Therapy and Counseling for Self-Harm and Self-Injurious Behaviors

Self-harm is a deeply personal struggle that many individuals privately face when emotions become overwhelming and unmanageable. Those who engage in self-harm are often trying to cope with these intense feelings by creating a physical sensation to release them or to feel as if they have some sort of control over their pain.

What is self-harm?

Self-harm, which may also be called self-injury, self-mutilation, or self-abuse, is the act of deliberately causing harm to oneself.

According to Alexandra Malin, Licensed Mental Health Counselor and Clinical Supervisor with Handel Behavioral Health, “Self-harm does not only involve causing physical pain to the body; it also involves putting oneself in a potentially dangerous situation, self-neglect, and doing something that goes against your core beliefs to inflict pain on yourself.”

Examples of self-harm behaviors include:

• Abusing alcohol or substances
• Burning or cutting the skin
• Excessive rubbing, pinching, picking, or scratching one’s skin
• Inserting objects under the skin or into body piercings
• Piercing the skin with sharp objects
• Hitting or punching oneself, or hitting/banging one’s head
• Intentionally breaking bones
• Ingesting harmful chemicals
• Overeating or undereating
• Sex as self-injury (SASI)

Self-harm can take many forms, but it often stems from emotional distress that a person has a hard time processing or expressing. Understanding the underlying reasons for self-harm is an important step toward finding healthier coping strategies.

Why do people self-harm?

There’s no single reason why a person might self-harm, and reasons can differ from person to person, as well as episode to episode. Broadly, people tend to self-harm as a way to cope with emotions that feel too big, confusing, or hard to deal with.

Self-harm is often seen in those who have experienced bullying, isolation, neglect, or trauma. It’s also observed in individuals living with anxiety, depression, or PTSD. Common reasons for self-harm include the following:

• Control: A life that’s chaotic or unpredictable can lead a person to self-harm. It can seem like the only element they have any decision-making power over.
• Emotional Numbness: When a person feels disconnected or empty, self-harm can be their effort to feel something.
• Escape: Self-harm may be used to pull an individual out of dissociation, flashbacks, or racing thoughts.
• Expressing Pain: When a person feels pain inside but can’t put it into words, causing a physical injury may be their way to make their suffering visible to themselves or others.
• Self-Punishment: Guilt, self-hatred, or worthlessness can cause a person to think that they deserve pain.
• Overwhelming Emotions: Anger, anxiety, sadness, shame, or another difficult emotion can build up faster than a person can manage it. Self-harm can feel like a way to get through the moment.

The relief that comes from self-harm is short-lived. Often, feelings of guilt, shame, and secrecy follow. This can add to the emotional distress that the person is already experiencing. This reinforces the cycle, making it harder to break. This is why self-harm actions tend to repeat, and why breaking the cycle is not simply a case of willpower.

Being unable to break the self-harm cycle alone isn’t a sign that there’s something wrong with the individual. Instead, it means their coping strategies aren’t able to keep up with the emotional load they’re carrying. Therapy for self-harm focuses on building and strengthening those strategies while working on what’s lying underneath.

What are the warning signs of self-harm?

Self-harm can often be masked beneath the surface of a person’s outward appearance or actions. Behavioral changes and increased risk-taking, such as substance abuse, picking fights, or engaging in risky sexual activities, may indicate an attempt to numb or escape emotional pain.

Recognizing the signs of self-harm can lead to early intervention and prevent further harm. Common warning signs and symptoms of self-harm include:

• Emotional withdrawal or isolation from friends, family, and social activities
• Frequent expressions of self-criticism or negative self-talk that come from feelings of worthlessness or self-hatred
• Mood swings or intense emotional relapse, such as shifting between deep sadness, irritability, or anger
• Showing signs of depression or anxiety, such as persistent sadness, irritability, fatigue, or excessive worry
• Preoccupation with or collection of sharp tools or objects (for example, razors that are not kept in the bathroom)
• Unexplained cuts, bruises, or burns, particularly in areas that are easy to conceal, like arms, wrists, or thighs
• Wearing concealing clothing, even in warm weather, may suggest that someone is trying to hide the physical evidence of self-harm

If you recognize any of these warning signs in a loved one, it’s imperative to take them seriously. Enter into a conversation as nonjudgmental as possible. Also, be aware that they may not open up right away about how they’re feeling. It is also important not to punish the behavior, as this may cause them to distrust opening up to you.

Do you suspect your loved one is self-harming, or do you recognize these signs in yourself? Early intervention and therapy can make a significant difference in managing self-harm and beginning the journey toward healing.

Is self-harm a mental illness?

While self-harm itself is not a mental illness, it is rarely an isolated issue. Often, there is an underlying mental health condition that leads to this unhealthy coping skill.

Common mental health conditions that accompany self-harm include:

• Anxiety
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Chronic Stress or Burnout
• Depression
• Eating Disorders
• Obsessive-Compulsive Disorder (OCD)
• Personality Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Schizophrenia or Psychosis
• Substance Use Disorder
• Trauma

It’s important to note that not everyone who self-harms has a diagnosable mental health condition. Regardless of whether an underlying condition is present or not, identifying contributing factors and emotional triggers can guide effective treatment.

4 myths about self-harm

There are many misconceptions about self-harm that make it difficult to identify the signs and help those who are struggling.

1. Those who self-harm are trying to kill themselves. Self-harm is a warning sign of severe mental distress and a higher risk of suicide. However, the act itself is used as a coping mechanism, not a suicide attempt. Still, the individual should be assessed for suicidal thoughts or ideation.
2. Those who self-harm are only doing it for attention. Commonly, a person who self-harms feels shame about their actions and will go to great lengths to hide the evidence, such as wearing long sleeves or harming in discreet locations on their body. If someone is showing their wounds or scars, think of it as them seeking support rather than attention.
3. Only teenage girls self-harm. While there’s a higher rate of self-harm in adolescent girls, over 8% of adolescent boys are at risk. Self-harm is strongly connected to boys who experience bullying or same-sex attraction.
4. Cutting is the only form of self-harm. There are many ways to self-harm, and it’s important to recognize the signs beyond cutting. If you’re only looking for wounds, you may miss other signs of self-injurious behavior (SIB), such as substance abuse, disordered eating, or high-risk sexual behaviors.

Debunking these myths reduces the stigma surrounding self-harm and encourages more compassionate and informed conversations. The more we understand this behavior, the better equipped we’ll be to recognize the warning signs and support someone who’s struggling.

How are self-harm and suicide related?

It’s important to understand that self-harm and suicide attempts are not the same thing. Here’s the primary distinction:

• Non-suicidal self-injury (NSSI) is a way of coping with difficult emotions and getting through the moment.
• A suicide attempt is an act that’s intended to end one’s own life.

People who self-harm are not necessarily trying to end their lives. However, making that distinction does not mean that self-harm is the less serious behavior. Self-harm is still a critical risk factor for suicide later in life.

With time, self-harm may become less effective at relieving distress, and people who engage in this behavior are at a higher risk of having suicidal thoughts and behavior in the future. This is why anyone who self-harms deserves a professional assessment for their own safety and well-being.

During an assessment, a counselor may ask questions about current or past thoughts of suicide, self-harm patterns, and support systems. These conversations are held with care and without judgment. By answering honestly, your therapist can build a plan that suits you.

Most importantly, clients shouldn’t hold back in a session for fear of crisis intervention. Carolyn Pacheco, LMHC, who specializes in self-injurious behaviors, told us that clients shouldn’t worry that the therapist will make a major decision, like placing a call to authorities, without discussing it with them first.

In this type of therapy, the main goals are checking on safety and helping clients build the proper coping skills. Carolyn explains that counselors don’t want to traumatize their clients further or send them somewhere that might be too intense for what the situation needs.

How to support someone who self-harms

Learning that a person you love is hurting themselves can introduce anger, fear, or guilt — or all three at once. Staying calm and steady is more important than finding the perfect thing to say. Here’s what to do:

Start the conversation. Choose a private space when you and your loved one both have time to talk. This isn’t a conversation that you want to rush through. Be direct, but be gentle. For example, start with, “I’ve noticed you’ve seemed really down lately. I’m worried about you, and I’m here if you want to talk.” From there, let them set the pace of the conversation, and avoid pushing for details they’re not ready to share yet.

Calmly respond to serious disclosures. If your loved one does decide to open up, thank them for trusting you. Listen without interrupting, even if you hear something that shocks you. You don’t have to completely understand the situation in order to be supportive. Simply saying “I’m glad you told me” or “I love you, and I’m not going anywhere” can be helpful.

Know what to avoid. There are certain actions and reactions that you want to avoid, such as:

• Giving the person ultimatums or demanding that they stop hurting themselves
• Punishing their behavior by taking away their privacy or imposing another consequence
• Showing disgust, panic or shock at the information they share
• Telling the person they’re just self-harming for attention

Encourage professional help. Most people can’t simply decide to stop harming themselves and then use sheer willpower to make a change. And while you can be a support for your loved one, you’re not expected to act as their therapist. Gently suggest that they speak with a mental health professional. You can also offer to help with the process, like researching therapists, setting up appointments or sitting with them during their first meeting.

Act immediately when the situation calls for it. When an injury needs medical attention or if you think the person is in immediate danger, go to the closest emergency room or call 911. If your loved one talks about suicide, you can call or text the Suicide and Crisis Lifeline at 988.

Being the support for someone who’s going through such a difficult time can take a toll on the caregiver. Make sure to look after yourself, too, which may mean speaking to a therapist of your own.

What does treatment for self-harm look like?

Therapy is one of the most effective ways to address and heal from self-harm. Our therapists understand that the process of recovery is deeply personal and will work with clients to create a treatment plan that addresses their unique needs and concerns.

Clients will begin to understand their behavior, develop healthier coping tools, and work through the emotional pain that leads to self-harm. The following is an overview of what therapy for self-harm typically involves at Handel Behavioral Health:

• Building a safe and supportive therapeutic relationship. Clients will find a nonjudgmental space where their emotions can be explored openly, allowing them to feel understood and supported.
• Identifying the causes and triggers of self-harm. This might include exploring unresolved trauma, chronic stress, anxiety, depression, or feelings of emotional numbness. By understanding what drives the urge to self-harm, clients can begin to make sense of their behavior and address the root causes.
• Developing healthier coping mechanisms. Therapists work with clients to help them learn new ways to manage intense emotions, which may include techniques such as mindfulness, breathing exercises, creative expression, and physical activity.
• Involving support systems: Having a strong support system can help individuals feel less isolated and maintain their progress when reducing self-injurious behaviors. Therapists may encourage individuals to rely on trusted family members or friends for additional emotional support.

To support these goals, therapists may use evidence-based treatments that are tailored to the client’s needs. Depending on the circumstances, treatment may include the following therapies:

• Cognitive-Behavioral Therapy (CBT): Therapists help clients identify their negative or distorted thinking patterns that lead to self-harm. By challenging these harmful thoughts and beliefs, clients can learn to reframe their thinking and develop healthier perspectives.
• Dialectical-Behavioral Therapy (DBT): Therapists emphasize emotional regulation, distress tolerance, and mindfulness to teach clients how to access their emotions and to change the behaviors that cause harm.
• Trauma-Informed Therapy: Clients explore past traumatic experiences in a safe and confidential environment. This can help them understand how past experiences may contribute to current coping mechanisms. As clients process intense emotions, they work toward healing and self-compassion.
• Medication: Medication may be prescribed by your psychiatrist or psychiatric nurse practitioner in certain situations, especially if there are co-occurring conditions such as depression, anxiety, or PTSD.

Recovery is possible, but it’s not always a straight line. While many people who once self-harmed find better ways to cope and lead a healthy life, recovery is gradual, setbacks are normal, and the pace is different for everyone.

Stressful periods can drive urges that have long been dormant, but a slip-up doesn’t mean that therapy was a failure or all progress was lost. Instead, setbacks provide useful information to your counselor. Understanding what happened lets the therapist adjust your plan and work with you to move forward.

Start Working With a Therapist for Self-Harm in Massachusetts Today

At Handel Behavioral Health, our therapists in Massachusetts are trained in the complexities of self-harm. We can guide individuals toward understanding, managing, and ultimately overcoming these behaviors.

Our mental health professionals will help individuals recognize and heal the underlying causes of self-harm, including low self-esteem, anxiety, depression, trauma, and family dysfunction. Individuals will then learn healthy coping techniques to manage intense feelings, rather than react to negative emotions with self-harming behaviors.

If you or your loved one are seeking healthier ways to cope with life’s challenges, our therapists are here for you.

We offer online therapy in Massachusetts, as well as in-person therapy at our offices in Amherst, Franklin, West Springfield, Wilbraham, and Natick. Call us at (413) 343-4357 or request an appointment online to get started.

About The Author