How to Create a Treatment Plan for Self-Harm

Self-harm behaviors are a significant global health concern. While self-harm can be tied to an attempted suicide, there has been a rise in non-suicidal self-injurious behaviors. Studies have shown that adolescents have the highest rate of self-harm, though it can occur with clients of varying ages. Additionally, hospital admission rates for youth struggling with suicidal ideation have doubled over the last decade. Keep reading to learn how I create treatment plans for self-harm. Keep reading to learn how I create a treatment plan for self-harm that you can use to better support your clients’ safety, healing, and emotional well-being.

The driving forces behind self-harm tend to differ between boys and girls. Studies have shown that for younger generations,  girls’ self-harming behaviors are driven by interpersonal reasons, such as expressing that they’re struggling and to relieve tension. Boys are more likely to want to scare someone or have underlying suicidal intent. It is important to be mindful of these differences because they can have a direct impact on your treatment plan for self-harm.

Examples of treatment approaches I may consider for clients who struggle with self-harm include Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and interpersonal therapy. Other popular options include psychodynamic therapy, family systems therapy, and parent training interventions for youth and adolescents. These approaches can be used in inpatient and outpatient treatment settings, depending on the severity of distress and risk concerns. Depending on the client, I may blend the use of psychotherapy,  group therapy, and psychiatric services to ensure comprehensive care. For even more tools, check out my resource on self-harm / suicide risk assessment questions I ask clients.

Setting Goals and Objectives With Clients in Your Treatment Plan for Self-Harm

When I begin developing a counseling treatment plan for self-harm, I start by considering my client’s development, especially with self-harming behaviors being more common among youth and adolescents. I take my time to ensure that I align treatment plan goals with my clients’ presenting symptoms, and that they are realistic and measurable. As I continue working with clients, I conduct treatment plan reviews to assess their progress and make necessary changes.

Incorporating worksheets into my sessions promotes session engagement and reinforces the material that we focus on in my clients’ home environment. Many have shared that worksheets are a valuable reference for them and can help them implement healthy changes into their daily routine. TherapyByPro is a valuable professional resource offering a range of resources, including customizable documentation forms and therapeutic worksheets. Examples of worksheets that I may incorporate into a treatment plan for self-harm include:

What to Include in a Treatment Plan for Self-Harm + Example

As we begin to outline our counseling treatment plan for self-harm, begin to brainstorm how you could use this template in your clinical practice. TherapyByPro offers a customizable treatment plan template that is easy to use. You can edit this form as needed to align with your clinical setting and clients’ presenting problems. Continue reading for a hypothetical case for Jane.

Example for Jane:

Jane is a 17-year-old female who presents with persistent low mood and feelings of sadness at an inpatient treatment program. Her symptoms began approximately four months ago and include social withdrawal, loss of interest, fatigue, decreased appetite, and unintended weight loss. She has also struggled with concentration, which has contributed to a decline in her academic performance. Her parents are concerned about how this decline will affect her college applications.

In addition to depressive symptoms, Jane engages in non-suicidal self-injury (NSSI) behaviors, specifically cutting her arms and thighs. Jane noted that she has passive thoughts of suicide, and denied having suicidal intent or a suicidal plan. Her relationship with her parents has become strained due to her irritability, social withdrawal, drop in grades, and her self-harm behaviors.

Jane has no history of mental health treatment or psychiatric medications. Jane noted that her self-injurious behaviors help her cope with emotional distress. She struggled to identify healthy coping skills for distress and noted that she often feels misunderstood.

Agencies Involved and Plans for Care Coordination

Since Jane is a minor, it is appropriate to coordinate care with her primary care physician. I make sure that I have the proper consents before proceeding. With an inpatient care program, she will have access to psychiatric services, which do not typically require consent for release.

Example for Jane:

Care Coordination: Primary Care Physician, Dr. Smith (123)456-7890

Clinical Diagnoses

Based on the information provided, Jane appears to be struggling with major depressive disorder. This diagnosis is supported by her depressed mood, low energy, irritability, and loss of interest. Additional symptoms include indecisiveness and poor concentration. Her symptoms cause impairment at school and in social settings. Because she experiences more than five symptoms for more than 2 weeks, she meets the criteria for MDD. Additionally, you can note NSSI as a secondary diagnosis because it is noted as a condition for further study in the DSM-5 Section II.

Example for Jane:

Clinical Diagnosis: Major Depressive Disorder, Recurrent, Moderate (F33.1). Other Specified Depressive Disorder (with Non-Suicidal Injury) (F32.89)

Current Medications and Responses

Upon admission, Jane will have a psychiatric assessment. This may lead to the use of psychiatric medications. Medications and their dosages may be adjusted based on her response, and the dosages would need to be updated to reflect these changes.

Example for Jane:

Current Medications: Fluoxetine, 10 mg once per day

Presenting Problem and Related Symptoms

For the presenting problem of my treatment plans, I provide a clear and detailed description of my client’s symptoms, severity, and functioning level. This case conceptualization ties directly to the goals and objectives noted in later sections of my treatment plan. 

Example for Jane:

Jane is a 17-year-old female who was admitted to an inpatient treatment program after the recent discovery of non-suicidal self-harm behaviors. She endorsed persistent depressive symptoms, including sadness, withdrawal from peers, irritability, poor concentration, and decreased appetite. Her symptoms have progressively worsened over several months and have led to a decline in academic performance, which her parents worry may affect future college opportunities. Jane explained that her self-harm was a coping strategy for emotional pain and denied a desire and intent to die.

Jane’s symptoms are consistent with Major Depressive Disorder, Recurrent, Moderate, as well as Non-Suicidal Self-Injury (NSSI). Jane noted that she struggles with intense emotions, low self-worth, and anxiety regarding her grades. She identified her family as her primary support system, though they have experienced increased tension in recent weeks.

Jane is motivated to engage in treatment and would like to learn healthier coping skills to avoid the use of self-harming behaviors. Evidence-based therapies, such as Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT), can be used to stabilize her symptoms and introduce new coping strategies. Family involvement is recommended to address recent tension, improve communication, and create a healthier family unit for everyone.

Goals and Objectives

Goals and objectives in my treatment plans for adolescent self-harm are mindful of my client’s development, emotional insight, and motivation for change. The treatment plan goals and objectives vary for each of my clients, ensuring personalized care tailored to their specific needs. I typically use treatment plan reviews as a time to check in on their progress and realign regarding their goals and setbacks. This can lead to adjustments to their identified goals and objectives. 

Example for Jane:

Goal 1: Decrease depressive symptoms with healthy coping skills

• Objective 1: Identify and label 3 emotions that cause distress each week
• Objective 2: Learn 2 new coping skills for each of the identified emotions
• Objective 3: Engage in one enjoyable or pleasurable activity daily

Goal 2: Replace non-suicidal self-injury behaviors

• Objective 1: Identify 3 triggers for self-harming behaviors, including thoughts, emotions, and environmental factors
• Objective 2: Create a safety plan
• Objective 3: Increase emotional expression with expressive therapies
• Objective 4: Use two DBT distress tolerance skills per week

Goal 3: Improve academic performance

• Objective 1: Attend one activity/club meeting/ sporting event/ etc. per week to decrease isolation
• Objective 2: Identify 3 barriers that could prevent improved grades
• Objective 3: Identify 2 healthy supports or resources at school that can be helpful when distress arises
• Objective 4: Create a healthy bedtime routine to promote quality rest

Specific Interventions to Be Used

I use this section of my treatment plans to outline specific interventions that I plan to use to help my client achieve their goals. I find it helpful to note who would be responsible for completing the action. In most cases, when my client is responsible for something, I will ask them to complete it as homework before their next session. During their next session, I will typically begin by checking in on their homework and processing their experience with it. You can update this section as needed as they progress in treatment.

Example for Jane:

1. DBT Emotion Regulation Module

The client will participate in the Dialectical Behavior Therapy (DBT) emotion regulation module to build skills in identifying, understanding, and managing intense emotions in adaptive ways.

Responsible Person: Counselor

2. Behavioral Activation

The client will engage in scheduled pleasant and mastery activities to counteract withdrawal and low mood, increasing opportunities for positive reinforcement and environmental engagement.

Responsible Person: Jane

3. CBT Cognitive Restructuring

The client and counselor will collaboratively identify and challenge distorted automatic thoughts and core beliefs using cognitive restructuring techniques to promote more balanced and realistic thinking patterns.

Responsible Person: Counselor and Jane

4. Journaling

The client will maintain a daily thought and emotion journal to increase self-awareness, track patterns in mood and behavior, and facilitate discussion of cognitive and emotional experiences in session.

Responsible Person: Jane

5. Safety Planning

The client and counselor will develop and regularly review a personalized safety plan that includes warning signs, coping strategies, social supports, and professional resources to manage suicidal ideation or crisis situations.

Responsible Person: Counselor and Jane

Family Involvement

In this case, I would involve the family in treatment. This could look like providing psychoeducation sessions, family group sessions, or a combination of both. During sessions,  I help family members create a safe, supportive home environment for one another. Depending on their needs, I may focus on enhancing communication, establishing clear boundaries, and fostering trust.

Example for Jane:

Family Involvement: Family therapy sessions once per week

Additional Services and Interventions

Here, I would make note of additional treatment services that can help my client reach their treatment goals. In this case, it would be appropriate to offer a referral for group therapy for further support. In this case, the extra service would enhance other treatment services and could be optional. Some clients are more inclined to use additional services after they begin to see the positive effects of counseling. Similar to other areas of my treatment plans, I make adjustments as needed. 

Example for Jane:

Additional Treatment Services: Refer to group therapy

Estimation for Completion 

In this section of your treatment plan, I include an estimate of when my client may be able to complete treatment. As they continue in treatment, there are signs that they are approaching treatment completion. This can include achieving their goals and objectives, subjective reports of reduced symptoms, decreased self-harm, and improvement in overall functioning. This is another section of my treatment plan that can be adjusted as needed during treatment plan reviews.

Example for Jane:

Estimated Time for Completion: 3 months of weekly individual and family therapy sessions

Aftercare Plans

The aftercare section of treatment plans is a valuable resource in the event of an early termination. Clients can end treatment for a range of reasons, including scheduling conflicts, payment concerns, and transportation issues. I write this section of my treatment plan in a way that includes referrals to other community resources that would be helpful if my clients were to disengage from treatment. This area is typically updated during my treatment plan reviews to ensure it is up to date.

Example for Jane:

Aftercare Plans:

• Refer to her primary care physician
• Refer to a community healthcare facility for family sessions

Final Thoughts On Creating a Counseling Treatment Plan for Self-Harm

Creating a treatment plan for self-harm can help you create a roadmap guiding your therapy sessions. This allows you to provide consistent, focused care tailored to your clients’ needs. Your treatment plan may focus on stabilization, skill building, or, when needed, developing emotion regulation skills.

Self-harming behaviors can present in clients of varying backgrounds and mental health concerns, which highlights the importance of accurate assessments and screenings. You can review nearby training and continuing education opportunities to learn more about non-suicidal self-harm and how to support clients struggling with these behaviors.

Resources:

• Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. Evid Based Pract Child Adolesc Ment Health. 2020;5(3):354-364. doi: 10.1080/23794925.2020.1806759. Epub 2020 Aug 26. PMID: 32923664; PMCID: PMC7480822.
• Miller M, Redley M, Wilkinson PO. A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls. Int J Environ Res Public Health. 2021 Mar 24;18(7):3361. doi: 10.3390/ijerph18073361. PMID: 33805082; PMCID: PMC8037877.