Tell Me About It: How do I tell my family I self-harm?

Q Since January I have been going to regular psychotherapy sessions for self-harm. While I have yet to fully recover, I have found it to be a great help. Rationalising things with my psychotherapist is helping me to live my own life and sort out my past, present and future.

However, my family do not know about it. I don’t know how or when to tell them. I feel afraid about “coming out” about my self-harm. I’m afraid my family will be worried or angry, or will treat me like I’m made of glass. Will they blame themselves? I don’t want that. Sometimes when I’m stressed and people are being unreasonable, I want them to know about my issue. But I’m afraid they won’t understand. It’s a big thing to land on someone.

A You are choosing to be courageous and positive by reaching out through this question, with the knowledge and hope, I expect, that it will help others to understand your situation. More importantly, you are participating in regular psychotherapy. You are putting your all into the process, and that takes bravery and perseverance.

Now you are at the point where you want to be open with your family, but you are afraid.

"It is very normal to have these fears, as very often a feeling of shame is connected to self-harm," says Marguerite Kiely, clinical manager at Pieta House, which works with people who self-harm and have suicidal thoughts.

Feelings of shame often accompany mental ill-health. Despite the awareness campaigns around depression, anxiety and other problems, people still fear the lingering stigma around mental ill-health.

Self-harm is secretive by its very nature. While 12,000 cases of self-harm are medically treated annually in Ireland, a further 60,000 cases are "hidden", says Ella Arensman for the National Suicide Research Foundation.

You say that when you are stressed and people are being unreasonable, you want them to know about your self-harm but are afraid they will not understand.

“Family members may lack information regarding the purpose of self-harm as a coping mechanism,” says Kiely. Together with your therapist, you could spend time in your sessions role-playing how you would address this, says Kiely.

It is important you are ready before you tell your family so you have the strength and the skills to deal with their reaction. You say it’s a heavy thing to land on someone, but that’s what family is for. If I were your parent or sibling, I would want to know what’s going on with you.

“We here in Pieta offer family support, and we find that families are so supportive and can be such an important part in the client’s healing,” says Kiely. Understanding, and being allowed the opportunity to help, brings families closer. Not knowing increases anxiety and isolates the client.”

One resource she recommends to help your family understand is a book by Joan Freeman, founder of Pieta House, called Cover Up. Kiely says she will send you a copy if you get in touch with her. She also says she would be happy to meet with you at Pieta to address your specific concern of how to disclose your self-harm to your family, without interfering with your one-to-one therapy.

Since most self-harm is hidden, families and friends may feel as awkward as you do about raising the issue. They may suspect self-harm without knowing for certain.

Family members can help their loved ones to think about self-harm not as a shameful secret but as a problem that can be solved. That doesn’t mean the family member has to solve it.They need to understand that self-harm is complex and doesn’t stop overnight.

All family members need to offer is love and acceptance. They need to understand they are not responsible for the self-harm and they cannot stop it. That’s up to the person who is self-harming, who should seek help, as you have.

You must get on with your own life, which will be easier once the elephant in the room has been acknowledged. The best thing anyone can do for a person suffering from inner turmoil is to spend time with them without trying to figure out their problems. Leave that to the professionals. pieta.ie

Email your questions to tellmeaboutit@irishtimes.com or contact Kate on Twitter, @kateholmquist. We regret that personal correspondence cannot be entered into