Coaching Caregivers to Respond to Self-Harm
Treating a teen engaging in self-harm can be extremely scary for clinicians - and even more terrifying for the teen’s caregivers.
This issue becomes more daunting for parents and providers, as attempts to identify the underlying causes of a teen’s self-harm behavior can be confusing and inconclusive. Studies show that self-harm can be an effective — albeit maladaptive — coping mechanism for numbing or decreasing emotional sensitivity while also communicating pain and suffering.
This is compounded by the natural by-product of self-harm, which is care and attention from others. This can become a reinforcing cycle over time, whereby a teen does not learn more adaptive strategies for managing emotional pain or communicating needs with others.
Helping caregivers manage self-harm can feel overwhelming, especially as improper treatment by any party can lead to an escalation in unsafe behavior that may require emergency services. While many providers receive direct training to work with teens, we often lack the training to work with caregivers, which takes an environmental approach.
Fortunately, there are steps that you can follow when working with caregivers to address the root issue of the behavior while maintaining safety and helping teens avoid higher levels of care.
A few weeks ago, I consulted with a therapist treating a 16 year old I'll call Elle. Elle’s parents frantically contacted Elle’s therapist after inadvertently seeing a text message on her phone indicating that she had been cutting herself. The therapist was well versed in how to work with Elle, but was at a loss for how to guide the parents to support their suffering child.
Providing a treatment called Dialectical Parenting, I merge evidence-based approaches from Behavior Parent Training and Dialectical Behavior Therapy to empower caregivers to keep their vulnerable teens safe and improve coping strategies.
When coaching caregivers, I have four immediate goals for the caregivers and four long-term goals:
Immediate goals
1.Regulate emotions
When receiving a call about a teen’s self-harm, it’s natural for parents to feel urgency and worry. Encourage parents to take a pause before responding. The behavior may feel like an immediate crisis, but it’s important to remember that self-harm is often a long-standing coping strategy, not necessarily an indication of suicidal intent. By taking a beat, parents can approach the situation with a clear, calm mindset, allowing them to act thoughtfully rather than react emotionally.
2. Increased monitoring
With the house secured, increased monitoring is crucial. Reduce the time that the teen spends alone, keeping doors open while frequently checking in on them. Again, remain calm throughout; the teen should feel supported rather than punished or ashamed.
3. Means restriction
The first step is asking the teen how they harm themselves, and then removing those objects from the home. This strategy often includes checking their rooms and removing objects that teens could use to harm themselves.
4. Safety Assessments
Continually check in with your teen, maintaining open communication while cultivating trust; the parent should be their teen’s first go-to, not the internet or their classmates. Ask them whether they are thinking about hurting themselves: “Do you want to cut, do you have a plan to do so?” Be specific about when, where, and how, encouraging the teen to open up, and emphasizing how you have the same goals.
Long-term goals
Adaptive Coping Skills
With increased monitoring and safety, we can turn our attention to helping our teen reduce longer-term suffering. Self-harm often indicates that there is a lack of other, healthier, coping skills. Talking to your teen about their preferred coping strategies (watching reruns, calling a friend, going for a run) and how and whom to ask for help when needed are necessary when helping a teen find positive alternatives.
2. Open Communication
Letting your teen know they can come to you with any problems is an important part of helping them reduce self-harm. Having open communication means listening to your teen, letting them know you are there for them no matter what they do or how they behave, and demonstrating you trust them to solve their own problems. Teens often become withdrawn when they expect people will respond to their problems with questions or solutions they know won’t work. Approaching them non-judgmentally while validating their emotions is impactful in helping the teens feel more secure.
3. Balanced Monitoring
While monitoring is necessary, a calm and neutral approach helps teens feel safe and respected. Caregivers should focus on maintaining a balanced tone during check-ins, keeping interactions nonjudgmental and supportive. When teens see that their caregivers can respond without emotional escalation, they may feel more inclined to share openly.
4. Increase Positive Activities
Finally, self-harm behavior can be representative of deeper-seated challenges afflicting the teen, so a comprehensive response is necessary. An important step can be helping the teen find other peers and activities that are positively impactful, as negative behaviors including self-harm can be influenced by their peer network, both physical and digital. Helping the teen discover and join something they’re passionate about like a school sport, club, or community service organization will enable them to channel their energy more productively.
Effectively treating teens who self-harm can be one of the most challenging tasks a provider and caregiver face, as there are many uncontrolled variables influencing this vulnerable group.
For additional details, here is a PDF handout and below is the lunch and learn recording where I take a deeper dive into Betty’s background, her challenges, and how we supported her recovery.
Disclaimer:
The information provided in this blog post and during Lunch & Learn sessions is for educational and informational purposes only and does not constitute medical, psychological, or professional advice. It is not a substitute for individualized consultation, diagnosis, or treatment by a qualified professional. If you or someone you know requires specific support or treatment, please consult a licensed healthcare provider. Participation in these sessions or reliance on the content provided does not establish a professional relationship or supervision. Proven Practice and its affiliates are not liable for any outcomes resulting from the application of this information.
