Q&A: Responding to a Teenage Girl Who's Self-harming

I received the following urgent text from a teenage female client, who at one point HATED coming to counseling and now, I'm grateful, trusts me and reaches out when she needs help. This is our text exchange (any identifying information or names have been changed or omitted to protect confidentiality). Bear in mind, as a text transcript, some of the conversation may seem disjointed, but I'm sure you'll follow along just fine. 

HER: "Hey, it's me. I need help. I really need advice."

ME:  "What's going on? How can I help?"

HER: "I told Jake about how I wanna smoke again and how I'm struggling and he said he has something serious he needs to tell me, but he didn't tell me, and I got really worried. And I got really upset and stressed and I erased again."

(For those of you who don't know, erasing is a form of self-harm, like cutting, where the person rubs a pencil eraser back and forth across their skin (usually on their forearm) to create a friction burn.) 

ME: "Hey, I'm so sorry to hear that. Thank you for letting me know and for reaching out instead of just struggling through it alone. I respect you for that. I know it doesn't seem like it will now, but things will be okay.

"At times like this when you don't know what to do or what's going on the best thing you can do is: 

1. SLOW DOWN:

  1. Slow down your breathing,

  2. Slow down your thinking,

  3. Slow  down your reactive emotions which have hijacked you--re-take control of the ship!

"And,

2. RE-CENTER on what you DO know:

  1. Re-center and remind yourself of what matters most in life,

  2. Re-center on what your worth and value is (it's GREAT, btw!!!),

  3. Re-center on what your long-term goals/plans/desires are so that short-term problems, fears and stresses don't derail you.

"This is hard. Remember though, that you ARE a strong woman and you CAN do hard things. Remind yourself that not only can you get through this—you CAN get through this well, with self-respect and dignity. I believe in you, kiddo!"

HER: "Thanks Jonathan, I was just so stressed and got caught in the moment. I just didn't know what to do when he said he wouldn't tell me. I can tell its a big thing and I'm really worried about him but he freaked out and he got really mad at me for being worried about him."

ME: "You're very welcome. Yeah, I get how that goes. Remember, I was once a teenage girl, too... Oh, wait! Shoot! Yikes, I've said too much!!! ;-) Ha!

"I do get it though. I understand what all of that is like and how quickly fear and anxiety can hijack the body and mind. Just think of this as a storm—don't go out in it and get struck by lightning and get hurt. Instead, just hunker down inside the best part of yourself, surround yourself with safe and supportive people, and just know that as this storm has come, it will also pass. So hang in there, stay safe and ride out the storm. Okay?"

HER: "Hahahah u were a teenage girl?;) thanks:) that helps a lot ;-)."

ME: "I knew that would get ya to smile! Just don't tell anyone my secret!!! Shhhhhh!"

HER: "Haha I won't tella  soul :) if I had one :) but I don't."

ME: "Ha! Oh, but I know you do. If anything THAT's you're problem: Too much soul, soul sista! That big heart of yours cares so deeply and so much, which is a wonderful trait, but it also gets hurt so much, too. So we'll keep working on how to connect with the former and use that more while we also learn how to protect the latter. How's that sound?"

HER: "Thanks:) I just wish I knew how to protect it before."

ME: "Yeah, no doubt! Here's the good news, though—we learn from pain. Trust me, I've got the biggest and most sensitive heart, am a people-pleaser, conflict avoider (considering how often I call you on things, I bet that's hard to believe, huh?! ;-)), take things very much to heart and get my feelings hurt very easily. That's my nature. That's who I am. Can you relate?

"Because of that I've been hurt a lot. And because of that pain I've also learned a LOT (please pause for a moment and stand in awe of my gigantic brain. Thank you...) from that pain. I've learned how to protect my feelings while still allowing myself to stay compassionate instead of shutting down and getting bitter, jaded or cynical. I've learned how to be assertive, not take things so personal, handle and even use conflict well, and be more confident. And if I was able to figure it out, trust me, you can, too. Trust me on this one."

HER: "I wish I would have learned sooner tho, it would have made life a lot easier.

"Wait, U a heart? No!!!"

ME: "I know, right?!!! Hard to imagine that not only is my head not hollow, I also have a heart! Who'd have guessed?!" 

HER: "Haha wait u have a brain?"

ME: "Yeah, I know. I wish I learned it sooner, too. But, I started learning it at your age. So it sucks now but it's not too late by any means." 

HER: "I hope I'll learn soon and quick."

ME: A brain or rocks. Something's rattling around up there!

HER: "Hahahah prolly rocks:)"

ME: "Prolly! But I enjoy my little fantasy that they are brains. Just let me enjoy my delusion, will ya?!

HER: "Haha nah I'll rub it in ur face that u don't got a brain :)"

ME: "That, I have no doubt, you will! ;-) So how ya doing?"

HER: "Better, but still stressed."

ME: "Okay, glad you're better. Hang in there, my friend. You can do this. Hold your head high. Ride out the stressful storm. And when it passes all that will be left is a stronger, wiser woman."

HER: "Ok, thanks Jonathan :) ur the best"

ME: "You're very welcome. And thank you, too, for that. I believe in you. Thanks for reaching out."

We then proceeded in a lengthy exchange of insulting each other creatively and guessing movie quotes. Yes, that is therapy. :-)


Review of what just happened...

There are some key ingredients, as shown in the above exchange, for responding when someone is in pain, grieving, suffering or in crisis:

  • Responsiveness, availability, presence, being there: Just plain good ol' fashioned genuine "giving a damn."
  • Joining her where she is not where I am. Teenage boy-girl drama is too often written off by adults who have forgotten how traumatic and HUGE it can be at the time. Gratefully, that stuff no longer affects me personally, but that's because I've gone through it and figured it all out and I'm 45-years-old. She's not there, yet. She's where she is. And that's where I joined her. 
  • Lots of understanding. Lots of empathy. Lots of compassion.
  • Normalize and validate: "Well, of course you're upset. Who wouldn't be?" Instead of, "You're making too big a deal out of nothing."
  • Good, helpful and practical tools and strategies. Pat, obvious, trite or cliche answers DON'T help: "Just have faith", "You shouldn't hurt yourself", "Don't worry about it", "Just ignore him". Avoid those, folks, like the plague! They sound good but are SO not helpful, and if anything, only shut people down.
  • Humor that playfully humanizes the people talking, without making light of their feelings or circumstances, can lighten the burden, be therapeutic, healing, connecting, puts the vulnerable person and the "expert" on an equal playing field of "hey, we're just two real people here" which helps the vulnerable person feel safe vs. humiliated or "weak", and, of course, it's just fun. As the comedian/pianist Victor Borge said, "Laughter is the shortest distance between two people."
  • Bear in mind, folks, she used to hate coming to counseling and she certainly wasn't thanking me nor did she think I was "the best." This is a perfect example of how important it is to stick with the seemingly "resistant" "rebellious" and "bad" kids, see them for who they truly are and never lose faith in them. They are so amazing and so worth it. This one certainly is.