#271 - Strategies for Teens Who Self-Harm

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC August 30, 2023

#271 - Strategies for Teens Who Self-Harm

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Strategies for Teens Who Self-Harm

Today’s episode is a brainstorming session in response to a listener question. We talk about different forms of therapy, different strategies for the family at home, as well as tips and tricks for therapists who work with teens who might be struggling with depression and self harm.

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Strategies For Teens Who Self-Harm

We received a question from a podcast listener, a foster parent, providing care for children aged 8 to 18, especially those facing behavioral challenges. She writes:

"As a foster parent, I use a combination of occupational therapy practices, peaceful parenting, and the evidence-based practice called trauma-based relational intervention, developed by TBRI and Karen Purvis. Right now, I have a teenager who significantly self-harms by cutting.

We are working to increase coping strategies even though they don't see the connection to anxiety and depressive feelings as triggers, though, as a care team, we do. But I also think we could address a component of sensory seeking.

They already have a number of sensory management tools and techniques, such as a weighted blanket, going outside for walks, listening to music, using a darker room and comfy corners, visual schedules, and super compression hugs. Have you ever worked on cases where there is a self-harm component? If so, what OT techniques would you suggest or other avenues to pursue?"


Acknowledging The Child's Story

When considering a child or teenager in foster care, it is crucial to acknowledge the significant trauma they may have experienced, potentially being moved from one home to another multiple times, resulting in a lack of trust. This lack of trust extends not only to themselves but also to caregivers and adults.

The first step in an Occupational Therapy approach for children or teens who self-harm is to start by listening and validating their story. Instead of immediately trying to understand why the child is engaging in self-harming behaviors, it's important for them to feel heard and understood.


Finding The Why

If your child is engaging in self-harming behavior, it is crucial to engage in conversations with a psychologist or consider the benefits of therapy or counseling. Your teenager may require support in expressing the reasons behind their self-harming actions.

Understanding the link between anxiety and feelings of depression can be challenging, making it difficult to express the underlying causes of self-harm. Initially, it is important to identify the root cause, followed by encouraging the caregiver to maintain a journal to track instances of self-harm.


Help Your Child Express Their Emotions

To help your teenager effectively express their emotions in a healthy way, you can guide them in journaling, whether through writing or voice notes. For younger children facing similar challenges, facilitated brainstorming sessions can be beneficial.

You can serve as the scribe, motivating them to express their thoughts and ideas openly. By encouraging individuals to mentally structure their thoughts, you can better understand their concerns and ideas.


Addressing The Specific Concerns For Your Child

Once we have everything documented, we can address and resolve these issues effectively. This approach can be tailored to meet the unique needs of teenagers and preteens who struggle with internal conflicts, bringing them significant benefits.

According to research, cultivating gratitude can play a significant role in managing depression. Keeping a gratitude journal holds immense value in this regard. For teenagers, a simple yet impactful routine could involve jotting down three things they are thankful for each night.

Expressing gratitude can encompass a wide range of things one appreciates, and it serves as a valuable opportunity to counterbalance persistent negative thoughts. Moreover, therapists can incorporate this practice into their sessions with teenagers undergoing therapy or receiving occupational therapy services, guiding them to engage.


Impact Of Retained Primitive Reflexes On Emotional Development

Exploring and integrating persistent primitive reflexes can offer numerous advantages, as these reflexes are intricately connected to cognition, emotional regulation, and the fight-or-flight response. Primitive reflexes encompass involuntary bodily movements, such as the startle reflex, which aids your response to sudden sounds or sensations.

These reflexes can persist into adulthood when certain regions of the brain responsible for higher-level cognitive functions and behavior have not yet fully developed. This often happens due to trauma, physical illness, birth trauma, or emotional distress.

Retained primitive reflexes can hinder the brain's capacity to process multiple information simultaneously, causing challenges in communication. Occupational therapists have discovered that integrating activities aimed at integrating these reflexes into daily life can significantly enhance patients' mental well-being and facilitate remarkable improvements.


Ways To Alleviate the Urge Of Self-Harm

When foster children enter a new home, it is widely recognized that they often experience heightened anxiety and exhibit reactionary behavior as a result of past trauma. A crucial aspect of support lies in addressing the specific needs of these children, particularly in relation to their sensory systems.

In order to prioritize their well-being, we place a strong emphasis on this foundational aspect and create a nurturing environment. Here are a few sensory tools that can be beneficial:

  • Vibration: Improve proprioception and tactile input by incorporating a full-body vibrating machine or vibrating massage.
  • Brushing Protocol: Implementing deep pressure for relaxation.
  • Acupressure Mat: Improving pressure input on the skin and joints.
  • Heavy Work: Utilizing weights, theraband, or resistance bands for strengthening muscles.
  • Weighted Blankets: Offering deep touch pressure to alleviate anxiety levels.
  • Compression Garments: Enhancing proprioception, calming the nervous system.
  • Animal Assisted Therapy: Introducing an animal into the therapeutic process for comfort and emotional support.


Additional Strategies To Help Teens Who Self Harm

Besides integrating sensory tools, there are numerous other strategies that can offer benefits to teenagers who engage in self-harm. Establishing a nurturing environment prioritizing their sensory needs is key to supporting their healing journey.

Engage with your community!

It is crucial to involve your teenager in community activities, whenever feasible. One suggestion is to motivate their engagement in group hikes or other recreational pursuits that resonate with their interests.

Stay active!

Boxing or kickboxing can offer invaluable outlets for adolescents to release their energy, frustration, and anger in a productive way. Engaging in various forms of exercise, such as meditation and mindfulness practices, not only boosts self-esteem but also provides an opportunity to acquire new skills.

Engaging in community service and volunteer work!

When faced with challenges and hardships, individuals often become consumed by their own thoughts, disconnecting from the world around them. However, your child can cultivate a profound sense of purpose and self-worth by actively assisting others.

Engaging in this practice enables individuals to acquire insightful perspectives and realize that situations may be less daunting than initially perceived. By providing support and extending a helping hand, we uplift others and uncover fulfillment and a rejuvenated sense of purpose in our lives.

Starting their own business!

Your child can unlock endless possibilities by pursuing their passions, envisioning their future, exploring their interests, and leveraging their expertise. This allows them to showcase their talents and provides invaluable assistance to those in need.

Set future goals!

While financial stability is undeniably important, it is equally crucial to empower teenagers with the invaluable skill of setting goals for their future. Oftentimes, they find themselves entangled in their own thoughts, succumbing to self-destructive patterns and unable to envision a life beyond the confines of the present moment.

Our primary focus has been on taking a holistic approach to the child's well-being, which perfectly aligns with the fundamental principles of occupational therapy. Our goal is to empower them by boosting their internal confidence and honing their skills across various domains, aiming to mitigate self-harm tendencies.




While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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