Tina, 14, is self-harming. How can a therapist win her trust that others can help?

‘These children can find themselves at the mercy of their emotions, consumed by rage, sadness and a raft of difficult feelings that they cannot regulate or manage.’ Photograph: Antonio Guillem Fernández/Alamy

Self-harm as a coping mechanism can be distressing and difficult to understand. Yet 12% of young Australians report having self-harmed on at least one occasion, most commonly via cutting. While we might associate such acts only with pain, cutting can release stress- and pain-reducing hormones and thus can have an addictive quality. Though the person cutting may experience emotional relief it is easy for parents and even mental health workers to view it as an act of aggression aimed at gaining attention and inducing distress. Indeed, cutting can serve as a impactful form of communication.

But communication is usually a secondary aim, even if this communication is powerfully felt by others. First and foremost, cutting is an attempt to deal with overwhelming feelings. Physical pain is preferred to psychic pain and, for some, seeing the blood and the scars allows the pain and anger felt inside to appear on the outside. This proved to be the case with my 14-year-old client, Tina*.