Feelings of blame and shame seemed to figure significantly in the interactional patterns of some families seen within the self-harm intervention family therapy (SHIFT) trial. Taking the SHIFT manual as a starting point, we elaborate the links between blame, shame, emotional regulation and adolescent self-harm, drawing on various theoretical models. We note the importance of attending to these emotional processes both in the family and the therapy team, arguing that these unhelpful patterns of interaction, emotion and meaning-making may also signal a motivation for change. We offer some ideas about using blame and shame as platforms for understanding and intervention in the context of adolescent self-harm and illustrate the application of these ideas with case vignettes.Practitioner points • Consider offering the young person and parents parallel sessions to scaffold better communication in family sessions. • If you can, work with a team to help reflect on your own emotional responses and their meanings. • When attempts to lessen blame provoke more, try to understand what underlies blaming behaviour. • When a family's reported lack of difficulties seems incongruent with the presence of self-harm, consider the possible silencing effect of shame.

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