SZN. 4 Ep. 16/Talking About Self-Harm Doesn’t Cause It: What Clinicians (and Parents) Need to Understand
Talking About Self-Harm Doesn’t Cause It: What Clinicians (and Parents) Need to Understand
By: Alexandria Gohla, MSW, LCSW, Ed.S, C-DBT, PMH-C, RYT-200
As a therapist who has spent my entire career working with individuals experiencing emotional dysregulation and non-suicidal self-injury (NSSI), I recently had the opportunity to be interviewed as part of a doctoral research study.
The conversation reinforced something I see every single day in my work:
We cannot afford to tiptoe around self-harm.
We have to talk about it—clearly, directly, and without fear.
Let’s Address the Biggest Myth First
One of the most common concerns I hear—from both clinicians and parents—is this:
“What if talking about self-harm or suicide gives them the idea?”
Here’s the truth:
Talking about self-harm does not create the behavior.
If someone is thinking about hurting themselves, those thoughts are already there. Asking about it doesn’t plant a seed—it opens a door.
And that door matters.
Because when we ask, we gain clarity:
What is the function of the behavior?
What level of risk are we actually dealing with?
What kind of support does this person truly need?
Without those answers, we’re guessing. And guessing is not good clinical care.
Not All Self-Harm Means Suicidal Intent
This is another critical distinction that often gets missed.
Self-harm is a behavior, not a diagnosis—and not always a suicide attempt.
For many individuals, NSSI serves a function such as:
Emotional numbing
Releasing overwhelming feelings
Creating a sense of control
Feeling something instead of nothing
Understanding the “why” behind the behavior is essential.
Because treatment isn’t about stopping the behavior in isolation—it’s about addressing the need it’s meeting.
Why Asking Better Questions Changes Everything
When I work with clients, I’m not just asking if self-harm is happening. I’m asking:
What methods are being used?
How severe are the injuries?
Is the behavior public or hidden?
What emotions come before and after?
What does the behavior do for you?
These questions are not intrusive—they’re clinically necessary.
Because effective intervention is not one-size-fits-all.
If we don’t understand the function, we can’t offer meaningful alternatives.
The Role of Shame (and Why It Matters So Much)
If there’s one thing that will shut a client down immediately, it’s this:
Shame.
If a client senses disappointment, judgment, or fear from us, they will stop telling the truth.
And when that happens, we lose the most important tool we have: honest information.
That’s why my approach is always grounded in:
Curiosity over criticism
Validation over judgment
Collaboration over control
When clients feel safe, they talk.
When they talk, we can help.
Relapse Is Part of the Process (Even When It’s Hard)
If you’ve ever worked with teens or young adults, you know this pattern:
Things are improving. Progress is happening.
And then—relapse.
It’s easy (internally) to feel frustrated or disappointed.
But clinically, that’s not the place we work from.
Instead, we shift to:
What triggered this?
What were the thoughts leading up to it?
What changed this time?
What do we need to adjust?
Sometimes the reality is this:
The coping skill that used to work… doesn’t anymore.
And that’s not failure. That’s information.
Telehealth Adds Another Layer of Complexity
In a virtual setting, we lose something important: visual assessment.
I can’t always see injuries.
I can’t rely on body language in the same way.
So everything comes back to one core foundation:
Trust and rapport.
Clients have to feel safe enough to say:
“I struggled this week.”
Without that, telehealth becomes much more challenging—and risk assessment becomes more complex.
When Does It Become a Safety Concern?
There are key indicators that signal increased risk:
Presence of a plan
Access to means
Stated intent
Escalation in frequency or severity
Shift from superficial to more dangerous behaviors
Even statements made jokingly about self-harm are taken seriously.
Because sometimes humor is how pain shows up.
When risk increases, we move toward:
Formal risk assessment
Safety planning
Higher levels of care when needed
And importantly—we don’t make those decisions in isolation. Consultation and collaboration matter.
The Reality: There Is Still a Gap in Care
One of the biggest challenges we discussed in the interview is this:
There are not enough resources.
Even in areas with growing support systems, options like:
Crisis centers
Mental health urgent care
Immediate placement
are still limited.
Which means clinicians are often navigating complex decisions with fewer supports than we’d like.
This is where continued research, advocacy, and system-level change are so important.
What Prevents Burnout in This Work?
This work is deeply meaningful—but it’s also emotionally demanding.
For me, sustainability comes from:
Strong consultation and peer support
A trusted personal support system
A deeply connected partnership at home
Intentional self-care (including daily movement, social connection, and quiet time to recharge)
Because the reality is:
You cannot pour from an empty cup.
The Most Important Takeaway for Clinicians
If I could leave clinicians with one core message, it would be this:
Check yourself first.
Before reacting to a client’s behavior, ask:
What am I feeling right now?
Is this about the client—or something in me?
Am I bringing judgment into the room?
Our clients are not here to meet our expectations.
They are here to:
Be understood
Be supported
Be met where they are
And when we can do that consistently, we create something incredibly powerful:
A space where clients feel safe enough to be honest.
And that’s where real change begins.
