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Section 6
Parents' Role in Adolescent Self-Injury

Question 6 | Test | Table of Contents

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In the last section, we discussed how loathing one's body and a preoccupation with food which can lead to self-mutilation. Also we discussed the differences between male and female self-injurers due to the way in which they vent their emotions.

You probably have observed, like I, the emotional damage that can be done to a family because one of their members is a self-injurer.

In this section, we'll examine the various ways a family can be affected by self-injury: We will discuss shock and guilt; anger and resentfulness; and stronger bonds.

3 Ways a Family can be Affected by Self-Injury

♦ # 1 - Shock & Guilt
Many times, the first feelings after realizing a loved one is a self-injurer are shock and guilt. Family members almost immediately question their past behavior with the client and worry that from now on every word or action will prompt an incident. As you probably have observed, often, the self-injurer themselves blames the family or a specific member of that family for the way they are. This kind of isolation is damaging to recovery as the ability to trust family members and close friends is an integral part of overcoming self-injury.

Bruce, the father of 15 year old Audrey, was having a hard time coping with the syndrome. He said, "I don't bring it up unless she wishes to discuss it, and so far she has not done so. But I am mostly concerned about what was causing her to do this." Bruce's concerns are common. A deep feeling of helplessness can occur and in many cases a severe bout of self-reprimand. However, too much guilt can divert energy from the need to be helpful in the here and now.

♦ # 2 - Anger & Resentfulness
As you know, members can lack understanding which stems from anger or resentfulness towards the self-injurer. Jill, age 25, was having trouble handling her younger sister's self-injuring and her own family life. Jill needed to find the balance between the rest of her family and helping her sister, 15 year old Christine whom I was treating at the time, in coping with her self-injuring.

She stated, "I've tried to tell my sister she needs to find a way to stop. I've also told her I'm proud of her for seeking help, and I'll always be here for her, although I have had to set certain emotional boundaries to preserve my own mental health." When asked what she would like to tell her sister about the behavior, Jill said, "Why can't you realize everyone has ups and downs, and just deal with life?" Jill's frustration is indicative of what many families feel when confronted with a self-injuring loved one.

♦ "Conflict Agreement" Technique, 2 Steps
Because Jill's frustration is rooted in her incapacity to express, how she truly feels about Christine's self-harm, I found the "Conflict Agreement" exercise to be beneficial. I asked both Christine and Jill to participate in this exercise while at home.
Step 1: First I requested them to write about a time when they were surrounded by family conflict.
Step 2: Then, I asked them to consider how they resolved that conflict.
Questions I had them contemplate were:
-- a. Was the conflict truly resolved?;
-- b. Was it done negatively, or constructively?
-- c. How well did the two of you communicate during the conflict?

Jill and Christine described an incident in which both of their parents were set against the wishes of the two girls. Jill wanted to go to a public college for an art degree while the parents wanted her to attend medical school. Jill ended up obtaining the art degree. In this case, Christine was Jill's support during the conflict. However, now Jill and her parents do not talk to each other. After they had finished the exercise, Jill could now see that her restraint of her feelings was due to the fact that she did not want to lose her last tie to her family, Christine

♦ # 3 - Stronger Bonds
While self-injury has been known to tear families apart, many times it can be a force that holds the unit together in a stronger bond. Usually this results from self-examination by the parents. Louisa, mother of Audrey, discovered her faults and learned more about her daughter after Audrey had been found self-mutilating herself.

Louisa stated, "First and foremost, I learned that Audrey can speak for herself, quite well, as a matter of fact. This is something I did for Audrey since the beginning of time. I lived her life for her, thinking I was helping her when in fact this made her feel worthless and small. I remember Audrey saying that no one listened to her or took her seriously. No wonder, when I did all the talking for her!" Audrey's self-mutilation led to her mother's revelation of her overly protective and controlling ways.

♦ Technique: "People in my Life" Paragraph
Because self-injury sometimes results from a need to retaliate against wrong doing, I found the "People in my Life" Paragraph to be of benefit to Audrey.

I asked Audrey to answer the following questions about the person she was retaliating against, in this case, her mother:
1. Identify the person or people you feel you have retaliated against.
2. Describe in detail the conflicts and disliked behaviors.
3. When do you feel more satisfied with this person or these people?
4. What are some possible strategies for improving these relationships or dealing with the conflict more readily?

To these questions, Audrey wrote this paragraph: "My mother and I are always fighting. She never lets me speak my mind about anything. Whenever we're out with people, she won't even let me get a word in. When they ask me a question, she usually answered it for me. The best times I've had with my mother were when we didn't even have to talk at all, like when we watched a movie together. I guess I should assert myself a little more to try and let her know that I'm a big girl and can speak for myself."

Audrey had now put down on paper a summary of her relationship with Louisa, her mother, and a way to resolve the conflict between them. Would the "People in my Life" exercise be beneficial to a client of yours? If you might consider replaying this section, section 6.

In this section, we discussed the various ways families are affected by self-injury: guilt and shock; frustration and misunderstanding; and stronger bond. We also included two techniques that you might find useful with one of your clients: "Conflict Agreement" exercise and the "People in my Life" paragraph.

In the next section, we will discuss various aspects to consider when treating a self-injuring client.
Reviewed 2023

Peer-Reviewed Journal Article References:
Adrian, M., Berk, M. S., Korslund, K., Whitlock, K., McCauley, E., & Linehan, M. (2018). Parental validation and invalidation predict adolescent self-harm. Professional Psychology: Research and Practice, 49(4), 274–281.

Emery, A. A., Heath, N. L., & Rogers, M. (2017). Parents’ role in early adolescent self-injury: An application of self-determination theory. School Psychology Quarterly, 32(2), 199–211.

Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview—Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689.

Frei, J. M., Sazhin, V., Fick, M., & Yap, K. (2021). Emotion-oriented coping style predicts self-harm in response to acute psychiatric hospitalization. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(3), 232–238.

In-Albon, T. (2015). Nonsuicidal self-injury in adolescents: What is known about this new research diagnosis? European Psychologist, 20(3), 167–175.

QUESTION 6
What is one question that might appear on a "Conflict Agreement" used with self-mutilating clients? To select and enter your answer go to Test.

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