The first therapist that I told was not a great experience, but I never had a decent relationship with him anyway. I remember that I mentioned that I had scratched my wrists in what I thought at the time was a suicide attempt. I was very uncomfortable saying that, and when I'm nervous and uncomfortable I smile or even laugh. He didn't react at all. I thought that he didn't hear me. But, a few weeks later he confronted me with it, and the smile, I felt implying that I had just been manipulating because I didn't show the affect that he would have expected in talking about a suicide attempt. That was the last that I saw him - I didn't make another appointment after that.

I was in therapy several times and didn't mention SI, but I wasn't actively cutting then and didn't know about SI (although I was using methods other than cutting, just not knowing that it was significant). I really never got anywhere with those therapists, largely because I didn't talk about significant things. I'm not sure that I knew what I was supposed to be talking about. Eventually I did get into more scratching and cutting.

The next time that I was offered therapy it was because my husband and others had gotten concerned about the cutting. I think my husband, who worked with that T in the same office, had mentioned it to him. But I did have to tell him about it too. He used a detailed questionaire and that brought it out (there was a question about wanting to hurt yourself, I think). And he went over the questionaire verbally and asked about what I wrote. Writing is the easiest way for me to talk about things like SI.

My next (current) T was the professor for a psychology class I was taking. I was in the habit of emailing her about class, and one night SI came up as a subject in casual discussion at my location (It was a distance class - we saw the professor on a TV screen and communicated mostly by email). I wrote to her that night and mentioned that the subject had come up in connection with the topics covered in class, and remarked about how much more common cutting was than I had ever thought before, as out of five of us present, one was a self-injurer (at that point I didn't tell her that it was me) and two others had a friend or sister who cut. A few weeks later I confessed in email that I was the one. She brought up self-injury as a class topic some time after that. Her responses were that she wasn't surprised about self-injury coming up as a discussion topic in our group, and when I told her it was me she put me at ease about telling her that, expressing concern and suggesting treatment, but acknowleging the need to cope in whatever ways we have learned if we haven't developed other ways.

When I finally did become a client, she already knew of course. At that point she said that she understood that she couldn't ask me to stop without having learned other coping methods, but she did ask me to limit it, and also to make a verbal agreement that I would not make any suicide attempts or do any significant injuries (defined as requiring medical attention) without talking to her about it first and giving her a chance to help work through it.

Not every therapist is good at handling self-injury, but they are getting better about it, and my last two handled it well. Neither of them have addressed it directly very much. It is important for them to know about it, but it isn't the main issue - just a symptom.

I've tended in the last several years to choose therapists that I already knew somehow, because that made it a lot easier to get started, and they already knew where to start with me. But that isn't always the best option or even a possibility. In that case, I think that writing it down is the easiest way to tell them.