This narrative literature review focuses on family factors that might be amenable to intervention using family therapy (n = 126). Domains of interest include parent/child interactions, inter-parental relationships, child characteristics, parental characteristics, wider system factors, treatment needs and moderators.The focus of family-orientated treatment with this population should focus on maximizing cohesion, attachment, adaptability, family support, parental warmth while reducing maltreatment, scapegoating and moderating parental control.Close working relationships with child protection services and schools represent additional opportunities.
Practitioner Points1. Over and above any inherited risk, a range of family interactional factors are strongly associated with self-harming behaviours in young people.2. Therapy has the potential to make a positive difference by focusing on enhancing family cohesion and adaptability, whilst reducing discord and violence. Discussions that enhance perceived parental support and warmth may be particularly helpful.3. Therapists should attend to issues of perceived difference and potential victimisation (bullying, gender orientation and identity, ethnic minority status) as these may play an important role in self-harm.
Family factors associated with adolescent self-harm; a narrative review
Aim:Our aim is to produce a narrative literature review of family factors associated with self-harm by adolescents in order to assist therapists in working with such families and support the development of further research in this area by highlighting what is already known (and not known). A number of factors shown to be associated with adolescent self-harm are potentially amenable to change, and even when they are not, greater awareness of these issues may change the ways in which family members think about themselves. We attempt to highlight those areas that might be amenable to change through family therapy
Method/Search strategy:We expected that the current body of literature would be of variable quality and diverse methodology and therefore chose to conduct a narrative review, attempting to summarise and integrate different primary studies. However, we have tried to be as systematic as possible in our search and reporting strategies.In this review we have defined self-harm as any form of non-fatal self-poisoning or self-injury (such as cutting, taking an overdose, hanging, self-strangulation and running into traffic), regardless of motivation or the degree of intention to die. This concept overlaps with NSSI (non-suicidal self-injury) which is considered to beselfinjury in the absence of suicidal intent (for review see Swannell, 2014). The focus of the search was non-fatal acts of SH, but we included the literature on death by suicide where it was pertinent to family functioning.The first author conducted a literature search using Medline (2000 week 4, June 2015 and Psychinfo (2000 June, week 5, 2015. A variety of terms was used to define self-harm including: suicide, attempt...