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Morgan Seymour, LCSW | Clinical Therapist | Adolescent Boys Group

July 12th, 2018

Self-Harm & Suicidal Ideation in Adolescent Boys

Morgan Seymour, LCSW | Clinical Therapist | Adolescent Boys Group

Misconceptions

In our society, boys and men often grow up without being taught the skills necessary to manage emotions. They are sent the message that it’s best they don’t talk about their feelings. Therefore, when a young man is struggling internally and feels he can’t discuss his emotions openly, self-harm can become a means of coping.  In this way, self-harm – particularly in adolescent males – can be considered a systemic, societal problem.

Many people associate self-harm predominately with females. However, studies show that at least 35% of those that self-harm identify as male. Additionally, self-harm does not only refer to cutting. In fact, the term is defined as any method of inflicting pain on oneself – burning, scratching, pulling hair, restricting one’s eating – to name a few.

People often write off self-harm as “attention-seeking” and don’t take it seriously. While it’s true that self-harm can be motivated by the desire to be seen, it’s important to understand this need for attention in a deeper sense—as a cry for help. When someone is self-harming, there is usually a lot more going on beneath the surface.

Many of the adolescent boys I work with at Open Sky don’t know how to express emotions or may not have someone to talk to that they trust or feel comfortable confiding in. So, they take it out on themselves as a way to communicate that something is wrong. In the moment, it may actually feel good to the person self-harming because it is a literal release of what they’ve been holding inside.

Self-harm versus suicidal ideation

As a wilderness therapist for adolescent boys, I try to assess the intent behind the student’s self-harming behavior. Is it a release of emotion, a cry for help, or a personal punishment? Or, could it be linked to true suicidal thoughts? It’s important to remember that self-harm and suicidal ideation are not necessarily linked: Someone that self-harms may not intend to end his or her life. Someone who attempts to end his or her life may not have ever self-harmed.

If I find that a student’s self-harming behavior is connected to suicidal thoughts, I give that student-specific Individual Goal Plans (weekly assignments) about the relationship between these thoughts and behaviors. I help him understand and become aware of this connection. Then, I create a safe space for him to talk openly about what lies beneath the surface of his actions.

How are students who self-harm kept safe in the wilderness?

At Open Sky, we keep students safe under supervision 24/7. Our group model supports this by having small teams (average 7 to 10 students per team) with a ratio of at least 1 guide for every 3 students. The team structure itself can be therapeutic for boys who struggle with self-harm or suicidal ideation. If a new student walks into Team G and realizes that other boys have struggled with the same thing, it’s easier to form connections, support each other, and hold each other accountable in the process of healing. It’s not about normalizing the destructive thoughts and behavior. It’s about these boys recognizing they are not alone. Our team can help and “hold up the mirror,” encouraging each new student to show himself love instead of self-judgment. We have students at all stages of their Open Sky experience who are at different points in their own personal growth. This diversity allows our students to show up for each other in beautiful ways.

At Open Sky, we also have specific interventions if a student needs even closer supervision. Through collaboration with the guides, I may determine that a safety watch is necessary for the student’s safety. Sometimes the student himself tells me verbally or in his behavior that he has the urge to self-harm and doesn’t feel safe. This shows that he is open to getting help. He finds relief once he is on the watch and receiving the immediate help that he needs.

A high safety watch means that he can’t use a knife and must be within arm’s reach of a guide day and night. It involves two or three check-ins each day in which the student assigns a number 1 to 10 to his self-harming urge or suicidal ideation. The patterns that arise in these check-ins can help in treatment. Our guides are trained and coached to carry out these interventions and keep the students safe.

While on a high safety watch, If a student shows that he’s beginning to build a foundation of coping skills and tools to support safe behavior, I will move him to a medium safety watch and eventually off the watch. Safety watches are an important intervention because of the obvious—the student’s physical safety—but it is also an ideal time for the student to become aware of and reflect on negative patterns and how to change them. Once trust has been rebuilt internally for the student and between him and his guides, his peers, and myself, we will take him off the watch.

Clinical approach to self-harm at Open Sky

First and foremost, my clinical approach comes from a place of compassion. I never shame the student; I seek to understand him. I don’t expect everything to click for him right away. Instead, I strive to listen, teach, and coach.

I start by naming the behavior. By doing so, I can point out that this is a way of coping with something. The next step is to talk about the “why?” behind the coping mechanism. This process is about body awareness and recognition of emotions. Many adolescent boys simply don’t have much of a vocabulary when it comes to emotion. They compartmentalize their feelings into “happy,” “sad,” and “angry.” I give each student a vocabulary list of emotions to reference when discussing what situations, experiences, and emotions led him to hurt himself or think about ending his life.

In our therapy sessions, we also talk about when the behavior started. What does he remember about what triggered him to self-harm the first time and what is his relationship to that action? The assessment is all about gathering information and drawing attention to the causes and intentions behind the behavior.

How can parents support their loved one who self-harms or has suicidal thoughts?

The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7 support for people in distress. If a parent notices that his or her child is self-harming, that parent should not shame or judge the child or draw conclusions about the child’s motives. It can be scary as a parent to see this happening, but it’s important to seek to understand. Address the behavior and the child’s physical safety without stopping there. Make sure the child knows it is a safe space to open up about the cognitive and emotional influences on his or her actions. Continue to show up for your child without judgment and shame and seek help from outside professionals.

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Morgan Seymour, LCSW | Clinical Therapist | Adolescent Boys Group

July 12th, 2018

Morgan Seymour, LCSW | Clinical Therapist | Adolescent Boys Group