Therapy
for Self-Harm

Understandably, it can be alarming and scary to find out that your loved one is self-harming. However, self-harm doesn’t always mean that someone is suicidal. In fact, both suicidality and self-harm are typically just a symptom of some larger unresolved issue.

In my experience, the first objective of treatment should not be to put an end to the self-harm, as this tends to clear up naturally once the root causes have been addressed.

Over the course of treatment, we will work to improve existing and identify new coping strategies. Once those are in place, I encourage clients to utilize those instead.

In the meantime, the goal will be to ensure that the client is being as safe as possible with their self-harming. This involves evaluating and providing recommendations around the following. In this example, the individual’s method of self-harm is cutting.

• Are the objects they’re using:

  • Dirty

  • Rusty

  • Jagged

  • Too sharp, which could lead to accidentally cutting too deep

• Wound care:

  • Are they performing any wound care?

  • Have any of their cuts gotten infected?

• Body location:

  • Are they cutting in any areas with major veins or arteries that could accidentally be cut?

• Frequency:

  • How often are they cutting?

• Quantity:

  • How many times are they cutting each time?

• Depth:

  • Are their cuts deep enough that they result in scars or uncontrolled bleeding?

After this assessment, we would safety plan and problem-solve around the following:

• Switching to using safer/sterilized objects

• Access to and engagement in proper wound care

• Switching to safer body locations

• Decreasing frequency, quantity, and depth

Learning about how self-harm works, what causes it, and how to manage it

Mapping out how YOU specifically experience the symptoms that trigger your self-harm, so that we can custom tailor your treatment plan

Building your coping skills, emotion regulation skills, and problem-solving skills

Identifying and resolving the root cause(s) of your self-harm

The purpose of a Safety Contract is to document the client’s agreement that they will no longer engage in self-harm.

While well-intentioned, Safety Contracts oftentimes leave clients feeling even more isolated and as though they can’t speak freely with the clinician they finally opened up to for help.

In fact, studies have shown that Safety Contracts aren’t very effective and sometimes even exacerbate clients’ symptoms.

In lieu of asking you to give up your coping skills cold turkey, we would collaborate on the creation of a Safety Plan.

A Safety Plan is different in that its purpose is to assist clients with understanding and preventing, and/or minimizing, their self-harm and the root causes.

My version of a Safety Plan includes identifying and tracking the following:

• Triggers:

  • What sparks your urges to self-harm

• Warning signs in your body:

  • How someone would know, just by looking at you, that you’ve been triggered (e.g., keeping to yourself, pacing, crying)

• Ways to prevent or minimize urges to self-harm:

  • Ways to decrease the occurrence of and/or avoid exposure to triggers

  • Activities you can engage in, people you can talk to, and places you can go that make you feel better, safe, and/or distract you

• Specific ways to ask for help:

  • Pre-planned phrases you can use in case you get anxious or flustered when it actually comes time to ask for help

• What needs the self-harm meets for you:

  • Your specific reasons for self-harming, because it’s different for everyone, and alternate/safer/healthier ways to meet those same needs

• Local resources:

  • Location and contact information of your preferred mental health hospital and emergency services in your area, should you need them

This plan will be updated and referenced regularly throughout treatment.

I conduct regular, typically weekly, Self-Harm Risk Assessments.

Once a baseline has been established, no disclosures will be made to parents/caregivers unless the client’s scores worsen significantly. This is to ensure that clients feel safe disclosing their self-harm.

Below is an example of what would be tracked for an individual who cuts:

• Risk-level of object(s) being used (e.g., sharpness, sterility)

• Quality of wound care (i.e., is it being performed, have any of their cuts gotten infected)

• Risk-level of body location (i.e., cutting in areas with major veins or arteries that could accidentally be cut)

• Frequency (i.e., number of times per week)

• Quantity (i.e., number of cuts per occurrence)

• Depth (i.e., did it result in any scars and/or uncontrolled bleeding)

• Any accompanying suicidal thoughts and/or behaviors

• The level of difficulty the self-harm has caused across settings (e.g., inability to engage in certain physical activities or change in front of others, missing school or work due to infections)

• Any triggers specific to that week

I'd love to talk with you either via phone or video chat, whichever is most comfortable for you, so I can:

• Get to know you

• Get an idea of what brings you in

• Answer any questions you may have

• Make sure we both feel like it's a good fit

If it is, we would move forward with scheduling a more in-depth intake.

Click the button below to schedule your free consultation.