The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

Parenting Youth Who Self-Injure, with Dr. Janis Whitlock

Episode Summary

Janis Whitlock, PhD, from Cornell University and Senior Advisor for The JED Foundation explains what parents and caregivers should look for if they suspect their child is engaging in self-injury. She also discusses how caregivers can effectively talk to their child about self-injury and self-harm and when to seek therapy.

Episode Notes

If you suspect that your child might be engaging in self-injury, how do you start the conversation and how often should you check in with your child so that you are not being too invasive? How can parents safely set rules if they fear their child might self-injure in response to these rules? In this episode, we answer these questions and more as we talk about how parents and loved ones can foster healing for their children who self-injure or self-harm as well as for themselves.

Dr. Whitlock’s book “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones” is available on Amazon ( Dr. Whitlock is a Research Scientist in the Bronfenbrenner Center for Translational Research at Cornell University and the founder and director of the Self-Injury & Recovery Resources (SIRR) research program, which serves as one of the best and most comprehensive collations of online resources about self-injury: It is a go-to resource for parents, therapists, friends, family members, schools, other caring adults, the media, and individuals with lived experience of self-injury. Follow them on Instagram @cornell_crpsir. 

Dr. Whitlock is also Senior Advisor for The JED Foundation. To learn more about The JED Foundation, visit

Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit and follow ISSS on Facebook and Twitter (@ITripleS).

Episode Transcription


The Psychology of Self-Injury Podcast

Parenting Youth Who Self-Injure, with Dr. Janis Whitlock

January 1st, 2021 | 49:09 | S1:E3

Dr. Westers: So, you’re a parent and you think your child may be self-injuring. You’re worried, and that makes sense. What should you look for, and is it okay to ask about it? And if it is, how do you start the conversation? If you know your child is self-injuring, when should you seek therapy for them? Or for yourself? And how often should you check in with your child so that you’re not being too invasive? As a psychologist, these are questions I often receive from parents. As do other clinicians.

To answer these questions and to talk about how parents and loved ones can foster healing for their children who self-injure as well as for themselves, I am joined today, from Cornell University in New York, by Dr. Janis Whitlock.

Welcome to the Psychology of Self-Injury podcast, a resource for parents, professionals, and people with lived experience. I’m your host, Dr. Nicholas Westers, clinical psychologist at Children’s Health, associate professor at UT Southwestern Medical Center in Dallas, TX, and Chair of the Media & Communications Committee of the International Society for the Study of Self-Injury, or I.S.S.S., or simply I Triple S.

I met Dr. Whitlock through ISSS a number of years ago. She is a past-president of ISSS and one of its founding members, so when she offered to send me a copy of her new book which she co-authored with incoming ISSS president Dr. Elizabeth Lloyd-Richardson, titled “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones,” I instantly made it a reading priority. Dr. Whitlock is a Research Scientist in the Bronfenbrenner Center for Translational Research at Cornell University and the founder and director of the Cornell Research Program on Self-Injury and Recovery. Her research is dedicated to linking science with efforts to support and enhance the lives of youth, especially in the areas of social and emotional health and well-being. As we will hear in today’s interview, she is also dedicated to making research accessible and useful to those best positioned to make a direct difference in the lives of youth, such as parents and youth-serving professionals. On a personal note, in her free time, she enjoys hanging out with her family and friends, practicing yoga and meditation, skiing, and being in nature.

Thank you very much for joining us today, Dr. Whitlock.

Dr. Whitlock: Thank you, Dr. Westers. I’m very happy to be here.

Dr. Westers: How did you become interested in working so much with parents of youth who self-injure?

Dr. Whitlock: That's a really interesting question because it really isn't where I started out. I mean, my entire path to studying self-injury was completely unexpected. But once I started, I didn't expect that parents were going to be playing a particularly prominent role other than being maybe, um, identified as risk factors for the onset and maintenance of self-injury. But as I got deeper into our studies and the data from these various studies we were doing started to come back in, there was a pattern of findings that kept pointing to the prominent role of parents. And so, it wasn't just our research; it was other research that was coming in and from other labs and it was interesting because I just, I didn't expect it. But as I said, as we got deeper and it became clear that they were not only prominent and important, but that one of the most fascinating roles that they seem to be playing was as a protective factor. And even in the instances in which it was clear they might have contributed to the onset and maintenance of self- self-injury, it became even more clear that they're pretty critical ingredients for recovery. And that led me to think we need to be doing this work. Plus, you know, I was a parent at that time of, I think, young teens and I was some- and my teens got older, and I was really understanding from a much more personal perspective the role that parents⁠—the complicated role⁠—that parents played in development, but the powerful role that I played as a parent in development. So, you know, I had personal insight, understanding, and also motivation. 

Dr. Westers: A healthy relationship with parents is one of the greatest protective factors against so many challenges and difficulties in life including self-injury and mental health disorders. Can you tell us a little bit about some of the research that you did with parents and what you found?

Dr. Whitlock: After the data came in that suggested that parents were important, I started a series of studies that were specific to parents and engaging with parents. So, the first set of those studies was a mixed-methods study that was largely qualitative. And we were interviewing parents and then we are also interviewing the teens in their life who self-injured. We didn't interview them all together; we interviewed them separately, and then we- we sort of compared, right? So, we had some quantitative data by way of survey and then we also interviewed them. The interviews were really rich. And the interviews focused very specifically on disclosure, reactions to disclosure, sort of what happened next, and then what the teens and the- the parents perceived as being sort of the key ingredients in those sort of turning points for better or for worse. So, we're looking really specifically to dig into the recovery processes. And then that led to a survey-based study with parents of young people who self-injure in which I was really interested in getting, again, to the- the dynamics of the recovery process, the supporting process, things that go right, things that go wrong.

One of the most interesting questions that I asked on that⁠—and I really loved looking through those answers—it was around growth. You know, growth is a byproduct of these struggles—whether people were after that or not, whether they parented really well or they parented not so well through it. It was really clear from the data that not only were parents saying that they'd learned a lot in the process of parenting a young person who was struggling through a period of time, they learned a lot about themselves and their young people. But the young people were saying that too. So, that whole piece of sort of growth as a byproduct of struggle⁠—which is, ironically, the study inquiry I was, that was the path I was on before self-injury research entered my life. I feel like I kind of took this detour. I was really heading down this like, “I want to understand how dark nights of the soul can lead to deeper wisdom and well-being.” And then the self-injury stuff came up. It’s like, okay, I don't know why me, why now, but I know I'm in a good position to do this research. I started it, and eventually I got to ask and answer a lot of those same questions.

Dr. Westers: I like what you said a little bit ago about struggle and how for all of us, struggle⁠—we kind of need to be able to grow, regardless of if self-injury or just in our personal lives. [Dr. Whitlock: Right.] I know a lot of parents, when they think about self-injury, they’re not sure if their own child self-injures or if their friend’s child self-injures, and if they're worried about their own child self-injuring, they may not know how to ask the question. So, what should parents look for if they're concerned that their child might be self-injuring?

Dr. Whitlock: So, the first thing maybe to look for is just sort of some of the overt signs and symptoms. You know, do you see wounds, are they patterned, do you see them regularly, when you ask about them⁠—gently and with respect⁠—do the answers make sense? Things like that. Are there, you know, do you ever see blood in the bathroom, do you notice strange paraphernalia in your child's room like blades of any sort? Things like that. So, those are the things you can kind of surreptitiously sort of keep an eye out for. The other signs might be wearing full body coverage when it doesn’t make a lot of sense⁠—like long sleeves or long pants when it's warm or constant use of wristbands, that kind of thing.

You know, if there's reason to believe that this might be an issue, then I suggest asking directly. But being really mindful about the tone, as well as the place and the time and- and sort of who's around. There's a, you know, fairly large section about this in the book because people often don't think about that—like the urgency that can come up around, “I gotta know and I gotta know now,” can mean that we don't think about, “is this the right time, is it the right place, are there people that can hear, am I careful in the way that I'm asking?” Because all those things can really make a difference in their young person's willingness and ability to open up.

But we do recommend a fairly direct question. And it can start with an observation, “‘I've noticed.’ I've noticed that you don't seem like yourself. I've noticed wounds on your arm that are there regularly. I've noticed these things and I'm worried. And here's what I'm wondering: I know that sometimes this is one of the ways that people cope⁠—is this something that's happening for you?” So, it doesn't have to be an assault⁠—or like, “you have to satisfy my need to know now!” If that's the motive then I suggest you take a pause, calm down, and figure out the most respectful way to ask. And expect that you might get a, you know, an unwillingness to say anything right away. So, you just want to keep the door open⁠—should be the first motive going in. I would expect there might be some resistance and just kind of gently circle around. You don't want to leave that conversation with everybody feeling angry and frustrated because it's going to make it much harder.

Dr. Westers: Yeah, I know a lot of parents are scared to know the answer that their child [Dr. Whitlock: Right] might share with them and to be able to be in that right headspace, like you mentioned, is going to be important because their initial reaction⁠- because I know a lot of young people may fear that if they tell their parents that they are self-injuring, their parents’ll be mad and punish them, or- or angrily ask, “why did you do this?” And- and rarely is that helpful. Do you have feedback about how parents can respond in that moment so that their child can feel openly able to share without feeling that they're going to be punished?

Dr. Whitlock: Yeah. I mean, I think the easiest way to deal with that one is—if you’re- you're listening to this or you’ve come across something like this in the past it, and you know that that's a possible fear that your child has—is to just bring it out into the open right away. So, in addition to the some of the suggested statements I just made, you can also say, “and I know that it might be hard to talk about this. And I know that you might feel afraid that I'm going to be upset or angry if you tell me the truth. I want you to know-”⁠ and then here's like the key for me with parents: you want to be authentic. So, you want to be as mindful as possible.

But it really helps a child to watch their parent model what it looks like and feels like and sounds like to acknowledge our humanness. So, if in fact the parent feels scared of knowing the answer, then I think it's the most right thing to do is to say, “and I do feel a little bit scared to know the answer. But I'm here and I really want to. I'm big, you know, I'm-” Basically the conveyance is, “I'm scared but I'm not so scared that I don't really wanna know. And I promise you I will do everything I can, you know, to stay grounded and not- not let my fear hurt you or me.”

And then the other thing I’d recommend is if whatever you hear does scare you or does cause a lot of feelings to come up inside, it's really okay to say, “wow I’m having a lot of feelings right now and- and I think what I need to do is- I think let's take a pause for a few minutes so I can calm down and let's come back.” Because not only are you then getting information and opening the door—that- that you hope is going to stay open for a good, long time and has other major benefits—but you're also modeling what it looks like, again, to take care of yourself in an emotional way.

The most important thing to avoid is the like free fall of emotion that ends up getting acted out. And even then, though, we did interviews with people who injured about what their parents did right and wrong, and one of the things that one of them said that was just so poignant for me, it just lodged in my mind, is she said, “It's okay. It's okay if you lose it. It's okay if you do it wrong. But just please come back. Please come back and say, ‘I'm sorry. I- I'm sorry. I recognize, I own what I did, I'm sorry, and here's what I really wanted to say. And I feel like I'm better equipped to do that now.’” So even losing it or- or making a mistake isn't like you've blown it and now it's forever blown.

Dr. Westers: Wow, so that is an extension of authenticity and being able to admit when we’re wrong or when we may not have responded in the best way. And kids—especially, uh, teenagers—they can see right through inauthenticity. And so being able to acknowledge, like you had mentioned that “this is not easy for me to hear. I don't like what I'm hearing but I'm- I want to be able to help and support you. And I may mess up in responding, but I am here to support you.” It sounds like that can go a long way. And another thing—you had also even mentioned this in the book—about remembering that it's not a single conversation but a series of small conversations that can provide [Dr. Whitlock: Right] bits of learning and understanding—can you tell us more about what you mean by that and what those small conversions might look like over time?

Dr. Whitlock: Sure. There’s a lot of ways that can go. I mean, I think one of the things we start off in the book is asking parents to think really about what are the- the meta-messages, what are the meta-learnings, what do they really want their child to know how to do as an adult, what's really important. And what's interesting about that practice is that as you sort of dig deeper, beyond the like, “I want my child to be success, I want them to feel good about their life,” and that sort of thing, there does start to be these larger wants for your child. And a lot of it boils down to, “I want my child to be able to feel happy inside. You know, I want them to know what it's like to be loved and to love. I want them to, you know, know what it feels like to feel mastery and to exercise mastery in the world in whatever it is they're doing.” And that—the sort of the basement of that, the ground floor of all of those things are—is there's this bedrock of being able to get really honest. And be able to be exposed—not in a way that feels unsafe—but in a way that feels, you know, to be- to be oneself in a space. And the first place that happens, whether we think it's happening or not actually, is in family.

Which is why I'm pretty, this is like what I came to with the parent studies is like oh, I think one of the reasons that- that the fact that a parent or family system may have really clearly contributed to the struggles that a child is having, one of the reasons why you can't just throw that out the window—because it's clear that family is, you know, not functional, and we're going to go ahead and take the child over here and do the work over here—is that some of the very first experiences of authenticity—whether they're welcomed and cherished and, you know, feel really good or not—happen in family. Especially in families that aren’t functioning very well, a lot of the remedy—it makes sense to me now—that a lot of the remedy would be in that same space. So, helping parents that aren't functioning really well understand how to allow what just regularly happens.

Even parents of kids who are really struggling probably know in the like, the heart way of knowing their kid- their child better than anybody else. And the child knows that. And vice-versa, right? There’s just this knowing, even if you're like every time you meet each other like, “grrr!” there’s still this knowing of each other. So, helping a parent learn how or tune into how can you use that knowing to invite a child to bring more themselves in, is really what's got to happen in those mini moments, right? So, it doesn't have to be about a particular thing. And I think this is something we- we try to get you a lot in the book: it's not what you say, it's really how you're saying it. And the how you're saying it can start out feeling a little rehearsed and contrived and that’s fine, but what you're really after is authenticity. You're really after getting quiet enough and still enough and clear enough about what you really want to experience with your child and what you want to show your child how they can also experience. That makes it worth it.

So, a lot of these conversations go best when they're not one-way, if it's not a parent just like peppering a child with questions. It's also really helpful if a parent shares something about themselves—it can be a memory, it can be a situation, it can be, “remember this time when, you know, this thing happened for us? I’m thinking about that and what I see about that now is.” It can be like demonstrated process of learning and growing and revisiting—like all the skills that we know a young person's going to need in order to sort of grow through this experience and thrive. They can kind of demonstrate how that’s done. But that's also one of the reasons we spend, I think, at least two chapters in the book talking to parents about their own process. Not really about like, “okay here's this thing we gotta fix, it’s out here, not everything-” It's really not. It’s really in the exchange that the healing alchemy happens. And I think that's why we see that parents are also coming out of this experience changed and they’re able to really talk about that. Sorry, that was a very long answer to your question but-

Dr. Westers: Well to the last point, our children, including teenagers, want to make their parents proud [Dr. Whitlock: Yes]. They don't want to disappoint them [Dr. Whitlock: Right]. They know that their parents are not going to approve of their self-injury. So, the parents’ response and recognition to be able to talk about it and recognize in their own discomfort and authenticity, I think you had mentioned, can go a long way in continuing it as a conversation rather than as a lecture from parent to child—as if the child didn’t [Dr. Whitlock: Yeah], as if our teens don’t know that adults [Dr. Whitlock: We don’t really know] don't really know, or don't necessarily approve of what they're doing but want to help them. And I know a lot of parents, including parents that I've talked to, are concerned that if their child self-injures, that is a reflection on them as a parent—such as [Dr. Whitlock: Yeah], “I'm a bad parent,” or “I'm- I haven't been attuned enough.” What feedback might you have for those parents?

Dr. Whitlock: That's really normal. It’s probably one of the most common things to feel because you're probably learning about your child’s self-injury some time into this process; your child's not in the same place as you about that. That was one of the most interesting parts of the interviews we did. It’s like the young people were often like, you know, “I’ve been doing this for a while.” This is familiar territory for them. The parent finds out, one way or another, and they have their own journey from start to finish that is not necessarily in tandem with where the young person is. And that's kind of interesting too.

So, the hard message I always have to give parents is: “This is yours. Like, this isn't your child; this part of- of this experience is yours. And the work you have to do—or the work you're invited to do or the work that’s going to be most productive to do in terms of dealing with those feelings of guilt and so forth—is important but it's probably stuff you should really do for yourself. You don't ask your kid to make you feel better about whatever it is that you think that might have contributed.” And then the next piece is and yeah so you do that, you go to therapy you, you talk with friends, your- your partner, with whoever, and you own inside whatever it is you think might have contributed. But don't get stuck there. Because honestly the other thing that—and I honestly think this is probably the most difficult thing for parents—is this is your child's journey. You didn't cause it. You can't cause another person to do anything. And you can't cause them to stop either.

Like we know from the divorce literature that one of the reasons children will often feel responsible for parents’ divorce or parents’ separating is because on some deep level, “if I caused it, then I can cure it.” And the prospect of not being in control, of not having any control over it at all, is worse than feeling responsible. I’ve been with a lot of- I’ve worked with a lot of parents who, you know, that's the hardest bridge they have to cross. Especially when they're trying to do everything right—they’re helping their child with support, they've owned their stuff, they've done all that stuff—and their child is still struggling. Then the journey becomes: how do you let go of the fact that this is this a, this person's human journey and there's only so much you can do. And the rest they have to do.

Gosh I can't tell you as a parent- how many times- my daughter didn't self-injure but she struggled with depression for a period of time in high school. And I so wanted to just crawl in her skin and do it. Like, if you could just, you know. I’m like, I- I can't. All I can do is- is lay here and love her and do all the things I know to do. And the rest is hers. And that- that’s, yeah that’s an interesting and hard parental journey especially if it goes through, you know, this particular set of woods because it's scary.

Dr. Westers: Yes. It’s completely natural for parents to want to protect their children [Dr. Whitlock: Absolutely] and fix whatever problem. It’s so hard to see people that we care about and love struggle and we can't do anything about it necessarily—of course there are some things that we can do about it which is why we're talking today [Dr. Whitlock: Right] to get some of that feedback. And building on that, many parents fear that setting rules, like curfews, punishments could contribute to their child's self-injury. And they may fear that they're not sure how to respond—is it okay for me to set a rule or to enforce a consequence even if my child may risk self-injuring? What advice would you give for parents in these circumstances? How can they set rules if they're fearing that their child might self-injure as a result?

Dr. Whitlock: Well first, they have to know that that’s a possibility. I mean, there’s a whole lot of different ways that people interact and it's totally possible that that would- would happen. What’s even more important than keeping a blade away from a child's arm or keeping them from self-injuring is- is helping your child to understand what it looks like to live in the world with healthy boundaries. And first those boundaries have to be outside, and then they- they get internalized. And so, it's a very- it’s, you know, it's- it’s a hard job as a parent in this position to feel like you're constantly walking on eggshells, but yes, the answer is yes; those boundaries need to be there. But there's important things in here. So, when possible, we really encourage parents to, um, negotiate boundaries with the child—rather than coming in and imposing boundaries, “thou shalt blah blah blah.” That's not a great approach. There are probably some instances in which that may be the only path, but it should be a last resort.

If it's possible to say, you know, “here's the situation. I, you know, I need to know that you're safe. And I need to know that we're working toward recovering and healing. I need to know that, you know, because of that- used to happen, here's what I want: I’d like for you, or I need for you, to not hang out with this friend or that friend for a while because it really seems like that's a big trigger.” So, you lay it out. So, what, where you can negotiate, you talk about agreements. There's going to be some bottom lines that are just the no-go zones—these are the things that have to happen. But you can say that in a way that helps them understand it comes from a place of love: why this, why does it have- “I need you to be in by X time at night because I need to know before I sleep that you're safe and sound.” And whenever possible, wherever the boundaries are there that one should draw, they, it should make sense. It's so much better if the boundaries that are there for especially a teenager, grow out of something that is directly related to whatever it is you're struggling with.

So, it's not, “you have been self-injuring so I’m going to take away your phone as a punishment.” It's not a punishment as much as it's sort of a guardrail. And the guardrail should make sense, even if the child rails against it. For the parent to be able to explain it, to lay it out that way, matters. I guarantee the child, it goes in there somewhere. They may very well pull it up later and say, “that was an important thing even though I didn't like it blah blah blah. I see that it made a difference.” But it's logical, it's clear, you know that it's important, it's a guardrail not a mandate. And to the degree that can be negotiated and agreed upon? Then you’re just going to have to bite the bullet and do what needs to be done.

Dr. Westers: And building on the comment about a guardrail for even the telephone use, it sounds like you're recommending that linking the consequence to the behavior is more important—because if a child or adolescent self-injures to punish themselves and they turn around and they see that their parents punishing them for having punished themselves [Dr. Whitlock: Right] that could be really hard for anyone, especially a teenager. And so being able to tie the specific consequence to the behavior, “I’m taking your phone away because I've noticed that each time if you have a conflict with one of your friends at night through social media that you tend to self-injure and I want to remove that, at least temporarily, or put a curfew on your ability to use the phone,” [Dr. Whitlock: Yeah] so they don’t interpret as so much of a punishment because they’re punishing themselves already.

Dr. Whitlock: Exactly. That’s it. And maybe, and if they’re like, “no, but I, you know, I need it.” then we’re like, “okay, let’s figure out how we work with this.” Where are the places that the parent feels like, “okay so for the afternoon you're hanging out in the living room, you’ve got your phone, we're all together; I'm cool with that. I'm cool with that because I haven't noticed that that's a really big trigger time for you or a trigger place. But at night, when you go in your room, and you tend to be on- online with wherever, I have noticed that that is a trigger point”? You help them understand the why, and the why should be in service to their growth, development—and the growth and development of the family.

And I mean, that’s the other piece; I’ve seen a lot of parents bend over 20 times backward for a kid they feel like really, really needs the support—and that's totally understandable—and the child is also going to have to learn that they live in a community with other people and there has to be space for other people. And if things stay really lopsided for a long time, as you know, I mean a lot of times it's not good. It can engender resentment, which then comes back at the young person who's injuring as- in a way that just compounds everything. So, it’s complicated. We- I always really recommend if you’ve got a kid who’s injuring and they've been doing it a while—it looks like it's fairly entrenched—I really recommend that a parent find a good therapist. It can be hard and they're probably going to need support.

Dr. Westers: When would you recommend that they do seek therapy for their child if they find out that they're self-injuring? Does it matter how long it's been since they've self-injured or how many times they’ve self-injured? When should they seek therapy for their child?

Dr. Whitlock: You know, I’ve got to say, I’ll turn to the parents we interviewed for that. Pretty much all the parents that we interviewed who went through this said, “as soon as you can.” And even if it ends up being mostly therapy for you, sooner is better. A lot of times, especially if a young person has done it—if it's a one-time thing and it's clear that they can talk openly with a parent about what was happening, what they've learned, then you can probably not run out and need to find somebody right that moment. But I would keep a close eye on not just the self-injury but mood states and are there other symptoms that might be betraying signs of prolonged stress or distress. In that case, I would definitely recommend it.

If injury has been going on a while when you flew in and the kid hasn't been in therapy, they’re probably going to benefit or need therapy to help out. So, I would say sooner is better than later, and also the sooner for the parent or parents is better than later for their own process. Because as I said earlier, sometimes the journey for a parent and the decision points that they're going to have to cross in this experience are different than the ones that their child is going to cross. And they're going to benefit probably from someone to kind of work some of those things out with.

Dr. Westers: And for those parents who are very eager for their child to stop self-injuring—that may not necessarily be a realistic expectation, especially early on in treatment if they are doing therapy, for some it might be. What feedback might you have for parents that want their child to stop self-injuring immediately?

Dr. Whitlock: Yeah, I mean this is, kind of goes back to some of the stuff we've been talking about. Find support, find support for you. Know that, you know, a young person who's been injuring for a while is probably- they're not going to just stop. Learn about it. Understand why it works so well. And there's lots of places now you can go to learn more about why it's such an effective tool. For the people it works for, it seems to work really well and it works quickly. And that's the thing- becomes very hard to walk away from if you’ve found this thing that, you know, you can use. So, it takes learning a good number of skills—and probably a fair number of slips and all that kind of thing—for somebody to start patterning themselves differently. And it’s true for any kind of easy, quick coping behavior that any of us have. It's no different than that. And so, you know, maybe the parent, if they've ever struggled with something that’s not been so healthy for them that's a quick go-to, they can start to have a little compassion. And then yep, you're going to need to be realistic. That's why the agreements are important. That's why if they just issue an edict, “you must stop this now.” And then they walk away and they're just going to be living, you know, they’re fooling themselves to think that that’s going to be that simple. It's much better to say, “I recognize this may not stop right away.” And then start the process of working at recovering.

Dr. Westers: So, making space for lapses or self-injurious episodes without losing composure. That will be key because in therapy, a therapist can help their children work through—as I'm a psychologist and I do therapy with a lot of youth who self-injure—and expecting them to stop immediately may not be realistic or implementing consequences when they do self-injure may not be realistic. If anything, it could push the behavior underground [Dr. Whitlock: Exactly] and their child may self-injure, and the parents think that they're doing well but they're not necessarily. On the other hand, just because someone self-injures and has a brief lapse over time, I don't think necessarily equates to them doing poorly.

Dr. Whitlock: Right, that’s so true. And that’s one of the reasons why, um, one of the big sections in the book talks about that like, you know, we actually recommend that parents don't expect the self-injury to stop, and progress won't be made there first probably. It'll be made in sort of the psychological architecture, you know, the underpinnings of the self-injury. That’s where if you’re an astute observer, you can start to notice the changes there before you notice radical shifts in behavior. Really watching the linkages between mood states, thoughts. So, engagement in social relationships and activities—those are the things that we direct, we try to direct parents’ attention to at first. Like that's probably where you’re going to notice it first. If you're only looking at the behavior, then yeah, it may take a while. But if you really want to watch track progress, get good at noticing whether- like for my daughter, I remember noticing (I used this very same thing, this is what went into the book, I’m like, “I know this one!”) um, it wasn’t so much self-injury, but I started to notice, for example, that she could go longer periods of time of nonreactivity.

I noticed that there were things that- that in the past I knew if I said this thing, or an event happened that was frustrating she would lose it or get really frustrated. I started to notice that she didn't do that as much. Or if she did it, she recovered more quickly. Or if she did it, it was a little more muted. Those were some of the very early signs that I had that she was starting to shift. I noticed that some of the negativity of the comments that she would make that were laced with this acerbic edge just became a little less frequent at first. And then, you know, add further times in between. I noticed that she made some slightly different choices in the people that she hung around with. Or she started—she didn’t necessarily stop hanging around with, you know, one of the people that I thought was particularly bad for her but—she dialed back the time and eventually that- that relationship just petered out. I noticed that she became more interested in- in some activities that she wouldn't- she hadn’t shown interest in. So, there were these little things first. And it did, it accumulated, it got broader and bigger, and she really pulled out of it nicely.

Dr. Westers: “Catch the positives,” I think you mentioned that in your book [Dr. Whitlock: Yeah]. I know it's so easy for us to focus on the negatives but sometimes our kids need us to catch them doing things correctly and doing those right and hear it. Hear it from parents.

Dr. Whitlock: I’d say more than sometimes. I’m like, we should be going out of our way to say. And I did practice that with her. I was like, I did not- when a slip happened—or it wasn’t really a slip so much in this case. But like when she would fall down that slope of moody depressiveness, I was like, “okay I have the practices I do to kind of keep myself from getting too affected by this.” And that's important: parents need to learn how to take care of themselves too. That’s supercritical; you will not be able to show up in the like day-to-day, moment-to-moment way that this may ask you to show up and be mindful without really doing a lot of self-care.

Plus, kids need to see what that looks like. So it was really good, you know, there were a couple of instances where, you know, she was, she was in her stuff and I- I was- I could feel myself, like my temper was a little shorter that day than normal or whatever, I was like, “Sweetie, I can see that you're falling into your stuff and I'm not going to be able to do so well with this. I'm just going to press pause. I'm going to go take a walk. I promise I’m going to come back round; I’m not abandoning you to your stuff. It’s just I want to be as grounded as I can be.” And I really watched it make a difference.

When I noticed her moods, like she could go longer without moods. So, it’s this balance because like, you know, you don't want to make them feel like they're under a microscope and you're watching their every move. So, I didn’t say it every time. But I tried to be sure that every few days I'd say, “I've noticed that situation you had with so-and-so, you handled that differently than I think you would have handled it before. I noticed that. And I want you to notice it too.” And I do think that made a difference in just helping her to sort of swing her gaze, if you will, to the things in her life where she was making progress because I don’t know that they necessarily notice. I mean, It’s not just catching the good; it's like you can actually point them to where it is that they are succeeding and by the very fact of paying attention to it you sort of expand it and it just, I don't know, I think the whole- we sort of just got much more oriented around the things that were going well and I'm just like let the things that didn't go well pass and yeah. It made a difference. It makes a difference.

Dr. Westers: A key comment that you made that I picked up on when you were just talking was when you were feeling overwhelmed as a parent and not able to be there fully for your child. You communicated that; you were being genuine, authentic, you said, “you know, I’m not in my greatest mood at the moment so I'm going to go take a walk. I'm going to come back and we can talk.” That itself I think can be incredibly relieving for a child to hear, a teenager to hear. To know that you didn't just walk out of the house because you didn't want to be around them, uh that you were so angry at them, but because you needed a break so that you could be there for them [Dr. Whitlock: Right] and they were not left guessing as to their role in your anger or not necessarily anger but your mood.

Dr. Whitlock: Yeah, exactly. And then my fundamental communication is, “I love you. I have every commitment to be here, and the way that I can best do to is to know that first I need to go take this bath and just take a few minutes so I can kind of regroup from my day and be really ready to show up.” And I knew that I was modeling to them and how to do the same thing. Because fundamentally that's the path out, right? That's the path into health: is when you can do that instead of go do whatever it is one does to self-injure so they can quickly feel better. You don't have to do that as much when you know that you have other avenues that feel good and that you're not going to hurt anybody because you can't show up right now the way that they need you to show up.

Dr. Westers: Another question that I hear a lot from parents is, is it okay for me to check in with my child if they’ve self-injured, if they’re struggling? And if it is okay, how often should I do it? Is this a daily check-in I should be having, a weekly check-in? What might be some of your feedback for those parents?

Dr. Whitlock: I’d say check-ins are fabulous. You definitely want to check in. You don’t want to check in on, “how's the behavior doing today?” You want to check in on, “how are you doing today?” That's a key difference. I know for a parent it can feel like they're the same thing, but for a child they're not. So, I validate the impulse—because especially with self-injury, know you, one of the things that makes self-injury kind of different than a lot of other things as you know is that it's- so viscerally looks like and feels like a potential suicide gesture to parents. And the idea, the subconscious or unconscious idea, that this person you love so much that you helped bring into the world might not be here anymore by their own hand is just, you know, that's really- that takes some time to kind of work through. So, I get the impulse and I want to validate the impulse.

But it does become- one of the practices for parents is to begin sort of withdrawing their focus on their preoccupation, as you said, with that and start focus on the child. So, they can check in with the child and then the other thing I was going to say, right? If they can check in with the child, it’s great, I would regularly- I would do that regularly. And it's even better if you can say to your young person, “I want, you know, I'm going to need to check in on you. I'm- I love you, I need to know, I need to know that for me—it's not about you, you haven’t done anything wrong—it’s just, I love you and I worry. Are you okay if...would it be okay if I ask how the- how- what's going on with the cutting? Or is it okay if I ask about what’s going on?” You guys can make agreements about how the check-in looks. Like are- are there things that just are going to be sort of out of bounds for a little while? You know I’ve said- done same thing with my child and say, you know, I just can't talk about that thing, and I say, “okay I cannot talk about that thing now. At some point we're gonna have to talk about that thing so can you give me a sense of when you think you might be ready?” Right? So, there’s that kind of interplay. So, that can also happen and then they feel like they have some control. And that's really going to be important: helping them be able to exercise control in the areas that it's really okay for them to exercise control is a big part of the recovery process for a lot of young people.

Dr. Westers: So, respecting their space but also being clear that at some point we need to talk about this and making sure that it's not a taboo topic, so it is okay to check in. [Dr. Whitlock: Yeah, exactly.] You had mentioned the confusion that a lot of people have between self-injury and suicide. You had mentioned that it can look or seem like a suicide attempt or behavior, but it very often is not. How can we help parents differentiate between the two? If they find out that their child is self-injuring, what are some important factors for them to consider to be able to know whether it's suicidal or nonsuicidal?

Dr. Whitlock: Well, probably the best way to differentiate is to ask. If your child has a therapist and if you're not totally certain that your child is being truthful with you, it's within bounds to ask the therapist if that’s something that they need to be concerned about, you need to be concerned about. And then the other thing might be to just kind of keep an eye on the behaviors. I mean this is where I think parents could really- one of the things that they should do once they find out really is to get educated. There's a number of great resources now for parents about what self-injury is, why it works, how it works, how it's different from suicide, things like that. So, they can start looking for- go in with a more knowledgeable and discerning eye. Typically, self-injury is kind of episodic. It's usually, you know, if a child is agitated and then they self-injure—or you know that you're aware that they self-injure—and they seem more calm then chances are excellent that they're using it as a means of coping with an emotion and not as a desire to end their life.

The other thing a parent can watch out for is the kind of, uh, language that comes along with suicidality. It’s a little bit different often than with self-injury. People tend to get very constricted if they're becoming suicidal; it's all-or-nothing kind of thinking, it’s black-or-white, good-or-bad, and there's a lot more signs and language related to hopelessness, purposeless, “I don't know why I'm here,” “I have no purpose.” Sometimes—I would venture to say that majority adolescents—the majority of us and adolescents are going to have moments like that at some point; that’s not an un- unnatural thing entirely. But if it's kind of persistent, if it’s a- you know, an unusual depth or breadth for your child, then you might be looking at least heightened suicide risk even if the self-injury itself is a suicidal gesture. Again, that’s something then to, hopefully the child has a therapist, and you can work with them, you can talk to them about how to best manage that.

Dr. Westers: Is there anything else that you would like to share with us today that you think is important for us to know and for parents to know that we haven't talked about already?

Dr. Whitlock: I guess the two things that I try- often try to tell parents—and that we tried to convey in the book—is that self-injury is often- for me, one of the things that I, you know, when somebody says, “I have a child who’s self-injuring.” The other thing I tend to think is, “oh you have a child who's pretty emotionally perceptive.” They may not know how to deal with the emotion, but they feel it in a big way; they pick it up in a big way, they generate it in a big way. This can be a real gift, but it comes with—burden’s the wrong word but—a heightened responsibility. A child’s going to have to learn how to deal. A child who feels deeply is going to have to learn how to deal with deep feelings. And that's not an easy task necessarily.

So, that's why I think parents being careful—not careful but mindful—about how they model dealing with their own big emotions is really helpful because these- this is a person who clearly has experiences in their body, big emotions. Also helping their child find the resources, the external resources, that are going to help them do that too. But I- so I try to reframe it. To me it's a sign that your child is sort of potentially gifted in this arena; help them work with the gift rather than make it feel like there's something wrong with them. I’d say like 99.9% of the time that resonates with anybody that I say. People who injure as well as people who parent someone who injures are like, “oh that makes so much sense.” And it’s so much easier. Parents need hope. It’s not a fabrication to say that; it's a true thing, right? It's a hopeful, workable frame for parents to understand it that way. So that's, to me, important.

And then the other thing that I try to help parents understand is this isn’t the end of the world at- by any stretch. And it doesn't mean your child is irreparably damaged, you know. They're not going to move into adulthood with this mental health burden that will forever plague them and their life. It’s understandable ways of feeling and thinking sometimes for some parents, but there's just no evidence to suggest that that is what happens. And in fact, as I said earlier in our studies, a third—a full third of the people in our studies—the people who injure said that they wouldn't wish it on anybody, but they’d gotten some pretty important gifts in terms of self-understanding and self-knowledge from it. And that they wanted to use that to help other people in the world or, you know, they were going to become a therapist. I mean, that in some way, it left them better informed about who they were as a person. And so that- that's the other thing I try to help them understand. I- I want to leave them feeling more relaxed and more hopeful and less alarmist, I guess.

Dr. Westers: What a great thing to be able to share, especially when it can be really overwhelming. There is still hope, there is still positives, there are advantages to feeling big feelings and being sensitive. There are certain professions that thrive off of that; for instance, therapists fall often times—not that every individual who self-injures will or should become a therapist but—that's just one example of a profession that might benefit from those big feelings and taking advantage of them like you had said. Based on our conversation today, what would you recommend to parents, professionals, and people with lived experience? We’ve talked all about parents, so feel free to address that here again. What would you advise when it really comes down to it, parents of children who have self-injured?

Dr. Whitlock: I think it’s really what I just said; I mean, the most damaging thing to do in a family or to somebody who self-injures is to have a story about them that basically forecloses the possibility of- of health and well-being and contribution to the world. Young people by virtue of development are developmentally primed, like they're focused on this question of, “who am I going to be out in the world outside of my family? What value will it be?” That's just like developmentally, we’re all—consciously or unconsciously—really concerned with that. So, the things that parents want to be mindful of is not to be communicating, “oh, well you’ve, like this is just going to really mess all that up. You've blown it now.” And a lot of times, even if they're not really conscious of it, a lot of young people worry about that. They worry that this experience—whatever it is they feel like they’re out of control of, that they’re in the throes of—that it’s not just disappointing their parents or disappointing themselves if they can be super honest about it; it's that they’ve shut the doors for themselves that they desperately didn't want to shut. So, I’d say that making that be the primary communication—and I think that's true for anybody who's working with somebody who injures.

And it's true for the person who injures. Like, the person with lived experience also is going to do best when they can reframe this entire experience they're having as something that may be teaching them something that they could and might use later. And you mentioned therapist, but artist, performers, people who work in emergency services, healthcare, anybody who's going to be needing to understand sort of the depths of human suffering as well human capacity, is going to stand to benefit from taking sort of their own journey through this so. We all just basically need to find ways to understand our experience as hopeful and helpful.

Dr. Westers: A growth mindset, it is sounds. [Dr. Whitlock: A growth mindset. That’s it.] What would you recommend to professionals, whether clinicians or researchers?

Dr. Whitlock: Same thing! I mean, I really feel like we put people in these little boxes and stories, and we describe everything as a pathology—and what’s pathology but something that’s kind of wrong, right—by the very idea even. We really- it’s understandable because we have a lexicon around it and we have, you know, risk factors and- and we’re always looking for what it- what it was or what it is that’s going to make this thing go wrong. I think that fundamentally eclipses a really important part of the real human journey.

So, I mean, I'm a-  I'm a researcher and- and I'm a human who gets it from this human perspective. I understand the benefit of that, of seeing things this way; it makes a lot of sense in that one place but when you- when you use it to talk about— especially to talk to real people whose lives, who have to wake up in their own skin tomorrow, or have to wake up with a child tomorrow and the next day and the next day and the next day, who want to know that it's possible for themselves or the people they love to grow and thrive—you can’t talk to them about the way their child as a risk factor or- or a compilation, “these five things wrong!” You just like—that is not helpful; it's hurtful.

So, we, you know, researchers, but especially clinicians, really need to be careful about who we’re talking to in the way that we’re talking about it. And the language for families and people with lived experience just has to fundamentally—at its foundation, even when we're having hard conversations about things that don’t seem to be working so well—it has to be hopeful. It has to be, there have to be pathways into well-being, and they have to be able to see what those pathways are. So, a conversation that kind of fundamental ends with, “well, you know, these terrible things were wrong and now you're really kind of screwed.” It's just, don't do that, don't have that conversation. Figure out how- You can have, “these things went wrong, and this is really tricky, and here is the path—or the one of several paths out—and I'll help you make your way through it.” And believe it—not just say it—believe it. That’s what I’d.

Dr. Westers: That is great. And based on our conversation today, what would you recommend to people with lived experience—whether they’re parents with their own lived experience, or adults with lived experience, or even children and adolescents that might be listening with lived experience?

Dr. Whitlock: Exact same thing. Find the ways, find the gifts that it has given. Find the ways in which you are stronger and wiser. Find the ways in which you have more capacity. The- find the ways in which tomorrow or- or today was just a little bit different in a better way than yesterday. Just look for the ways in which growth is happening. That's what I would say. And if you're an adult with lived experience who’ve really struggled with a sense of shame, then there's- there's advantages to kind of looking back and reframing: like how can you find a different angle on the story that's equally true? Because when a story is just, it’s just the story of, “how I messed up,” or “what went wrong,” I guarantee there's something being missed there. There’s always an aspect of the story about what went right. How, it was somehow, there's something about it, that was—even if it’s one, tiny little thing: a relationship you made, a conversation you had—pretty much everybody, no matter how sort of resistant they are to finding the positive—and that’s- that’s a true thing. The inability to find the positive isn’t because there’s not positive to be found; it’s resistant to finding the positives. So that’s it. Like that’s your like- you know, you as a therapist, I'm sure you work with this; you're not working in an objective reality, you’re working with a resistance to seeing a different way. Okay so, that’s fine but can you, like, just broaden just a little bit and find the ways in which it really didn’t quite go like that.

Dr. Westers: Well, that is great. Thank you very much for sharing that. If people want to learn more about your work, where can they go?

Dr. Whitlock: The best place for them to go is to my website. It’s the Self-Injury Recovery Resources, SIRR, or they can just Google “Cornell” and “self-injury” and it’ll come up. And we have all sorts of mat- resources there and the book link is there, and I think the information about me is there, so.

Dr. Westers: That is a great resource. I have checked it out and highly recommend it as one of the best resources out there. So, thank you very much, Dr. Whitlock, for sharing your expertise, your passion with us. And I think it's going to be really helpful for parents, so thank you very much for joining us.

Dr. Whitlock: You’re welcome. Thank you, Dr. Westers.

Dr. Westers: We hope you enjoyed this episode of The Psychology of Self-Injury Podcast. It is not considered therapy or meant to be a replacement for therapy, so if you or someone you love is in crisis and needs to talk to someone, you can reach out to the crisis text line—a global, not-for-profit organization providing free mental health texting service through confidential crisis intervention by texting “home” to 741-741. If you found this podcast helpful, please subscribe, give us a rating, and tell your friends. For all things psychology, follow me on Instagram and Twitter @DocWesters. For all things self-injury, follow I Triple S on Facebook and Twitter @ITripleS. I'm Dr. Nicholas Westers, thank you for listening to The Psychology of Self-Injury.