Can My Therapist Force Me Into Inpatient Care For Self-Cutting?

Published: November 17, 2014
Dear Can My Therapist Force Me Into Inpatient Care For Self-Cutting?,

Today I went to my first appointment with a counselor to deal with cutting. The counselor seemed very disturbed by how frequently I harm myself (usually at least once a day.) When I told her that I feel like I need to cut myself every night, that if I don't the thought will stay in my head until I fulfill it. This seemed to confuse her as she threatened to put me into inpatient care if I can not find a way to stop. She had me make a commitment to not cut myself anymore. I agreed as not to concern her, but really? If it was that simple I would have stopped months ago. I've already cut myself since the appointment. The cuts are never life threatening. I'm not going into inpatient care, I refuse. I know that say I were suicidal and told her about that she has the power to tell someone and place me in the hospital. However, my cuts are never suicide attempts, so I was wondering if she could force me into inpatient care? The reason I am so against inpatient care is because I can not put my life on hold like that. I have an apartment, rent to pay, a job to go to, classes to pass. I can not just take 6 to 8 weeks of my life to sit in a hospital and have nurses control everything I do. No.

Dear Can My Therapist Force Me Into Inpatient Care For Self-Cutting?,

Your therapist cannot force you into inpatient care given the circumstances you are describing since this kind of self-cutting behavior is usually not viewed as any kind of actual suicide attempt. Involuntary inpatient psychiatric hospitalization will generally only occur in the following instances:

  • A mental disorder, mental illness or substance abuse issue has left a person unable to make decisions for themselves in terms of caring for their basic needs related to food, shelter and medical care.

  • A mental disorder, mental illness or substance abuse issue has resulted in a person being in danger of hurting themselves or others.

Given the situation with your current therapist, TeenHealthFX thinks that it would be helpful for you to find a reputable therapist, such as a clinical social worker or clinical psychologist, who is familiar in working with people with self-harming behaviors for the following reasons:

  • We are concerned that you are not going to be open or honest with your current therapist from this point on because you have moved into a space of presenting what you feel she wants to hear (whether to appease her and/or avoid threats of hospitalization). This is only going to hurt the work and get in the way of your effectively addressing the issues at hand.

  • It would be helpful for you to be working with someone who has a better understanding of self-cutting behaviors; someone who understands what the general underlying issues are that need to be addressed.

In meeting with a new therapist FX suggests you check in with them right away about whether or not they are willing to work with you on an outpatient basis giving the self-cutting behaviors. If the therapist is not, then you need to find someone else who is willing to do that.

If you live in northern New Jersey and need help finding a therapist you can call the Access Center from Atlantic Behavioral Health at 888-247-1400. Outside of this area you can log onto the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration website for referrals in your area. You can also contact your insurance company to get a list of in-network mental health providers or check with your school social worker or psychologist to get a list of referrals in your area.

You can also contact the Self-Injury Hotline (information only, not a crisis line) at 1-800-DON’T-CUT, 1-800-366-8288.


FX would also like you to be aware that you may not have any kind of passive or active suicidal ideation, but it is possible for some people who self-harm to be at risk for suicide attempts. Perhaps that is why your current therapist is so concerned. The following is information presented by the Mayo Clinic:

Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-injuring. And the pattern of damaging the body in times of distress can make suicide more likely.

If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:

  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.

  • Seek help from your doctor, a mental health provider or other health care professional.

  • Reach out to family members, friends, teachers or spiritual leaders for support.