Self-Harm Discussion Prompts

1. Check-In and Rapport Building

• "On a scale of 1 (lowest) to 10 (highest), how would you rate your mood right now? What makes you pick that number?"
  
  
  
• "What’s been on your mind lately? Is there anything that’s been particularly heavy or stressful?"
  
  
  

2. Exploring Self-Harm Thoughts or Behaviors

• "Have you had any thoughts of hurting yourself or urges to self-harm recently? Can you tell me about when those thoughts come up?"
  
  
  
• "What usually happens right before you feel like harming yourself?"
  
  
  

3. Identifying Triggers

• "Which feelings—like sadness, anger, anxiety—seem to show up before these thoughts?"
  
  
  
• "Are there certain situations, times of day, or people that make you more likely to have these urges?"
  
  
  

4. Coping Strategies and Supports

• "Have you ever tried something that helped you get through a tough moment? What did you do, and how did it feel?"
  
  
  
• "Who in your life do you feel you can talk to or reach out to when you’re upset?"
  
  
  

5. Establishing Today’s Goals

• "Today, we’ll identify your triggers, explore healthy ways to cope, and begin creating a personal safety plan you can use when you feel at risk. How does that plan sound to you?"
  
  
  

Trigger Identification Worksheet

Purpose: Recognize patterns that lead to self-harm urges by identifying your personal emotional, situational, and physical triggers.

1. Emotional Triggers

List the feelings or moods you notice right before you have urges to hurt yourself. Aim for at least three.

• 1. ___________________________
     
     
     
     
     
     
• 2. ___________________________
     
     
     
     
     
     
• 3. ___________________________
     
     
     
     
     
     

2. Situational Triggers

Describe specific situations, people, times, or places when these urges appear. Write three examples.

1. ___________________________
   
   
   
   
   
   
2. ___________________________
   
   
   
   
   
   
3. ___________________________
   
   
   
   
   
   

3. Thoughts and Self-Talk

Record the kinds of thoughts or messages you tell yourself before an urge arises. List three.
• ___________________________






• ___________________________






• ___________________________

4. Physical or Bodily Sensations

Note any physical signs (e.g., tight chest, headache, numbness) that coincide with these urges. List three.

• ___________________________
  
  
  
  
  
  
• ___________________________
  
  
  
  
  
  
• ___________________________
  
  
  
  
  
  

5. Patterns and Reflection

Looking back at your answers, what common threads or patterns do you notice? Which trigger feels strongest or most frequent?

Next Step: Use these identified triggers to inform your coping strategies and safety plan. You'll focus on the top one or two triggers when choosing which skills to practice.

Coping Strategies Handout

When you notice urges to hurt yourself, using a healthy coping strategy can help you pause, reflect, and ride out the emotion without harm. Below are several quick and simple options. Pick three you feel most comfortable with, then practice them in moments of stress.

1. Breathing Techniques

• Square Breathing: Inhale for 4 counts, hold 4, exhale 4, hold 4. Repeat 3–5 times.
• Deep Belly Breaths: Place one hand on your chest and one on your belly. Breathe in slowly through your nose until your belly rises, then exhale gently through your mouth.

2. Grounding Exercises

• 5-4-3-2-1 Method: Name 5 things you see, 4 things you can touch, 3 things you hear, 2 you smell, 1 you taste.
• Describe Your Surroundings: Slowly describe the room you’re in—colors, textures, objects—using your senses.

3. Physical Movement

• Stretch or Shake: Roll your shoulders, stretch your arms overhead, or shake your hands to release tension.
• Short Walk or Jumping Jacks: Move your body for 1–2 minutes to shift focus and get blood flowing.

4. Creative Outlets

• Draw or Color: Use colored pencils or markers to sketch how you feel—abstract shapes or scenes.
• Write It Out: Jot down thoughts or feelings in a journal. Don’t worry about spelling—just let it flow.

5. Self-Soothing Sensory Activities

• Cold Water on Wrists: Splash or hold cold water on your wrists for 20–30 seconds.
• Comfort Object: Hold a textured item (a soft scarf, stress ball, or smooth stone) and focus on how it feels.
• Music Pause: Play a favorite song and focus on the lyrics or melody.

6. Social and Support-Seeking

• Text or Call a Trusted Person: Let them know you’re struggling and ask for a moment to talk or text.
• Safe Word or Phrase: Prearrange a code word with a friend or family member that signals you need immediate support.

My Top 3 Strategies

Write the three strategies you want to try first. Practice these when you feel the urge coming on.

1. ___________________________
   
   
   
   
   
   
2. ___________________________
   
   
   
   
   
   
3. ___________________________
   
   
   
   
   
   

Next Steps: Keep this handout somewhere you can reach it quickly—your locker, notebook, or phone. Practice your top strategies each day, even when you’re feeling okay, so they become easier to use in tough moments.

Personal Safety Plan Template

Use this plan when you notice urges to harm yourself. Keep a copy where you can access it quickly.

1. My Warning Signs

What thoughts, feelings, physical sensations, or situations let me know I might be at risk?

• 1. ___________________________
     
     
     
     
     
     
• 2. ___________________________
     
     
     
     
     
     
• 3. ___________________________
     
     
     
     
     
     

2. My Coping Strategies

Choose from the Coping Strategies Handout or your own ideas.

1. ___________________________
   
   
   
2. ___________________________
   
   
   
3. ___________________________
   
   
   

3. People I Can Reach Out To

List 3 trusted individuals and how you will contact them.

1. Name: __________________ Relationship: ______________ Contact: ______________
   
   
   
2. Name: __________________ Relationship: ______________ Contact: ______________
   
   
   
3. Name: __________________ Relationship: ______________ Contact: ______________
   
   
   

4. Safe Places & Distractions

Identify places or activities that help you feel calm or grounded.

• ___________________________
  
  
  
• ___________________________
  
  
  
• ___________________________
  
  
  

5. Professional & Emergency Resources

If you feel unsafe with yourself, use one of these immediately:

• Crisis Text Line: Text HOME to 741741
• Suicide & Crisis Lifeline: Call or text 988
• School Counselor: __________________ (ext. ___)
• Emergency Services: Dial 911

6. My Plan Steps

When I notice my warning signs, I will:

1. Step 1: ____________________________________________
   
   
2. Step 2: ____________________________________________
   
   
3. Step 3: ____________________________________________
   
   

7. Commitment Statement

I, _______________________ (your name), commit to using my safety plan and asking for help when I need it.

Signature: _______________________ Date: ________________