Understanding adolescents' experiences of self-harm: secondary analysis of Family Therapy sessions from the SHIFT trial

Research suggests that self-harming behaviour has increased and rates of self-harm are consistently higher in adolescence compared to adulthood. Understanding why adolescents engage in self-harming behaviour is important. Adolescents who self-harm are at higher risk of a repeated episode and self-harm is a key risk factor in completed suicide. Only a small number of studies have directly explored adolescents’ views of their self-harm using first-hand accounts. Data was gathered via a secondary analysis of video-recorded Family Therapy sessions collected as part of the Self-harm intervention: Family Therapy. Session recordings of 22 participants, approximately 170 hours of footage, formed the dataset. Data was only transcribed data for later analysis if the adolescent was directly involved in the conversation. Using thematic analysis to analyse the data, five core themes were developed; (1) Distress can be difficult to convey (2) Self-harm and suicidal ideation; a complex relationship (3) Self-harm as a form of communication (4) Self-harm to manage emotions and (5) Moving forward. Prominent social discourses around self-harm resulted in some adolescents attempting to manage alone and fearing the consequences if they talked about self-harm. Accounts highlighted the complex interplay between self-harm and suicidal intent; for some this fluctuated across episodes of self-harm. Self-harm was a means of communicating distress as well as managing emotions. Encouragingly, many participants described being able to resist self-harm, often mirroring why some adolescents harmed themselves in the first place. Findings from the analysis are discussed in relation to the literature along with strengths, limitations, clinical implications and future research.