Why did she cut herself?

You are about to enter a therapy session with a struggling parent wondering if his child is going to kill herself (I have the parent's permission to print this session in hope of helping other families).

I ask, "Tell me what happened last night."

The father offers a play-by-play of the night before.

"Turn off that stupid music?" I scream as my 14-year-old daughter cranks Linkin Park's, "In the End."

She yells back through her closed, locked door, "Shut up!"

"OK, another dynamically beautiful night!" I think sarcastically, too tired to fight and too discouraged to argue.

This happens every night. I go to my family room and Elise goes to her bedroom. I watch the same TV show every week on the same couch and she listens to crazy music too loudly, locked in her room.

"I'm a single parent you know?"

"We suck as a family."

As I turn up "Survivor" on my flat screen she turns up, "In the End," on her boom box and the fight begins. The dance of parent verses child is on and my little girl who I love dearly, changes into a person I don't know. She's not kind, not loving. She is evil and doesn't love me.

I become frustrated, mad, insulted, ashamed and forget all the parenting skills I learned trying to be the best parent I can be. Her door is locked; I kick it in. She's startled, scared, ashamed, mad, insulted, frustrated and reverts back to the little girl I knew 10 years prior.

She hides her right arm. I ask, "What are you hiding behind your back?"

She says, "Nothing." In a tone I've not heard for 10 years.

I scream, "Show me what's behind your back!"

She starts to tear, slowly moves her arm from behind her back and holds it fully extended in front of my face, emotionless. I start to cry, look in her eyes; I am paralyzed.

Her arm is bloody, marked with long straight lines of bloody crimson, puffy and white in the center of each line. She'd surgically cut herself 13 times in deliberate, calculated, straight lines. Blood pours down her arm from each cut. The music seems twice as loud now that I'm in her room and I can't think.

"Oh my God! Are you trying to kill yourself?" I scream.

"What? I'm not trying to die, I'm trying to live," Elise screams, surprised at my fear.

Why do children hurt themselves? Self-mutilation comes in many forms and is not a form of suicide ideation or a desire for the child to die. A child cuts or mutilates to feel alive. Most claim a feeling of elations, don't feel pain and mutilate to feel something. As the Goo Goo Dolls song sings, "You'd bleed just to know you're alive."

Cutting is not the only way children self-mutilate. Boys punch walls; some get tattooed, pierced, while others scrub their faces and bodies raw. Others search out physical fights to feel pain while others hit their heads against walls, purposefully put themselves in painful situations or pull out their body and facial hair.

"I had thoughts about suicide, but I wouldn't ever have attempted it," A young girl describes. "[Cutting] was just a way of doing something a lot less severe and a lot less permanent to express what I was feeling? I guess I didn't have any other way. It really scared me, because I was making myself bleed and it freaked me out. I felt that I just had so much pain inside me and so much I was going through that I felt like nobody could see, so I quantified it. That was what it was about for me, I think. It was like, 'This is how bad it is.'"

People who cut are usually depressed and struggling to express their anger, agitation and emotional pain. Cutting is often hypnotic with symbolic music and ritualistic tools such as razors or knifes.

"There is no stereotypical type of child who mutilates his or her body. Self-mutilation is a desperate attempt to have some control over unbearable feelings of aloneness, loneliness and helplessness," says Dr. Margaret Paul, therapist and co-author of "Healing Your Aloneness," a book that examines self-mutilation.

Kids who mutilate know they are doing something atypical. "Self-mutilating behaviors, as well as eating disorders, drug or alcohol use and extreme violent behavior are all cries for help," Dr. Paul says. "These kids are saying, 'I don't know what to do, so this is what I do instead. And don't try to take it away from me because it is all I have.'

"There is no place where we learn how to manage our intense fear, anxiety, hurt, anger, depression or whatever the feeling is. There is no one place that teaches that. A person must find a method that works for them. Whether spiritual meditation, breathing or something else that helps an adolescent manage inner stress, having the equipment to deal or cope is the first step in gaining control."

So, what does a parent do? This is a systemic problem. The whole family system needs help. The child who cuts is searching for an answer the parent nor society has been able to offer. This problem is bigger than the family and a concerned parent should look outside the home for help. Family therapy, therapeutic books, the family doctor and the Internet offer help to a struggling family.

I professionally believe a healthy family structure can cure most behavioral or mental difficulties but self-mutilation is different. A child who self-mutilates is stating, "This family does not offer an opportunity to alleviate my pain so I need to search for my own way." This might be the time to search for professional help. For questions or referrals, please e-mail me.

Bill Rutherford is a psychotherapist, public speaker, elementary school counselor, adjunct college psychology instructor and executive chef, and owner of Rutherford Education Group. Please e-mail him at bprutherford@hotmail.com and check out www.foodforthoughtcda.com.