Understanding Self Harming Behavior in Clients
SOAPsuds team
Published: 7/7/2025
SOAPsuds team
Published: 7/7/2025
Self-harming behavior in clients can be one of the hardest challenges a therapist may face. While about six percent of adults report having self-injured at some point in their lives, teenagers seem to engage in it nearly three times more often. No matter the numbers, this is a troubling issue that calls for careful attention. Here's what therapists should know when working with clients who engage in self-harm.
Overview
In mental health research, self-harm is often called non-suicidal self-injury or NSSI. The term includes any intentional act of harming the body that is not accepted socially (e.g., tattoos, piercings) and is not meant to cause death. Its most often linked with borderline personality disorder, though NSSI is listed in the DSM-5 as a “condition for further study,” which could lead to it being defined as a separate disorder in the future.
There are many reasons people might engage in NSSI. The following factors help explain the behavior:
More on what leads to self-harming behavior
Self-harm and suicide thoughts are not equal. Most who self-injure don’t plan to end their lives. Still, self-injury might be an early sign for some who go on to attempt suicide. More than half of children who die by suicide had self-harmed before. NSSI may make the act of self-injury more familiar, which can be dangerous for those having suicidal thoughts.
How to treat self-injury
Treating NSSI can be tough and isn't fully supported by research yet. Still, some approaches have shown promise:
CBT
CBT has been tested the most for treating NSSI. Approaches like problem-solving therapy and Acceptance and Commitment Therapy (ACT) show potential in lowering self-harm.
DBT
DBT, a type of CBT, is especially noted for helping those with NSSI. It focuses on handling emotions, solving problems, and dealing with distress. DBT's ACCEPTS skill is often useful.
The "Dialectical Behavior Therapy Skills Workbook" is a helpful resource with exercises for clients who self-harm.
Medication
There’s limited research, but some medications like SSRIs and SNRIs may help reduce self-injury.
Be open
Clients usually try to hide self-harming behavior and feel ashamed. Therapists need to talk about it directly and without judgment. Offering empathy can reduce shame and build trust for deeper conversations.
Recognize triggers
It’s important to find what leads up to self-injury. Once triggers are clear, therapists can help clients choose healthier ways to cope.
Include family
Involving the family—especially for teens—can help reduce self-injury. Family members should learn about NSSI and show support. Parents need to avoid punishment and instead offer encouragement and understanding.
Practice mindfulness
Mindfulness helps those who feel disconnected. It allows clients to be more in tune with their emotions or shift attention to body and surroundings rather than
Emotional pain. It also encourages facing feelings with less judgment.
Avoiding relapse
Helping clients who self-harm often means staying in closer contact than usual. More sessions or check-ins may be needed. A benefit of full DBT programs is that clients can get phone support when needed between regular visits.
Self-injury is serious and can be distressing for therapists to treat. It requires steady support and careful attention to progress and risk.
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