Discovering One's Own Way: Adolescent Girls' Different Pathways Into and Out of Self-Harm

摘要

Self-harm is associated with mental illness and suicide risk. The present study aims to increase knowledge of adolescent girls' pathways into and out of self-harm. The participants were 19 girls, 13 to 18 years of age, who were strategically selected from an outpatient care unit. A naturalistic multiple case study was done with personal interviews. The interviews were analyzed using Interpretative Phenomenological Analysis, and the capacity for "mentalization"-representation of behavior in terms of mental states-was measured with the Reflective Functioning Scale. The analysis of the topic "beginning self-harm" resulted in two meta-themes: (a) beginning self-harm as a way to handle difficult feelings and relational problems and (b) becoming influenced by peers to experiment with self-harm. The analysis of the topic "quitting self-harm" resulted in three meta-themes: (a) ambivalence toward help, treatment, and ending self-harm; (b) finding one's own way of quitting self-harm; and (c) exploring self-harm together with the therapist. Three case stories illustrate variations in trajectories of change and capacity for mentalization. The findings suggest that self-harm may be a way of handling developmental challenges in autonomy and identity formation during adolescence. Adolescents need an opportunity to discover their own way of quitting self-harm. Variations in mentalization may provide for different pathways.