RESEARCH

JCHC
Guilt and shame: experiences of Journal of Child Health Care
Copyright © 2007
parents of self-harming SAGE Publications
Los Angeles, London,
New Delhi and Singapore
adolescents Vol 11(4) 298–310
DOI: 10.1177/1367493507082759

GLENDA McDONALD, BSocSci

PhD candidate, School of Nursing, University of Western Sydney, Penrith, NSW, Australia

LOUISE O’BRIEN, RN, PhD

Associate Professor, University of Western Sydney, Penrith, NSW and Sydney West Area Mental
Health Service; Head, Mental Health Nursing Research Unit, Cumberland Hospital, Sydney,
Australia

DEBRA JACKSON, RN, PhD

Professorial Fellow, University of Western Sydney, Penrith, NSW, Australia

Abstract
This paper reports the findings of a qualitative study that used a hermeneu-
tic phenomenological methodology to develop insights into the experience
of parents of young people who engage in self-harming behaviour. Six
mothers (and one father who accompanied his wife) participated in the
study. Findings reveal that mothers experienced guilt and shame, and that
these feelings shaped their reactions and responses. These mothers
described experiencing emotional dilemmas, such as the degree to which
they could be responsible, uncertainty about how to understand self harm,
and the best course of action to take with their child. They also encountered
difficulties in combating the negative emotional effects for themselves and
other family members. Findings provide insights that can help nurses
and family health workers to understand and assist parents with greater
effectiveness; by maintaining a non-judgemental stance, acknowledging
the difficulties of their experiences, encouraging confidence in their
parenting abilities, and promoting effective stress management strategies.
Keywords adolescent health guilt
● ●
mothering ●
parenting ●
self
harm

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Introduction
Deliberate self-harm in adolescence has been identified as a significant problem
both in Australia and internationally (De Leo and Heller, 2004; Hawton et al.,
2002). The term ‘self-harm’ has been used in the research literature to describe a
range of behaviours involving injurious behaviour to the self without the inten-
tion of suicide (Connors, 1996; Everett and Gallop, 2001). However, there is no
common definition with clear demarcation of which behaviours constitute
self-harm. Connors suggests that self-harm may involve body mutilation such as
self-cutting or poisoning, or overdosing on prescribed or household medica-
tions. Self-harm can include the use of alcohol or other drugs and engaging in
risk-taking behaviours, such as placing oneself in unsafe situations (Connors,
1996). Lindgren et al. (2004) also include burning, scratching, skin-picking and
hair-pulling.
Some adolescents go through stages of self-harm that may resolve themselves
with the passage of time and/or treatment. However, this behaviour may become
entrenched as a way of dealing with difficult situations (Meekings and O’Brien,
2004). Factors identified by De Leo and Heller (2004) as being associated with
self-harm include having family or friends who self-harm, having a coping style
of blaming oneself and self-prescribing medication. The literature suggests that
motivations for self-harm include wanting to get relief from a terrible state of
mind, self-punishment, wanting to die, wanting to show how desperate they
felt, wanting to find out if someone really loved them, wanting attention or to
frighten someone and getting revenge on someone (Rodham et al., 2004).
There is increasing evidence of significant links between psychiatric co-
morbidities, self-harm and substance abuse in children and adolescents (Ehrmin,
2001; Myles and Willner, 1999). These comorbidities include anxiety disorders,
mood disorders and borderline personality disorders (Meekings and O’Brien,
2004) and other problems such as delinquency (Ehrmin, 2001), antisocial behav-
iour, conduct disorders (Myles and Willner, 1999) and schizophrenia (Bonomo
and Bowes, 2001). In addition, self-harming behaviour has been linked to child-
hood abuse (Everett and Gallop, 2001; Herman, 1994; Meekings and O’Brien,
2004; Noll et al., 2003).
Three recent research studies into the incidence of self-harming behaviours
of high school cohorts in Australia, Norway and the UK found that similar
numbers of students (between 6.2 and 6.9 percent) had met the criteria for self-
harming acts in the preceding year (De Leo and Heller, 2004; Hawton et al.,
2002). Despite the fact that self-harm is relatively common in high school-age
children, most of whom are still living at home, no studies have been identified
which examined how families experience self-harm in their adolescents, how
parents coped in this situation, or whether specific family support interventions
assisted them in dealing with their self-harming adolescent.
The majority of literature about self-harm in adolescents, as it relates to the

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definition of self-harm in this study, does not acknowledge or address parents,

neither does it position self-harm within the context of family life. This could be
due to a pervasive belief that young people who self-harm come from ‘dysfunc-
tional’, abusive or chaotic families. While there is evidence that frequently this
may be so, the reality is that not all self-harm can be linked to abusive family
members or family dysfunction (Meekings and O’Brien, 2004). Furthermore,
accurate understandings of parents’ experiences are unlikely to be found unless
they are approached from a position of looking for family strengths, not only
weaknesses (Allison et al., 2003). The aims of the research were to examine the
experiences of mothers dealing with self-harming adolescents and to gather
insights about the ways that this affects their own well-being and that of their
families. This article presents the experience of shame and guilt.

Method
The focus of this research study was the personal experiences of mothers of
children who self-harmed. Hermeneutic phenomenology, based on the work of
Heidegger, provides the framework for the study. This approach is concerned
with meaning and understanding in the practical everyday life of people
(Heidegger, 1962[1927]). The focus is on subjective experience, the meaning of
experience and the contexts in which these experiences occur (Koch, 1995;
O’Brien, 2001). The implication of this approach is that there is a commitment to
view the experience as a whole, participants are viewed as reflective and able to
articulate their experiences, shared meaning can be established through a con-
versational process, and interpretation is borne of the ‘text’ and the researcher’s
experience and pre-understandings (Kvale, 1996; van Manen, 1990). The subse-
quent writing is a creative process that moves beyond description of the experi-
ence and towards meaning and understanding (O’Brien, 2001).

Ethical approval
Ethical approval for the conduct of this study was granted by the relevant institu-
tional human ethics review committee. Informed consent procedures were used,
participant confidentiality was maintained through the use of pseudonyms for
each person interviewed and all data were stored in accordance with institutional
ethics committee requirements. The topic of adolescent self-harm is a sensitive
one and participants were reminded of their right to cease or temporarily
suspend participation without explanation; however, no participant chose to do
so. The participants were positive about the experience of contributing to the
study.

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Recruitment
Participants were recruited to this study through appeals for volunteers in the
local news media. Parents were invited to contact the researchers if they wished
to take part in an audiotaped interview. The inclusion criteria were that they had
an adolescent or young adult child who was presently self-harming, or had a
history of self-harm such as cutting, burning or risk-taking behaviours, were able
to speak and understand English and were willing to participate. Each participant
selected their own pseudonym, which protected their identity.

Participants
Six mothers participated in the study. One father also attended the interview with
his wife in a supportive role; his comments were not used in the analysis. All the
participants were parents of adolescents aged between 12 and 21 years at the time
of the study (six daughters and two sons). There was also a range of experiences
with self-harming, with the majority of participants’ children having problems
with self-harming over a period of months and one participant whose daughter
had a history of self-cutting and medication overdoses over seven years. Of the
six parents, five were currently in intact marital relationships, two having re-
partnered; and one was a single parent.

Data collection, management and analysis

In phenomenological studies, the purpose of the interview ‘is to gather descrip-
tions of the life-world of the interviewee with the intention of interpreting the
meaning of the described phenomena’ (Kvale, 1996: 149). Interviews were more
conversational than formal and the interviewer attended to issues of engagement
and establishing rapport, thus allowing participants to describe their experience.
Each participant was interviewed once, with interviews lasting between 60 and 90
minutes; all the interviews were audiotaped. The interviews opened with a broad
general question: ‘Tell me what your experience has been of having a child who
is self-harming.’ The participants required few prompts to begin their stories.
Prompts requesting further information or clarification were used if required. A
number of the participants became tearful when recounting their experience,
but none chose to terminate the interview. If the participant did not venture
information about some aspect of the experience, they were asked directly: for
example, ‘What was it like for your other children?’
The audiotaped interviews were transcribed. All speech was included and
pauses and silences were noted. Interview transcripts were analysed by all three
authors reading the data text in its entirety, reading in sections and discussing
and rigorously questioning the emerging meanings and underlying structures of
experience in order to develop sub-themes and ultimately themes. The process
was one of immersion in the data by reading and re-reading in part and whole,

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reflecting upon the data through discussion and questioning, identifying patterns
and structures and generating rich descriptions of the experience (Thorne, 2000).
Throughout the analytic process the focus was maintained on the following
question: ‘What does this data reveal about the experience of being a mother of a
self-harming child?’ The rigour of the data collection and management process
was maintained by checking the researchers’ assumptions about mothers of self-
harming adolescents, maintaining a research journal of the interviewers’
thoughts following interviews, and engaging in discussion about the analytic and
phenomenological writing process.

Results
The discovery that an adolescent child is deliberately injuring themselves by
self-cutting, abusing medications or other substances, engaging in risk-taking
behaviour or placing themselves in unsafe environments, was very distressing for
the parents in this study, and left them with feelings of guilt and shame. They felt
overwhelmed by the problem and inadequate as parents, in that there was a sense
that they lacked knowledge and understanding of their child’s experience. They
often felt isolated throughout their experiences, afraid and ashamed that others
would judge them harshly. These feelings complicated their understanding of
what was happening to their child, what their own responses were and should be,
and what was the best course of action to take. However, despite their confusion,
these mothers also displayed positive, loving support for their children.
The following themes were identified and are discussed in detail below:
● dilemmas of guilt and shame;
● searching for a reason;
● echoes from other relationships;
● embarrassment – you should not think of it in terms of yourself, but you do;
● becoming hypervigilant; and
● diminished roles.

Dilemmas of guilt and shame

All of the mothers interviewed in this study expressed the view that their primary
emotional reactions to the discovery that their adolescent was self-harming were
feelings of guilt and shame. They felt guilty that their child was unhappy or hurt-
ing to such a degree that they would even contemplate self-harm, and were upset
that they enacted their unhappiness in such a way. It was also a source of shame
for them that such a depth of unhappiness was present in their children’s lives. In
response to their children’s expressed unhappiness, the mothers questioned their
relationships with their children and felt that they may have failed them. This

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caused deep feelings of guilt, as Melanie said: ‘I feel so guilty, what have I done,
how have I let her down for her to be like that?’ Annie described her reaction in
this way:
It was like, what have I done? . . . You tend to blame yourself . . . I wasn’t watching, I
wasn’t caring enough, I wasn’t showing enough love, I wasn’t giving enough praise.
The mothers described feeling guilty about their denial or minimization of
their child’s difficulties and sometimes their delay in getting treatment for their
child. As Jayne expressed:
How could it have gotten this bad without me knowing? I felt like I had been a
really bad parent.
Jayne also felt as though she should have been able to read the warning signs
in her daughter’s behaviour (‘I should be psychic’) and felt guilty that she had not
done so. As she described it:
This whole feeling of, I don’t even know my own child, what sort of a parent am I?
Annie also spoke about feeling as though she was to blame:
You feel like you have failed your kid. That they are hurting, something is going
wrong and you are not aware of it.
The mothers were aware of the stigmatized nature of self-harming and
feared the judgements of others. This fear further contributed to the shame that
they experienced.

Searching for a reason

Guilt was exacerbated by a sense that circumstances in their own lives or the
emotional fallout from their own experiences, had caused their child to self-
harm. They thought that the experiences of losing parents or other family mem-
bers, marriage breakdowns or other relationships ending between themselves
and significant figures in their child’s life, for example grandparents, had caused
emotional pain for their child which had led them to engage in self-harming. As
a consequence, they blamed themselves for its occurrence. Jayne felt that her
daughter’s self-harm had been caused partly by a relationship breakdown
between herself and her stepfather, who had been a close grandfather figure to
her daughter. This relationship soured and disintegrated while Jayne’s mother
was dying, and after her mother’s death the relationship had ended abruptly.
Jayne believed that an escalation of the self-harm had taken place because her
stepfather had sent back her mother’s belongings to her in boxes:
Some of it was gifts that my daughter had given him, anything that said
‘grandfather’ or ‘grandad’ was returned. It was very symbolic that, ‘you are not my
granddaughter’.

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The next day Jayne’s daughter cut herself badly on the thighs with a razor:
‘She just felt so bad about what had gone on and felt such a strong sense of
self-loathing and rejection.’ Jayne felt responsible for the incident; she described
herself as having ‘this huge, really strong sense of blame’.

Echoes from other relationships

Jayne also felt that another prime cause of her daughter’s self-harm was because
she had no contact with her father. Even though Jayne had made serious attempts
to locate her daughter’s father at various times, she still felt responsible for his
absence from her daughter’s life. Clearly, Jayne felt that her own difficulties with
the men in her life had caused her daughter’s current difficulties. Rany spoke of
her guilt over the fact that her husband shouted at her daughter:
I thought the more that he shouted at her, the more she was going to do something.

Fiona felt that her daughter had been affected adversely by negative family
events during the period of self-harm. These events included the serious illnesses
and deaths of family members, the suicide of the mother of her daughter’s
best friend and a serious car accident involving her brothers. Even though this
mother acknowledged that her attention had been taken up with responding to a
series of family crises, she still felt guilty about it. She believed that as a result of
the family’s emotional resources being severely depleted, their daughter had felt
insignificant and as though her problems were not important.

Embarrassment – you should not think of it in terms of yourself, but

you do
The mothers related stories from their own experience of feeling embarrassed
about their child’s self-harming behaviours. Melanie recounted her feelings
when she went shopping with her daughter, who was wearing a short sleeve top
so that self-inflicted scarring on her arms was visible: ‘It was really embarrassing
for me.’ Similarly, another mother related how her family went on a holiday
cruise immediately after their child’s episode of cutting, where they could escape
thinking about it as a problem:
It was just, it happened. Let’s go on the cruise, let’s forget about it . . . Well, you
don’t know anyone there, so . . .

This statement suggests both a sense of denial and underlying shame. This
mother and several others who were interviewed did not think that they could
talk to anyone, family or friend, about their child’s self-harm. Their attitude
came from either a sense of shame and embarrassment or not wanting to burden
or upset those close to them. Rany reported that she would not have spoken to
family or friends at the time about her daughter’s self-harm, and that if her

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parents had found out about her daughter seeing a general practitioner, Rany
and her husband had planned not to go into detail:
We were just saying she was sick, that was all. I wasn’t going to say more than that
to them.
Another mother said that, although she had benefited from the positive
support of close friends and work colleagues, she was not planning to disclose the
situation to her sisters:
I believe my older sister would attribute it to my failure as a parent, because that is
what she does. My middle sister would [think]: ‘God, she [niece] is psychologically
unbalanced.’ . . . I have chosen to be very careful about the audience.

Becoming hypervigilant
Another source of guilt for these mothers stemmed from their need to be far
more vigilant of their adolescents after the self-harm was discovered. Their guilt
led them to believe they had not been caring enough and to revert from a posi-
tion of letting the child become more independent to adopting one of scrutiny
and watchfulness. The mothers reported having read their child’s journals and
emails, listening in to conversations between their child and their friends and
changing household routine so that they could supervise their child’s activities
more thoroughly. They no longer allowed them their usual privacy, shown by
such measures as removing televisions from bedrooms, keeping their child in
the communal areas of the home, removing internet access and computer use,
keeping their children at home; and generally being much more inquisitive about
their child’s lifestyle. As Annie commented:
It means that you are constantly aware, watching them for any signs . . . which is
terrible. You feel like you are sneaking around all the time.
Another mother recounted the story of how she found herself intruding on
her daughter’s privacy in an attempt to find out more about her feelings and the
best ways to help:
If she went out I used to go into her drawers, which is something I swore I would
never do, but she was just so secretive and always told lies.
Examples such as these demonstrate that these parents were driven to act
against their principles in relation to core values such as trust and privacy in their
relationships with their adolescent children, and they felt guilty as a result.
Several of the parents were driven to the point of emotional exhaustion because
of their constant desire to check on their child’s safety and well-being, such as
Charlotte, who stated:
The phone would go and everything would just tingle . . . It affects you in every way
. . . as if you could never let your guard down.

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Diminished roles
The mothers in this study felt guilt regarding their roles within the family – as
wife, mother and mainstay of the family. Dealing with their child’s self-harm
often took them away from their usual roles at work and home, causing them to
feel guilty because they believed that they were not meeting expectations of them-
selves or others. Mothers reported strategies such as reducing their work hours or
even leaving paid employment to take on a more active role in caring for their
self-harming child. In some instances this caused feelings of guilt in relation to
their husbands or partners having to shoulder the full financial contribution to
the family.
Four of the mothers interviewed also considered that the extra time, energy
and attention spent on their self-harming child meant that they had neglected the
mothering of their other children. When the self-harming experience lasted
some years, as it had for one mother, she felt trapped in the guilt; either for
neglecting the self-harming adolescent or neglecting the others in the family. She
related that one of her children’s self-harm had caused serious disruption to their
family life and that her son had missed out on the happy and healthy upbringing
he deserved, irrevocably changing the family’s communication and relatedness,
even years after: ‘He talks to us but there is something not quite the way it should
be.’ Melanie related how her son had had to cope with being left behind
frequently when she and her husband took their daughter to hospital, having
either overdosed or bleeding, often during the night. These mothers’ expressions
of guilt and loss were palpable; and frequently were overlaid with feelings of
inadequacy and powerlessness.

Discussion
The findings from this study contribute to our understandings of parental attri-
bution of self-harming. In contrast to the idea (Hurd et al., 1999; Sansone et al.,
1995) that self-harming practices emerged from parental backgrounds of neglect
and abuse, this study found that these mothers were caring and extremely con-
cerned about the well-being of their children. In particular, past research had
linked childhood sexual abuse with self-harm (Gladstone et al., 2004; Weaver et
al., 2004); however, only one of the mothers in this study thought that childhood
sexual abuse had contributed to, but not caused, their child’s self-harm. This
finding resonates with comments made by Meekings and O’Brien (2004), who
suggest that sexual abuse be considered a risk factor rather than a cause of self-
harm. The participants in this study were self-selected, so it could be the case that
mothers who believed sexual abuse was a factor in their child’s experiences chose
not to participate.
Rather than associating self-harm to sexual abuse, the mothers in this study
saw their children’s experiences from a perspective of maternal guilt and family

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turmoil. They expressed the belief that negative family events, such as death,
illness and family breakdown, had led to episodic or longer-term self-harm for
their adolescents. These mothers revealed that they had searched for a sensible
understanding of the self-harming phenomenon; to attach some meaning to it
for themselves and their child. In their cases it was interpreted as justification for
self-blame, guilt and feelings of responsibility.
These findings support the need for nurses and family health workers to
normalize the experience of guilt and shame which can be felt by parents, giving
them accurate information on what is known about the motivating factors of
self-harm for adolescents and discussing realistic options for helpful strategies
from a holistic approach to the family. For example, this would include an
honest evaluation of the difficulties for all family members, both in the past,
which could have motivated the self-harm, and in the present, which may
influence the current situation.
Another finding of the study was that the deeply-felt levels of guilt and
shame of these mothers worked to isolate them from traditional support net-
works of family and friends. They expressed a need for greater knowledge about
what to look for and what to expect in caring for their self-harming adolescent, as
they often felt alone in their experiences. As past research has highlighted, the
tendency for health workers to distance themselves from self-harming clients and
their family members, due to a feeling that their problems may be insoluble
(Smith, 2002), means that there is a need for more open discussion with parents
about various aspects of self-harming. Facilitation of support groups or networks
for parents of self-harming adolescents may be one possibility to alleviate isola-
tion and distress. Open communication could assist parents to accept more read-
ily the appropriateness of seeking professional help and support and to feel more
comfortable doing so. It is essential that adolescent and family health and welfare
workers do not add to the stigma attached to parents of self-harming adolescents,
but rather that they realize the difficulties that parents face. This is especially true
for mothers, who are most targeted for blame when children are deemed to be
rebellious, ill or otherwise having placed themselves outside the acceptable
‘norm’ of adolescent behaviour (Ehrmin, 1996; Jackson and Mannix, 2004).
The findings of this study illustrated the fact that the families – and especially
the parents – of self-harming adolescents and young adults were affected by a
variety of stressors. The effects of these dilemmas of guilt and shame were serious
for these mothers. They became stressed and overwhelmed, hypervigilant and
overly responsible for the reactions of their family. Caring professionals need to
take an individualized approach to helping these parents to reduce or manage
their stress levels in ways that fit their lifestyle, perhaps by encouraging the use of
relaxation, massage, alternative therapies or suggesting strategies to improve
general health and well-being.
It is also important to consider the emotional burden that these mothers
may carry within the sometimes tangled connections and diverse dynamics of

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the extended or blended families of today. A deeper understanding calls for a

broader view of the challenges associated with dealing with self-harming adoles-
cents within a family context; as well as the options for care and support of this
group of parents. This could include providing opportunities for dialogue with
mothers that confirms both their efforts to come to grips with their situation, and
their value to their families.

Limitations of the study

Due to the size and scale of this study there were obvious limitations to the
ability to generalize its findings. However, findings do contribute to the know-
ledge base of experiences faced by parents. The small group of participants
enabled a depth and richness of data not accessible by other data collection
methods. In addition, participation may have been self-limiting in that families
where abuse had occurred may be much less likely to volunteer for such a study.
The voices of these parents, even of the non-abusing parents in these families,
may be much harder to capture. Participation in this study was limited to those
proficient in English and almost all came from the dominant Caucasian, Anglo-
Saxon culture group within the Australian population. Also, they were over-
whelmingly from a medium to high socio-economic status. It would be beneficial
for researchers to reproduce the study with participants from non-English-
speaking backgrounds or those experiencing the effects of poverty.

Conclusion
This study highlights the guilt and shame revealed by parents of self-harming
adolescents. Parenting adolescents is known to present challenges, and the
findings from this study shows how self-harming can complicate the parenting
experience. The issues raised in this article have implications for nurses and
family health workers who encounter self-harming adolescents. They can affirm
and encourage parents to have a positive view of their roles within their families
and reassure them that their responses are not unusual. They can also provide
psycho-education on coping skills and affirm that it is appropriate for them to
seek help and support for their families.

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GLENDA McDONALD is a PhD candidate in the School of Nursing, University of

Western Sydney. Her thesis work focuses on resilience among nurses and midwives
in the face of workplace adversity. Prior to commencing her doctoral work, Glenda
worked as a research assistant on a number of projects in diverse areas such as
adolescent self-harm and drug use, childhood obesity and nursing workforce
issues.

LOUISE O’BRIEN has a joint associate professorship with the University of

Western Sydney and Sydney West Area Mental Health Service, and is the head of
the Mental Health Nursing Research Unit, Cumberland Hospital, Sydney,
Australia. Her research interests include inpatient and community mental health
nursing in a range of contexts, nurse–patient relationships, mental health
assessment and borderline personality disorder.

DEBRA JACKSON is Professorial Fellow in the School of Nursing, University of

Western Sydney, and leader of the NFORCE (Nursing: Families, Outcomes,
Resilience, Capacity, Evidence) research group. Her research interests focus on
family health, particularly adolescent health. She has led projects in various areas
including adolescent violence, adolescent self-harm, adolescent drug use and
childhood obesity, and currently is leading a large project which aims to develop a
family-focused model of care to promote child protection.

Correspondence to:
Debra Jackson, School of Nursing, College of Health & Science, University
of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797,
Australia. [email: debra.jackson@uws.edu.au]

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