Conversations after self-harm can help young people understand their experiences and identify changes that matter to them. McCabe et al. (2026) describe how the Supporting Adolescents with Self-Harm (SASH) intervention combines therapeutic assessment, enhanced safety planning and solution-focused brief therapy. Through four young people’s cases and one carer’s case, they illustrate collaborative work grounded in each person’s language, relationships and hopes, offering examples of practice and proposed mechanisms of change, rather than trial results demonstrating that SASH reduces subsequent self-harm.
Why the conversation matters
Emergency care is an important point of contact for young people who self-harm, but seeking help does not always lead to feeling understood. McCabe et al. (2026) place their intervention within this context, alongside gaps in support after discharge. SASH was developed with young people and carers with lived experience and expert clinicians. It offers rapid follow-up after emergency department attendance and up to six sessions, with therapeutic assessment and safety planning followed by solution-focused conversations. Delivery is flexible, and carers can participate according to the young person’s preference and consent. SASH is additional to usual care, with ongoing attention to risk, safeguarding and referral for further support where needed (McCabe et al., 2026).
Developing a shared understanding of self harm
Therapeutic assessment involves jointly drawing a young person’s self-harm cycle, starting with a previous episode (if available), the practitioner explores the distress underlying it, the sequence of events and behaviours, and possible points at which the cycle could be interrupted. The diagram uses the young person’s own words to develop a personalised understanding and a basis for change (McCabe et al., 2026). In the published case of Adah, a pseudonym, friendship difficulties at school were linked to overwhelming sadness and stress. The conversation explored both the immediate relief associated with self-harm and the distress that followed. Adah identified noticing stress after friendship conflict as a possible opportunity to respond differently. The authors describe this process as helping her connect feelings with behaviour and identify alternative coping strategies (McCabe et al., 2026).
Making safety planning personal and usable
SASH adapts the safety-planning model of Stanley and Brown (2012). Its enhanced plan begins with the young person when they are feeling well: their qualities, preferred activities, sources of support and barriers to wellbeing. This opening section was suggested by the study’s Young Person Advisory Group. It helps establish a fuller picture of the person before exploring warning signs and responses to escalating distress (McCabe et al., 2026). The subsequent conversation identifies emotional, physical and cognitive warning signs, where these tend to occur, and coping strategies suited to those situations. It also explores whether the young person would actually use each strategy and what might prevent them. In Eliana’s case, fear of burdening others or being judged complicated reaching out to family. Discussing these obstacles made the plan more specific than simply listing available contacts (McCabe et al., 2026). The authors emphasise working through barriers before a crisis, including what would make seeking support feel more possible. They also acknowledge that evidence for safety planning with children and young people is limited, (Abbott-Smith et al., 2023). The case material illustrates how a personalised plan can be developed; it does not independently demonstrate its effectiveness in preventing further self-harm.
Helping young people describe their preferred future
Solution-focused brief therapy begins with what the young person hopes will improve. The practitioner follows their wording and asks for increasingly concrete descriptions. In Charlotte’s session, initial uncertainty was followed by further questions that helped her describe wanting to feel mentally better and communicate more easily. The agenda developed through the conversation rather than being supplied by the practitioner (McCabe et al., 2026). Charlotte was then invited to imagine what a better day would look like. Her descriptions included getting up more readily, attending school and socialising. These details translated a broad hope into recognisable changes in everyday life. The authors situate this work within solution-focused approaches discussed by Jerome et al. (2024), while using session transcripts to show how questions elicit personalised descriptions (McCabe et al., 2026). Follow-up conversations attend to signs of progress and occasions when difficulties have been less dominant. Wai described feeling more comfortable at school and sharing her feelings with a friend. The practitioner explored what had made that interaction reassuring. Scaling questions then helped Wai identify what was already supporting her progress and what a small further improvement might look like. These exchanges illustrate the authors’ proposed emphasis on recognising resources and strengthening agency (McCabe et al., 2026).
Supporting carers and adapting communication
Carers are offered space to consider their own needs, as well as opportunities to join sessions with the young person’s agreement. In Michelle’s case, the conversation explored her wish for an outlet, better sleep and greater calm. Questions helped her identify activities already supporting her wellbeing and consider how feeling better could influence interactions with her daughter (McCabe et al., 2026). This focus is consistent with the needs described in Mughal et al.’s (2022) review of people supporting young people who self-harm. SASH offers carers up to two individual sessions incorporating psychoeducation and a solution-focused approach. McCabe et al. (2026) present support for carers as a potential route to helping them better support the young person, rather than as a demonstrated independent effect on self-harm. Practitioners also reported that younger and neurodivergent adolescents could need more time to identify feelings and connect events. Adaptations described include additional rapport-building, a feelings wheel and emoji scales (McCabe et al., 2026).
What the study can and cannot establish
The cases draw on clinical materials, recorded sessions and qualitative interviews, selected to illustrate the intervention’s components. All four young people were cisgender girls. Recordings were available for only 16 intervention sessions across a group of 78 young people allocated to SASH, and selection considered availability, recording quality and fidelity to the intervention. The authors acknowledge that these cases may not capture the diversity of delivery or experience (McCabe et al., 2026). The associated trial recruited 154 young people across nine London emergency departments, randomising them to SASH plus usual care or usual care alone (McCabe et al., 2026). Its primary outcome is repeat self-harm at six months (McCabe et al., 2025). The case-study paper does not report those comparative outcomes. Its contribution is to show how therapeutic conversations were conducted and how the authors interpret their potential mechanisms (McCabe et al., 2026).
Conclusion
McCabe et al. (2026) illustrate a collaborative approach in which young people’s words shape understanding of self-harm, safety planning and hopes for change. Their cases show how practitioners can explore links between distress and behaviour, examine barriers to seeking support, and help young people recognise existing resources. Carer conversations extend this attention to the family’s experience. These examples clarify the intended therapeutic processes within SASH, while leaving its clinical and cost-effectiveness to comparative trial evaluation.
Where next?
Join us on 1 December 2026 for the most important conference on self-harm this year, ‘Understanding and Responding to Self-Harm: Latest Evidence and Clinical Practice. Judy Dunn International Online Conference 2026‘, with Professor Nav Kapur, Professor Paul Plener, Professor Rose McCabe, Professor Caroline Richards, Associate Professor Johan Bjureberg and Professor Joan Asarnow.
Bringing together leading international experts, this conference will explore current evidence and key developments in the field, from emerging insights into the neurobiology of self-harm to the role of emotion regulation, assessment and engagement in care.
References
- Abbott-Smith, S., Ring, N., Dougall, N., & Davey, J. (2023). Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people?—A systematic scoping review. Journal of Psychiatric and Mental Health Nursing, 30(5), 899–910. https://doi.org/10.1111/jpm.12928
- Jerome, L., Masood, S., Henden, J., Bird, V., & Ougrin, D. (2024). Solution-focused approaches for treating self-injurious thoughts and behaviours: A scoping review. BMC Psychiatry, 24, Article 646. https://doi.org/10.1186/s12888-024-06101-7
- McCabe, R., O’Keeffe, S., & Long, M. (2026). The “Supporting Adolescents with Self Harm” (SASH) intervention supporting young people (and carers) presenting to the emergency department with self-harm: Therapeutic assessment, safety planning, and solution-focused brief therapy. Healthcare, 14(2), Article 168. https://doi.org/10.3390/healthcare14020168
- McCabe, R., O’Keeffe, S., Ougrin, D., Priebe, S., Martin, P., Feng, Y., Temple, R., & Long, M. (2025). Protocol of a randomised controlled trial of a novel brief psychological intervention for young people presenting to emergency departments in the UK with self-harm or suicidal ideation with recent self-harm: The SASH study (Supporting Adolescents with Self-Harm). BMJ Open, 15(9), Article e101015. https://doi.org/10.1136/bmjopen-2025-101015
- Mughal, F., Troya, M. I., Dikomitis, L., Tierney, S., Corp, N., Evans, N., Townsend, E., & Chew-Graham, C. A. (2022). The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis. eClinicalMedicine, 48, Article 101437. https://doi.org/10.1016/j.eclinm.2022.101437
- Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001