How do your Ts handle self-injury?

This thread carries a trigger warning for general discussion of non-suicidal self injury.

For people who struggle with self injury, what do your therapists do about it? Do they forbid it? Understand it as a coping strategy? Ask that you contact them before or after engaging in it?

Talked about it. Asked if contacting her before it would help.
She knows she can't just stop it. So we continued to talk about it.

When I first mentioned it to him, he asked if he could see it. I felt comfortable showing him my arms because he didn't overreact or dramatise it. He tends to think of it as a bad habit, like drinking too much or smoking.

Since then, he would occasionally ask if he can see my arms. He never made a big deal out of it. If I don't mention it for some time, he brings it up.

I like that he's never freaked out by it.

We talked about it. She was not shocked or disgusted or anything, which helped. She never asked to see mine. She reminds me of coping skills and asks me to use those before I engage in SI.

Treats as any other coping mechanism. She won't bring it up (then again she doesn't bring things up very often).

I had another T that felt that as long as it was cathartic/pleasurable, controlled, and brought no shame; there was nothing wrong with it.

I agree with both of these concepts. I struggle with knowing if why I am doing it is for cathartic purposes or destructive purposes.

She treats it like another coping mechanism like drinking. She asks about it occasionally to see how I am doing. She’s never asked to see, but she also knows it is shallow cuts.

Current T asked to see it the first time (first session) that I mentioned it. She hasn't asked to see it since. She straight up asks about it, like have you cut? She tells me about stuff to do instead. Former T asked more like what's behind it? What led me to do it? Etc. Kit

My current T and I talk about it if I mention it. Sometimes if he knows I'm struggling he'll ask where I did it and if it was deep, if I got treatment for it, etc. We've talked about why I do it and how I feel about it, but he's never told me not to do it.

Well, he terminated over it once.

At first we just talked about it. He wanted me to work on quitting.
But when I was getting worse to the point that it freaked him out, he terminated in a well-intentioned but poorly executed plan to get me to go do DBT.


I abstained from SH for a while once I started working with him again because it was a requirement for the IOP I was in. Then there were a few instances of moderate SH, nothing as severe as it used to be, and eventually I got rid of my suturing tools and supplies.
He's made it a very "we'll cross that bridge when we get to it" kind of thing with my questions about whether he'd terminate if it got worse again, but he's promised he wouldn't do it that way again.

For quite a while I wasn't mentioning episodes of SH because it felt manipulative or attention seeking. Then it came up because of an insurance thing and I told him that I hadn't really been mentioning it but it still happened occasionally. He wanted me to tell him, and I said it was hard for me to tell him if he didn't ask. So he started asking.
It's all quite minor these days though. He still takes it seriously because it's reinforcing my negative beliefs about myself, etc, but it's not medically serious.

He has made the request that if I want to SH because of something that happened in session or something related to him that I wait and at least bring it up and give him a chance to talk to me about it first (because often it's very distorted)

He's seen my upper arms where my scars are most numerous but not the deepest, just because there have been days when I needed to do laundry and my clean shirts had very short sleeves.

My T is very strict. SH urges are part of my weekly DBT diary card that he asks to see at the beginning of each session. Last time I did SH he made us do a Chain Analysis on it which really pussed me off as I had other pressing issues I wanted to discuss and he wouldn't lwt me talk about them until we completed the stupid CA which took al.ost 3 sessions. Although he says tge CA is not a punishment I told him it feels like one. Since then I usually try to sustain from SH jyst to avoid the negative consequences from T.

If I bring it up, we talk about it, but T never raises the issue or directs what we discuss. I have a personal policy that I will contact him before I do anything, but he didn’t suggest it. I haven’t actually self harmed in years but the urges are an ongoing issue that I i bring up. He has at times suggested alternative behaviors, but generally he just accepts this as something that I do/think about doing to cope.

This is a really timely thread for me because I am struggling to understand why the urges are so persistent after so many years of not doing anything. I really hoped they would fade. I have been trying to discuss it with T but the shame I feel makes it difficult to discuss.

He talks to me about it, like asks what I've done and in the beginning he wanted to see what it looked like. He's willing to discuss it on a more detailed level as well if I need that (like I'm ashamed of something about it). He doesn't want me to do it, but knows it's a coping strategy that works for me and knows that it's hard to do something about it.

I don't need to contact him at any time, but it's always okay to do so if I feel the need to.

I don’t anymore but I used to, when I was seeing him ten years ago (I left him and then came back). We just talked about it. He still asks occasionally because I’m borderline and it’s part of my history. He asked me once if I would tell him if I was going to. I said of course.

I don’t think I would ever go back to physical self-injury. For one, I’m scared he would terminate over it but more importantly I just don’t feel the need to anymore. I do self-sabotage in many other ways, and it’s a frequent topic of conversation.

For a long time I’d bring it up in my writing and she once asked to see (to get an idea of the severity) and then wouldn’t react or respond or anything. When I told her it was escalating, she said we should address it. Since that time, she’s asked to see it once and we started on dbt skills. But she hasn’t professed any feelings pro or against. I don’t always tell her when I do, only if I think it’s getting out of hand.

I had a couple of light cuts on my arm today she could see in therapy but she didn't comment

Mine ignores it.

I was 17 when I told T1 about it for the first time. She said that if I didn't stop doing it she would have to tell my parents (She never did, though).
She asked questions like where I used to cut, what tools I'd use, how many times a week I'd cut, the depth of the wounds, etc.
This was a very hard topic for me to talk about, so I'd never bring it up unless she did first.
She asked about it a few times, but stopped doing it after I turned 18. I don't know if it had something to do with me not being underage anymore, but I always felt like this topic made her uncomfortable. I was doing CBT at the time and I wanted help with finding new coping mechanisms that could I use to replace the self-destructive ones... but not feeling understood by my T made me give up on seeking help.

Pdoc asked about the places where I used to cut. She asked if I was doing it on my stomach (I don't know why she asked this), and if I had ever had any wounds infected.
She seemed relaxed when talking about it and this made me feel a little more comfortable.

I haven't self-harmed in almost 2 years now. I'm happy that I've come this far, but recovery has been a very lonely journey for me.

My T is pretty good about it. She knows it's a thing but she doesn't make me feel (more) ashamed about it. She doesn't generally ask about it and has never asked to see, I don't think. We talk about it sometimes, but I have a lot of shame that makes it hard to bring up without prompting.

T has said she wants me to contact her prior to doing it, but so far I haven't been able to. It feels too needy or attention-seeking or something. I don't want her to think I'm doing it for attention.

My Pdoc (who I see weekly for some therapy as well as med management) does tend to ask about it more. She uses it as an indicator, I guess, of where I'm at. She has asked to see, though she's okay with me saying no as long as there are no concerns about needing medical attention (due to the injury itself or indications of infection).

The therapist doesn't ask about SI much, except a certain type that she refers to as "abuse" I guess because it involves somebody else. She doesn't like that and will pressure me to stop making it happen.

My current T has an interesting approach that has helped me. I used to self harm for attention a lot, and I don’t do that anymore, because of her method. Her policy is that she is happy to talk to me outside of session, on the phone, as much as I need it (assuming she has time). However, if I call or email her saying I self-harmed, she won’t call or email me back. She refuses to acknowledge the behavior in such a way, and she said that I’m in telling her that, then I already made my choice and she has no reason to call me back. She will always, always call me back if I say I am having trouble fighting off urges and need her help. She has called me after hours before, and stayed late just for me, because she doesn’t want to leave without making sure I’m going to be okay. There was one time, though, a couple of months ago now, that I self harmed and I drunk emailed her about it, and then didn’t get a call back for 2 days straight and I was SO angry at her and was ready to charge in there and tell her off, until she made me realize that my own behavior is why she purposefully did not call me. I would’ve gotten to talk to her 2 says sooner and not have had 2 extremely miserable days had I thought about my self harm behaviors and held off for help. That was a painful lesson, and she said it was painful for her to have to do that to me, knowing I was upset, but that it was important. Most effective thing anyone has ever done for me in regards to self harm.

Don’t get me wrong, I still have my slip-ups, and I can still talk about those in session, but I do not attention seek with them, and instead we work through more solutions of what I can do to avoid it. She always says that she’s never going to condemn me for doing it, because slip ups happen and she doesn’t expect me to be perfect, but she also doesn’t condone it.

My T isn't really aware of our self injury. It isn't frequent, it is very violent, but it isn't very visible. We have only just started mentioning it to T after a few months of alluding to it. She really wouldn't/doesn't know about it unless we tell her. We want to start addressing those parts of us that do it.

I have only SHed a few times in the year and a half I've been seeing T. The first time, I mentioned it right at the end of session (intentionally), and he just said "I'm sorry." At some point, I explained how I generally did it, and how it wasn't risky. We discussed in more in a future session, in terms of whether he considers it a crisis (like worthy of potentially calling him over). He said the way some people do it, it could be pretty dangerous and/or sort of on the borderline of a SU attempt, so he'd consider that a crisis. But the way I did it, he wouldn't think of as a crisis. That it's not nothing, and there's some element of risk in what I do (infection), but he doesn't think of it on the same level as what some others do. And he generally will just say "I'm sorry" if I mention doing it, or something else sort of empathetic. I do tell him at times when I've had strong urges but didn't act on it--a couple times just emailing him to say I had the urge was enough for me not to do it. He's never asked to see it, and because it's generally my stomach, I'd feel weird offering, with his being a male.

I'm content with how current T handles it--takes it fairly seriously, seems sympathetic that I felt bad enough to do that, is open to talking about it, but doesn't act like it's some awful thing or like I need to be hospitalized. In contrast, Ex-T seemed too personally upset/emotional about it (especially when I showed her the first time and she seemed about to cry), so I felt like I couldn't talk about it with her. Ex-p-doc tried to get me to do intensive outpatient the second time I did it, so I also felt like I couldn't talk to her about it. Ex-marriage counselor, on the other hand, acted like it was nothing, so it didn't seem he took it seriously enough (he does work with a lot of teens, so maybe that's why? Though current T does, too, so...)

Self harm was an addiction for me when I was younger (well before I started seeing T), now that I am in my 20s I only self harm every so often. Because of that I have never brought it up. She once pointed to cuts on my leg and asked if it was self harm. It was, but I lied and said it was from something else. She said "Ok, I just had to check."

I relapsed this summer and cut deeply on my arm. The scars are taking a long time to fade -- one is still very red. It's getting warmer and I spent all summer and fall wearing long sleeves and I've decided I'm tired of it, when it's warm I will dress warm. If she points them out, I will tell her the truth but also tell her I don't wish to spend a lot of time discussing it because it's not a problem very often.