Q. Okay, my name is Michelle. I am 16. I have extreme OCD. This causes a big problem in my life. It can become very overwhelming. I get severe anxiety to the point where I need a release…I tend to “cut” myself. I know it isn’t healthy or a good coping mechanism. I see a therapist once every two weeks. I have been seeing her for about two years now. I never really opened up to her…at all. I finally said how I “used to” hurt myself when I couldn’t handle my emotions. She asked if I write. I said yes, but everything sounds suicidal. Now, I’m not suicidal…I think it is wrong and selfish. I know I need to open up to her more, but I can’t. She said how because I don’t open up to her she doesn’t know how I feel so she is unsure if I am “safe.” She said she doesn’t know what she is going to do, so it is making me extra anxious. I did cut myself, stupidly, but it will hopefully heal by the time I see her again. The thing is, if she is this worried about me now when I haven’t really told her anything, then what will she do if I tell her about my behaviors now? Is it possible that I can be put in a hospital for telling her? It’s not like I cut myself all the time. I’ve never cut deep or a lot, but I am worried that she might over-react. That is way too possible. I hate thinking about it. I know she’ll ask me what triggers it, how I feel, etc…but will she be forced to tell my mother? Will she put me in the hospital? I never gave her any reason to suspect that I would try to kill myself or anyone else. I really don’t know. I’ve tried to gain info on this, but not all of my questions have been answered. How should I go about telling her in a calm, reasonable way? What if she over-reacts? Do I have certain rights as a minor to what can go on? What kind of decisions can I make and what kind of decisions can I be forced into? I am scared and confused. Please help. Thank you.

A. It is important that you open up to your therapist. She cannot help you if she does not know the truth about how you feel. I cannot predict exactly what she will do after you reveal to her that you do cut. I am pretty sure (every state has different laws regarding commitment) she cannot commit you to a hospital for cutting alone if it is not accompanied by suicidal ideation (thoughts of suicide) and a plan for suicide. Generally, without the thoughts and a formal plan for suicide, she would have no basis for recommending or forcing you into the hospital. Cutting behaviors are pretty common among women and especially common among females your age. If hospitals committed everyone who cuts, they would need to triple or quadruple (or more) the number of hospital beds available—it is that big of a problem.

I do not know if she will tell your parents since I do not know the nature of the relationship between your parents and therapist. Usually, therapists will discuss this with their clients-that is what types of information can be revealed and to whom that information can be revealed to. Therapists also usually have you sign confidentiality agreements spelling this sort of thing out. In many states, 14 is the age that young adults can consent that they do not want certain personal therapist-client information revealed to their parents. This is a gray area since what information the therapist can reveal and to whom that information can be revealed to all depends on the nature of the situation. In sum, it is likely she cannot commit you to a hospital unless you are cutting AND have serious plans to commit suicide. I do not know if she will tell your parents but you can discuss this with her when and if you reveal that you are cutting.

If you are uneasy about telling your therapist, perhaps you can write her a letter and have her read it during a session. She might be on to something when she asked you if you write. She probably knows there is more going on with you than you are willing to reveal to her. Write her a letter about how you have been feeling when you cut, how the cutting starts, what are thinking about when you cut, and so forth. Writing may be an easy way for you to share with your therapist that you do cut and help the both of you find the source of your cutting and problem solve ways to stop it. I am sure that you are cutting as a way to release negative and painful emotions. Your therapist can help you find other avenues to release and rid yourself of these emotions once you let her in on the fact that you are experiencing these strong emotions and cutting as a way to deal.

The first step in you stopping this problematic and dangerous behavior is to tell your therapist the truth about what is going on with you. You must remember that she is not a “psychic” and without you opening up to her, she does not have enough information to fully help you recover. Therapy is the place when you can learn to heal. Your job as the client is to be honest. By not revealing what you are experiencing in therapy, the therapeutic process is stalled and prolongs your suffering. Write your therapist a letter, tell her the truth about your feelings and behavior and let your therapist help you stop cutting and feel better. Remember no good therapist would ever reject you. She may be disappointed or show a high level of concern but she is there to help you not verbally punish you. Please keep me updated on how things are going. Take care.