About 5% of people harm themselves by cutting, biting, burning, or hitting (Samhsa.gov, 2023). This is called self-harm or self-injury and it is something that I hear a lot from my clients in therapy. It can be a difficult thing for clients to bring up in session, so today I am going to share some information about what to expect if you decide to tell your therapist that you are self-harming.

If a client comes into my office and tells me that they are self-harming there are a few things that I already know from training that I have had. First of all, I understand that most of the time when people self-harm (like cutting or burning or something like that) they aren’t doing it because they are trying to kill themselves. Even though I know that, there are some screening questions that I am going to ask because it will help me determine the reason that my client is engaging in self-harm.

To begin, I am going to try to get an understanding of how severe or how potentially lethal the self-harm is. This is a basic screening and is going to include questions about a person’s history of harming themselves. This includes whether the person has thoughts about wanting to die or if they are harming themselves with any intention to die as a result.

The reasons that these questions are asked is because a person who engages in harming themselves is also more likely to attempt suicide (Samhsa.gov, 2023). It doesn’t mean that a person who is self-harming is going to be suicidal, but therapist screen for that anyways. If you tell your therapist that you are self-harming be prepared to answer some questions about suicide ideation and behavior.

Next, after I ask some basic questions related to suicidality, I am going to ask questions to help me understand why the person is self-harming. Self-harm is usually something that people do as a means of coping.

Let me explain that just a little bit. All people have different ways of coping with big emotions. Some of these methods of coping are healthier than others. All people have some coping that is healthy and some coping that is less healthy. Healthier ways of coping include healthy distractions, sitting with emotions, taking deep breaths, and other things like that. Less healthy coping looks like cutting, emotional eating, using substances, zoning out, and anything else that can cause the person additional problems in their lives.

The truth is that people use cutting as a method of coping because it works. People who don’t understand this may be very judgmental about self-harm, but usually therapists understand that there are real reasons that people self-harm and it isn’t as easy to stop as most people think.

Once I have established that the person is not trying to end their life, I will spend some time understanding how their self-harm is being used as coping. I might also try to learn more about the times that they use other coping skills that are healthier.

Some of the most common reasons that people self-harm are because they are punishing themselves, they are trying to soothe themselves, they are needing help and don’t know another way to express it, they are trying to stop feeling numb, or they are dealing with emotions that feel so big that they don’t know how else to let them out.

There are other reasons why people self-harm, but these are the ones that my clients express most frequently. As a therapist, I want to learn why the self-harm is happening so that we can find some different solutions.

One of the things that my clients are frequently worried about is whether or not I am going to tell someone that they are self-harming. This is especially something that my teen clients are worried about. They are worried that I am going to tell their parents.

To be perfectly honest, this is one of the “grey areas” when it comes to client confidentiality. I think most therapists agree that there is no need to tell anyone about an adult’s self-harm- unless the person discloses information that makes the therapist concerned that the severity of the self-harm is going to lead to the person’s death and the person won’t make a plan to be safe.

On the other hand, a teen’s self-harm is something that I have seen therapists handle in many different ways. Some therapists tell the parents. Some therapists do not tell the parents. Some therapists tell the parents only if the self-harm reaches a certain level of severity I wish I could give you a clearer answer, but it is actually best for teens and therapists just to ask the therapist. If you are concerned about this, ask them what things they will tell the parents. You can actually just ask a list of things so that you get a better understanding of how the therapist operates. For example, you can ask the therapist what things they will disclose to parents. Suicidal thoughts? Self-harm? Drug use? Sexual behavior? Breaking the law? Breaking rules at school? Sneaking out? This will help you get a better idea of what to expect.

Finally , the therapist is likely to work on making some kind of safety plan with you. This plan is a plan to engage in healthier coping when you are faced with the urge to self-harm. These plans are important but honestly seldom work on the first try. Instead, the plan for safety will need to be worked on repeatedly until you can find some insight into effective ways to intervene when you feel like self-harming. This will likely become a goal for therapy and will be something that you will work on until it gets better.

Sources:

Substance Abuse and Mental Health Services Administration. (2023, April 04). Self-Harm. https://www.samhsa.gov/mental-health/self-harm