Understanding Self-Harm
Treatment available in Washington State
If you're hurting yourself, you're not doing it because you're broken or necessarily because you want to die. You're doing it because it can help in the moment, in the short term. It may provide relief from unbearable emotional pain, a way to feel something when you're numb, a sense of control when everything else feels chaotic, or a way to communicate how much you're hurting when words don't seem to reach anyone.
Understanding in what way self-harm works is the first step toward finding alternatives that work without the cost.
You may have tried to stop on your own and found it harder than you expected. You may feel ashamed of the marks it leaves, or scared by how much you've come to depend on it. You may have been told to "just stop" by people who love you — and you know they mean well, but their frustration doesn't give you anything to replace it with.
Effective help for self-harm exists. The goal isn't to shame you out of it or take away your only coping strategy without giving you something better. The goal is to help you build a set of skills that make self-harm unnecessary — because you have other ways to manage what you're feeling.
Understanding Self-Harm
Non-suicidal self-injury (NSSI) — including cutting, burning, hitting, scratching, or other forms of self-inflicted physical pain — is more common than most people realize. Research suggests that roughly 17% of adolescents and 13% of young adults engage in self-harm at some point. It occurs across all genders, backgrounds, and demographics.
Self-harm is not the same as suicidal behavior. Most people who self-harm are not trying to end their lives — they're trying to manage a life that feels unbearable in the moment. That said, self-harm is a serious concern that deserves compassionate, specialized attention. It is a signal that something is significantly wrong and that safer coping tools are urgently needed.
Self-harm commonly serves one or more of these functions:
Releasing or reducing overwhelming emotional experience
Interrupting emotional numbness or dissociation — using physical sensation to feel real again
Punishing oneself for perceived failures or flaws
Communicating the severity of emotional pain to others
Feeling a sense of control when circumstances feel uncontrollable
Providing a predictable, reliable source of relief in a life that feels chaotic
When you work with a therapist to help understand what function self-harm serves for you specifically, it becomes possible to find alternatives that serve the same function — without the physical harm, the shame, or the escalating dependency.
Why Stopping Is Hard
Many people feel frustrated with themselves for not being able to simply stop self-harming. It's important to understand why stopping is genuinely difficult:
Self-harm produces a real physiological response — the release of endorphins and the activation of the body's pain-response system can create a powerful sense of relief or even calm. This isn't weakness; it's biology. Your brain has learned that self-harm is a fast and reliable way to change how you feel.
Additionally, if self-harm is your primary or only way of managing intense emotions, stopping it without learning alternatives leaves you with nothing to use when emotions become overwhelming. This is why approaches that simply focus on stopping the behavior without addressing the underlying emotional pain tend to fail.
How We Treat Self-Harm
Dialectical Behavior Therapy (DBT) is the most evidence-based treatment for non-suicidal self-injury and is the primary approach we use. DBT was developed specifically for people who struggle with intense emotions and self-destructive behaviors, and it directly targets both the emotional dysregulation that drives self-harm and the behaviors themselves.
Treatment involves:
Individual therapy — Weekly sessions with a therapist who helps you understand the specific patterns driving your self-harm — what triggers it, what function it serves, what happens in the chain of events leading up to it — and who supports you in finding and practicing alternative responses.
Skills training group — Learning and practicing concrete skills in four areas: mindfulness, distress tolerance (crisis survival skills that don't involve self-harm), emotion regulation, and interpersonal effectiveness.
Phone coaching — Between-session support so you can reach your therapist when urges are highest and get real-time help using skills instead of self-harming.
Consultation team — Your therapist is supported by a team of DBT clinicians, ensuring you receive consistent, high-quality care.
You can learn more about DBT here.
Who We Treat
We treat adolescents (ages 13+) and adults who self-harm, in-person in Ruston, WA and via telehealth across Washington state. Self-harm in adolescents is treated within a family model — parents attend skills group and learn the same skills, which is essential for creating a home environment that supports change.
Frequently Asked Questions
Do you treat self-harm in teenagers and adolescents? Yes. We treat adolescents ages 13 and up who self-harm, both in-person in Ruston, WA and via telehealth across Washington state. DBT for adolescents who self-harm includes the whole family — parents attend multi-family skills group and learn the same DBT skills their teen is learning. This is one of the most important parts of treatment, because it means the home environment supports change rather than inadvertently working against it. If your teenager is self-harming and you don't know how to help, please reach out.
Do you offer self-harm treatment via telehealth in Washington state? Yes. We provide DBT for self-harm via telehealth to clients anywhere in Washington state, including Seattle, Spokane, Olympia, Bellingham, the Tri-Cities, and communities throughout the state. In-person services are also available at our office in Ruston, WA near Tacoma. Phone coaching between sessions is available regardless of whether your primary treatment is in-person or via telehealth.
What treatment approach do you use for self-harm? DBT is the most thoroughly researched and effective treatment for non-suicidal self-injury and is our primary approach. DBT directly addresses both the emotional dysregulation that drives self-harm and the behaviors themselves — through individual therapy, skills group, and between-session phone coaching. Our founders are certified DBT clinicians through the DBT-Linehan Board of Certification, and DBT was originally developed specifically for people struggling with self-harm and suicidal behavior.
How is DBT different from other therapy approaches for self-harm? Many therapy approaches treat self-harm by focusing on insight, processing emotions, or developing a safety plan. DBT does these things too, but it goes further by directly teaching practical alternative skills — concrete strategies for surviving emotional crises without self-harming, and for reducing the emotional intensity that makes self-harm feel necessary. DBT also includes between-session phone coaching, which means you have access to support when urges are highest — not just during your weekly appointment. Research consistently shows DBT reduces self-harm more effectively than other therapy approaches.
My teenager is self-harming. Should I take away sharp objects and watch them constantly? This is one of the most common questions parents ask, and the answer is nuanced. Some safety precautions make sense, but surveillance and removal of all possible means rarely solves the underlying problem and can significantly damage your relationship with your teen — which is one of the most important protective factors for their recovery. The most important things you can do are: take it seriously without overreacting in ways that shut down communication, seek specialized professional help promptly, and stay connected with your teen so they feel safe coming to you. We can give you much more specific guidance during a consultation.
I'm not sure I want to give up self-harm — it's the only thing that helps. Can I still come to treatment? Yes. Ambivalence about giving up self-harm is extremely common and completely understandable — it has been serving a function, and the prospect of losing it can feel frightening. DBT doesn't require you to have already committed to stopping before you start. We begin with a pre-treatment phase that involves building motivation and commitment together, understanding what self-harm does for you, and beginning to identify alternatives. We ask for a commitment to work toward reducing self-harm — not a guarantee that you'll never do it again.