Self harm/injury
Self-harm is a very delicate symptom. It needs to be handled with care, compassion, and without judgment. When I see self-harm listed in a referral, I pay close attention to how I present myself. I use a calm and gentle voice. I maintain kind eye contact, and my body language shows that I genuinely care. When I approach the conversation with empathy and curiosity, most clients feel safe enough to open up about their self-harming behaviors.
Assessment of self harm
First, I ask whether they understand the difference between self-harm and suicidal ideation.
Then, I gather a detailed history. Some questions I ask include:
- When did you first start having thoughts of self-harm?
- When did you first act on those thoughts?
- How severe has the self-harm been?
- How often does it happen?
- Did anyone know about it?
- How did self-harm help you during those difficult moments?
- What stressful events were happening at the time?
If you are looking for ideas and resources on suicidal ideation and safety planning, read my post on https://ideasforcounseling.com/every-session-check-in-suicidal-and-homicidal-ideation/
Reasons for self harm
Instead of asking why someone self-harms, I ask how self-harm helped them during difficult situations. This small change often makes clients feel less judged. As a result, they are usually more willing to share their experiences.
Some reasons clients have shared with me include:
- Self-punishment
- Wanting to feel alive
- Wanting to feel visible rather than invisible
- Avoiding difficult emotions
- Finding temporary relief from emotional pain
Self love plan
I usually ask clients to make a list of people who care about them. Some clients mention friends or family. Others say that nobody cares about them. When that happens, I gently tease them by saying they forgot two people who are already in the room. First, I tell them that I care. I chose this profession because I want to help people and show compassion to those who come to my office. Then, I tell them that the second person is themselves.
This often leads to a conversation about self-love. We discuss how society, culture, and even families rarely teach us how to love ourselves. Instead, many people grow up without learning healthy ways to care for themselves during emotional pain. As a result, some people turn to self-harm instead of self-compassion when they feel overwhelmed.
If clients are open to learning new skills, we work together to create a personalized self-love plan. We identify healthy behaviors they can use whenever they notice the urge to self-harm. The goal is not just to stop the behavior, but to replace it with actions that provide comfort, care, and emotional support.
Involvement of loved ones
Because I work with children and families, I try to involve parents or caregivers whenever the client is willing. First, I validate the parents’ fear, guilt, and worries. Then, I give them the handout below with ideas for changing their communication in ways that better support their child. I also ask the client to create a list of things they would like their parents or caregivers to do differently.
