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.

No you're not rambling.

Did she ever get any hassle at school after she came out?

Perhaps those three events were enough to create the anxiety in her, I imagine they were all very unsettling to say the least. Going through a medical ordeal must have been quite frightening for her and being in pain is tough. How was the difficulty settling in after moving back, did she have trouble making friends?

OP we have had similar. V stable home, high performing child. Developed depression and anxiety in yr11. Self harming, also with pills. CAMHS didn't want to know although eventually provided eight sessions of not great counselling and closed her case before it was finished. A year befor that - the first time they closed her case we engaged a private psychiatrist.

She had CBT - not great
An underlying endocrine condition diagnosed which didn't turn out to be the root of the problem.
Fluoxetine which helped a bit 20mg
Anorexia
The teeny overdose she took herself to hospital with which resulted in some indifferent CAMHS counselling.
But was the catalyst for further investigation which revealed she had ADHD, ADD variant. So many bits of the puzzle slotted into place and explained so much. That was the start of her recovery - she had gone a long way down.
Fluoxetine at 20mg wasn't brilliant but adding another 5mg really had a huge impact.
There was a point where she saw her psychiatrist weekly
Eventually I also found her a great counsellor who she can dip into see at bad times.
I'm quietly confident she has recovered. Took two years to find the cause and then another hear.
CAMHS refused access to a psychiatrist.
IME CAMHS work very hard to do as little as possible. If you deal with them my advice would be to document everything they tell you and confirm back to them everything they have said they will do.

CAMHS input was 8 counselling sessions. They didn't look at physical causes or consider a neuro developmental disability. Their advice was "get her a counsellor off the internet". That when she was cutting and poisoning but just not enough for them.

It may be that counselling isn't very effective because self harm can be about dealing with strong emotions, and the bits of our brains that deal with emotions is not well connected to our cognitive functions and can't be instructed what to do in any straightforward way. Often when therapy works it's more about the relationship with the therapist that helps to develop stronger neural pathways in the brain rather than dealing with "faulty thinking". Encouraging her to develop relationships with well adjusted adults adults will help her to mimic them and regulate her emotions - family or friends, youth group leaders or teachers? Other things like playing music / singing in a group, yoga, drama, other types of group physical exercise particularly anything that's rhythmical can help. Not saying give up on any of the other things, but it's not always the things that are immediately obvious that will make the difference.