Why does my teenager cut? A brief guide to understanding self-injury in adolescents

First of all, I’m going to say that focusing on the why this behavior occurs is probably not the most effective approach to addressing adolescent self-harm. I’ll give you some reasons why teenagers self-harm in a minute, but the one fallacy that people often have is that if they could explain why behavior occurs, then they would actually have the tools to fix or change it.  More specifically, teenagers who may not understand the behavior themselves can often be put in an awkward situation in which they are forced to explain the unexplainable. If they don’t understand why the behavior is occurring in the first place, they may end up giving inaccurate reasons simply to appease their environment.

Self-harm behaviors likely have something to do with emotional pain. Possibilities include ways to control feelings, ways to control oneself or one’s behavior, ways to increase intensity of feeling (ie, the need to feel “real” or the need to feel “something”), or ways to decrease intensity of feeling (“If I didn’t cut I wouldn’t have been able to tolerate the situation”). Understanding how emotions work and what they do for people may is critical in understanding the role of self-harm behavior. For instance, feelings are functional in that they give useful information about what matters to us, communicate to ourselves and others, and help us become organized and prepare for action. Without feelings we just wouldn’t care.

In adolescence, self-harm behaviors may play a role in identity, communication, and intimacy. Self-harm may be kept very private or it may be made public. It may be an attempt at controlling one’s environment or letting someone else know that the person doing the self-harm cannot be controlled. The function of the behaviors may communicate to oneself (I know I matter, I know what I have to say is important, I can’t stand by and let nothing happen, I am not pleased by the situation, This is my way of making a statement), or to others (Back off, This is too much, I can control your reactions, I know you will be upset and freak out, There is nothing you can do about this, You can’t claim to know me, You think you know everything and you don’t).

Treatments for self-injury are not as simple as publicizing behavior (ie, making sure that others know about it), invading privacy by doing body checks, or just stopping doing it. If there was no benefit to doing it, no one would do it! That’s just simply how it works. Knowing the benefit can help someone to organize an effective solution. Teenagers who can obtain help in identifying, accurately labeling, understanding, and communicating their feelings effectively will have more options for what they can do when the urges to self harm show up. Increasing options, understanding the short and long term consequences of this behavior, and providing alternatives for how to tolerate intense, painful, and negative emotions is certainly one way to start.

It’s important to remember that teenagers also have their own feelings about this behavior. Some are opposed to changing it, some don’t want anyone to know about it, some want everyone to know about it, and some feel really hopeless that they can’t stop doing it. Most have some degree of mixed feelings. Assuming and communicating that a teenager simply doesn’t want to change is probably not going to help solve the situation. While it might be a likely, blaming a teenager for doing it usually only serves to communicate a parent’s frustration.

Similarly so, parents have their own feelings about it and may feel disgusted, hopeless, overwhelmed, inadequate, or guilty. How parents communicate and address painful emotion will also impact the situation; and thinking through the effectiveness and intensity of one’s own responses may be part of the work involved in addressing teen behavior.

I think it is important to consider that the problem of self-harm behavior has solutions. Sometimes providers, teachers, parents, and community react with an abject horror that stirs the pot, gets everyone all worked up, and in some cases emphasizes the solution (self-harm) and not the problem itself. Emotional problem solving is really just that- emotional problem solving. If a person can figure out how to problem solve (ie, address, tolerate, understand, deal with, validate, survive) painful emotions, then their way of solving problems (ie, self-harm) may decrease. Finding effective solutions means having an adequate way to assess and address these behaviors with a skilled professional who understands the role that these behaviors serve.

Three mindfulness exercises to use right now to quiet your mind and focus your attention

One of the reasons mindfulness is used is to get yourself calm. If you are a person with a lot of anxiety, your anxiety might get in your way of handling problems, thinking clearly, or addressing something with your full attention.

Mindfulness is one way to lower emotional arousal, center yourself, and help you get back on track. When emotional arousal returns to baseline, accessing the problem solving part of your brain becomes easier.

1)   Inhale to the count of one, exhale to the count of two. Keep going until you get to the bottom of six. Start over. Do this for about three minutes. If you get lost or distracted simply start over. The point is to have something to focus your attention on; which helps cut the distractions of your mind.

2)   Trace your hand. Inhale on the way to the tips of your fingers, exhale on the way to the crevice. This can be done with pen/ pencil on paper or with the finger of the opposite hand. This is a tactile way to “trace” your breath and focus your mind. Keep your attention on your breath.

3)   Pause for three minutes and focus your attention entirely on sound. Try to tune in to every possible nuance of sound. See what you can hear that you typically don’t pay attention to. If your mind drifts, bring it gently back to the experience of hearing.

When individual therapy with adolescents doesn’t work

Individual outpatient therapy with adolescents can sometimes be limited in that

1) It can fall into Question and Answer sessions-losing the spontaneity and flow of a helpful interaction

2) Adolescents have shorter attention spans, and keeping them focused on painful topics on purpose can be, well, painful!

3) Sharing personal information with an adult you don’t know, but were paired up with because your parents are making you, doesn’t always have the desired results.

4) Adolescents aren’t necessarily going to do things differently because an adult is telling them to.

Group therapy has several advantages in that

1) Its members will be able to tell your daughter if they like it, how it is helpful, and what it has done for them.

2)  It is private (no one knows each other outside of the groups) and participation can be minimal (it doesn’t have to be about you all the time).

3) Group members can help each other think things through, make decisions, look at consequences, generate feedback, and put words on experiences in way that an adult provider may not be able to.

4) Talking about peer situations leads to identifying oneself in peer situations- thus what matters is sometimes brought up by someone other than yourself- or an adult, who may not have a clue.

(Hey! I’m not in high school anymore!)

Click here to see more on what group can do for your daughter. 

Is someone you love in extreme emotional distress?

Did you miss the teleseminar in February on

How to Be Around People in Extreme Emotional Distress? 

If so, make sure you sign up for my mailing list so you can be alerted to upcoming classes for April, May, and June of 2014.

Online classes cost about the same as an insurance co-pay, are packed with information, and present opportunities to listen live and ask questions.

Discounts and announcements for all upcoming classes are available to persons on my mailing list.

10 Reasons why you need The Emotional Extremist’s Guide to Handling Cartoon Elephants book this holiday season

1. The Cartoon Elephant book, after being temporarily unavailable through Amazon, is now back on the market. The retail price is $26.95, but sometimes Amazon will let it go for a bit less.

2. Cartoon Elephants approach painful emotions with humor. If there is an elephant in the room in your family, this book is the starting point for approaching avoided conversations. You will recognize yourself and others in this book. There is no finger pointing or blaming.
3. Cartoon Elephants is something you can put on your coffee table. Because it is a graphic book with pictures and fun fonts, it is an easy read. The elephants will fit nicely next to big picture books about Africa and Asia.
4. The Cartoon Elephant book is being used to teach people in Dialectical Behavior Therapy skills groups about emotions. Loaded with psycho-educational material and teaching points, it cleverly accomplishes the task of making people think they are reading something fun yet giving them something valuable.
5. This book is not hard to read. There is no “plugging away” at chapters. If you want to bring something to someone’s attention in a way that is universally applicable, this book will do the trick. You don’t need to have painful emotions to appreciate elephants- you just need to have emotions.
6. If you are going to buy someone a self-help book for Christmas, this is safe bet.
Whether they believe it or not, everyone has cartoon elephants. The research proving this to be true is cited in the back of the book.
7. This book can be used and re-used, read and re-read. You can share it with family members, friends, or long lost relatives. It won’t go out of style. Emotions, as a rule, will be with you as long as you live.
8. You will get some food for thought about how and where you see yourself in relationship to your elephants. This is great for discussion groups, weekend retreats, and writing workshops.
9. This book is great for people of all ages. If you’re trying to get your kid to read something important, heavy, and deep, you can give them this book. It won’t take long to read and it is much more fun with illustrations.
10. The book will be the perfect introduction for my live series on emotions starting January 20, 2014. Of course you don’t need the book to sign up, but if you have the book you will have a better appreciation for cartoon elephants in general.



When two different concepts can both be true: A tip for handling and understanding your emotions

Two different concepts that often come up for handling emotions might at first appear contradictory:

1)   In order to handle emotions effectively, a person has to be able to step back and notice what they feel (observe).

2)   In order to survive strong emotions, a person needs to fully experience the nuances and physiological discomfort that arises when emotion is present (enter into the experience).

Can you see how both of these concepts make sense?

Being able to step back and observe emotions is effective because it increases options and awareness for how to respond to emotional material. Without the ability to “stand by”, a person might immediately act on their emotion. When a person always acts on their emotions, he/ she might regret it later. For instance, if you become really angry at someone you care about, you might lash out. The ability to “step back” and observe what you are feeling can help you organize a thoughtful response in which you maintain integrity, speak clearly, and feel better about yourself later. Sometimes refraining from taking immediate action is very effective.

On the other had, a willingness to experience strong emotions when they arise is a critical element to being human and being alive. Emotions give us very important information that we can’t always ignore. When we experience emotions fully, we are in touch with what matters. When we suppress, hide, ignore, or push away strong feelings they may become worse or “blow up” on us down the road.

In some ways, a person can both experience and observe emotion. A willingness to get in touch with what hurts and to hold off on any immediate reactions can increases options for the best response.

On being “right”: Demystifying the “stiff and rigid” cartoon person from The Emotional Extremist’s Guide to Handling Cartoon elephants.

StiffRigid2 copySometimes being “right” has to do with maintaining a sense of justification, power, or virtue. Sometimes being “right” has to do with feeling valued or heard, or even finding others to support your point of view. Sometimes it has to do with taking sides, feeling validated, or knowing that you have something important to add that is being left out of the equation. Sometimes being “right” has to do with not sacrificing a point of view, a perspective, or an observation.

Sometimes, when people feel emotionally threatened, they focus on the “right”-ness of where they are coming from. When threatened, attention is often narrowed and constricted to the threat- thus making it difficult to shift perspective, see things from different points of view, or understand the person who is identified as a threat. Sometimes being “right” has a certain quality, characteristic, or experience that feels guarded, shut down, or even restricted. It’s a way of being that builds walls, doesn’t let other people in, and sends a strong message. It builds a dichotomy in which one person has the upper hand, and the other person doesn’t.

Sometimes people need to be “right” to gain a sense of influence, power, or importance in a relationship or situation. Being “right” may have to do with making a statement, communicating something strongly or clearly, or not yielding to an expectation. It may have to do with mattering.

Sometimes being “right” means sacrificing a relationship, failing to get along with someone, or being seen as someone who is approachable. This can create difficulties in important and unavoidable relationships.

Sometimes being “right” isn’t so much about being non-negotiable as much as it is about trying to define values, being clear about how much you can take, knowing that you can no longer make the sacrifices you are making, or suddenly realizing the demand that someone is placing on you. Sometimes it is difficult to define the “right”-ness of your experience and keep important relationships.

Here are some ways in which you might re-consider being “right”:

  • Even if you are “right”, consider the impact that communicating being “right” has on the relationship.
  • Stop thinking about one person being “right” and the other person being “wrong.” Start thinking about it as “this is my experience” and “this is the experience of the other person.” Make space for them to be different.
  • Sometimes it makes sense to simply stop bringing it up. Refraining from pointing out your point of view can challenge you to tolerate differences, anxiety, or some other threat in order to make for better relationships. Making strong overtures in which you are constantly proving your point can exhaust any conversation.
  • If you are in the middle of one of those conversations that bring out the “I have to be right” in you, consider having the conversation while practicing loose and floppy (refer to the cartoon elephant book for more specific guidelines!).
  • Consider what you would lose if you found out conflicting information that challenges your “right”-ness. What’s the threat?

PS- Want to get a free Cartoon Elephant book? Make sure you check out the last blog post for details…

Cartoon elephants (emotions!) up close and personal: When you don’t like what you see

Sometimes, if you look closely at what actually feel, you won’t like what’s there. Sometimes it’s just too much. Here are some tips on what to do when you get up close and personal with your elephant, and this


may be what you find.

  • Start with whatever is present in the moment. See if you can notice and allow for what is there vs. actively trying to ignore or push away.
  • See if you can get yourself to willingly tolerate all sensations, discomfort, or urges associated with the emotion. Noticing if there is anything holding you back from doing so.
  • Bear in mind that the better able you are to tolerate, you will be better equipped to survive the moment. Redirect your attention back to your elephant and practice the gentle yet curious gaze.
  • Tolerating sensation does not mean that you have to approve of reality, take action, or fail to take action.
  • An unwillingness to tolerate what is there will not make cartoon elephants disappear. (You can’t have a life without cartoon elephants!) A refusal to tolerate can actually create more problems later.
  • What you pay attention to= what your life is about. Do you want your entire life to be characterized by the struggle of not looking at your cartoon elephants?


The cartoon elephants are here!

Click here for The Emotional Extremist’s Guide to Handling Cartoon Elephants: How to solve elephantine emotional problems without getting run over, chased, flattened, squished, or abandoned by your true cartoons.

Here is a sneak preview of the book chapters:

Part I: The problems of cartoon elephants

  • The non-existence of cartoon elephants
  • The weight of cartoon elephants
  • The equilibrium of cartoon elephants
  • Stampeding, out-of-control elephant situations

Part II: The basic steps for solving elephantine problems

Part III: When your cartoon elephants are in danger: How to cope with critical obstacles

Part IV: When solving elephantine problems seems impossible: What to do when stuck beneath an elephant’s foot

Part V: What to do when elephants end up on your back

Part VI: What to do when your cartoon elephant turns blue

Here are some FAQ’s about the book:

Is this book for children? The intended audience for this book is adults (hey, adults need cartoons too!) and is fine for adolescents. Younger age ranges may have some difficulty with the abstract reasoning and the metaphors, and may not grasp all the concepts and big words. However, the big pictures, changing fonts, and fun graphic design makes this an attractive book for young kids (my 9-year nephew zipped right through it).

Why are the elephants in the male gender form? I used “he” and “him” when referring to the elephant to make the book simple and less wordy. I did not have any gender specific intentions. If you experience your elephants in the female form, you are welcome to take your own copy of the book and change all the pronouns.