Understanding Adolescents’ Experiences of Self-Harm: Secondary Analysis of Family Therapy Sessions from the SHIFT Trial

Abstract

The objective of this study was to explore, using first-hand accounts, adolescents' understandings of why they self-harmed, what their responses to self-harm were, and how they resisted or ceased self-harm. Secondary analysis was conducted of video-recorded family therapy sessions from the Self-harm Intervention: Family Therapy (SHIFT Trial). Recordings of 22 participants, approximately 170 hours of footage, formed the dataset. The study developed 5 core themes: (1) Distress can be difficult to convey; (2) Self-harm and suicidal ideation: a complex relationship; (3) Self-harm as a form of communication; (4) Self-harm to manage emotions; and (5) Moving forward. Self-harm was a means of communicating distress as well as managing emotions. Accounts highlighted the complex interplay between self-harm and suicidal intent. Encouragingly, many participants described being able to resist self-harm.

How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm

“…They recommended mental health professionals to ask for feedback to increase helpful interventions. Adolescents also describe ending self-harm by managing and communicating difficult affect and distress to their family (Holliday, Brennan, & Cottrell, 2018).…”

“What I couldn’t do before, I can do now”: Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence

“…Meanwhile, while the participants per Ammerman et al’s ( 2017 ) definition quantitatively reported clinically significant levels of NSSI in adolescence, little significance was attributed to self-injury per se . NSSI was narratively situated as one method among others to manage contextual stressors, and not something intended for communicating distress to others (e.g., Holliday et al, 2018 ) or as causing distress in itself (e.g., Brown & Kimball, 2013 ). This implies that in the current study, NSSI was neither the source nor a symptom of their issues, meaning that discontinuing NSSI within this context was a change in endurance strategy rather than indicative of greater psychological well-being or improved life circumstances.…”

“…This might be particularly important because all participants who had sought counselling said it had been unhelpful prior to their turning point, and narratives about difficulties in engaging in healthcare are commonly reported by individuals who self-injure (Lindgren et al, 2018 ). Moreover, youth who are self-injuring also commonly report unique difficulties concerning ambivalence, honesty, engaging with difficulties beyond the therapy sessions, and decisions to keep up a façade and manage alone (Holliday et al, 2018 ). Furthermore, in accordance with Kelada et al ( 2018 ), tensions and mistrust may be narrated when individuals perceive healthcare professionals to be focused more on their behaviours (e.g., self-injury) or symptoms (e.g., depressive symptoms) rather than on their context, or as our participants noted, they had a need to talk about what had happened to them.…”

“…For example, qualitative studies show that a desire for change (e.g., Gelinas & Wright, 2013 ; Ryan-Vig et al, 2019 ) or a deliberate decision to stop (e.g., Hamza & Willoughby, 2014 ; Kelada et al, 2018 ; Lindgren et al, 2018 ; Long et al, 2015 ; Rissanen et al, 2009 ) are instrumental to initiating the discontinuation process. The desire or decision often follows after a personal realization that NSSI negatively affects one’s relationships (Buser et al, 2014 ; Gelinas & Wright, 2013 ; Shaw, 2006 ), is futile or meaningless (Gelinas & Wright, 2013 ; Holliday et al, 2018 ; Rissanen et al, 2013 ), or could interfere with current life and prospects (Shaw, 2006 ; Weber, 2002 ).…”

How do people conceptualize self‐harm recovery and what helps in adolescence, young and middle adulthood? A qualitative meta‐synthesis

“…A key advantage is the possibility to develop theories beyond those established in individual studies and thus, identify any knowledge gaps (Walsh & Downe, 2006). Further, qualitative evidence more accurately elucidates individual experience, offering a unique insight for improving service provision and tailoring therapeutic interventions more accurately to patient need (Holliday et al, 2020).…”