Therapy For Cutting: How To Talk With Your Teen And Help Them Talk About What They Are Feeling

Often when parents seek therapy for teens who are struggling with depression or anxiety, they are also looking for therapy for cutting. Cutting is when someone is takes an object such as a knife (dull or sharp), scissors, a paper clip or another sharp object and cuts themselves with it to create a painful but releasing sensation. Cutting falls into the category of self-harm behaviors, which also includes biting, skin picking, burning, scratching, banging, hitting body parts and hair pulling.

There are many reasons teens cut. In my therapy practice, I’ve seen teens cut because they’re angry, anxious, sad or feeling unsafe. Overall, though, cutting is a form of the teen saying they don't have the words or outlet to express what’s going on internally. It represents a conflict and a release–the act of cutting can release and calm the emotional and physical pain teens are feeling. Often, this release helps temporarily, but eventually, their feelings and physical uncomfortableness comes back. They need to cut again to find that release.  

In the New York Times article “Why Teenagers Cut and How To Help,” Jessica Lahey terms this inability to express emotions and experiences as “emotional illiteracy.”  This means the teen doesn’t have the language to express themselves, so instead, it gets bottled up and expressed by cutting. But, cutting is also isolating, which is why it under-expresses teen’s emotions. By under-express, I mean it only allows for a momentary release of the teen’s pain, depression, anxiety, anger, frustration, loss, and trauma.

That is why, in order to address cutting, parents, therapists and other adults have to help teens express their feelings and needs. Cutting happens more than parents, teachers and others with teens think, and what is often missed in these discussions is how cutting needs to be talked about with the teen to teach them how to articulate their internal and external experiences without self-harm.

Cutting Therapy: What Do You Do If You Find Your Teen Is Cutting?

For parents of teens seeking therapy for cutting, cutting is scary. There is often a sense of crisis. Is it a suicide attempt? Is it never-ending? How bad is it?

Cutting is not always the product of a suicide attempt and doesn't typically lead to suicide. That said, if cutting is taking place, parents need to be explicit about suicide. Without freaking out, ask: “Are you having thoughts about being better off dead? Are you having thoughts about killing yourself? Do you have a plan?” A crisis should always be assessed, particularly if a teen is suicidal or needs immediate help. Take the cutting seriously, but don't freak out unless the injury needs emergency attention or they have thoughts or a plan to kill themselves.

If you are continually jumping into crisis mode (calling 911 or a therapist or psychiatrist on speed dial) without slowing down to talk through how the teen is feeling after the event has passed, then you teach them to exist permanently in crisis mode. Instead, teens need caring adults to get closer to them. As a parent, you need to be one of these adults, who will listen to your teen, reflect what they are saying and let them voice what is going on in their life.  A caring adult helps them express themselves without cutting. The finding and exposing of cutting and self-harm can be an offering for you and others to get closer with your teen.  

Cutting Therapy Solution: Talk To Teens About Their Feelings

If cutting represents that teens don’t know how to talk about what they are feeling, teens need to create new avenues of expressing themselves emotionally, namely through talking in a coherent and, even messy way. In my therapy practice, I call this getting “up and out,” meaning, “Let’s get these feelings and thoughts up and out” and connect with someone else because otherwise, these feelings just get bottled up.

Of course, cutting never stops just like that. But, you can start by asking your teen: “How are you feeling?”  “What has been going on today?” “What it is really like to go to school?”  “Do you like school?” or “Tell me about your friend that makes you feel relaxed, scared, stressed, hurt.”  Let your teen answer. Don’t react right away except to acknowledge how hard this must be to say aloud and how glad you are to hear it. Teens need to talk. They also need a connection with adults in their life with whom they can collaborate on unpacking their feelings–both physically and emotionally–and most importantly, voice their individual experiences. This connection with adults in their life can help their conversations take fuller shape, knowing that someone wants to get close to them and their feelings.   

How To Listen And Help Your Teen Develop How To Talk About Their Feelings

Everyone wants things to be “okay” and resolved quickly and quietly. But sometimes, things are not okay for a while. Stating feelings of struggling or being in pain can suck. It can be awkward and hard to explain, as well as hard for everyone to hear aloud. For parents, embrace the awkwardness in a loving way by saying “I’m so glad you told me this,” or “Maybe we don’t know how to solve this yet, but let’s both think more and keep talking about this.” Teens can learn to embrace awkwardness when they are given an environment to experiment and be expressive in–a place where there is no “right,” “safe,” or “best” answer.  Parents can encourage this by just listening and asking teens to tell them their experiences before they react (And parents: this can be hard to do!).

Approach your teens on their level. You can learn a lot by listening to their favorite musician (even if it's not your thing). It can unexpectedly encourage them to say what they are feeling. In therapy with teens, I ask teens about their friends, movies or TV shows, and, at times, ask about who they are in a broader sense.

Parents can listen to teens by simply not talking and just supporting when your teen is ready or when they say they have talked enough. I know this sounds deceptively simple, but often our schedules, work and life in general gets in the way of listening. The act of being fully in the conversation–looking at them and just letting them talk while you are present–can be therapeutic. Parents can also collaborate with teens by sometimes letting school work and college goals take a back seat. Give school, after-school activities or college applications a little bit of logistical space so teens can feel the specialness they once felt a younger age when had their parents’ full attention.

Therapy For Cutting Can Help Continue This Conversation

Talking about our feelings is a process that takes practice and exposure. We often forget you learn to read slowly and you often need help from a teacher, tutor or another outside party to do it. Therapy for cutting can provide teens with this space to learn to articulate their interior and exterior worlds with someone who will play, but also take things seriously. With a therapist, teens can have the space to try out expressing their emotions and be messier with how their words, feelings, and experiences fit together.

Cutting Therapy Helps Parents As Well As Teens

Therapy can help not only the teen who is cutting, but the entire family. Parents can know they have a therapeutic space where the cutting is directly addressed and where teens can talk and process how emotions are expressed. It also helps parents to know someone is watching out for their teen. It is hard to step back as a parent, but with therapy, parents have a partner and the therapist can bring you in if needed.