Safety planning happens early
One of the first steps in treatment is collaboratively developing a personalized safety plan for high-risk moments. You will not face crises alone.
Trauma Care Psychology
Therapy for Self-Harm & Suicidal Behaviours in Ontario
Self-harm and suicidal thoughts are often signals that emotional pain has become unbearable. Effective, compassionate therapy can reduce these behaviours and help you build a life where they are no longer needed.
Now Accepting New Clients · Virtual & In-Person · Ontario
Understanding the Condition
What is Self-Harm?
Self-harm means deliberately hurting yourself, most often as a way to cope with emotional pain that feels unbearable in that moment, rather than to end your life. Suicidal thoughts exist on a spectrum: from a vague wish not to be here, through thinking about it more specifically, to making a plan. Both are signs that someone is carrying more than they can manage with the tools they currently have. They are not attention-seeking. They are not manipulation. They are signals of genuine, serious distress. Because these experiences carry so much shame, they are often hidden for a long time before anyone reaches out for help. That silence makes things harder than they need to be. DBT was originally built specifically to address self-harm and suicidal behaviour, and decades of research confirm it is the most effective treatment available for these presentations. Reaching out for help when things feel this hard takes real courage, and you deserve support that is both effective and non-judgmental.
Common symptoms
Non-suicidal self-injury (NSSI)
Deliberate harm to the body such as cutting, burning, or hitting, typically used to manage overwhelming emotional pain rather than to end one's life.
Passive suicidal ideation
Thoughts of wanting to die, not wanting to exist, or wishing for death, without a specific plan or intention to act.
Active suicidal ideation
Thoughts of ending one's life that include some degree of planning, intent, or specific method.
Emotional dysregulation
Extreme emotional intensity that feels unmanageable without a crisis behaviour. Rapid escalation of distress in response to triggers.
Hopelessness
A pervasive belief that things will not improve, that help will not work, or that there is no future worth living for.
Shame and secrecy
Deep shame about self-harm or suicidal thoughts that leads to concealment and delays in seeking help.
Causes & Risk Factors
Who develops Self-Harm and why
Self-harm and suicidal behaviour typically develop as coping strategies when emotional pain becomes unmanageable and no other effective tools are available. They are most common in people with high emotional sensitivity, significant trauma histories, or conditions such as BPD, depression, or C-PTSD that involve sustained emotional suffering. For most people, these behaviours began because they worked. They provided relief from pain that felt otherwise unbearable. Understanding the function they serve is central to finding alternatives that work just as effectively without the harm.
Invalidating environments are a significant contributing factor, whether that means growing up in a home where emotional pain was minimized or punished, receiving repeated messages that distress was attention-seeking or manipulative, or simply having no one around who knew how to help. Many people who self-harm describe a sense of profound isolation, the feeling that the degree of their pain is invisible to those around them. Reaching a point where self-harm or suicidal thoughts emerge is not a character failure. It is a sign that someone is carrying more than they should be carrying alone.
Risk factors
- History of trauma, abuse, or neglect
- Diagnosis of BPD, depression, C-PTSD, or other conditions involving emotional dysregulation
- Previous self-harm or suicide attempts
- Access to means
- Social isolation and absence of supportive relationships
- Chronic hopelessness or a sense of being a burden to others
- Substance use that lowers inhibition during crises
Our Approach
How we treat Self-Harm
Our clinicians are trained in evidence-based approaches for self-harm and suicidal behaviour, with DBT at the centre of our approach. We work collaboratively with clients to develop safety plans, build distress tolerance skills, and address the underlying emotional pain driving crisis behaviours. We take a non-judgmental, compassionate stance and do not shame clients for the coping strategies they have relied on.
Dialectical Behaviour Therapy (DBT)
The most evidence-supported treatment for self-harm and suicidal behaviour. Directly targets crisis behaviours while building alternative coping strategies.
Learn more →DBT-PTSD
For clients with self-harm and co-occurring complex trauma. Combines safety-focused DBT work with structured trauma processing.
Learn more →Acceptance and Commitment Therapy (ACT)
Reduces experiential avoidance and builds psychological flexibility as alternatives to crisis behaviour.
Learn more →Cognitive Processing Therapy (CPT)
Addresses trauma-linked beliefs and hopelessness that maintain self-harm and suicidal thinking.
Learn more →The Recovery Journey
What to expect from treatment
Self-harm and suicidal behaviours decrease meaningfully with structured DBT treatment. The goal is not to suppress distress but to build a wider range of skills so that crisis behaviours are no longer the only available option.
Skills replace crisis behaviours gradually
As you build distress tolerance and emotion regulation skills, the function that self-harm or suicidal thinking served becomes less necessary.
Shame is addressed directly
Shame around self-harm often keeps people stuck. Therapy creates a non-judgmental space where these experiences can be discussed openly and without judgment.
Crisis frequency and severity reduce over time
Most clients in DBT experience a meaningful reduction in self-harm frequency and severity within the first several months of treatment.
Related Conditions
How Self-Harm differs from related conditions
vs.
Suicidal ideation vs. self-harm
Non-suicidal self-injury (NSSI) involves deliberate self-harm without intent to die. Suicidal behaviour involves a wish to die. Both require clinical attention, but they are distinct and treated somewhat differently.
vs.
BPD
Self-harm is common in BPD but also occurs in depression, PTSD, and other conditions. The presence of self-harm does not automatically indicate BPD, and a thorough assessment is needed to clarify the underlying diagnosis.
vs.
Impulsive behaviour without self-harm intent
Some impulsive behaviours such as substance use or reckless driving serve similar emotional regulation functions to self-harm. Treating the underlying emotional dysregulation addresses all of these.
Frequently Asked Questions
Common questions about Self-Harm
Is self-harm always a sign that someone wants to die?
No. Non-suicidal self-injury is often used as a way to manage emotional pain, not to end one's life. However, self-harm is a serious signal of distress and increases risk over time. Both self-harm and suicidal ideation benefit from professional support.
Will my therapist tell someone if I disclose self-harm?
In most circumstances, disclosing past or current self-harm does not trigger mandatory reporting. Confidentiality is only broken when there is imminent risk to life. Your therapist will discuss the specific limits of confidentiality with you in your first session.
Can DBT actually reduce self-harm?
Yes. DBT has been shown in numerous clinical trials to significantly reduce self-harm frequency, suicidal ideation, and psychiatric hospitalization. It is the most evidence-based treatment specifically developed for these presentations.
What if I am in crisis right now?
If you are in immediate danger, please contact 988 (Suicide Crisis Helpline Canada), go to your nearest emergency department, or call 911. Our clinic provides scheduled therapy and is not a crisis service, but we can help you develop a safety plan and access appropriate support.
Take the First Step
Compassionate, evidence-based therapy for self-harm and suicidal behaviours in Ontario.
Our clinicians will help you find the right treatment fit and build a plan that works for you.
Book a Free Intro CallVirtual & In-Person · Ontario
Getting Started
Starting therapy is simple and supportive.
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Get in touch by booking a call online with our intake coordinator or by completing the contact form. You can also email admin@traumacarepsychology.ca or call (647) 456-7500.
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Complete a 20-minute intake call so we can determine the best therapist fit and treatment direction. Alternatively, browse our clinician directory and book a free 20-minute consultation directly with a clinician you feel is a good fit.
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Schedule your first session and begin a personalized treatment plan based on your goals and concerns.
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