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Self-Harm Conversation Prompts

The examples below provide an outline of conversations, please also consider the following factors and think about how they may influence your conversation:

  • Choice of language – are the words appropriate for the child’s age and comprehension.
  • Tone of voice.
  • Body language.
  • Non-judgemental approach to ensure the child does not feel stigmatised.
  • Environment.
  • Timing.
Topic Prompt Questions
  • ‘I appreciate that you may tell me this is in confidence but it’s important I let you know that your safety will always be more important than confidentiality. If I am sufficiently worried that you may be feeling unsafe or at risk of hurting yourself, part of my job is to let other people who can help you know what’s going on but I will always have that discussion with you before and let you know what the options are so that we can make these decisions together’.
Starting the conversation / establishing rapport
  • Let’s see how we can work this out together. I may not have the skills to give you the help you need, but we can find that help for you together if you would like?
  • Use active listening – for example: can I just check with you that I have understood that correctly?
The nature of self-harm
  • Where on you body do you typically self-harm?
  • What are you using to self-harm?”
  • Have you ever hurt yourself more than you meant to?
  • What do you do to care for the wounds?
  • Have your wounds ever become infected?
  • Have you ever seen a doctor because you are worried about a wound?
Reasons for self-harm
  • I wonder if anything specific has happened to make you feel like this or whether there are several things going on at the moment? For example, peer relationships; bullying, exam pressure, difficulties at home, romantic relationship break-up, substance misuse or abuse.
Coping strategies and support
  • Is there anything that you find helpful to distract you when you are feeling like self-harming? Perhaps listening to music, playing on your phone, texting a friend, spending time with your family, reading, going for a walk etc?
  • I can see that things feel very difficult for you at the moment and I am glad that you have felt able to talk to me. Is there anyone else that you have found helpful to talk to before or is there anyone that you think maybe good to talk to? How would you feel about letting them know what’s going on for you at the moment?
  • How could we make things easier for you at school?
  • What feels like it is causing you the most stress at the moment?
  • What do you think would be most helpful?
Speaking to parents/carers (where appropriate)
  • I understand that it feels really hard to think about telling your parents, but I am concerned about your safety and this is important. Would it help if we did this together? Do you have any thoughts about what could make it easier to talk to your parents?
Ongoing support
  • Why don’t we write down what we have agreed as a plan together, then you have a copy that you can look at if you need to remind yourself about anything. Sometimes, when you are feeling low or really want to self-harm, it is difficult to remember the things that you have put in place – this can help remind you.