Full Show Notes
Self harm is not just about cutting yourself. And it isn’t something that’s only an issue with girls. A teenage boy who punches the wall in anger so hard that his hand starts to bleed is also taking part in self harm. So is the college student who drinks enough alcohol to make herself sick, or the kid who purposely picks a fight with someone twice his size.
As odd as behaviors like this might appear, they actually make perfect sense from a teenager’s perspective. This week on the podcast I spoke with Michelle Mitchell, the author of the new book, Self Harm: Why Teens Do It And What Parents can do to Help.
Michelle told me self harm happens when teenagers have strong negative emotions they don’t know how to deal with. By making themselves sick or hurting themselves teenagers can find a sense of escape. The physical pain has a numbing effect and that temporary release can be highly addicting.
And the numbers are pretty scary. By some estimates, over 20% of teenagers experiment with self harm at some point and another 14% consider it but ultimately decide not to try it. It’s hard to pin down exact statistics because many teens and their families never report the behavior to their doctor.
What Can Parents Do?
The first thing to think about is how you can equip your teenager to cope with very strong negative emotions in ways that are healthy and productive. Michelle told me what you can say to your teen to get them to reflect on their emotions and try out different strategies for dealing with them.
Of course, the best scenario is if you can have this talk before your teenager even thinks about self harm. However, this obviously isn’t always an option. What should you do if you think your teen might already be self harming?
Your first reaction is VERY important. Many parents react with worry and fear and rush into “fix-it” mode. But this just piles more negative emotions on your teen and often makes a tough situation even worse.
On this episode, Michelle breaks down exactly what parents can say in the initial conversation, as well as the follow-ups. The key is to reduce your teenager’s feelings of vulnerability so they feel comfortable talking about it. Then, you want to help them discover a replacement behavior they can use instead of harming themselves next time they experience negative emotions. Finally, you can talk about more long-term coping mechanisms and encourage your teen to work on it further with a therapist.
Word-for-word examples of what to say to your teen
1. Convince your teen to try something new by using a “trial period”:
“All I want you to do is to try this three times. And if you really aren’t comfortable with it or you don’t like it after that, we can talk. I’ll be listening to what’s effective for you and what isn’t but I just want to try it for three times.”-Michelle Mitchell
2. When your teen messes up, show them you’re not mad:(Members Only)
3. Don’t let your teen get hopeless:(Members Only)
4. Convince your teen to try something new by making it about yourself:(Members Only)
5. Convince your teen to try something new by being honest about it:(Members Only)
6. When you aren’t sure how to help your teen:(Members Only)
7. Compliment your teenager 5-10 times a day:(Members Only)
8. Compliment your teenager 5-10 times a day:(Members Only)
Step-by-step guides for applying the ideas from this interview
1. Use “Hit-and-Run Praise” To Build Your Teen’s Self-Esteem:Most parents intuitively know that it’s important to give kids lots of honest praise and recognition. But with teenagers the problem is that they usually roll their eyes or say something sarcastic when their parents try to say something nice. The solution, Michelle told me, is to use “hit-and-run” praise. To do it, throw your teen a compliment while your walking by and be sure not to pause or stick around for the eye roll. Just keep in walking and don’t give them a chance to respond sarcastically. If you need to, Michelle says, you can roll your eyes for them as you walk away. She recommends doing this 5-10 times per day. Take 10 minutes to write down 50 compliments, enough to get you through about one week. Make a list and then cross off each compliment as you use it on your teenager. Can you get through all 50 during the next 7 days?
2. Does Your Teen Experience Intense Emotions?(Members Only)
3. Reduce Your Teen’s Feelings of Vulnerability Before A Big Talk:(Members Only)
4. A Simple Technique to Get Your Teen Doing Something New:(Members Only)
Complete Interview Transcript
Andy: So, self-harm… What made you say, “Hey, this is the topic. This is what I got to write about for book number five”?
Michelle: It’s been such a privilege to write it, actually. I wrote about this topic, because I noticed that families were really struggling to find hope-filled material, and I wanted to cover the depth of this topic, but at the same time, make sure it’s really practical and positive, and was going to help prevent self-harm as well.
Andy: I think it’s really cool to be bringing this out into the open. Do you have any statistics here for us? Is this something that’s common, that’s happening a lot, is this a rare thing or what?
Michelle: As far as how many young people are self-harming, I think it’s pretty widely accepted that around about 10% of young people will consciously experiment with self-harm at some stage through high school, and in Australia that’s 186,000 kids.
Michelle: And when I wrote this book, I sat down and thought to myself, this is for the 186 families that, this year is going to discover their child is self-harming, and they don’t know what to do, and they don’t know how to handle it. I don’t know if you’re interested in this, but 60% of the young people who do self-harm, do so more than four times in a year. So, you can really see the addictive properties of self-harm. And although, I guess, the stats of self-harm are often taken through GP clinics and hospitals, but we know that about 87% of young people who self-harm never present to a GP or a hospital. So the issue in some community studies is saying about 27%. About 14.6% of young people have thoughts about self-harm, but haven’t carried them out yet, and this is a lot of the work that I do preventatively.
Andy: Can we just talk a little bit about what it is and how it works?
Michelle: Okay. It’s a really good question and I want people to get this because I think, they say, “Oh, well, self-harm is just that cutting stuff.” But when our kids have destructive thinking, and they want to hurt themselves in order to try and control the emotional pain or cope with what’s going on or even trying to express themselves, you think of maybe a young boy who gets mad, but bashes a wall, but continues to bash the wall till his hand’s bleeding, that’s self-harm. But if you ask boys, if they’ve self-harmed, they’ll often say, “No, that’s a creative thing.”
Andy: Yeah. Right, right.
Michelle: So it’s really important that we’re very broad-minded in our thinking. When a young girl comes to me and she says, “I’ve got a piano exam tomorrow, and I don’t know how I’m going to cope if I don’t pass,” I’m not just looking for cuts. I’m actually listening for the destructive thinking.
Andy: So that’s the precursor then, is having some sort of a really strong negative feelings that they are not able to cope with or having-
Michelle: Yeah, yeah. We need to realize that initiation starts in these middle school years. So that’s like 13, 14, 15, that’s the time, and if we think back to those years, what they were like for us, they had these big intense emotions, and sometimes those emotions can be incredibly overwhelming. I don’t know about you, but my kids go to the fridge and if there’s no milk, it’s the end of the world. It’s just-
Andy: Well, I can relate.
Michelle: If they want to go to a party, they’re really excited about going to that party. So everything’s really exaggerated, so it’s no wonder that in those years, when they feel sad, they feel anxious or they feel out of control in themselves, they might look at self-harm as a really legitimate strategy. The thing with self-harm though, is that because it doesn’t solve problems, it’s not really helping them regulate their emotions in a healthy way, and it can be a bit of a vicious cycle.
Andy: And so you also actually write in here, the very first page of the book, is a quick definition and the clinical term for this whole thing is Nonsuicidal Self-Injury, NSSI.
Michelle: And that’s the area that I’ve really focused on, and it’s not that it can’t move into intent for suicide. It can, and it’s not that it can’t move and change, but it’s really important that this is a issue that can stand completely alone.
Andy: And I think that is important, because that’s the first place your mind goes. It’s like, well, so what, you’re trying to kill yourself and why, and it’s like a failed suicide attempt or something. But I think it’s so important to realize that, that’s not really what’s going on. It is a coping strategy that’s being used.
Michelle: Yeah, and it’s not like it’s not dangerous, so that’s not my point. But again, we’re looking at intent, and I think understanding the cries that young people have in their intention is the first point of call, because when a parent automatically goes to, they want to kill themselves, that really drives… That fear can really drive how they respond to it. We really want to reinforce healthy coping strategies. So we want our kids to get from overwhelm to calm, with those healthy strategies, rather than unhealthy strategies, and we can play into that sometimes, if we’re not careful.
Andy: I kept thinking, reading your book, about this idea from Charles Duhigg’s book, The Power of Habit. He talks about a habit loop, that habits consist of these three phases: the cue, the routine and the reward. And I kept coming back to that, reading your book, because it helped me to just understand why this is so addictive. And because you talk about it in the book, it’s what we were just saying, the cue for the teenager is when they feel some overwhelming or feelings of despair or-
Michelle: When their internal dialogue starts to say, “I need to stop this feeling now. I don’t know how I’m going to cope if I don’t just stop this, I can’t cope anymore.” Then that real defeatist, no escape, no rescue kind of thinking, that’s really when young people are in a lot of danger.
Andy: Ah, yeah. So then the routine would be some sort of a negative, like you were saying, anything that involves harming your body, it’s not just cutting, it’s jumping from crazy heights, punching walls, holding your breath until you pass out, which is risky, reckless kind of behavior. So then how is there a reward at the end of this whole thing, because it wouldn’t just be an anti-reward, because you are hurting yourself?
Michelle: When you think about it, like we all have a stress plus something equals relief circuit. And for me, stress plus a pack of Tim Tams sometimes equals relief. I don’t know, Andy, what your unhealthy habits are, but we’ve all got some. But stress plus a razorblade wouldn’t do it for me. So we’ve got to remember, that we’ve all got some unhealthy habits that we tend towards. But when young people, just say let’s take the example of cutting, when they cut, endorphins are really released in their body, and there’s an adrenaline and pain inhibitors are released, and young people actually report this rush or this high. It actually changes the chemical state of their body. They have a physical response to it, and it’s very similar to the pain of a really good workout, and I know that’s healthy and cutting isn’t, but it’s the same response that your body goes into to, I guess, protect itself.
Michelle: But also, young people’s focus goes on the physical pain and the sight of the blood, and the problems that they were experiencing or the overwhelming emotions that they’re experiencing tend to seep into the background, and it becomes that relief. But it’s actually after that high, that young people report the low or the numbing pain that leads to their body’s exhaustion and crashing and shut down. And that recovery period, that knock-on effect is just as addictive for young people, and I hear them talk about the guilt and the hiding and the shame associated with what they’ve done, which leads them back into that loop of having overwhelming emotions, and background that high and low phase again.
Andy: I really loved this chapter that you had on the psychology and physiology of it, and you talk about these two different needs, the cry of pain versus the cry for help needs. So how do those work, and how can you spot those?
Michelle: A cry of pain can look like something to punish myself, to get relief from a terrible state of mind, to escape an impossible situation, to get out of something that I’m really not coping with. A cry for help can look very different, to show how desperate I’m feeling, to frighten someone else, to get my own back, to find out if someone really loves me or to get someone’s attention. And it’s not just about attention seeking, but a part of what we need as human beings is validation of where we’re at and our emotions. And young people can use self-harm to try and evoke that validation.
Andy: Yeah. I’ve seen that. We’ve seen some parents here, who feel really manipulated by it, I guess, with kids who almost make demands, but for different things.
Michelle: And if you don’t do this, I’m going to cut. Yeah.
Andy: Yeah, yeah. And they’re like, “Man, what do I do? Because if I give in, then I’m teaching them that this works.” But you know… And so, that struck me as that cry for help that you talk about.
Michelle: Parents can get caught in that loop as well, that cycle of drama, it can be really difficult, and that’s when parents really need a professional to stand besides them, and help them make some of those judgment calls. Parents are often very concerned that their kids want to die or are attempting to commit suicide. Not in all cases is that linked to suicide. In fact, it’s most commonly not linked to suicide, and the link between suicide and self-harm definitely needs to be researched further, but there’s enough evidence to show that self-harm can stand completely independent of suicidal thoughts, and it’s important for us to understand that young people that self-harm don’t necessarily want to die. It can be something that’s completely separate, but that has to be assessed by a professional. I think as parents we’re way too close to our kids to make those assumptions and judgments, and we need an outside eye to help us.
Andy: And so there was a chapter in here, a whole chapter on digital self-harm, which is so fascinating to me.
Michelle: Did you like it?
Andy: Yeah. Can you tell us about what the heck is digital self-harm, and how does that even work?
Michelle: Digital self-harm is when a young person might set up an anonymous profile, some alias, and they actually bully themselves online. So I see young people sometimes going to the student support counselors at school and saying, “Look, I’m being bullied online,” and they’ve got this history of messages and blah, blah, blah, and they’re actually bullying themselves. So they’re damaging or destroying their own reputation online. You can imagine if a young person has a bad day at school, and they go home and they want to find out who their real friends are, doing that actually sometimes siphons out their friends, will their friends agree with the bully or their friends back them up? So it’s a bit of a tool that young people have in their hand to try and change things quite quickly. It’s really, really scary and it can get out of hand very easily socially for young people as well.
Andy: So, I mean, what does this actually look like? I mean, this is just someone basically in the comments on their own Instagram post or something like that, they would just-
Michelle: It can be one, it can be 100s, it can be messages of any sort, hate messages, “If you don’t break up with your boyfriend, I’m going to smash your head in,” and then the girl goes, shows her boyfriend the next day, and it creates a whole lot of drama and attention around their relationship. It can be any number of the thousands and thousands of things. But I guess, it’s a tool that young people are using to shift the chemistry of things very quickly.
Andy: It got me thinking about this guy that we interviewed, Mark Goulston, and he has this strategy that he calls mediated catharsis where, what he recommends-
Michelle: I’ve listened to that podcast.
Michelle: It’s brilliant.
Andy: So it’s cool stuff, and what you do is, say all the things that your teenager is probably thinking, and it sounds a little crazy, but it works, because it gets it out without, as a parent, making you feel bad, because you’re leading it and you’re in charge of it. It strikes me that this is the same phenomenon, just a little bit. It’s like that these kids have stumbled upon a way to use that on their friends or on their peer group, because that allows them to get those comments out there and to see what’s going on, but they’re in control of it and it puts them back in power, and at least-
Michelle: Drive pain, drive help.
Michelle: So just think about exactly the same way I cry for help, I want to see if someone really loves me, I want to frighten someone. A cry of pain, I’m not coping, and I need more support.
Andy: Yeah. Or even a cry for help like, I’m being bullied in the real world, but I don’t have any evidence or think people would believe me. So I’m going to create this online thing, that I for sure have evidence for, so that people will help me.
Michelle: That’s a big one. Yeah, that happens just often, and that’s probably the most common form of digital self-harm that I see. It’s this trying to draw attention to something that they already feel like is out of control.
Andy: So I am really big on vulnerability. I just think one of the most important things parents can do is, be vulnerable and share how they’re really feeling. But you had a really interesting point here in your book, about minimizing vulnerability for your teenager, and I thought that was so smart. It made me think of, this is a super vulnerable time for them already, so you don’t have to do anything to make them more vulnerable. Anything you can do to reduce their vulnerability and then combine that with being vulnerable yourself, how do you do that though? How do you minimize the vulnerability for a teenager?
Michelle: Okay. When any of us feel unsafe, we shut down, don’t we? We lock up, we shut down, and when we feel judged or criticized or feel like a parent’s going to overreact or blame us for everything. And I think one of the things that you just said there that was gold, is when parents have put themselves in a vulnerable place, even when they say, “Hey, this is a family issue, and if you want to get counseling together, we will be there in the room with you, and we will be working through our stuff just with you as a part of this process,” and I’ve seen parents do that, just so incredibly.
Michelle: And those parents that can actually be vulnerable themselves, automatically minimize vulnerability in their kids, because their kids, all of a sudden, are not the only ones that are overexposed here. We’re actually all laying it on the table, and we’re all prepared to work through it. Instead of pointing the finger and saying, “Hey, you’re the one who’s got to change and you’re doing the wrong thing, and you’re causing the stress here and you’re causing the problem,” it’s an all-in kind of approach. And I’ve always found that these issues, they’re family issues, they affect all of us and in some way or another, we’re all intertwined in it, and parents that can take that on board are just brave, and I find that they really get through these times with their kids in such a connected way.
Andy: You have a big section in here, about having this conversation, and what I really liked, it was that you start out by talking about your initial reaction, which we talked about earlier, right? Because I think the initial reaction a lot of times is like, “You’re doing what? Or like you were saying, “Why are you trying to kill yourself? We’re not good enough for you. How could you do that?” And that’s so human, I think that it’s going to be hard not to react that way. So what I mean-
Michelle: And I don’t think that’s so wrong as well, because kids judge the severity of something, oftentimes by how we respond to it. So where as I say to parents, “Look, process your emotions away from young people, so you can be your best self in front of them. So go and see a psychologist or go and talk to someone before you talk to a young person, just to get in the right frame.” But I think it’s also really important that kids know that it’s a big deal, and it does affect other people. So we can’t just mask how we’re feeling.
Michelle: I think we’ve got to be really real with kids, because they actually gauge a lot by how we respond and react to something. The reason I’ve got the beginning, middle and the end frameworks in that chapter to talk to young people about this and have those first initial conversations, is you want to try and strip the shame and the guilt away from it, and really get to things like, “Hey, it’s not that I’m angry. I’m concerned about you and what can I do to help?” Not making all the assumptions, but actually really being able to get to the point where I go, we need to get solutions focused together and what can we do together to make things better?
Andy: Yeah. So you go through the three phases, the introduction, and then the conversation?
Michelle: Yeah. And then getting to that point where, you’ve got to leave it on a point where we’ve got somewhere positive just to put our foot next. So I think that’s really important, and how you leave a conversation is important. So if you can see a conversation, a tough conversation with a teenager landing in a good place, exit it, and say to them, “Hey, let’s pick this up and talk about it again tomorrow.” Because sometimes it lands in a good place and then starts escalating somewhere else, and someone says something that just triggers off some emotion somewhere and we’re off. So if you can see a good landing place, 40, 45 minutes in, land it and you can come back to it the next day, the day after. I say to parents, try and keep it under an hour, because conversations that go over an hour seem to deteriorate in quality.
Michelle: And you got to remember, this is not the last conversation you’re going to be having about it. You want to layer these conversations and keep them going, because every word that you say, they’re likely to go and rehearse in their mind a 100 times over. So, that conversation is going to need clarifying, and that conversation is going to need further care. But we want to keep that first conversation quality, we want to bring that to them. And I say to parents too, “What you say and what you do right now matters. It matters and it’s likely to sink really deep into your child’s heart. So seize this moment as a key opportunity to help them develop and also connect with them.”
Andy: Yeah. Give them some time to think about it, then think about it yourself a little bit. So what do you say to kind of wrap it up?
Michelle: Yeah. You want to get it to that hope-filled type of place, and I guess what we’re trying to help our kids do is, ride a wave of intense emotion and get through the peak of it, and I think a lot of our conversations can be around how intense those emotions can be. And remembering when you’re telling a teenager to stop self-harming, you might as well be saying stop feeling, stop feeling so intense and stuff.
Michelle: So we’ve got to help them come through that wave of emotion with, I guess, self care. We want them to replace self-harm with self-care and we have to help them, I guess, reduce the peak of that wave. But also if they get to a place where they feel overwhelmed, that they’ve got strategies that they can do alone, and strategies they can do with other people that are actually going to help them get through it. Because emotions are like waves, they’ve got a limited life span, and they always demand movement. So our kids are going to move somewhere where they’re feeling overwhelmed. We just want them to move in healthy places.
Andy: There’s certain conversations that as an adult, you look back on, and if you can replay in your head, every word that was said, and I think this is one of those-
About Michelle Mitchell
An award-winning speaker, author and educator, Michelle started her career as a primary school teacher before leaving that position to found a harm prevention charity called Youth Excel. For the next 20 years Youth Excel continued to grow and work with schools, alternative education, and child safety. One of Michelle’s most successful projects was opening a private practice which offered psychology, counseling, and mentoring services to young people aged 6 – 18. Her team of 12 staff serviced 120 families and 50 local schools with tailor made care.
Michelle’ work has been featured on The Today Show, Today Tonight, and Channel 10 Morning News, as well as countless print media including The Age, The Courier Mail, and Daily Telegraph. She is a regular contributor to radio. Michelle speaks to groups of parents, students, and professionals in schools and conferences. Her down-to-earth, energetic, and passionate style resonates with a broad range of people and enables her to transfer years of hands-on experience to others in a practical and honest way.
She is a registered teacher and lives with her husband and two teenagers in Brisbane, Australia.