Therapy With Teens For Cutting And Self-harm

What Is Cutting And Self-harm? Does It Mean Teens Are Suicidal?

Cutting is the most common of a handful of behaviors identified by therapists as self-harm and is particularly seen in teens. At Tribeca Therapy, we’ve worked with teens that cut, punch themselves, burn or puncture parts of their body. Cutting is by far the most common of these self-harming behaviors. Often teens use a sharp object–usually a knife or a razor blade–to make small incisions, either one or many. Common cutting sites are arms (upper and lower), thighs and calves–usually on one side of the body opposite the cutter’s dominant hand.

While suicide attempts, drug abuse and other kinds of reckless behaviors can all cause harm, when we talk about self-harming behaviors with teens, we are generally referring to behaviors that are specifically intended to cause harm, but not intended to be suicidal (This doesn’t mean teens that self-harm can’t also engage in these other reckless behaviors). Even though the relationship between cutting and suicide is complicated, many cutters self-harm without any intention of suicide. Often cuts are quite small and are usually not deep.

What Might Drive A Teen To Cut?

Cutting often serves a purpose. If a teen is cutting or engaging in self-harm, something’s wrong–sometimes very wrong. It’s possible that cutting, while unsafe and scary, is helping a teen cope. Teens might be feeling lost or a deep emotional pain that is or isn’t understood.

Often it’s helpful to understand cutting as a breakdown in understanding of feels and communication. For example, a teen might cut because he is feeling things that are difficult to understand himself and the pain of cutting makes sense. Similarly, another teen may cut because she is desperate to have her pain acknowledged by others. Our task, as therapists who work with teens, is to understand what this is and to introduce other ways of managing those feelings in ways that are less harmful (including therapy itself).

Cutting Meets Emotional Needs For Teens

Only your teen knows really why they are cutting, but both teens and their parents might need help to understand the behavior. Cutting meets emotional needs for teens and it meets those needs badly. In fact, early in treatment, we may not immediately rush to take this away from a teen. This can be difficult for parents to hear, but is nonetheless important.

In therapy, we, at times, choose to look at certain behaviors–even ones that are unhealthy–as serving a function. In the case of self-harm, we want to be careful in how we respond to the cutting for two reasons: First, as frightening as cutting is, it may be less dangerous than the alternative. Cutting is a kind of release, a self-built strategy for dealing with stress, fear or loneliness. In therapy, we simply must offer other healthy options for dealing with these challenges or the cutting will either not truly stop or will result in more dangerous behaviors.

Secondly, it is difficult to police cutting. If we place a demand on a teen that they stop cutting and they are not ready to do that, we effectively create a scenario in which that behavior is being kept secret, which degrades trust and can make it harder to impact.

How Do You Know If Your Teen Has Been Cutting?

The first step should always be to ask. As with all important matters with teens, getting close is key to creating conditions in order to talk about tough issues like cutting. Some teens cut and share fairly soon after–they tried it, it scared them and they need someone to help them make sense of it. Often, though, there’s shame or even a desire to protect this behavior that, while scary, is meeting an emotional need.

Don’t Freak Out, Be Curious: Talking To Teens About Self-harm

As a therapy practice that works with teens, we encourage parents to be both respectful and curious when talking to their teens about cutting. Work hard to make sure your asking comes off as concern rather than blame. Say something like:

“I know you’ve been having a hard time and I know that some people, when things are really tough, experiment with cutting. Have you?”

Knowing that cutting isn’t usually about suicide can help inform parents’ state of mind when asking about cutting. Cutting is scary and concerning, but it’s important to know to show the right kind of concern. Freaking out makes cutting worse. Alfred North Whitehead offered wisdom for philosophers that is a helpful guiding principle for parents, “Don’t block the path to inquiry.”

What’s most important for parents to do is be curious and create conversations in which they can come to understand their child’s experience. That’s a surprisingly difficult task, made all the most complicated when frightened. As therapists, we give parents hope and confidence that this will and can get better and guide them on how to get close to their kid’s experience.

So What Are Our Prospects–Will Therapy Get My Teen What He Or She Needs To Stop Self-harm?

The good news is cutting and self-harm are behaviors that get better usually for the long-term. When emotional pain gets the attention it needs and teens are supported in their development of healthier ways of coping with emotional challenges, they get better and the cutting stops. Equally important in therapy with teens that cut is giving parents hope that this will get better. Parents need to be told that the help they seek in getting therapy for their teenage child will function in partnership with them.

In therapy with teens that cut, the work involves getting close and allowing teens to be less alone with pain, which makes it more bearable. Being with teens in pain isn’t an easy task. Beyond that, we offer replacements for self-harm. These could be quite practical (running, punching a pillow or journaling), relational (emailing their therapist, friends or parents) or more sophisticated cognitive behavioral skills like redirecting self-talk or avoiding getting fixated on negative thinking. Importantly, therapy can operate to help make meaningful changes in how a teen’s life is organized: making friends, dealing with difficult teachers, improving study habits and having hard conversations with parents.