DD (16) has been self harming now for 5 years

[ChildrenoftheNewForest]

DD is 16 and diagnosed as autistic. She has been self-harming now for around five years - cutting her arms and sometimes her legs. She is covered in scars. It got much better but over the summer it has really ramped up again. She has had a succession of private counsellors and therapists but has not found any of them useful - she has just stopped with the most recent one.

She won't tell me what are the triggers for her current self harm (but recently has started leaving out bloody tissue etc., which I take as a sign she wants me to know she's doing it). She identifies as trans and has a trans partner who she spends a lot of time with. I am also concerned she has started restricting food - this happened in the past but resolved. She is out the house a lot so it is more difficult for me to keep tabs on this.

I'm at my wits end. She won't talk to me so I've asked her to consider another therapist. She hates being challenged and approaches like CBT apparently "don't work" for her. She's happy to talk about her feelings with a therapist and is extremely intelligent and articulate, but seems much less able to take real action to change her thought processes or move on. She has told me she is not sure if she wants to stop self harming - I think this (and mental health difficulties more broadly) have become an integral part of her identity. She has a group of friends who are all trans-identifying (and my guess is all autistic although not all are diagnosed) and mental health issues seem to be the norm within this group.

She will be going to University next September and I feel really concerned about her going while still so mentally fragile - transitions are hard for anyone but for someone like her it could be catastrophic, and I'm so worried that I won't be there to spot anything. She won't consider a gap year and doesn't want to live at home. I feel we have a year to try and get her in a better place (while also doing four A levels!). Any advice would be really helpful - types of psychotherapy that might suit her and she might engage with, helplines etc. We don't seem to have any specialist self-harm organisations in our area but am aware of some of the national helplines etc. CAMHS were useless.
Thanks very much.

sorry OP. This sounds extremely difficult and worrying. Hopefully someone with better advice will be along soon as you may not like what I am going to say.

It sounds extreme but I would take her out of school, get her as far away from her friends and partner as possible and get her away from ideologies which are destroying her life.

@slet as tempting as that may be it really isn't possible, and she is nearly 17 and basically has a say in her life now. She would never agree to it.

Hi I don't have much helpful advice as such but I just wanted to let you know that I self harmed at that age ( I'm possibly undiagnosed autistic) and as I got older and got more autonomy and control of my own life I stopped completely by around 18/19. Going away to uni may actually help to give her this. Just my perspective.

Thanks @ladygindiva - that's helpful to know. Was there anything you found useful (other that your increased independence and autonomy) that helped you stop?

I don’t know if there is much you can really do other than keep facilitating access to therapy where you can. I think eventually she’ll find other ways to express her feelings. For stories of hope, I thought this was good: https://www.bbc.co.uk/videos/cg64ny7l03wo

What has she been looking at online? You say this has been happening for five years and TikTok especially is renowned for self harm and eating disorder material.

Have you done any work with her on emotional regulation? DBT is good for this. Has she been diagnosed with anything? She could have OCD.

CBT often doesn’t work for autistic people. Have you looked for a ASD specialist?

www.autisticadvocate.co.uk/post/why-cbt-is-often-not-helpful-for-an-autistic-person

Dialectical Behavioural Therapy is often recommended for people who self harm and also often neurodiverse people. It teaches emotional regulation, distress tolerance and interpersonal effectiveness. Honestly it changed my life (former self harming teenager here, unfortunately only accessed DBT in my 20s- but better late than never.) I know it used to sometimes be available on NHS but probably easier to access privately now. Full treatment involves 1-1 therapy, group therapy and doing “homework”.

Is she taking an antidepressant medication at all.? As a psychiatrist once told me, sometimes we are too poorly to make the therapy work, and need to let the meds do some of the work first. Then the therapy can follow.

It’s true that CBT doesn’t work for everyone. It didn’t for me. It’s especially unhelpful for people who might feel like they want to ‘win’ at therapy because it’s quite easy to work out what the therapist wants to hear.

Have a look at Compassion Focused Therapy. You’ll have to pay for it I imagine, but I found it very helpful. It’s very good for people who may have feelings of shame or self-loathing.

Sending solidarity to you. I self-harmed as a teen but don’t any more. It can be beaten.

Thanks for these thoughts and suggestions. My guess is she is she would not put the work in for DBT. She has expressed an interest in somatic therapy, which I am looking into - any thought would be very much appreciated. I'll look up compassion-focused therapy too.

I’m sorry to hear this OP. My DD went through similar self harming and food issues at around 15/16. She’s 19 now and doing much better, and hasn’t harmed for a few years.
I’m afraid I don’t agree with taking her out of school, away from friends etc although if I had no experience of this that would probably have been my mindset too. I believe this would make her feel more isolated and depressed, and possibly resentful toward you and right now she needs you on her side.
Keep the metaphorical door open, no judgment, and keep talking. I encouraged my daughter to stay on at college doing a foundation course rather than going to uni. And I encouraged her to get a job, at first volunteering and then when she had more confidence a paid job in a cafe. The independence and responsibility, whilst still having the safety net of home, has helped her enormously. And as a PP has said, anti depressants help them to reach a place where therapy can start to work. Good luck to you both.

It's interesting what several of you say about antidepressants, and maybe that should be the next step. To be honest she doesn't appear particularly depressed - she's motivated at college (her friends are quite ambitious and academic, which has made her much more aspirational) and she is constantly out and about with her friends, but she would say she is depressed. I think maybe a GP visit would be a good start - she's seen them before on a number of occasions and they have been moderately helpful, but would not prescribe anything until she had tried talking therapies.

So sorry to hear this. I self harmed from 14 to about 36. I still self harm but not by cutting anymore.

What helped me was reading about using a red marker pen. Sounds a bit crazy, but using a pen had the same aesthetics but didn't leave scars. Took me to that grand old age to learn that one and then discover tattoos! They've covered up the scars.

@DinoLil Thanks - can you recommend any resources about the red pen? And thanks so much for sharing.

No one therapy will work for x condition, and CBT is no different. Some ASD kids love it, because it is so very structured and predictable, but other hate it because it's also reductionist and oversimplistic.

Have you tried psychoanalytic psychotherapy? My experience is that children who hate CBT get on really well with that, as long as you get a thoughtful therapist.

https://childpsychotherapy.org.uk/find-child-psychotherapist-search

We have also been going through a very similar situation for 5 years, except the trans bit. That was over by age 12. Dd is on two meds via CAHMS and has completed CBT and DBT. Unfortunately nothing has worked for her yet and she has had 2 hospital admissions for suicidal thoughts in the past month. Handhold for you as it is sooo hard

Thanks @CAMHSDoctor for your insights - I’ll look into that. And so sorry to hear you are going through this @Pomer0l - that sounds incredibly tough.