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Confidentiality With Self-Harm

by Kristina Randle, Ph.D., LCSW

Hi. I’m going to be 18 in a week, and… well, how do I start? I’ve been cutting (sometimes making myself bleed with scissors, nail files, plastic knives, safety pins, paper clips, etc.) since I was 12. And it’s sort of been going on intermittently since then. I have multiple diseases, and I’m pretty sure I have depression, although I’m on Cymbalta now and that used to help. But I think family problems are getting too out of control now. Anyway, I want to tell my psychologist that I’m cutting, and I’m probably going to start again because of things going on, but I don’t want him to tell anyone. I have an appointment three days before I turn 18. If I tell him when I am 17, will he tell my parents? And if I wait until after I turn 18, will he not tell anyone? I’m not going to kill myself, and I am never in danger of dying.

In all likelihood, your therapist would not inform your parents that you are cutting. Generally, therapists cannot reveal that type of information if the client has not given their permission to do so. If you had a definitive plan to end your life, your therapist is legally bound to inform the authorities and would likely tell your parents. In most cases, cutting is a form of self-harm or self-punishment and not an attempt to end one’s life. Most therapists understand the distinction.

It will be difficult for your therapist to effectively help you if you don’t report the cutting behavior. I understand that you are worried about your parents finding out but it only prolongs your recovery. Therapy is confidential except in cases that involve serious threats of suicide or homicide. You could ask your therapist what type of information he or she would report to your parents.

It’s important to tell your therapist and your prescribing physician that the Cymbalta is no longer working. The medication may need to be adjusted. The fact that you no longer believe that your medication is working might explain why your desire to cut has returned.

An unfortunate number of people, especially young adults, engage in cutting and other self-harm behavior. It is dangerous and ineffective. Some report that it provides temporary relief but it never solves the problem. Cutting is a sign that an individual is suffering and a sign that he or she has not yet developed healthy emotional regulation skills. These skills can be learned if you utilize the therapy resources available to you. I hope you are able to receive the help that you desire.

I wish you the best of luck. Please take care.

Dr. Kristina Randle

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