My T has always let me set the pace when it comes to SH/SI thoughts and actions. If I want to talk about it, she's more than willing to listen. If I don't want to talk about it, that's okay too. When I'm really struggling emotionally, she will just check in and see how I'm doing with SH and if we need to devote some time to it. My T knows what kind of situations can trigger my SH, so if I'm dealing with one of those situations, she will make sure that I remember my alternate coping skills, and just ask me about the SH urges.

Mostly, my T has tried to focus on the reasons why I self harm. What purpose does it serve for me. How can I get those needs met with something less harmful. She doesn't focus on the act itself so much as the reasons behind the act.