about it.
Myth: Teens who self harm will 'grow out of it'
Fact: Self harm is a serious & risky behaviour that requires specialist treatment. Left untreated, self harm often escalates to suicidal behaviours.
Myth: Nothing can be done to help a teen who doesn't want help
Fact: Nobody wants to be in distress, including teens. But ambivalence about getting help is normal. Teens do want help if it is made available & they are told there are things that can help.
Myth: Any therapist or health service can treat self harm.
Fact: Self harm is a specialist area that requires a different treatment approach to other issues. There are specific treatment models designed for the treatment of self harm (eg. dialectical behavioural therapy).
Myth: Removing access to means of self harm is enough to stop it
Fact: If someone wants to self harm, they will find a way to do so. Removal of means (eg. knives/ razors etc) on its own won't stop self harm unless the issues of high distress & lack of other skills are also addressed.
Myth: Punishment of self harm is an effective method to make a teen stop self harming
Fact: Punishment has been shown in many studies to not reduce self-harming behaviours, & in some cases it makes it worse &/or makes the teen be more secretive about it (which then makes it more dangerous).
Understanding Self Harm
There are some core elements to understanding self harm. Once you understand these elements, you will be in a better position to help your teen.
Self Harm is a Symptom- The Real Problem is High Distress & a Lack of Skills to Manage the Distress
One of the key mistakes people make when finding out a loved one is self harming, is they focus intently on the self harm. This makes sense- it's scary & confusing!
But if we only focus on the self harming, we're not addressing the real problem.... which is high distress & lack of other skills to manage that distress. We need a plan that addresses the actual, underlying problem.
Using Traditional Safety-Planning Methods is Often Not Adequate
This relates to the point above, in that traditional safety planning only addresses the symptom of self harm. It does nothing to address the high distress, or to teach any new skills.
Asking someone to stop self harming, but not giving them any new skills is setting them up for failure.
Safety plans can be more effective when combined with the teaching of new skills & exploration of the underlying distress (such as with dialectical behavioural therapy).
Self Harm is not a 'Manipulation'
The aim of self harm is to reduce one's experience of emotional distress. It has nothing to do with trying to 'manipulate' or 'trick' others.
It is not uncommon for parents to feel manipulated at times by threats of self harm, but that's rarely the intention. Again, the problem is very high distress & a lack of skills to reduce or regulate that distress.
Self Harm is a Risk Factor for Suicidal Behaviours
People who self harm are more likely to engage in suicidal behaviours. Commonly, there is a pattern of escalating self harm that then transitions into suicidal behaviours.
The longer someone has been self harming, the more at risk they are for completed suicide.
The longer someone has been self harming, the lower their tolerance to distress becomes- which makes life even harder. Therefor, early intervention is recommended.
Not All Mental Health Treatment if Effective for Self Harm
Treatment for self harm needs to address 3 key issues:
Effective risk assessment & confident ongoing risk management
Providing a safe therapeutic relationship & environment to explore distress
Teaching the person new skills so they can reduce & stop self harm, & increase long-term distress tolerance
Without all 3 of these elements, there is a risk that treatment will not work. Some services may provide 1 or 2 of these elements, but all 3 are essential. Many people struggle with self harm for years longer than they need to due to a lack of understanding about what effective treatment involves.
Research shows the most effective treatment for self harm is dialectical behavioural therapy (DBT), which was designed for the treatment of self harm as well as emotion regulation difficulties.
Help/ Resources
There is help for you, your family & your teen. There are dialectical behavioural therapy (DBT) programs in most areas, some of which even specialise in treatment for teens.
Some options to consider are;
1:1 sessions with a DBT-trained therapist: Beware of professionals who list all specialties in their bio! Ask for details of training they have done in DBT & whether they have experience working with teens from a DBT model.
A DBT group program: This will teach your teen practical skills to reduce/ cease self harm & increase their tolerance to distress. Group programs can vary between 12 weeks- 12 months. The gold-standard treatment is 12-months, but shorter groups can be effective for fitting into school & other life schedules.
A specialised DBT practice: If you have a service in your local area who specialise in DBT & provide a range of programs for teen & families, you've hit the goldmine!!! These services work with self harm day in, day out & are very good at it! Get in touch asap, arrange an assessment & utilise their expertise.
Online programs/ resources: There are online programs for parents of teens struggling with self harm. Even if your teen won't agree to treatment, that doesn't mean you have to go it alone.
Check out 'Self Harm in Teens: A Parents Guide' by the Mindful Recovery Services team.
If you'd like more information or individualised support for teens who are self harming, please feel free to reach out to the Mindful Recovery Services team at www.mindfulrecovery.com.au
Alex:)
留言