My T has an interesting approach. He doesn't try to stop me from self-harming. Rather, he validates that I do it for a release, and empathizes with all of the reasons why I engage in this behavior. He is much more interested in working with the emotional process of the self-injury, rather than trying to stop it. He and I both know that contract or not, I am going to continue the behavior right now. Sometimes we do make sort of "contract" in which it is known that I probably am going to self-harm, but I am not going to do it to a very serious extent. I had to call him today because of overwhelming suicidal ideation. He knows that the strongest thing for me is my connection to him.... so he said, "I want to see you on Friday. I don't want to hear about you, I don't want to read about you, I want to see you." I told him that I already SI'ed today. He said, "I don't want anything to happen to you... but you must have needed that release so badly. I am going to see you on Friday, right?" His last words in the conversation were, "Please try to stay as safe as possible until then."

Not only does each T differ in his/her approach to self-harm/suicidal ideation, but it also really depends on the patient and to what extent the T feels comfortable letting it go. Some Ts are going to cover the risks more than others depending on who they are dealing with and what the situation is. Also, if there are certain connections, etc. that can be identified, those might work first. Whatever the method, your T does care about you.