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Ask a Professional: Self harming 13 year old - monitoring and concerns about labelling

Ask a Professional: Self harming 13 year old - monitoring and concerns about labelling

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Linda-ROPro

Ask a Professional: Self harming 13 year old - monitoring and concerns about labelling

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Our 13 year old girl has been gradually changing over the past 12 months, getting more withdrawn from her favourite activities and seeming to be down. We noticed she has stopped wanting to swim (previously one of her favourite activities). She also started to wear long sleeve shirts. Because she is embarrassed of the scars and wants to cover up, she is not doing much exercise and we are worried about her overall health.
She has struggled a little with friendships over the years. Also, our marriage has been difficult and so she has seen and heard too much conflict.

Eventually I approached her and asked if she has been self-harming as I had been reading about that and we had seen some sharp objects in her room. She admitted that she had and although she didn't show us, we have seen some scars on her left arm and also I think somewhere near her groin area. We don't think she is having suicidal thoughts (and that is what she says to us).

Last year she went to see a psychologist we arranged for her but did not like the sessions and so stopped. We have spoken to a few psychologists by phone. She is not comfortable with the school counsellor. She says she wants to talk to someone but we are not sure who the right person is. She is a sensitive type who keeps so much inside. My wife and I feel it is so much our fault for mistakes over many years.

We feel that some of this was made worse by our mistake letting her watch too much on her ipad. She got into goth culture and heavy music and became aware of all the gender issues everyone is talking about. She now seems to be stressed about her gender identity and so that is also part of her struggle and all connected.

1. My first question is whether we should be monitoring her self harm by asking to look at her scars and how much to insist to see them (or take her to a doctor). We are so worried that she will have some serious injury or lifetime scars from this but one psychologist told us it's probably best not to push to check them. I feel like I would like either us or a doctor to take a look at them from time to time but she doesn't feel comfortable showing anyone. When I ask she says she is not doing lately but II think she probably still does sometimes. How hard to we push to find out what she is doing and how often?

2. Should we be actively checking her room for sharp objects? She will be very resistant if she thinks we are checking her.

3. About seeing psychologists, my wife and I are both hesitating because we are scared she might be labelled and see herself as something wrong with her (even more than she already probably does). I have seen kids go to psychologists for years and years and often they don't seem to make that much progress but rather get a bad self image of themselves.

I am sorry this is so long. We honestly don't know where to start with help for our wonderful, talented and sensitive child.

Thank you for taking the time to read this.

JosephH

Dear @JosephH,

You sound like a really caring and concerned parent, and I just want to acknowledge the step you took in asking directly about self-harm. It’s something which many parents find difficult, but it is such an important first step.

I wanted to talk a little about your concern that seeing a psychologist would result in your daughter being labelled. This is a really common worry that parents have, and it is really understandable. Not everyone who self-harms has a particular mental health diagnosis or ‘label’, and not every psychologist actually diagnoses as part of their approach.

If a diagnosis does make sense, the psychologist would be able to discuss what this means for your daughter, but a helpful way to think about diagnosis is as a tool which helps psychologists identify what types of treatment might be most helpful, rather than as something which defines a person.
If your daughter completes a Mental Health Treatment Plan with her GP (to allow her to access Medicare rebates to make seeing a psychologist more affordable), this will often include wording like ‘depression’ or ‘anxiety’ - this is because the MHCP requires the GP to identify the type of concern being treated. But, you can think about this as a description of the current concern, rather than a conclusive diagnosis or ongoing label (this is how many psychologists think of this information).

It’s great news that she is wanting to talk to someone (with teens that’s often a challenge in itself). As @Courtney-RO mentioned, the GP is a great place to start with finding someone as they will have local knowledge. If you need more options, or are having difficulty finding someone who seems like a good fit, you can also search for a psychologist here. You can sort by relevant issues as well as location, and there are profiles of the psychologists which might be helpful in identifying who your daughter would feel most comfortable with.

Regarding how much to monitor your daughter - I want to start by saying there is no ‘one size fits all’ answer to this question. It depends on the person, the relationship and the degree of self-harming. Seeing a GP for a general check-up and discussion is a great idea, but your daughter may not be willing for the GP to check for marks of self-harming at this stage.

The most effective approach is often to address how you can reduce risk for your daughter as part of an overall plan to help her stay safe from self-harm - this allows her to contribute ideas for what you can do to help her stay safe, as well as you suggesting things. This could include an agreement that you will remove things like sharp objects from her room (this is a reasonably common boundary for parents), but also can include ways she can communicate when she needs more support. This article about developing a safety plan is written with suicide in mind, but the concept is also relevant for self-harm.

It’s important to realise that steps like monitoring for injuries, removing items that may be dangerous, etc are only part of the picture - they can help in the short term, but it’s important to address the reasons for self-harm. This is where seeing a professional can help - they can discuss what is happening for your daughter emotionally and help her learn alternative ways of coping.

Lastly, it can be really tiring supporting someone who is going through a tough time. I encourage you and your wife to make sure that you take time to do things which you find relaxing and enjoyable, as a way to make sure that you are ‘recharging your batteries’ so you have enough energy to keep providing support (it also sets a great example for your daughter), as well as talking to someone if you feel overwhelmed.

Best wishes,
Linda

 

Linda is a psychologist experienced in working with people across the lifespan, including teenagers and their families, in a variety of settings, and is ReachOut's Clinical Lead.

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