Transcript for
Understanding and supporting children who self-harm: Giving them a voice

David Newman (00:00): 

What I’ve been taught by children, young people around self-harm is that it is a form of communication. It may not be a form, a direct form of communication, and it may not be even to other people. It might be a form of communication to oneself. 

Narrator (00:14): 

Welcome to the Emerging Minds Podcast. 

Amanda Kemperman (00:19): 

Hi, everyone. My name’s Amanda Kemperman. Welcome to this Emerging Minds Podcast for practitioners supporting children who may be using self-harming behaviour. I join you today from the lands of the Kaurna people of the Adelaide Plains, and invite you to take a moment to reflect on and acknowledge the lands on which you’re listening to this podcast. I pay my deepest respects to the traditional custodians of these lands, honouring the centuries of knowledge and wisdom they hold in working in harmony with the land and fostering strong, resilient communities and healing practises. I also extend my respect to all Aboriginal and Torres Strait Islander peoples, their ancestors, elders past, present, and emerging from the many diverse First Nations across Australia, as well as those listening today. 

(01:04): 

Recently, we developed an online course named Understanding and Responding to Childhood Suicidal Ideation. I had some great conversations with parents and practitioners about how they support children experiencing suicidal thoughts and behaviours. As a part of these conversations, the topic of self-harming behaviour came up. I had two follow-up conversations with social worker and narrative therapist, David Newman, and community psychologist, Dr. Lyn O’Grady, about their work with children using self-harming behaviour. And this podcast shares their unique perspectives in understanding and responding. I asked Lyn how she begins to respond when she finds out a child is self-harming. And Lyn explains how she addresses both the non-suicidal self-injury, also known as NSSI, and suicidal ideation with children. Here’s what she had to say. 

Dr Lyn O’Grady (01:59): 

Do they have suicidal thoughts when they’re hurting themselves? Or are they hurting themselves to feel better? It’s a really important question to explore with kids. So I try to think about them together and then get that understanding of it. And then if it is that they’re doing it to try to feel better, then it’s much more clearly probably NSSI. But if they’re doing it with the thoughts about wanting to die, well, then we’re talking about actual a greater risk in lots of ways. The whole thing can be risky if it escalates. 

Amanda Kemperman (02:31): 

I asked David about when he notices self-harm is happening, how he thinks about self-harm in a way that helps him manage his response. 

David Newman (02:41): 

Asking children about it. What have they found useful? What have they found not useful? What would they like in terms of a response from caregivers, from therapists? How would they like people to engage with it? So that’s been shaping of things for me. And a key thing that I’ve heard from young people and children is that when one panics, when one flinches even, that it can make things more difficult for them. They have a sense that something is significantly wrong. They have a sense that something’s out of kilter, that something needs fixing, that the person is wrong. And they can feel more alienated. They can feel like the connection is interrupted as a result of that. So flinching and panic, not terribly helpful. 

(03:28): 

And so that has shaped the ways that I respond to self-harm. And also, young people have said to me, and children, that there are some helpful meanings that do get missed. There are some helpful meanings around what self-harm can be about or cutting can be about. And some of those things are that they’re doing whatever they can to survive, get through the toughest of times. And it’s really important for that to be acknowledged, that this is not passivity. It’s some kind of action. Young people have told me and children have told me this is about a response. It’s not about being passive. So that helps me kind of just stay a bit more settled in the conversation if I hear about it. 

Amanda Kemperman (04:14): 

I then ask David about his priorities and what children have shared about what they need from those who support them. 

David Newman (04:21): 

The other thing that young people and children have said, and this actually is also in the realm of suicidal experience, is that they really hope for understanding, not some kind of plan about how to stop it, but they really, in conversations, hope for some understanding, some sense that they’re able to talk about just what’s rough-going at the moment and how come this is of some assistance, or is something that they might be doing and they don’t want to do so much, but some level of understanding, not some kind of pushing to do something differently or stop the cutting or stop the self-harm. 

Amanda Kemperman (05:02): 

Lyn discussed how she explores what’s happening for the child underpinning their behaviour. And David shares what he has learnt from young people and a question he finds particularly helpful in understanding the behaviour. 

Dr Lyn O’Grady (05:16): 

So I’m trying to hold that curious kind of stance and that listening and what’s happening and get that context around it. And I guess you’re trying also to get a sense of the seriousness of it. So is it a scratch versus an actual cut? What’s the context around it? Is it a planned thing? Is it happening a lot? Has it been happening for a long time before we know? Is it just happening now? Where did the idea come from? Do other people around them do it? So that can be one of the things that happens, even in upper primary schools, where you’ve got a group. And sometimes primary schools are dealing with that. 

(05:50): 

So where’d they get the idea from? And is it like an online thing? Because, again, that can happen, has happened in the past, where there’s stuff, uploading photos and things and comparing and stuff like that. So has it got that kind of aspect to it? Or is it a very solitary alone thing? Would anybody else know? Where does it happen? Does it happen more than one place? So that curious gathering all this, it’s like an assessment really, but it’s this broad assessment, not just a sort of ticker box assessment, but just curious approach. 

David Newman (06:21): 

What I’ve been taught by children, young people around self-harm is that it is a form of communication. It may not be a form, a direct form of communication, and it may not be even to other people. It might be a form of communication to oneself. So I’ve come up with a question that I think can be helpful, especially when there’s a crisis looming that a child or a young person is on the verge of getting really stuck into themselves. And that is, I’ve asked children and young people if self-harm could not act, but could only speak, what would it be saying? And in that question, sometimes the immediacy, like if there’s a crisis looming, that can just settle the crisis, potentially, and it can also be a means of expressing what self-harm might be trying to communicate and can be very, very helpful. Generally, when things are in the spoken word, the meanings can be a little bit more accessible, more clearer. 

(07:17): 

I think that’s not always the case, but it can be. So when I’ve heard people say, “Well, look, self-harm is a way of saying … What I’m communicating with self-harm is I’m just can’t cope anymore because my heart is in turmoil,” well, that’s an important thing for us to listen to. Self-harm might be saying to others around you, “I need you. I need your support.” Well, that’s a really important meaning for us to make of it. So in other words, to try and find a way to get clarity around what communicating self-harm might be doing and go from there because those meanings can be more helpful when they’re in the spoken word rather than in gestures and actions sometimes. 

Amanda Kemperman (08:02): 

Lyn highlights a secrecy that often surrounds self-harming. And David discusses the challenges of talking about self-harm and the importance of using careful and respectful language. 

Dr Lyn O’Grady (08:14): 

I think trying not to panic about it because it’s … At least we know now that’s one of the things, I think. So what we know about in suicide risk and self-harming is that we often don’t know. People don’t always tell us. So there’s often a secrecy around it. And the research will tell us that sometimes people die from suicide and haven’t told anybody, and people are shocked. 

David Newman (08:37): 

Self-harm and cutting can be incredibly hard to speak about. Young people and children, in my experience, can get very worried about how a caregiver might respond. They can feel very, very guilty if a caregiver gets very stressed by it and or feels that they’re responsible for a child in their care to be cutting or self-harming. So the language is very tricky. We ask each person, each child, each young person, how they would like to refer to it, but the language, being very careful. So I will often say, “Look, what’s the best way to speak about for you? Cutting can be very strong. What are your thoughts? Self-harm. Okay.” Or sometimes I’ve heard young people speak about battle scars. “What are your thoughts?” 

Amanda Kemperman (09:26): 

Navigating conversations about self-harm with young people requires a thoughtful approach that avoids traditional adult-child power dynamics. Instead, favouring curiosity and collaboration. Lyn and David emphasise meeting children where they’re at, fostering curiosity, and responding without alarm. 

Dr Lyn O’Grady (09:47): 

Yeah. With children, if you feel like you’re getting into that power struggle, it’s better to withdraw a bit. Go back to those basic principles of meeting where they’re at, have a game, have a chat, have some fun, and then maybe come back to it again at the end. 

David Newman (10:02): 

Tread lightly around power relations. So if we, even in a very benevolent or gentle way, say words to the effect of, “Well, let’s see if we can find a way for you to stop doing this,” and rather just stay curious. What does it mean to you? What are the effects for you of this? We are treading more lightly in the power relation. If we’re treading more lightly in the power relation, I think it frees people up to critique their own actions, to question their own actions, to evaluate their own actions because we’re not doing it. But if we are doing it, I think people are less likely to evaluate, critique their own actions. 

Amanda Kemperman (10:43): 

Lyn emphasises the need for a comprehensive psychosocial approach to understanding self-harm, looking beyond the behaviour itself to the broader context. She highlights the importance of supporting both children and their parents, acknowledging the vulnerability of children who may also be quiet or withdrawn, and addressing the critical role adults play in recognising and responding to a child’s needs. 

Dr Lyn O’Grady (11:10): 

We need the psychosocial full kind of comprehensive assessment, not just focusing on the actual behaviour, but everything that’s sitting around the behaviour. And then I think having that approach with parents as well. And again, the normalising with parents that this does sometimes happen and that it’s a bit of a sign for us. It’s telling us something. So let’s hear that. Let’s understand it. And then thinking about how do the parents get support or what do they need. 

Amanda Kemperman (11:38): 

I also asked Lyn about her trauma-informed approach when working with children and how this helps her navigate and guide her conversations. 

Dr Lyn O’Grady (11:46): 

Well, the way I think about trauma-informed is the safety in the space, the safety in the relationship, where the client’s at, meeting them where they’re at, and giving them as much choice and control in the session as I can and being aware of where they might’ve been if there’s been trauma. And we’re not always aware, of course, of what’s happened, but being alert to any kind of triggers or anything that I might say or do that is going to cause some kind of rupture or distress with the child. So being alert to that and then responding quickly if that does happen. 

Amanda Kemperman (12:19): 

I was curious about using safety planning with self-harming behaviour. Lyn explained that although it was originally intended for suicidal ideation, it can also be helpful with self-harm. 

Dr Lyn O’Grady (12:31): 

So I use safety planning even when people are talking about panic or distress with the risk of some kind of danger there. So I think, yeah, the safety plan came from the suicide sort of place, but I think it is actually appropriate to use in terms of people who are hurting themselves. 

Amanda Kemperman (12:50): 

I went on to ask them both about how practitioners can collaborate with children and follow their lead when using tools like safety plans to ensure they feel empowered rather than pressured. 

David Newman (13:02): 

Some feedback I’ve got from a couple of young people about self-harm that has been quite helpful, that they’ve suggested not saying things like, “What are you doing? And please, can you promise not to do it?” When children or young people are asked to promise not to do it, it can be a bit of a bind, especially if they’re finding self-harm useful. Can be like they’re robbed of something that’s useful. And also, can position children and young people to lie, to make a promise when they know they’re going to break that promise, and that can make them feel worse about themselves if they are lying. So those two questions, “What are you doing? Please, can you promise not to do it?” can really be unhelpful. But the same group of young people, I’m thinking of a group that I ran, said something like, “How are things going? How is self-harm helping you right now?” are questions that might be preferable. 

Dr Lyn O’Grady (13:56): 

So I think it’s good to be open and curious and accepting what’s happening, but also have that message around, “I really want you to be safe. And I don’t want you to be hurting yourself, but I’m hearing what you’re saying.” So it’s sitting with both of those things, hearing what you’ve got to say, and then trusting that what you do with kids anyway is what’s going to be helpful here as well. So not feeling like you’ve got to do a whole lot of other stuff. And then including the parents, having that as a focus. So thinking about how do I actually get the parents on board with this and keep that responsibility with them as well so that I’m not feeling like I’m the only person that knows with the children. 

Amanda Kemperman (14:32): 

David highlights the importance of acknowledging a young person’s sense of agency when discussing self-harm rather than focusing on stopping the behaviour. He emphasises that recognising the intentions behind their actions, such as choosing less harmful alternatives or considering the impact of their behaviour on others, can foster great understanding, strengthen their hope, and enhance their relationship with caregivers and practitioners. 

David Newman (14:59): 

When you took that step, when you took action like that, you might not have been so pleased about it. You might not want to do it for the rest of your life, but you took some action. What effect did it have on the pain? What effect did it have on your emotional pain? What effect did it have on the turmoil? And sometimes young people and children can speak about some of the positive effects that it has. Sometimes there’s negative effects, but sometimes there’s positive effects. I think it’s always helpful to shine a light on agency. It’s always helpful for children and young people to have a sense that they’re taking action. That’s for a couple of reasons. 

(15:37): 

One would be that I think self-accusation, self-hatred can gather more momentum if people feel like they’re being just simply passive in life. It’s harder to be on good terms with yourself because you’re not doing anything in life to make it better. But also, I think it’s very helpful to shine a light on agency and action with children and young people because of the power relations of age, power relations of size that so often children and young people understood as being relatively mindless. They don’t put a lot of thought into things. Their action, their considered response, their intentionality is often left out of the picture. But can I say that there’s a whole lot of ways that there is intentionality, there is agency taken with children and young people? And they’re missed. It’s often missed. 

Amanda Kemperman (16:27): 

I asked David how we can recognise and acknowledge the agency children demonstrate in their choices around self-harm, even when those choices may not be immediately visible or understood. 

David Newman (16:39): 

And young people have told me about a few examples that they really would hope aren’t missed around agency and taking action. So one of them is that I’ve heard young people say, “I deliberately choose to not harm myself in front of other people because I know that would be upsetting for them, and that means that we care, or I care.” And I think that’s an important intention and an important meaning that we can reflect back. That we can acknowledge. Another one is that, and this one, young people have been quite emphatic with me about this one, is that there’s often a hierarchy of harms, and they choose the least harmful harmful action to do. 

(17:21): 

So if it’s about … Young people have told me that the agency involved in choosing less harmful action is really important for that to be acknowledged. That there’s something in that. It’s quite subtle, I think, for us as practitioners and maybe caregivers to notice those thing, but I think it can really make a difference. I think it can make a difference. That we give credit, that we acknowledge and we honour some of the action and agency of … Young people are taking. 

Amanda Kemperman (17:52): 

I’ll leave you with one final important consideration from David. He explains that when self-harm is seen as a part of a person’s identity, it can make them feel trapped and defined by the problem. This can make change feel like a difficult internal struggle. Instead, he suggests viewing self-harm as something influenced by external factors, which helps people see themselves in a broader way and find more options for change.

David Newman (18:22): 

If experience is somehow, or problem experience, like self-harm, is somehow located within a person, they’re very much in danger. It has two key effects. It has more effects than that. But the two key effects is that a person is much more likely to become defined by that experience. They become just a basket case or they become just a self-harmer or a cutter or something. And that is the totality of their identity. All of the other ways that they show up in life, all of the other potential storylines of their lives get obscured. 

(18:59): 

But the other problem of keeping things just internalised, and identity being an internalised product, is that people, if they’re going to make room or change things, they have to be in some kind of internal war with themselves, an internal war with themselves in order to kind of do something differently, in order to leave something behind. And that’s a pretty awkward and pretty stressful thing to require of someone. Now, if people are understanding that their experience is shaped by something other than them, it’s outside of them, they’re less in danger of being totalized, defined by the problem, and they’ve got more room to manoeuvre in their life. They’re less just the problem. They can see themselves through other lenses, through other ways. So yeah, it opens a path for an easier action to take place. 

Amanda Kemperman (19:57): 

Thank you for joining us for this discussion. I hope it’s given you some valuable insights and tools for supporting children with care, understanding, and respect. If you’re interested in learning more about recognising and cultivating the skills children and their families use to respond to distress, including understanding how children’s resistance can reveal pathways to their skills, values, and hopes, visit our website. There, you’ll find resources, including our online course for practitioners, Understanding and Responding to Childhood Suicidal Ideation. Thanks for listening. And thank you for all you do in supporting children and families’ health and wellbeing. 

Narrator (20:37): 

Visit our website at emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health. Led by Emerging Minds, the Centre is funded by the Australian Government Department of Health and Aged Care under the National Support for Child and Youth Mental Health Program.