Self-Harm and Adolescent Therapy

Self-harm is when an individual causes physical harm to their own body and often appears as a result of psychological problems such as anxiety, depression, and lack of self-confidence. Self-harm is a serious health issue and requires professional support.

Adolescent therapy is a type of therapy that addresses the physical, emotional, and social problems of individuals in adolescence. In this way, adolescents can cope with their bodily, emotional, and social changes, and the difficulties they may experience are addressed.

The therapist can address problems such as anxiety, depression, and lack of self-confidence in adolescents and offer solutions aimed at resolving these problems. Adolescent therapy can help individuals in adolescence gain the physical, emotional, and social skills necessary for a healthy and happy future.

What Is Self-Harm?

Acts such as creating wounds, cuts, scratches on the skin, pulling out hair, and in some cases breaking bones, cutting or damaging organs to a degree that can cause harm are defined in psychiatry as self-harm (self-mutilation).

In 1938, Karl Menninger, as a result of his work, argued that self-harming acts are a kind of effort at self-healing and claimed that this situation prevents suicide aimed at death. 

According to psychodynamic theory, self-harm is defined as an attempt to separate ego boundaries or as an externalization of the anger that these individuals feel toward themselves.

Self-harm behavior is not a suicide attempt, but it should be perceived as a kind of signal of things that are not going well. Self-harm is the person’s struggle to protect their existence against self-annihilation. In this respect, self-harm can be defined as a health problem in its own right. 

The most severe form of self-harm is major self-mutilation. This stage mostly develops in relation to severe psychological disorders in the person. At the stage of major self-mutilation, conditions such as bipolar disorder, schizophrenia, and substance and alcohol dependence can be seen. Eye gouging, skin flaying, amputation of limbs or genital organs are behaviors observed at this stage. Most of the patients state that they carry out their acts with an irresistible urge.

Acts such as hair pulling, biting oneself, head banging, creating gouges in the skin and throat are considered part of the stereotypic self-mutilation stage of self-harm. Conditions such as Tourette syndrome, schizophrenia, and autism may lead to stereotypic self-harming behaviors. In this situation, patients are generally not aware of what they are doing.

Self-Harm In Adolescents

Self-harm in adolescents can be defined as self-harming acts that arise for the purpose of coping with negative emotional states, especially anger and sadness, that do not carry the aim of suicide but should be perceived as a signal of suicide. 

In the early stages of adolescence, rapid changes occurring in the individual’s body constitute the most concrete situations that occupy the adolescent’s mind. The cognitive functions that develop with adolescence bring the importance of considering the feelings of others to the forefront. Especially during the adolescent period, the activation in sex hormones causes attention to be directed toward the body. 

The body forms an important reference for identity development. Therefore, adolescents who experience various vulnerabilities in the process of self and identity development may become excessively preoccupied with their bodies. For this reason, in self-harm situations occurring during adolescence, comprehensive evaluations must be carried out regarding the underlying causes of the behaviors. 

What Are The Reasons For Self-Harm In Adolescents?

• Problems with self-perception or body image
• Having a chaotic family structure
• Being in a home with dominant, authoritarian figures
• Having a low frustration tolerance
• Perceiving self-harm behavior as something that will provide acceptance or prestige within the peer group
• Taking pleasure in seeing pain and blood

It has also been observed that there are underlying psychiatric conditions at the root of self-harming behaviors during adolescence.

These psychiatric conditions can be listed as follows:

• Family history of psychiatric illness
• History of suicide attempts
• Psychiatric problems present in the adolescent’s siblings
• Symptoms of depression
• Bipolar disorders
• Borderline personality traits
• Substance use or eating disorders 

The Meaning Of Cutting To Calm Oneself In Adolescent Self-Harm

In his 1895 article entitled “Anxiety Neurosis,” Freud distinguished current neuroses from psychoneuroses. In the article, it is mentioned that the relationship between somatic sexual excitations and unconscious sexual fantasies is disrupted. In his 1926 anxiety theory, he showed that anxiety can be explained in two ways. Current neuroses arise as a result of the direct impact of a traumatic effect on the person. In another explanation, anxiety is perceived as a signal, which explains psycho-defensive neurosis. In neurosis, the voice of Eros becomes louder, whereas in current neuroses the voice of the death drive is present, and the individual needs to calm down. Overloading and overflowing of the inner world eliminates calmness. Calming protects the body and prevents somatic deterioration.

Considering the issue from the perspective of individuals who self-harm, it can be said that they are in a state of hunger for calmness. Each of them also speaks of “a storm breaking inside them,” “constantly fluctuating emotions.” In Freud’s affect theory, which he revisited in 1938, affects follow three paths: they are either repressed, turn into anxiety, or transform into opposite affects (Freud, 1938). When an affect turns into anxiety, generalized anxiety becomes the harbinger of current neuroses. As for the adolescents discussed in this book, like at the crossroads Freud describes, the important questions in understanding them are why they take the path behind the cutting behavior, why they cannot repress, and what leads them down that road. These adolescents are unable to calm down and cannot soothe themselves. Therefore, the first material that prevents calming is the question of what the moment of experience or the entire set of affects at that time actually is. Studies on “self-soothing” began especially in the 1970s at the Paris Psychosomatic Institute. Michel Fain, one of the members of this institution and the first to conceptualize self-soothing methods after noticing them clinically, drew attention in 1971 to special types of rocking for sleepless infants and defined such rocking as a soothing method.

The mother is exhausted and the baby will not sleep. While Freud discusses the non-regressing (non-regressed) infant in “Three Essays on the Theory of Sexuality,” he speaks of the erotic aspect of rocking and describes the act of “rocking” performed to lull the excited child to sleep (Freud, 1905). The child, who is inadequate in controlling inner excitations, may later become an adult who urgently seeks tranquilizing methods. On the other hand, Freud states that not every feeling that brings calm necessarily brings satisfaction. The ego is only seeking to relieve itself. Therefore, the way to control the intensity and even the overflowing of inner excitations is through things taken from outside and methods applied from outside. As in cutting, burning, and other self-directed destructive (self-destructive) behaviors… Especially cutting behavior is a method that almost entirely encompasses the phenomenon of self-harm (self-mutilation) and alone can explain these behaviors aimed at calming. As those individuals frequently state, they are experiencing very intense affect; but it is as if they have no capacity to repress these affects. In this state, they do not appear to have a neurotic organization. The inhibition of affect by self-harm has been discovered by the individual; especially with the onset of adolescence, dealing with these increasingly intense affects, being able to control them, stopping the overflow and reaching calm requires the psychic structure to receive some primitive-external reinforcements, and as a result, to achieve calm by cutting, burning, and using other methods. Each of these is used as a method of controlling affects. In other words, the function of self-harming (self-mutilative) practices here is to provide calm, to relieve the ego, to prevent the overflow and exuberance of intense affect, to provide and adjust affective regulation, to assume a psychic defensive role, to short-circuit the connection between affect, the traumatic memory trace or experience associated with that affect via the body, and thus provide affective isolation, prevent the ego from dissociating, maintain the integrity of the self, and protect bodily boundaries (the function of psychotic cuttings is different). Self-harming (self-mutilative) behaviors appear in every situation of affective overflow, and their most important feature is that they are constantly repeated. The reasons for the repetitive nature of these behaviors and, as those who engage in them say, their addictive quality are related to the fact that they are effective but temporary methods of calming at the time. As in substance use, the individual resorts to this behavior when confronted with intense affects. Self-harm behavior continues until the affect comes under the control of the person performing it, in other words, similar to someone in a drug crisis, until the crisis is over. This dangerous behavior appears to have almost an inner peace–providing function. It can be said that one of the basic concepts emphasized by the Psychosomatic Institute, the “mentalization mechanism,” functions inadequately in individuals who self-harm. This mechanism is related to the capacity to come to terms with and cope with anxiety. In this situation, the emergence of self-harming behavior can be interpreted as the psychic apparatus’s inability to function fully or as this intense, overflowing affect seriously disrupting the functioning of the psychic apparatus. The point at which psychosomatic patients differ from self-mutilative individuals is that in psychosomatics there is a deficiency in the mentalization process, while in self-mutilative individuals the intensity of internal affective stimuli is so great that it disrupts the functioning of the psychic apparatus. The common condition for both issues is the presence of a state of non-mentalization (dementalization). In individuals who self-harm and constantly speak of an inner scream and cry, there are intense inner pain, inner anger, feelings of violence, and in fact extremely primitive experiences, trauma, and the memory traces they create in the inner world that cannot be represented and therefore cannot be put into words, all of which seriously strain the psychic apparatus. This strain and/or the compulsive pressure experienced by the individual may find expression as a kind of “noise coming from inside.”

The repetitive nature of calming methods can be associated with whether self-mutilative individuals possess operational thinking, just as psychosomatic patients do. Operational thinking consists of everyday thoughts lacking any connection to fantasy and symbolic functions, detached from drives. The repetitive and monotonous aspect of operational thinking coincides with the frequent repetition of calming methods and the reduction of anxiety by the same means. From a theoretical perspective, as A. Green says, all excitations leave the body and then return to the body. Excitations have no memory, project, story, or meaning. Drives, however, are materials that have a goal, a source, an object, a story, and investments (D. Cupa, 2005, Paris). This raises the question: in cutting behavior, is the aim to control excitations or drives?

If individuals who self-harm resort to certain external methods in order to calm down (such as self-mutilation), then there is also an indication that the preconscious is not functioning properly. M. Fain also sees self-soothing methods as anti-traumatic actions. Due to a lack of fantasy capacity in psychic life, insufficient preconscious functioning, and an inability to form representations, the person resorts to action to reduce excitations. As in psychosomatic patients, in self-mutilative individuals the anxiety they experience is not neurotic but a generalized anxiety that envelops the entire psychic world. That is, the feeling of depression has replaced castration anxiety. In all self-mutilative individuals, the presence of a strong depressive affect underlying self-harming behaviors is striking. At this point, the conflict is not Oedipal in nature, but rather aims at maintaining the continuity of psychic life and preventing the self from disintegrating. Does the ego, in the face of this disintegration, completely move away from erotization? This question concerns the share or intensity of erotization in such a highly self-directed destructive (self-destructive) behavior as self-harm, which is described as a calming method. In the personality organization of individuals who self-harm, there are sado-masochistic attitudes and a highly aggressive, violent behavior—cutting, burning, etc.—that provides calm. Therefore, we cannot say that there is no erotization in self-mutilative behaviors and that the self is cleansed of it during calming. It can be said that with repetitive behaviors and excitations held under control, secondary processes progress in a distorted way.

The individual brings self-harm into play as the only way to calm down and control this intense emotional state. This is clearly understood from the often repeated expression: “Cutting is the only thing I can turn to in that moment.” With self-harm, a primitive and regressive coping method, the self can calm down and maintain its integrity only through this pre-verbal expression. While providing calm, the fact that this behavior is also exciting and that, from time to time, it both meets a need and yields pleasure points to two different situations: a behavior that both calms and provides pleasure and gratification. How then can a behavior that is defined as a need and not a desire still provide gratification, even though need and desire are different? This can be explained by saying that what is described as pleasure here is the gratifying quality of calm itself, of the self-protective function that calm offers. Before the act of self-harm, there is an extremely intense affective state; afterward, there is talk of relief achieved through the act and the gratification brought by that relief. There is a state of calm achieved by experiencing pain and then relief. In other words, there is a state of removing pain with another pain, and in this respect, there appears to be a fully sado-masochistic situation. Gillibert refers to self-soothing as “auto-sadism” (J. Gillibert, Paris, 1977). This is not an ordinary sadistic drive directed at the self. Here, there is an effort to gain control over one’s own body and self. This can be explained as a kind of “objectless sadism.” Gillibert gives the example of children who fall asleep by banging their heads against the wall. In self-mutilative behaviors too, in the face of distress, anger, and similar intense affects, the individual bangs their head against the wall, harms their body, and explains this as a way to relax and avoid hurting someone else. Most importantly, they say they do it to feel relief. The person’s calming themselves by self-harm is not done in order to receive pleasure; the discharge that occurs afterward is not related to desire and there is no gratification. Although individuals say they derive pleasure from it, the repetitive nature of this act, its emergence after a severe affective state, and the lack of an alternative eliminate the presence of desire. The fact that those who self-harm say they derive pleasure from it suggests the presence of desire, in that calm feels good. Their desire is to find calm. In this behavior where there is no desire or gratification, the focus is on the presence of direct destructiveness. At this point, Gillibert’s question comes to mind: “Is self-mutilation auto-sadistic, or is it a sado-masochistic attitude?” In the economic principles of masochism, Freud explains sadistic drives as the realization of sexual excitations through muscular activities. However, in auto-sadistic behaviors, there is a situation opposite to mentalization, and sado-masochistic gratification is not present here.

Another important point, considering Bion’s emphasis on the importance of the mother’s containing function and his view that the mother lends her own internal methods to the baby to protect it from all kinds of trauma, is that the mothers of adolescents who self-harm are themselves people who experience difficulties in self-soothing and who turn to external reality for calm. In interviews conducted with adolescents who self-harm and present to the clinic, it is stated that their mothers have attempted suicide in the past or have harmed themselves by hitting themselves or banging their heads against the wall when facing a problem. In some parents, alcohol and substance abuse are also present; therefore, it can be said that these adolescents’ parents have difficulties with their own capacities to calm themselves and that they seek to meet needs rather than attain gratification. Problems in the mother’s early containing function and the weakness of her shields against emotions, and consequently her inability to lend these to the baby, mean that the child will have to fend for themselves in adolescence and adulthood, and may resort to destructive or self-harming methods in order to calm themselves. In mother–child relationships where a psychic bond cannot be established, attempts are made to provide protection based on “behavior” through self-soothing methods. In the families of these individuals, psychic functioning in response to affects is often maintained through acting out. When the mother’s calming attitude (behavioral and psychic) cannot be adequately internalized, the child begins to search for self-soothing in external reality rather than in psychic life. This leads to impoverishment in terms of drives, depletes internal resources, and directs the person toward external reality. The fact that this situation manifests as hyperactivity and constant resort to action in adolescence can be interpreted as the increased pressure of the stagnation experienced before puberty. Under the influence of emotional and drive intensity, self-directed destructive (self-destructive) behaviors emerge. The child who has not learned how to self-soothe tries to calm themselves in adolescence and adulthood with both substance use and self-harming behaviors. The adolescents whose therapies I conduct and whose school performance I observed to be high tend to shut themselves off from excitations and heavily use intellectualization before resorting to cutting. After the onset of cutting, their school performance declines significantly, and their social relationships weaken. This suggests that they are trying to minimize excitations coming from the outside world. In self-mutilative

adults, cutting is replaced by psychosomatic complaints (especially severe headaches and migraine attacks). A striking example of this can be seen in what Lara, one of the cases examined in this book, said while undergoing a projective test in the hospital. Lara suddenly says that her thoughts are hurting her waist, as if speaking of thoughts that manifest as bodily pain.

In another example, another adolescent reports intense migraine attacks that emerged after the cessation of cutting behaviors. Cutting behavior is transformed into psychosomatic complaints. In other words, cutting behavior becomes somatization. Indeed, self-soothing can be regarded as a regression to behavioral level in individuals who cannot regress psychically.

An important point concerns the ways in which substance and alcohol use differ from self-mutilative behaviors and are closer to the auto-eroticism seen in psychosomatic patients. The types of alcohol and substances used function like a baby’s pacifier, which has an auto-erotic function. The child attempts to calm themselves with a false reality (a false pacifier); there is something that substitutes for the mother but is not an object. Therefore, the importance of alcohol and substances as warning shields for those who use them can be better understood due to the insufficient development of warning shields that were supposed to form in the early mother–child relationship. In a healthy mother–infant relationship, the warning shields that form differ from artificial warning shields in that they have the functionality of a filter and protect the ego in situations of intense emotional states. In instances of self-harm behaviors, however, they show a feature of “shutting off the brain rather than protecting it,” lacking any permeability. The calming methods provided by external reality do not have a gratifying aspect; however, an important point that should be emphasized is that in self-mutilative individuals, the investment in objects is greater than in those dependent on alcohol and substances. The calming methods emphasized by clinicians working on psychosomatic illnesses (such as rocking and excessive movement) serve the same function against anxiety as the neurotic’s neurotic symptoms, which protect the person against castration, and in self-mutilative individuals, all mutilative behaviors such as cutting and burning seem to serve to sever the connection between intense emotional stimuli, intense affect, and traumatic memory traces and events. As a result of the mother’s operational thinking, lack of fantasy, and feelings of inadequacy, the child resorts to self-soothing mechanisms and repeats them (self-mutilative individuals cut and burn themselves, take a break, and then resume; they can continue this for years). By constantly resorting to action, they feel what they are experiencing and prove to themselves that they are not dead. They may continue to harm themselves until their inner resources develop and they no longer need to resort to external reality for calm.

Among those who experienced childhood trauma and/or grew up in a family environment that could create trauma, self-directed destructive behaviors have been observed alongside various impulsive behaviors (Van der Kolk, 2005). Such early relational experiences shape the structural development of the brain (Fonagy, 2002; Schore, 1994). Positive emotional experiences or negative emotional experiences (such as separation, loss of the caregiver, etc.). Negative experiences with caregivers at an early age delay the structuring of the brain and create cracks. Later in life, this limits the functional capacity of the brain. A safe and facilitating environment, safe touches in relationships with the external world, and various childhood environments ensure that the feeling of security and creativity continues and that this balance is maintained during difficult times while sustaining relationships with others (Fonagy, 2002; Schore, 1994).

Many internal factors play a role in the development of self-harm behavior. The fact that this behavior begins during early adolescence (puberty) and emerges in adolescents experiencing depression, anxiety, eating disorders, poor impulse control, and low self-esteem reveals that they were generally exposed to trauma or neglect in childhood (Conterio & Lader 1998; Farber 2000; Hodgson 2004; Nock & Prinstein 2005; Stare & Sias 2003; Walsh & Rosen 1988).

Putnam, in 1999, described self-harming patients receiving inpatient treatment as follows:

1. The primary function of self-harm behavior in the individual is affect modulation. These affects can be general or specific. Examples include fear, anger, shame, and suicidal thoughts.
2. Loneliness is related to affective regulation. For instance, feelings of emptiness and isolation.
3. Self-punishment.
4. Influencing others.
5. Impressive, magical control.
6. Self-stimulation, waking oneself up (especially in those who use substances).

Brown and Linehan (2002) obtained indicators similar to these factors, and their sample group consisted of 75 women who self-harmed. The expressions these women repeated most frequently were as follows:

“To stop feeling bad,

To cope with feelings of loneliness,

To eliminate feelings of emptiness and isolation,

To get rid of the awful state in my mind,” are the reasons they report. About 63% of the women, a high proportion, associated self-harm behavior with self-punishment and feelings of anger.

Common Characteristics Of Adolescents Who Self-Harm

In adolescents who self-harm and whose psychotherapy I have undertaken, the following points share common features:

It can be said that the age at which they begin self-harming behaviors, especially cutting, is around 12–13 years.

It is striking that cutting behavior is repetitive at certain intervals and that cutting is the most frequently used and most pleasurable method of self-harm. The pleasure derived from cutting and scratching the skin appears greater than from other methods. This is followed by hitting oneself and pulling out hair.

It is repetitive that they say how much they enjoy seeing blood and feeling pain and that they insistently mention the pleasure cutting gives them.

It can be said that the parents of adolescents who self-harm are couples who started living separately and divorced when the adolescents were young (in the adolescents I treat, the divorce often coincides with the pre-primary school period).

The way adolescents who self-harm describe their fathers is usually as inconsistent, easily angered, hollow authority figures. The majority describe their mothers as highly dominant, rigid and rule-oriented, intrusive, yet neglectful of their own self-care and distant from feminine traits. Some of the mothers are reported to have received or to be receiving psychiatric help due to past dissociative disorders, major depression, alcohol, substance use, and suicide attempts.

None of the adolescents are regular users of drugs; they have, at most, tried cannabis a few times experimentally.

Their academic performance is high until major depression emerges. They have not engaged in truancy or received any disciplinary penalties, which distinguishes them from those with conduct disorder and other behavioral disorders.

They appear to have problems with body image (such as seeing themselves as fat or ugly).

Their self-harming and other damaging behaviors are not due to substance or alcohol abuse.

Eating disorders and self-mutilative behaviors can also be seen in the siblings of these adolescents.

Adolescents try to hide the areas of their bodies where they injure themselves (they mostly tend to wear long-sleeved clothes to hide cuts on their arms).

The body areas most frequently harmed are, in order, the arms, hands, wrist areas, and legs, and rarely the neck; they absolutely do not harm the genitals or breasts.

The cuts are never at a level that would cause disability or sever a limb from the body.

The forms of harm, in order, can be listed as cutting, burning, picking at scabs, reopening wounds, head banging, and hair pulling.

They explain the reasons for these behaviors as momentary relief, controlling anger, relaxing upon seeing blood, calming down, relieving tension at that moment, and deriving pleasure.

They state that they do not engage in self-harm in order to kill themselves.

Their self-harm behaviors do not clearly serve the purpose of secondary gain or controlling others.

Their histories are marked by significant physical and sexual abuse.

It is noticeable that they have attempted suicide at least once with medication.

The most commonly used materials are utility knives and razor blades, scissors, nail clippers, knives, and, more rarely, pencil sharpener blades.

Compared with other adolescents who show behavioral disorders, these adolescents, who self-harm, appear relatively conservative on sexual issues (libidinal discharge may be achieved through cutting behavior).

Many of them have particular talents, especially in drawing and cartooning (the body is used as a kind of canvas. This talent can be a way to reach the adolescent in the early stages of therapy).

It can be said that in most of these adolescents, their older sisters have at some point in their lives received psychiatric treatment (especially treatment for bulimia nervosa) or reached a point where treatment would be required. Considering these individuals, some of whom also engaged in cutting for a period, it can be said that acting-out behaviors are widespread in these families and that anger cannot be verbalized.

In some adolescents (based on information obtained when those who interrupted therapy returned to treatment), cutting behaviors are later replaced by bodily pains and especially intense headaches, and they receive a diagnosis of migraine. Cutting behavior may have been replaced by a psychosomatic condition.

Among these adolescents, some are close to receiving a psychosis diagnosis, but when considering the others separately, adolescents who self-harm can be placed somewhere between normal adolescents and those with behavioral disorders and borderline problems.

They are most often treated with a diagnosis of bipolar disorder or borderline personality disorder.

In general, their first cutting behaviors take place in the evening or at night.

A statement common among them is this: Even at times when everything is going well, they sometimes still harm themselves.

It is particularly noteworthy that when they talk about cutting behavior, they more frequently use verbs or idioms related to cutting. For example, they use expressions such as “cut it out,” “cut it short,” and sentences ending with “cut it off.” It can be said that this form of self-harm, which manifests as cutting, has somehow permeated their entire soul and become a catchphrase.

In female adolescents who self-harm, it is observed that when they talk about cutting and other harmful behaviors, they do so with a noticeable excitement, almost in a hypomanic affective state, and with great appetite. It can be said that adolescents who appear depressed, whose conversations and facial expressions reflect sadness when they first present to the clinic, become animated and experience an increase in energy when they talk about cutting.

Adolescent Therapies Implemented In Cases Of Self-Harm

Adolescents who show self-harming behaviors toward their own bodies tend to have low self-worth, intense feelings of worthlessness, and a lack of self-confidence. In adolescents, self-harm behaviors that can manifest in different forms such as eating disorders, vomiting, and internet addiction carry unconscious aims of being loved, appreciated, and valued. 

The most effective medical approach in individuals who exhibit self-harm behaviors is a combination of psychotherapy and medication. 

• Through therapy, the person can be helped to understand the feelings and thoughts associated with self-mutilation. In addition, work can be done on alternative positive behaviors that can prevent self-harm. 
• Although there are no medications specifically for self-mutilation, drugs used for pathologies such as obsessive–compulsive disorder, anxiety, depression, and sleep disorders can contribute to treatment.
• As one of the recently developed methods, a new psychotherapy method called imagery has recently begun to be used in the treatment of self-harm behaviors. In the imagery method, the person’s psychophysiological reactions to the image or memory of an event are used to imitate the reactions given during self-mutilation experiences. 
• EMDR treatment can also help by resolving traumatic memories in the person and thus contribute to the treatment. 

Recommendations For Parents In Cases Of Adolescent Self-Harm

In cases of self-harm during adolescence, parents receive recommendations and information on how to behave. Since this will be addressed in detail during therapy sessions, efforts should be made to ensure the most appropriate behavior. First of all, parents should try to be understanding and calm and make an effort to understand their child.

If very serious problems are emerging, therapy should be started before the situation progresses. In this way, support can be obtained. The methods to be applied are determined during treatment and the root of the adolescent’s self-harming inclination is explored.

When Should A Therapist Be Consulted In Adolescent Self-Harm?

Recent changes should be monitored and efforts should be made to understand the adolescent’s mood. However, it is very important not to create conflict at this point. Creating conflict may lead the adolescent to avoid the things that are said. First, they should be approached with affection and a sense of love, and an effort should be made to understand them. Love and correct communication methods are very helpful at this point.

However, if the adolescent has self-harming tendencies and does not give up this behavior, therapy is absolutely necessary. Otherwise, different and more serious problems may arise. It is recommended that therapy be initiated before events become larger and more serious.

How Is Self-Harm Treated In Adolescents?

First of all, it is necessary to be aware of what the adolescent feels, thinks, and what kinds of problems they are experiencing. Great care must be taken in behavior and communication during this process. For an adolescent with a tendency toward self-harm, it is necessary to understand why they are doing this to themselves and to proceed in the direction of the problem identified there.

The course of treatment may vary depending on the psychological problems present. The family situation also has a major impact on this issue. In this regard, it may also be necessary to meet with the family. With therapy, which sometimes ends in a short time and sometimes takes quite a long time, recovery is achieved. In this way, the inclination to self-harm is brought to an end.