dd self harmed again last night. It's bad. Why is counselling not working? :(

[RhythmNBooze]

dd1 has been self harming for about 2.5 years and sees a CAMHS counsellor on average every couple of weeks. She started off by making lots of small cuts weekly but has now progressed to deeper cuts every few weeks. Last night she did it again but we didn't find out until this morning. It's another bad one. Very deep, she's gone right into the fat layer. It looks awful. Took her to the practice nurse who has stuck it together with steri strips and dressings. This is the 3rd or 4th time she's done it so deep.

dh and I are really struggling to understand why the counselling isn't helping. We just feel so ground down by it all. I'm worried she is escalating to doing something more serious.

At what point does a child with suicidal ideation and self harming need more serious intervention?

I don't know why I am posting, I think I just needed to write it down.

That must be so difficult for you all. How old is your daughter?

I've never had counselling but I imagine it's tough making yourself think about difficult things.

Does your daughter have friends? Hobbies?

Thanks Imperial, it's kind of you to respond.

dd is 14 and in Y9. She has found it difficult to make friends in the past (mainly due to her anger and OCD issues) but this year she has found a group who are happy to take her at face value and care for her.

She also loves Taekwondo and she goes 3 times a week. She only started a year and a half ago and has progressed quickly through the belts. The last time she self harmed this badly we had to stop her from going because any physical contact would have reopened the wound. She wasn't happy but accepted it and we thought this would be a good deterrent in the future. Obviously not .

So found out she'd used a Stanley knife blade Told her she had to hand it over as it was our parental responsibility to keep her safe. I'm not sure if I said the right thing. To be honest I never know if I'm saying the right thing.

What made her do it this time? Has she said? Would it work to have an agreed signal that she needs to harm and have a distraction plan in place? Exercise can really help.

Hi rhythm. That sounds really difficult. Does your dd feel counselling is helpful? Helpful doesn't always mean pleasant it can be challenging and thought provoking. If talking therapy isn't working there are other types you can try. I'm a play and creative arts therapist. We often work with children who self harm. It often works well when the person finds it hard to talk about things or if they aren't really sure what the difficulty is. Happy to pm if you want more info. Don't let the word play put you off its for all ages even adults.

She doesn't know. We've said to tell us as soon as she feels like harming herself but she didn't want to wake us up. She has a punch bag in her room so she can practice her kicks but also release her stress.

Has her counsellor discussed alternatives to self harm, like drawing on her skin with markers, pinging a hair elastic round her wrist, running ice cubes where she would normally cut etc? Is she on any medication or had a review with a psychiatrist as well as counselling at CAMHS? It might be worth having a chat with her counsellor if you can, not to discuss what she is disclosing in her sessions obviously, but to ensure the counsellor is aware of the depth of the cuts etc. Good luck to all of you, and hope it improves soon

Alternatives sound good.
Also the actual saying the words of what she wants to do could be a challenge. Agree a signal and what your response should be.

It is possible that the counsellor may not be the right one for your daughter. Has she said anything about the person? Does she seem happy with them, engaging in her treatment?

I found counselling utter useless, the woman doing it was awful. I know others who have found it amazing as they found a great person.

Have they got her doing a thought diary? Or using a safe word that she can tell you when she feels she needs to harm without having to say the words? Something utterly benign and unrelated like "hippopotamus".

Sorry should have mentioned she was on fluoxetine but this didn't help so she was given sertraline. This made her up moods really hyper with the subsequent crash. She has been coming off the sertraline to see how she manages without it. I don't think that's why she self harmed though.

She has her next appointment with camhs tomorrow and I will definitely be updating the counsellor on what's happened.

None of the distraction techniques work for her. We're definitely seeing an escalation in the severity of her injuries. I'm so worried about what the next stage will be.

One of her issues is she seems to expect a miracle cure from the counselling without her needing to do anything herself. So becsuse the diary, mindfulness, distraction techniques require her effort she can't be bothered. A symptom of her condition I suppose.

She has had a few counsellors and not all of them have been effective. She does seem to like her current one though.

Ok so this is radical but I would be tempted if you can to take her out of her environment and challenge her with exciting survival stuff like building your own shelter on a remote Scottish island. I heard of a person who did this for troubled teens who had them one at a time and just got them out building fires and stuff. It sounded helpful as gets you thinking outside your own head and just about healthy outdoor things maybe.
I wish I had more to help as that may be no help at all and I just feel so sad for you as can't imagine what this is like for you. I really hope you're ok, and that your DD gets much better.

I've been through this with DD. Each person is different. A year of weekly counselling worked for us, though I am always on the lookout in case it starts again. I confiscated all blades sharp objects too. But they're so easily available and easy to hide.

for you both. Good luck.

Ps in fact my post sounds really random . But I would be ready to try anything new just in case it brings a new perspective

It may not be she can't be bothered. It may not be something she feels able to do. How quickly is she coming off the meds? Should be very slowly. Onto a new medication or nothing at all?

I wouldn't under-estimate the effects of coming off sertraline, tbh.

It can cause agitation and anxiety, which may have felt overwhelming. Sometimes the effects are quite subtle, but enough to tip someone who is already fragile.

Who is overseeing your dd coming off antidepressants? Do they know about her recent self-harm?

Best wishes to you both.

I was on citalopram and it took me months to come off!

Her camhs psychiatrist is supervising her meds. She was allowed to stop taking the setraline straight away as she was on such a low dose.

Junglefowl I would love to let her do something like that. Trouble is I think her younger sister would be jealous

That's also another worry....how it's affecting dd2.

What's the plan about medication? However low the dose, it usually isn't advisable to come off SSRIs quickly.

The plan is to see how she gets on without any meds as they were mainly prescribed to help her with her OCD but the side effects were not helping. He has mentioned possibly trying another one (can't remember the name but it begins with an O).

Hello, hoping I can help as I have experience of self harming myself.

I am extremely concerned that they've taken her off medication and left her on nothing at all, especially when she is SH-ing deep enough to cut into fat. That's serious. I think you need to see a different Psychologist asap, be frank about the situation and get her on some new antidepressants, or maybe beta blockers as well. I'm on escitalopram and propranalol and they keep me more level (I'm bipolar). Taking her off everything when she is this unwell is very puzzling.

I don't know if this helps but SH is a way of getting out pain inside. The way to help is to work on what caused the pain in the first place.

Thank you for sharing your experience Chocolate. Can I ask whether you had therapy as well as medication to help you? Which did you find most useful?

To be honest I am at a loss to understand what's going on with CAMHS. All the counsellors she's had have had differing opinions on what the issue is. One thought she was on the autistic spectrum and this one thinks she is suffering from trauma (she does have a medical condition that may support this theory) but no one seems to be able to work out how to support her.

We have left a message with her Therapist (who she is seeing later on today) to let her know what's happened and to tell her how worried we are about it escalating but no call back yet.

Yes ive had a variety of therapy types over the years, in all honesty it wasn't until I started having private therapy with a counsellor that we really got to the bottom of my problems (abusive childhood) and working through that has helped me find myself (excuse the psychobabble). Also having a secure life situation (married with kids) helped me. CBT was okay, but it only really scratched the surface. I have a number of comforting tactics in place for when I'm feeling distressed- certain music, cuddling a soft toy, putting my pjs on, having a bath, watching ASMR videos on YouTube, they all help as well.

Do you have any idea what the root of this may be for her? It sounds like she is probably dealing with a huge amount of anxiety.

I think you should ring and ask to speak to the head of the mental health team and explain the confusion and disagreement between the staff and that your daughter needs some proper help, they are letting her down badly.

I think this is the thing that confuses me the most. She comes from a stable home, she is loved and cherished and we have always tried to do the best for her. Yet she is so unhappy she is harming herself.

Thinking about it there are 3 events in her life that may be triggers. We moved to France when she was 4 years old but moved back to the UK when she was 9. She was happy in France and seemed to have difficulties settling in here. She still calls the garden of our house in France her 'happy place'.

She suffers from a neurological condition which caused her severe pain but she successfully underwent inpatient treatment at GOSH. Her pain is much reduced but it will always be there.

She came out as gay in Y7. We support her and have never challenged her about it.

I suppose when you put all that together it probably looks like she has had a lot to deal with. This is why her current therapist believes she is exhibiting symptoms of trauma. The self harm is her need to complete something.

Sorry for the rambling but it is helping to write it all down.