It’s important for anyone trying to help a child to recognize that cutting is only a symptom. The real problem is the emotional disturbance that creates the behavior. Like drug use, self-injury fills a void that exists within. Therefore the best hope for recovery is to make a child whole again. This means helping them acquire the skills necessary to cope with life while steering them towards things that will offer a sense of purpose. Here are some suggestions to help you get started down this path:
Getting kids to stop self mutilation
A) Help them recognize that there’s a problem
Get an agreement that this habit needs to be corrected: “You know this isn’t the healthiest way to be handling your feelings, right?” Most kids are well aware that this isn’t productive and that they shouldn’t be doing it, so they don’t need a grand lecture. You just want them to acknowledge that this isn’t a healthy habit, so that as you go about trying to correct it or get them in therapy, stopping and becoming more skilled at handling their emotions seems like their idea, not something you’re pushing onto them. Otherwise, they may be inclined to cut precisely because you don’t want them to.
B) Don’t punish or offer rewards
Avoid threats, bribes, ultimatums, or punishments. This behavior emerges from psychological distress, so punishing a child is sort of like scolding them for being bullied – it only adds insult on top of injury. They need help, not punishment. Never try to control this habit with rewards or punishment. You can, however, link cutting to other non-punitive consequences: “If you aren’t able to stop on your own, we’re going to have you see a therapist.
C) Help them develop other coping mechanisms
This behavior will stop when it no longer serves a purpose; i.e., when a child discovers more productive and beneficial ways to cope with their pain. So help them do this. Select books on emotional intelligence and offer them some type of reward if they read it. Make sure you get in the habit of talking with them daily about what goes on at school. Whatever outlets you can provide that lower the potency of these pent up emotions, the easier it will be for them to break the habit.
D) Help your child find purpose and pleasure in life
Look for whatever small improvements you can make that give a child joy or a sense of purpose. Nature excursions, hobbies, sports, volunteer work, caregiving, mentoring younger kids, and so on. Like drug use, self-injury thrives when lost teens have little else in their life that serves to relieve stress or which provides a sense of meaning and purpose. This would be a good time to get to know your child’s passions, and facilitate them in whatever way possible. Quite frequently, kids this age will have hidden interests that aren’t expressed simply because they don’t know how to go about exploring them.
E) Seeking professional help through therapy
Don’t passively ignore the situation and hope it goes away. Though many kids go through a phase where they cut (or merely try it once just to see how it feels) it’s also true that this habit becomes more ingrained and more difficult to treat the longer it goes on. So if the self-mutilation continues, seek professional help immediately. “Kids who’ve just started to cut do well with outpatient therapy,” says John Peterson, M.D., director of child and adolescent psychiatric services at Denver Health Medical Center. (Moninger, 2011)
Cognitive behavioral therapy and dialectical behavior therapy are most commonly used. (See our information on choosing a therapist.) Cognitive behavioral therapy teaches kids healthier thought patterns and different ways of viewing their experiences. Dialectical behavior therapy (DBT) teaches kids how to deal with stress, manage their emotions and conduct themselves more efficiently in relationships. “The focus is on mindfulness, recognizing and accepting whatever is coming up at any particular moment,” says John Peterson, M.D. “Patients learn to be at peace with negative thoughts and feelings as they arise, rather than do things to try to force them to go away.” (ibid)
F) Should you try to treat the problem through medication?
Antidepressants and/or anti-anxiety drugs are commonly given to self-injurers. However, we do not recommend either. These medications often increase suicide risk in children and teens, and they’re a band-aid that covers up the root of the problem. So we would suggest medication only as a last resort after all other options have failed.
G) Expect relapses & stay vigilant
Kids may go through on-again, off-again cycles when they cut. Even after a child is in therapy or otherwise managing the behavior, there may be times when they relapse. “Many recovering people test the behavior, and the majority find that it no longer provides relief,” says Wendy Lader, Ph.D., president of Self Abuse Finally Ends. (ibid, p. 56) Expect that there might be a regression or two, and should this happen, help a teen understand that one relapse does not mean they’ve failed or need to feel ashamed.
Also loosely monitor their computer use. While we never recommend spying on kids (it’s intrusive, it erodes trust, violates their privacy and generally creates more problems than it solves), you do want to steer them away from self-injury websites, which can fuel the behavior.