Monday, September 16, 2013

When Your Child or Teen Cuts

The moment you learn your child has been cutting is surely paralyzing. Of course, you are going to rush and call in the troops and get your child some help and counseling.  That's a good idea.

You're also going to want to "do something"More than likely, that call to a therapist won't initially feel like you're doing enough. You're going to want to know what to do, how to respond, and what to say in the moment.

First thing's first. Try not to panic.  I know.  Easier said than done. I worked with teens who cut for ten years and my heart raced all ten of those years when I saw cutting behavior.  Staying calm isn't easy but it is crucial.

Let me back up.                          

Cutting is a behavior that has been seen in kids, teens, and adults.  It is a behavior that people use to harm themselves when they are feeling an incredible amount of emotional pain.  While tough to understand from the outside looking in, people who cut say that it numbs them.  They feel a release of the pain they are holding inside. It can be seen in people who experience chronic or clinical depression but it can also occur as a response to singular, stressful events.

When a child or teen first starts to cut, it is often experimental.  They have heard about it from other kids or from news stories and they try it out to see if it works.  Some kids may try it once and never try it again.  Others will find a fascination, a sense of calm, or a reward from cutting and will continue.

The reason for staying calm is two-fold:
  1. If you find out your child has been cutting, you'll want and need the lines of communication to be open.  They will be more likely to talk to you about their cutting, if you're calm, curious, and open to discussion.  Extreme shock, fear, or anger will shut them down.
  2. Some will dismissively say that kids who cut are looking for attention. I argue that it is much more complicated than that.  If a child has resorted to cutting as a way to engage others, he or she is in a fragile state and deserves a response.  That being said, a grandiose reaction to learning your child has cut will increase the likelihood that he/she sees the behavior as a way to get others to respond.  In psychobabble terms, I call this secondary gain.  In parent terms, it will feel like you're being manipulated.
Using a neutral tone, ask your child about the cuts and if he/she is alright.  If medical attention is necessary, calmly apply first aid.  Try not to be nurturing about it.  You don't want to inadvertently send the message that this behavior will earn nurturance.  Ideally, you'll sit with your child and assist him/her while he/she applies first aid themselves.

Once everything has been medically treated, this is where you calmly talk to your child.  Using a nurturing and non-judgmental tone, calmly ask about the behavior.  Something like "Billy, it's hard seeing your arm cut up like that.  Are you ok? This looks like you did this to yourself. What's going on?"

Be prepared for the "I don't know" or "I don't want to talk about it".  Try saying something like "I don't blame you.  This must be so confusing for you.  I want you to know that I love you.  Your cuts tell me you have been feeling pretty alone these days.  Do I have that right?"

Another response is to offer them the education I just offered you by saying something like "While I don't know much about cutting, I do know that kids who do it are usually feeling pretty bad about something and some kids feel better when they cut.  What's it been like for you?"

You want to express curiosity and get information.  Lots of kids cut for different reasons and you want to know what's going on with your own kid.

Cutting is usually not a suicidal gesture.  More often than not, it is an expression of pain. However, don't take any chances and clearly ask: "I worry that this means you want to die.  Have your been thinking about killing yourself?"

Whew, that is a painful one.  Take a deep breath.  That's a question no parent wants to ever ask but asking creates safety, is preventative, and assures your child that you can handle the tough talks like this one.

If they try to sneak out of the conversation or avoid it, it's ok to give them space and not push the issue.  However, be strong with rules and boundaries until the conversation has been had.

You might say something like "I know this isn't going to be easy for us to talk about.  You can take your time with it.  However, until we do talk about it and I understand what is going on for you, I am going to be keeping a closer eye on you.  Your bedroom door will need to be open and I may ask to see your arms and legs for new cuts".

Kids will tell you they feel punished by such limits.  That's ok.  

Limits tell kids that they are safe and that an adult is in charge. 

Ignore their resistance. 

In most cases, they want your help in stopping.  Think about how you found out about the behavior.  Many kids "get caught". This is their way of asking for help.  Again, you may feel manipulated.  Just remind yourself they are limited in the moment and they will get stronger and more capable over time.

You've heard this from me before and you'll hear it again: Once you have an idea of what's been hurting your child and why the cutting has happened, in no uncertain terms, tell your child what you want him or her to think. You might say something like "I'm really upset to know that you've been hurting yourself.  Life is going to suck and you're going to be in pain again.  I don't want you dealing by cutting yourself. I want you to know you can talk to me.  If not me, another safe adult"

Start to engage your child in a conversation about alternatives to cutting.  Make suggestions and encourage your child to come up with some.

Here are some ideas:
  • Talking to safe adult
  • Getting therapy
  • squeezing ice cubes
  • rubbing ice on places where they normally cut
  • ripping up a phone book (remember those?)
  • punching a pillow
  • screaming
  • taking a shower
  • going for a run
Join my email list if you need more suggestions than this.  Ten years of working with this behavior gave me a long one.

Once you have talked initially about the cutting and alternatives, you're going to hit the "Now What?" moment.

The first goal, almost more than stopping the behavior, is to keep the lines of communication open with your kid.  Literally create a "Now What" plan or something like that, if necessary, where you lay out what happens next. You certainly don't have to get that formulaic but you want an agreement between you and your child that you are working together to find alternatives to cutting and ways of dealing with the original hurt.

It should be clear that the talk doesn't stop here.

In your agreement, include times of touching base, expectations of honesty, and how you're going to be following up.

You might be tempted to take away the sharp objects your child or teen has been using.  If this is consistent with your parenting values, go ahead.  My take, though, is that sharp objects are everywhere and if a kid is hell-bent on cutting, it's going to happen so taking sharp objects away is a pointless control battle and something parents prefer to feel psychologically safe, themselves

A more powerful response is to say something like "You're going to be working hard not to cut.  That's going to mean that you're going to have to sit with those awful feelings cutting has been helping you avoid. I'd like to help you keep yourself safe.  Would you like me to hold on to whatever you've been using until you feel in control enough to have it again?"

Something like this puts you on the same team, gives the kid control, and serves as a sense of safety for kids and parents, alike.

Lastly, I would encourage you to talk to your kids about NOT talking to friends about cutting. 

Sure, we want kids to talk to their friends about their hurts and frustrations.  However, it creates a high-risk situation when other kids talk to their friends about their cutting.  It is an adult issue and friends will experience undue amount of pressure if they are holding information about your child cutting.  It will increase the sense of drama and crisis.  Be clear with your kids on this.  They may not listen but tell them what you want them to think on the issue, regardless.

Don't get complacent after the initial reveal of this.  Keep checking in on your child and checking for new cuts.  Consider getting some coaching for yourself or therapy for your child on this.

This is a tough topic and one that is ineffectively covered in a single blog post.

If you're dealing with this or know someone who is and think I might be able to help, don't hesitate to find me at  You don't have to feel lost and you don't have to manage it alone.

Until next time,

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