Discussion and Q&A with Sophie Koch, LCPC: Addressing and Supporting Your Child Through Self-Harm
How many times have you heard the phrase, “I just need to pinch myself back to reality,” and understood that the “pinch” is meant to ground someone when reality feels uncertain?
I often tell clients that splashing cold water on their face can help regulate body temperature and calm the autonomic nervous system during times of stress or anxiety. We might even gently slap our cheeks to “wake ourselves up.”
The idea of using brief physical discomfort to reconnect with the present moment is not unfamiliar to us.
During my time working in an intensive outpatient program for teens, I often heard the phrase, “Ms. Sophie, I don’t want to die. I just need to feel something.”
As humans, we know that pain—or any sudden sensory change—can profoundly reconnect the mind and body. In fact, self-induced pain has existed across cultures for centuries, with documented examples in ancient Greece, the Victorian era, ritualistic practices in Christian, Jewish, and Muslim traditions, and Indigenous spiritual ceremonies such as the Lakota Sun Dance.
This article is not intended to highlight or romanticize self-harming behaviors. Rather, it aims to challenge the misconception that self-harm is “something new” or “something we never did in my day.”
When a parent notices their child wearing long sleeves in the summer or discovers unexplained marks on their body, it is natural for fear to set in. Many parents immediately wonder, “What if they take it too far?”
Knowing the Difference Between Suicidal and Non-Suicidal Teen Self-Harm
This is where self-harm is often misunderstood as a direct path to suicide. In reality, many teens engage in self-harm to cope with overwhelming emotions they fear could lead to suicidal thoughts—or because they feel emotionally numb and are desperate to feel something.
The distinction matters.
Non-suicidal self-harm (NSSI) involves intentionally causing physical pain without the intent to die. It can include cutting, burning, hitting, pinching, banging against walls, picking at wounds or scars, or using objects to create pain.
As self-harming behaviors occur in as many as 1 in 5 adolescents, parents naturally ask how to respond, prevent future episodes, and help their child stop. Before we can do that, however, we must first understand why the behavior exists.
Understanding the Functions Behind Teen Self-Harm
Rather than viewing self-harm as simply “one step away” from suicide, it is often serving one or more important psychological functions:
- Grounding a teen who feels emotionally depleted, overwhelmed, or numb
- Regulating intense emotions during periods of distress or crisis
- Distracting from suicidal thoughts, intrusive thoughts, or substance cravings
- Making invisible emotional pain feel visible and tangible
- Communicating a need for help when a teen feels they have been carrying too much for too long without enough support
- Punishing themselves in response to low self-esteem, perfectionism, body image concerns, or deep self-criticism
The point is not to minimize the seriousness of self-harm. However, before sounding the alarm, it is important to understand your child’s triggers, needs, and reasons for engaging in the behavior. Doing so creates an opportunity to connect, problem-solve, and approach recovery as a team.
In this Q&A, teen therapist Sophie Koch, LCPC, discusses how parents can support teens in managing overwhelming emotions and self-esteem struggles while maintaining both safety and respect for their child’s growing autonomy.
Q: My teen is self-harming. How do I know if they are suicidal?
A: To be completely transparent, self-harming does not automatically mean a teen is suicidal. However, self-harm is associated with an increased risk of suicidal thoughts and behaviors, making it important to take seriously. Research suggests that approximately 70% of teens who self-harm report at least one suicide attempt, and 55% report more than one.
As parents, it is natural to want the risk to disappear as quickly as possible. However, addressing the behavior without understanding its purpose can unintentionally reinforce the factors contributing to it.
For many teens, self-harm provides a temporary sense of control during a time when they feel powerless. Rather than assuming intent, ask questions with curiosity and compassion.
If your teen expresses hopelessness, talks about feeling like a burden, withdraws from others, gives away belongings, or verbalizes a desire to die, seek professional support with a mental health care provider who specializes in teen mental healthcare and self-harming behaviors.
Otherwise, remember that non-suicidal self-harm and suicidal intent are related—but they are not the same.
Q: My teen knows that self-harm is dangerous but can’t stop. What do I do?
A: This is one of the most common questions I receive from parents. One of the biggest misconceptions is that successful treatment begins by immediately eliminating the behavior. More often, treatment starts by understanding how the behavior started and how it is being reinforced.
I often compare self-harm to an addiction. Even when a teen knows it is harmful, the temporary relief it provides reinforces the self-harm cycle and makes it difficult to stop.
The cycle often looks like this:
- Emotional pain or overwhelming stress
- Feeling unable to cope
- Self-harming because it has worked before
- Temporary relief, release, or the ability to “feel something”
- Shame, guilt, or disappointment afterward
- Emotional distress returns, restarting the cycle
Understanding this cycle shifts the conversation from, “Why would my child do this?” to “What need is this behavior meeting?” Once we understand the function of the behavior, we can begin replacing it with healthier coping strategies that meet the same need.
Q: Should I take away the source of the self-harm?
A: Safety is always the priority, but how we create safety matters just as much as what we do.
This article is not suggesting that parents allow self-harm to continue unchecked. Instead, it is emphasizing that responding with punishment, shame, or complete loss of control often causes teens to withdraw, making honest conversations and progress more difficult.
If your teen has access to sharps, lighters, or other items they have used to self-harm, involve them in creating a safety plan whenever possible. Talk openly about what items need to be temporarily secured, where they will be stored, and what expectations need to be met before access is restored.
Many teens describe treatment for self-harm as feeling infantilizing. While parents are trying to increase safety, teens often experience it as another loss of independence.
Inviting your teen into the conversation helps preserve trust while reinforcing that the goal is safety—not punishment.
Being transparent about your decisions also reduces secrecy. Explain what is changing, why it is changing, and what your teen can expect moving forward. Even during difficult conversations, collaboration builds far more trust than control alone.
Q: My teen says they can’t stop and that self-harm is the only thing that works for them. How can that be true?
A: This is another common question I hear from parents of teens who self-harm. It can be incredibly difficult to understand how something that causes pain can also provide relief.
To understand this, it helps to look at what happens in the brain and body during self-harm. When someone self-harms, the body can release endorphins and other neurochemicals that create a temporary sense of calm, relief, or even emotional release. For a teen who feels overwhelmed, numb, or disconnected, that shift can feel powerful.
Joseph Franklin’s concept of “pain-offset relief” helps explain why this cycle can become reinforcing. When pain is repeatedly paired with relief, the brain can begin associating the painful stimulus with emotional regulation.
For example, imagine a teen self-harms for the first time after a painful argument. They experience physical pain, but they also experience a temporary decrease in emotional distress.
Over time, their brain may begin to recognize self-harm as a reliable way to escape overwhelming emotions.
This does not mean a teen wants to self-harm or that they are choosing to suffer. It means their brain has learned that this behavior provides immediate relief. Treatment focuses on helping teens build additional tools that provide relief without causing harm.
Q: I understand why my teen self-harms, but I still don’t know what to do. How do I help them?
A: The way we respond to self-harm can significantly impact whether a teen feels safe enough to seek help, and understanding self-harm is the first step toward changing it.
Many parents understandably respond from a place of fear. However, when a teen experiences yelling, judgment, panic, or assumptions that they are “doing it for attention” from their parent, they are more likely to hide their struggles rather than share them.
Instead, begin with curiosity and validation. Let your teen know that you want to understand what they are experiencing and what the behavior is helping them manage.
When parents understand the purpose behind the behavior, they are better able to respond in ways that reduce shame and increase connection.
One important thing to remember is that self-harm urges are often temporary. Research suggests that urges typically peak within 5–15 minutes after they begin, meaning early intervention with alternative coping strategies can be incredibly helpful in riding out the wave of urges and emotions.
The goal is not simply to tell a teen, “Don’t do it.” The goal is to help them find something else that meets the same need.
Safer Coping Strategies for Teen Self-Harm
If your teen is seeking a strong sensory experience to feel grounded, alternatives may include:
- Holding an ice cube or placing ice on the skin to create a strong but safe sensation.
- Eating sour candy to provide an intense sensory experience that redirects attention.
- Using a fidget or another hands-on activity to occupy the body while emotions settle.
It is also important to create a safety plan with your teen. Ask questions such as:
- “What was happening before you felt the urge?”
- “What does self-harm do for you in that moment?”
- “What feelings are hardest to sit with?”
- “What could help you feel supported when urges come up?”
Creating a safety plan together can also help your teen feel more involved and less powerless.
Discuss who they can reach out to, what coping strategies feel realistic, and what language feels supportive when talking about urges. This includes identifying:
- Who they can contact when urges increase
- What emotions or situations commonly trigger urges
- Which coping skills match different emotional needs
- How they can communicate when they are struggling
When a teen experiences an urge, helping them name their emotions and rate the intensity of the urge on a 0–10 scale can create distance between the feeling and the action.
Expanding the Toolkit Beyond Teens’ Self-Harm
Before assuming a teen needs emergency hospitalization, consider involving their existing supports, such as their therapist, pediatrician, or school counselor, in a way that respects your teen’s voice and collaboration. Therapy can help reduce self-harming behaviors, strengthen coping skills, and help teens understand the emotions and experiences driving their urges.
Ultimately, treatment begins with understanding the behavior—not treating it as a problem that needs to be hidden or punished.
More often than not, teens self-harm because it has become the only tool in their toolkit that feels like it works.
That is why, in working with teens and young adults that self-harm, our initial goal is to add other tools to the toolkit so that self-harm is not the first and only resource they have in their back pocket.
Meet Sophie Koch, LCPC – Teen Therapist
Sophie creates a trauma-informed, affirming, and holistic space where clients feel seen, supported, and understood. Her collaborative approach combines evidence-based practices with creativity, humor, and authentic connection to foster resilience, self-understanding, and values-based growth.
She specializes in supporting clients navigating identity development, self-esteem concerns, life transitions, and the challenges of being neurodivergent in a largely neurotypical world.
Whether clients are new to therapy or returning after previous treatment, Sophie brings experience from high-acuity settings and a flexible, grounded approach to helping people make sense of difficult experiences and build meaningful lives.
Sophie provides both in-person and virtual individual therapy for teens, children, young adults, and adults, making support accessible from home or at our Baltimore office.
Whether you’re seeking support for yourself, your child, or your teen, Sophie is here to support you. Schedule a free 15-minute consultation to get started.
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