McCabe等描述SASH干预：如何与自伤青少年展开治疗性对话

对话为何重要

自伤之后的谈话，可能帮助青少年理解自己的经历，并找到对他们真正重要的改变。McCabe等（2026）把支持自伤青少年（SASH）干预放在急诊就医这一重要接触点及其出院后支持缺口的背景中。SASH由有亲身经历的青少年、照护者与专业临床医生共同开发，在急诊就诊后快速跟进，最多提供六次会谈：先做治疗性评估与安全计划，再进行焦点解决式对话。它是在常规照护之外的补充，持续关注风险、保护和必要时的转介。

把自伤画成可理解的循环

治疗性评估邀请青少年一起画出自己的自伤循环：从一次既往事件出发，探讨其背后的痛苦、事件与行为的顺序，以及循环可能被中断的位置。图示使用青少年自己的语言。在化名Adah的已发表案例中，学校里的友谊困难与压倒性的悲伤和压力相连；对话同时探讨了自伤带来的即时缓解和随后的痛苦，Adah把友谊冲突后察觉压力视为可以不同回应的机会。作者称这一过程帮助她把感受与行为联系起来，并识别替代性应对方式。

让安全计划真正可用

SASH改编了Stanley与Brown（2012）的安全计划模型。强化版计划从青少年状态较好时开始：他们的品质、喜欢的活动、支持来源和影响生活状态的障碍——这一开头部分由研究的青少年顾问组建议。随后识别情绪、身体和认知方面的警示信号、常发生的地点，以及适合这些情境的应对策略，并追问青少年是否真的会用每种策略、什么会阻碍他们。在Eliana的案例中，害怕成为负担或被评判使向家人求助变得复杂；讨论这些障碍让计划比单纯列出联系人更具体。作者强调在危机前处理障碍，同时承认针对儿童青少年的安全计划证据有限（Abbott-Smith等，2023）；案例材料说明个性化计划如何形成，并不独立证明其预防后续自伤的效果。

描述更愿意看到的未来

焦点解决短期治疗从青少年希望什么变好开始，实践者跟随其用词，追问越来越具体的描述。在Charlotte的会谈中，起初的不确定经进一步提问后，转为希望心理上更好、更容易沟通；议程由对话生成而非实践者给定。她随后被邀请想象更好的一天，描述包括更顺利地起床、上学和社交，把宽泛的希望转化为日常生活中可辨认的变化。后续会谈关注进展迹象和困难不那么占上风的时刻：Wai描述在学校更自在、向朋友说出感受，实践者追问是什么让那次交流令人安心，再用评分问题帮她识别已在支持进展的因素和再小一步改善的样子。

照护者与沟通调整

照护者有自己的空间考虑需求，也可在青少年同意下加入会谈。在Michelle的案例中，对话探讨她希望有宣泄出口、更好睡眠和更多平静；提问帮她识别已在支持自己生活状态的活动，并思考感觉变好会如何影响与女儿的互动。这与Mughal等（2022）综述中描述的照护者需求一致。SASH为照护者提供最多两次个别会谈，包含心理教育和焦点解决取向。

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

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