What teens can teach us about treating self-harm
By Michael Riquino, LCSW, PhD Candidate Adjunct Instructor, University of Utah College of Social Work
The number of referrals I get for elementary school students engaging in self-harm has increased every year—but most of the people I’ve treated for self-harm are junior high and high school students struggling with depression, anxiety, and trauma.
Self-harm is a perplexing and growing problem among teens and young adults. According to the 2017 SHARP survey conducted by the state of Utah,1 14.7% of Utah teens in 6th through 12th grades engaged in self-harm at least once in the previous year. While several types of treatments may be used when teens engage in self-harm, we still don’t have evidence that these treatments work.2 To effectively address self-harm, we need to know what works, and how those treatments work, so we can focus on providing the care self-harming teens need.
Unfortunately, self-harm is still commonly thought of as an attention-seeking behavior. The reality is more disheartening—teens are most likely to hurt themselves as a way to manage overwhelming emotions or feelings of numbness.3 Teens also engage in self-harm to distract themselves from negative thoughts or because they believe they are bad, worthless, or deserve to punish themselves. Because of the bodily harm teens cause themselves when they engage in self-harm, it’s easy to confuse self-harm with suicide. Although individuals who hurt themselves are at greater risk for attempting suicide,4 they are not trying to kill themselves when they engage in self-harm—they may even be trying to distract themselves from suicidal thoughts.
In my work with self-harming teens and their parents, I help individuals see self-harm from a functional perspective—to understand the reasons why people hurt themselves by examining the thoughts and feelings that motivate the behavior. Rather than relying on misconceptions of self-harm, I provide my clients the opportunity to understand where their self-harm is coming from. As they become aware of these functions, they become more likely to find alternative ways of managing distressing thoughts and feelings rather than relying on self-harm like they’ve done in the past. I adopted this perspective because of my work with teens and what they taught me about the experience of self-harm.
With my Interrupting Self-Harm Study, I’m comparing two different therapeutic techniques to see which one is more effective at treating the psychological processes that contribute to self-harm among teenagers. This study is also designed to expand our understanding of how these techniques work. I hope to build upon existing knowledge about what works to treat self-harm—and most importantly, I hope to gain a greater understanding of what teens believe needs to be done to address self-harm. Teens have a tremendous capacity for creative problem-solving, but aren’t always given the chance to share their experiences. I hope to hear and honor the stories of those who are impacted the most by self-harm—the teens themselves.
The views and opinions expressed on the interACTION blog are those of the authors and do not necessarily reflect the official policy or position of the University of Utah or the College of Social Work.