How to help your clients create a safety plan for self-harm in therapy

A comprehensive safety plan serves as a personalized roadmap for navigating crisis situations. The most effective plans are developed collaboratively during calm periods when clients can think clearly and engage meaningfully in the planning process. Each component builds upon the previous one, creating layers of support and intervention.

Identify warning signs

Help clients recognize their unique early warning signs that indicate increasing risk for self-harm. These might include specific thoughts, emotions, physical sensations, or behavioral changes that typically precede self-harm episodes, such as excessive crying. Work collaboratively to identify patterns from past experiences, encouraging clients to notice subtle changes before reaching crisis levels. Document both internal experiences and external circumstances that tend to trigger distress.

Define internal coping strategies

Explore healthy coping mechanisms that clients can implement independently when experiencing distress. These strategies should be specific, accessible, and previously proven effective for the individual client. Examples might include deep breathing exercises, progressive muscle relaxation, journaling, creative expression, or physical activities. Ensure each strategy is detailed enough that clients can implement it even when distressed, alone, or thinking less clearly.

Explore ways to find social support

Identify people and places that provide comfort and distraction during difficult periods. This might include specific friends, family members, support groups, or public spaces where clients feel safe and connected. Help clients think beyond immediate family to include broader social networks, online communities, or professional relationships that offer different types of support. Document specific ways to access this support, including contact information and preferred communication methods.

Clarify when to seek professional help

Establish clear criteria for seeking immediate professional intervention, including emergency services or crisis hotlines. Help clients understand the difference between situations they can manage with their safety plan and those requiring professional support. Include specific contact information for crisis services, emergency departments, and after-hours mental health support. Discuss transportation options and potential barriers to accessing emergency care.

Identify ways to restrict access

Collaborate with clients to identify and limit access to means of self-harm during vulnerable periods. This might involve avoiding certain places, and/or removing or securing sharp objects, medications, or other potentially harmful items. Approach this sensitively, recognizing that clients need to maintain autonomy while creating safety. Discuss practical strategies such as asking trusted individuals to temporarily hold certain items or using time-delay methods to interrupt impulsive behaviors.