How do you discipline a teen who self harm's?

[Heather2000]

Hi, my daughter is 14. She's autistic, has high anxiety, and we've discovered she self harms. She was placed under CAMHS, but they said she wasn't a severe case. She was seeing the school counsellor, but stopped going. She has another counsellor who she currently sees once a week.
She used to be the sweetest, funniest, kindest girl, really affectionate, and we were a close family. It's me, my husband, her and her younger brother. When she went back into school after lockdown the anxiety started, she started seeing the school counsellor who said she was autistic.
Over the last year she's withdrawn from family life. I put dinner on the table and she picks her plate up and takes it to her room. She doesn't want to watch a movie or play a game, she doesn't want to come on family days out. We had a family holiday booked for later this year but now I'm going with our son and my husband is staying behind with her.
I don't know what triggers the self harming, but I think it's mostly school anxiety. Little things she says about the noise, why don't people say what they mean, having to wait for other people's reactions in conversation because she doesn't get jokes and sarcasm. I think she's masking all day in school, then comes home and has 'post restraint collapse,' and needs time alone to recharge. So I understand that if she's been dealing with people all day in school that she needs time and space alone in the evening.
What's really upsetting is the way she speaks to me. She hates me. She's apparently moving out on her 18th birthday. I bought her a jumper she wanted, it arrived yesterday. She was out with her friends (she has a lovely group of friends and a lovely girlfriend, they've been dating for I think about 8 months, not that she tells me anything!) I put the jumper outside her room (I'm not allowed in) for her to check she was happy with it, before I removed the tags and washed it. My husband picked her up from her friends yesterday evening and she went straight upstairs to her room without speaking to anyone. I left it a bit, then took her a cup of tea. She opened the bedroom door and reached for the mug. I saw fresh cuts on her hands, she must have just done them. She took the mug and shut the door without speaking to me. This morning she's just walked into my room with her new jumper, dropped it on my bed and said 'I thought you would have washed it,' in her usual hostile voice (she never used to speak like that) and walked out.
I know she likes clothes to be washed before she wears them, but I like to make sure she's happy with them before I do that, as then I can't return them if they're wrong. She won't try clothes on in shops. I'd like her to say 'thanks for the jumper mum, I love it. Please could you wash it?' or even better wash it herself as she's perfectly capable!
But I'm so scared of causing her to self harm that I let her speak to me like this. I don't ask her to do any chores around the house at all. She send me a WhatsApp saying what she wants for dinner, she doesn't eat the same as the rest of us so I have to cook different meals. She won't cook for herself as she doesn't have time,' she always has too much homework. She's a good cook, I've always cooked from scratch and used to get them both to help. Because I can't ask her to do any chores I then don't ask her brother to as it isn't fair. So for the last year they've barely lifted a finger, not even emptying the dishwasher, making a sandwich or anything.
Every article I read about self harming talks about supporting them, why they're doing it etc. I can't find anything that tells me how to discipline her. How do I say 'That was rude, don't speak to me like that,' when she'll go and cut herself? So I'm basically a doormat, a scratching post, and I can't stand up for myself for fear of what she'll do. A few months ago I asked her to dust the living room, which she used to do as her weekly job (takes less than 10 minutes!) She gave me back a mouthful of attitude and I told her not to speak to me that way, she was being unfair and unreasonable. I did raise my voice. She came downstairs later looking like something from a horror film and we had to go to A+E. We were in the hospital for 21 hours, from A+E to the pediatric ward. The counsellor there was trying to get her to see that she lives in a house with other people and everyone has to contribute to the running of the house, but she refused to agree to any compromise.
I can't risk another A+E trip now, I think we'd be waiting there 3 days to see anyone! And I don't want my beautiful girl to have permanent scars because I asked her to empty the dishwasher. She's doing brilliantly at school, her reports are all excellent. She has a lovely group of supportive friends. It's just at home she's awful. She's terrible to family members as well, just puts noise cancelling headphones on and blanks them. I kept secretly crying in the loo Christmas day as it was so different to every Christmas before, I'm constantly apologising to family for her behaviour.
I don't know what to do. It's not fair on my son, he's 12 and sees his sister talk to us like dirt, she's horrible to him as well. I don't know what to do. I'm crying every day, I feel so lost. A year ago I never could have imagined our family being in this situation.
Does anyone have any ideas on how I can approach her about her rude way of speaking and her attitude to the family? I'll email her counsellor tomorrow, maybe they can bring it up with her. I don't know what to do. Please don't suggest taking away her phone and laptop, school homework is all apps and websites, plus she streams music to sleep and has study WhatsApp groups with her friends. I'd love to take it all away and see if she comes back to us, but I don't think it's realistic. Maybe in summer after her mocks!
Sorry for how long this is, it's all bottled up inside!

Hello, I'm really sorry to hear how much you and your family are hurting at the moment, walking on eggshells and not being able to relax in your home, it sounds tough.
I cant offer much advice but I can relate to the hostility, attitude and rude speaking. My dd17 also ADHD & ASD has been like this with me in the past at times, not so much with her dad or sister. However mine has never self-harmed - when it has got really bad in the past I've been at breaking point I've had a stern word & confiscated her phone for a week, ( only a couple of times & it worked). I had some good advise from the neurodiverse team on this, who reminded us that maturity wise they are often a couple of years younger. I also spoke to Contact which helped a lot too. My dd is a lot better than last year but still tricky to handle at times & I'm on edge as to what she will get up to next! Feel free to PM if that would help :-)

Gosh its so hard, really feel for you. Some positives, her friends and she does attend school. I have a 17 yr old similar, we have phases where it improves and phases where its worse.
The "letter your teenager can't write" is very useful imo. Here.

What kind of support is your daughter getting from her counsellor?

I’d strongly recommend finding someone who can do Dialectical Behavioural Therapy with her, it’s extremely useful for people with tendencies towards self harm.
She needs help with her emotional regulation and distress tolerance- and also to learn to improve her interpersonal communication.

It might be useful for you to read up on DBT yourself, as you may find you can communicate more effectively with your daughter if you can understand her mental state better. It sounds extremely difficult for your whole family, I am sorry.

Thank you, walking on eggshells is exactly right! I'll look up Contact, thank you for the link. I've been told they get better as they get older so here's hoping 🤞 I hope things get better with your daughter.

Wow that pretty much finished me off! Tough read. Thank you for sharing it.

I don't really know. CAMHS signed us off after the hospital visit. For all the blood they said the cuts were 'medically superficial,' she wasn't suicidal, she was attending and performing well in school so wasn't a severe case. They offered family counselling, which I've been asking our GP for for 10 months, so I jumped at it. Unfortunately for me family counselling is the counsellor seeing her for an hour, nothing for the rest of us. The only feedback I get is that she's agreed to another session. Obviously I understand that the counsellor can't tell me what they've discussed in the session, but I'd love it if she could give me any sort of hint, any crumb of information that I could use to make home life better. I tried a few local counsellor's but they were all full, not taking on new clients. Except for one, and when I explained she was autistic and self- harming he said it sounded too complicated!!!
I'll look up the DBT, thank you. I've been reading up on CBT, sequence repatterning therapy and all kinds, but I haven't come across that one yet.

Sorry everyone, I clicked 'reply' but it looks like I've not replied individually. First time on here! Apologies. Thank you all for taking the time to reply, it feels a bit less lonely here now xxx

She sounds like most 14 year old girls tbh.
When you said her counsellor told you she had autism, what professional qualifications does this counsellor have? Because it sounds like you’ve not actually had her assessed for autism. It’s important that this is done - a school counsellor generally is not able to do this. As a SENCo for many years, I’ve come across some awful school counsellors who think they know everything but get most of their information from the internet. A well trained, qualified counsellor would support your daughter in getting a proper ASD assessment.
If you do get a formal diagnosis, she should be able to access appropriate help for her self harming.
You should stop walking on eggshells with her. If she’s rude to you, pull her up on it. She eats her meals with the family, not in her room. As for the jumper episode, I’d be sending it straight back in she responded so rudely.

It depends why she is scratching or cuttig, sometimes its for the sensation, the feeling,, the relief or release. Its shocking to look at but in terms of injury or medical need its not high risk as was assessed previously

That doesnt necessarily mean it stays at that level of risk, it could change over time of course

In addition unfortunately the dynamic of self harm can often result in parents an carers walking on eggshells and being fearful of threats of self harm or actual suicide. I cant tell you the amount of times Ive heard (in my job), if you dont let me stay out/see this friendor adult/refuse school etc etc I will kill myself/cut myself

The result of this means that once you start not folowing through with appropriate boundaries and rules, the child is less protected and less 'held', not more held. A difficult line to balance. I would be pulling her up on her presentation to you and I would get her to wash the jumper if she wants to keep it

We had a similar journey last year so you have my sympathies. To add to it mine was anorexic and lost 8kg in 2 months. I was at my wits end not knowing what to do! Did all the counselling, not shouting, allowing them to get away with bad behaviour etc. But what helped most in my DD's case was just being there for her as a rock - sometimes just sitting with her in silence, sometimes just holding her hand, just giving her hugs for no reason (not taking no for an answer), praising her little good deeds, trying to talk and understand her triggers (mine isn't autistic but is an introvert and too much time at sch

Sorry OP, it's sounds really hard. My teen has adhd and says similar things - down to the moving out when he's 19 and never speaking to me again. He doesn't self harm though. He is unkind to me so often and then swings and speaks normally. We don't get any help other than meds which don't seem to work. Some behaviour seems similar to ODD, have you considered that?
can you get back in touch with school? Sometimes I think I just have to ride it out.

School or with friends just stressed her out.

There were no straight answers but we are beginning to see light at the end of the tunnel now. I think 13.5 to 14.5 was the worst period. Fingers crossed she doesn't relapse.

Good luck to you. Love/patience is the only answer.

I'm sorry I have no advice but just wanted to send my love to you. This sounds incredibly tough. Hoping you and your daughter get the support you need

Op please google OCD, inattentive ADHD and infant reflexes not going dormant and see if any of these applies.
My daughter has OCD and ADHD and its been tough - I think she takes it out on my sometimes because she knows our relationship is solid and has to mask for other people.
I think maybe its about chipping away at boundaries like saying 'I would like you to speak to me nicely please.' without waiting for a response and walking off so as not to engage in an argument. It's tough - my daughter has gotten better as she has matured my theory is if we stay solid she'll grow out of some of her behaviours plus she is having therapy.

I would make it clear you are not going to respond to emotional blackmail. If she wasn't self harming what would you do and do that.

The school years are the hardest for students with autism - so many demands and the need to do things that make you anxious and you don't want to do. It gets easier once they leave school - as adults, we are much more in charge of our environment and we can choose what to take part in to a great extent.
Has she been officially diagnosed or is it just the opinion of the school counsellor? I would start there if not. 'appearing fine' is not the same as being fine and the system is not designed for teens who are not disruptive enough to attract the attention of the health service sadly. I would start by looking at what makes her stressed - sensory needs are important. The feel of clothes, the smell of food, the noise, lights all can cause distress. If she can choose, what does she avoid? Sometimes you have to let go of societal norms and look at what suits your child. Conforming just because everyone expects it is not a good reason most of the time! Once we stopped trying to make my DD do things just because everyone expected it, rather than because it was actually important, made life much easier for her and therefore for us. Until the anxiety reduces, everything will be a battle, for you and for her. Be kind to yourself and each other and know that there will come a point when it is easier, it will just take time.

She sounds like most 14 year old girls tbh.

What? She absolutely does not. Why on earth are you minimising OP's situation and the girl's condition @Soontobe60 ?

@Soontobe60

As a 'senco of many years' I'm surprised you think a diagnosis is a gateway to support and that a school counsellor can support with an ASD diagnosis

As for eating with the gamy -or what? She doesn't eat?
Traumatic for everyone involved

The easy answer is that you have to stay totally calm in the face of her storm. Nigh on impossible to do, but that's what you have to aim for. I found it very hard to stay calm so DH would take over as he's calm personified.

I really feel for you as I was there 10 years ago, with a self harming autistic teen daughter on the path to self destruction, who absolutely hated me. But things do get better. They do find their feet and settle down. My DD now looks back and realises how bloody lucky she was to have me as her mum. I'm sure your DD will do the same.

Removing phones etc work with NT teens because the behaviour is likely to change. It’s not an approach that I found worked with an ASD teen because the behaviour didn’t change

We are going through similar with my DD. She was referred to CAHMS by the school after she admitted self harming to a teacher but they've not even called us yet and it's been 6 weeks. GP was helpful in that he gave us a private referral letter to a local children's psychiatric hospital and DH's health insurance has agreed to fund initial consultation and treatment - the wait is still three months though. She's already been waiting 14 months for treatment after being assessed by The psychology team at Great Ormand St for OCD and anxiety.

It's almost impossible to discipline or set any boundaries. She does absolutely nothing around the house and ignores all homework and revision. School won't push as they believe her mental health is the priority. She also has a chronic illness which was the trigger for her anxiety and as an adopted child she has all sorts of issues relating to that.

DH say's we have to look at positives because we can't control the negatives. She goes to school everyday , is happy when there , isn't taking drugs or getting into any trouble. She has nice friends and a social life.

I can't help but worry though as she will probably leave school with no qualifications due to this situation. She has a mild learning difficulty but could get level 4 GCSEs if she put the work in. At least your DD is getting on with school work - I'd forgive everything else if DD would at least do that.

The rudeness and hostility is unbearable and I am the main focus of that. She often makes me cry with her meanness. Even acts of kindness on my part are met with rudeness.

This week after another incident where she made me cry I got mad at her. I told her that I understand she has mental health issues but that doesn't give her the right to be rude. I listed everything we have done to help and support her and told her we have done everything in our power to help her and while we wait for professional help she is going to have to try harder to be kind to us.

She hasn't been rude since but she has still spent the weekend refusing to clean her room or do any homework.

It's all just so frustrating and you have my full sympathy OP.

I always find with my ASD girl that when they are anxious they try to pull back all control. This means that they want all control of everything and sometimes the anxiety also means they come across as rude.
This is not acceptable, but understandable. I try hard to remain calm, and explain what I need from her and why when it's calm.
There is no reason for her not to do housework or help. There is also no reason not to discipline and what she likely needs is more routine and structure.
As for the self harm, there is some great course and support out there. MIND is a good place to start, KOOTH, and YoungMinds.

This is interesting to read, as I've been having a tough weekend with DD (13) and she cut her arm for the first time in ages.

Her counseller (private) has suggested she might have ADHD but we haven't been to the GP for CAHMS referral yet. Last time we went to CAHMS DD refused to engage so they dismissed her 🤨

Her life sort of blew up when she started high school; it's really sad to see the difference in my happy girl when school starts back again.

Anyway...I don't know how much we do differently. She is still expected to do chores (although is constitutionally untidy so doesn't do them all that well) and rudeness isn't tolerated.

What scares me is that she goes to cutting when she feels bad about herself or something daft she's done. It's difficult to know where to understand and where to enforce, ie when it comes to attendance at school, for example.

I don't think I can go back though; if I don't try to keep her on the right path and treat her like the maturing girl she is, I think we'll have gone off in the wrong direction. And her little brother feels the chaos when it comes and that's not fair on him either.

She sounds like most 14 year old girls tbh.

She absolutely doesn't.

OP,
I highly recommend this private practise who do DBT. They do a course for adolescents- I wish I’d had access to something like that when I was a teen. DBT is very very different to CBT (and a lot more useful in my experience).

I’m aware I’m writing from a different perspective perhaps than most posters, perhaps- I’m in my mid thirties but am responding as a former teenage self harmer. It’s not ok, it’s not a chosen behaviour or just deliberate rebelliousness, as I think you get OP. I liked the posters who advocated for staying calm and also loving/warm, however hard that must be.