Bringing forth stories of blame and shame in dialogues with families affected by adolescent self‐harm

Abstract

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.

Non-suicidal Self-Injury in Clinical Practice

“…Notable is that the NSSI group relatively often used the coping skills self blame, acceptance, putting in perspective, and less positive re-interpretation and less blaming others. Especially for adolescent girls, it seems important to change the negative coping strategies such as self-blame as adolescence is the period when NSSI, personality disorders ( Tyrer et al, 2015 ; Amoss et al, 2016 ) and several major mental health disorders develop ( Kessler et al, 2005 ). Prevention and treatment interventions can target these coping skills to prevent NSSI behaviour.…”

Rite of passage for care leavers

“…Early difficult lives have usually left the young people in care coming to therapy extremely sensitised to blame and shame, and their emotional reaction to these has often led to disrupted relationships and rejection (Amoss et al, 2016). Often, people who have been in care go on to engage in criminal activity, a trajectory which many, including one in the case studies below, start on whilst still in care.…”

Adolescent Self‐cutting: An Embodiment of the Unsaid

“…Hannen and Woods () use a narrative therapy intervention to improve resilience, emotional well‐being, and behaviour in adolescents who self‐cut. Amoss, Lynch, and Bratley's () study of self‐harm interventions in family therapy explores the connections between shame, blame, and emotional regulation.…”

“…Hannen and Woods (2012) use a narrative therapy intervention to improve resilience, emotional well-being, and behaviour in adolescents who self-cut. Amoss, Lynch, and Bratley's (2016) study of self-harm interventions in family therapy explores the connections between shame, blame, and emotional regulation. Morales (2008) proposes understanding self-cutting through three key elements: socio-cultural context, family structure or dynamics, and individual psychological traits.…”