Q. Hi,Im a 19 year old female college student I live at school. I have had issues with self harm for over 4 years. and I know I can’t stop on my own .my parents are worried and they have made a appointment for me to talk to a therapist.that specifically deals with self esteem and cutting issues with young adults.they are afraid I will make a mistake and go too far one day.my big problem is im afraid that if I talk to someone they will put in a hospital against my will.also im worried that I will scare this therapist.because I feel like no can understand why I have to hurt myself and if I talk about it I will feel worst. and they might think im a danger to myself because I cut so much and with anything I find.so my question is does therapy have to be so scary? I just want to feel better but im so afraid.

A. People are usually nervous about issues or situations that they are unfamiliar with. I understand your fear but please understand that the therapist’s goal is to help you. You have lived with this life problem for over four years. You have experienced such deep emotional pain during this time that it has led you to harm yourself. Isn’t it time to stop the self-harm and find a new and less painful way to exist? You deserve a more pleasant and pain-free life.

You said that you were worried about being put in the hospital against your will. The therapist will ask you questions regarding self-harm and whether you have had thoughts of suicide. Mental health professionals are primarily asking these questions to assess whether or not a person is suicidal. If an individual tells a therapist that he or she is thinking of suicide and has an imminent plan to carry it out, the therapist is obligated by law to alert the authorities. A therapist is legally required to call the authorities when he or she has been informed that an individual “is a danger to themselves or others.”

Therapists are trained to make the distinction between an imminent plan of suicide in which a person is planning to end their life and an individual who self-harms (such as cutting) as a way to feel better or relieve pain. Generally, cutting and other forms of self-harm are symptoms of an individual who is experiencing extreme emotional pain and may not necessitate a hospitalization. Self-harm is dangerous but it does not always mean that an individual will be hospitalized. Whether or not a person needs hospitalized is dependent on a number of factors such as what type of self-harm an individual is engaging in, how severe the self-harm is, how often, and so forth. The therapist will likely be asking you many questions regarding these issues. There is no guarantee that you will not be hospitalized but generally, a person is only hospitalized if a mental health professional has a reason to believe that an individual is planning to commit suicide in the immediate future. Most “cutters” are not hospitalized.

You said that when you talk about these issues you feel worse. It may feel “worse” to discuss these issues but without help, you situation will most likely “get” worse. Please listen to your parents and seek help. There are other ways to feel better that do not involve dangerous self-harm. A good therapist can change your life.