The application of “seeking common ground while reserving differences” in parent-child conflict among adolescents with non-suicidal self-injury: A qualitative study

Parent–child conflict is a known risk and maintenance factor for non-suicidal self-injury (NSSI) in adolescents. Seeking common ground while reserving differences (SCGWRD), a cognitive philosophy centered on managing interpersonal conflict and fostering harmonious relationships, may hold the potential for improving parent–child dynamics. However, Western-originated psychotherapeutic techniques have shown limited effectiveness in addressing NSSI in Chinese adolescents. In addition, no prior studies have adapted and innovatively applied the SCGWRD concept as a psychotherapeutic intervention targeting parent-child conflict in this population. This study aimed to describe and explore the therapeutic experiences of adolescents with NSSI and concurrent parent–child conflict, who underwent an intervention based on the SCGWRD concept. Using a qualitative research approach grounded in inductive and descriptive analysis, semi-structured in-depth interviews were conducted with 12 adolescents experiencing parent–child conflict and receiving SCGWRD-based intervention. Data were analyzed using a thematic analysis framework. Five core themes with progressive relationships were identified: (i) distinctiveness from traditional intervention models; (ii) low cognitive load during acceptance; (iii) cognitive restructuring; (iv) stabilization of negative emotions and reduction of self-injury behaviors; and (v) improvement and harmony in parent–child relationships. Moreover, most participants viewed the intervention as a turning point for self-growth, with cognitive shifts exhibiting a three-stage trajectory: Conflict deconstruction – concept internalization – behavioral adaptation. Rooted in Eastern traditional culture, the SCGWRD concept may serve as a culturally adaptive cognitive-behavioral therapeutic technique. This approach holds promise for repairing parent–child relationships in adolescents with NSSI and may contribute to the reduction of self-harm behaviors.
- Lawrence HR, Balkind EG, Ji JL, Burke TA, Liu RT. Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review. Clin Psychol Rev. 2023;103:102302. doi: 10.1016/j.cpr.2023.102302
- Wilkinson P. Non-suicidal self-injury. Eur Child Adolesc Psychiatry. 2013;22(Suppl 1):S75-S79. doi: 10.1007/s00787-012-0365-7
- Kruzan KP, Muehlenkamp JJ, Claes L. Identity, self-blame, and body regard in NSSI: A test of moderated-mediation. Compr Psychiatry. 2022;116:152322. doi: 10.1016/j.comppsych.2022.152322
- Mars B, Heron J, Klonsky ED, et al. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: A population-based birth cohort study. Lancet Psychiatry. 2019;6(4):327-337. doi: 10.1016/S2215-0366(19)30030-6
- Tørmoen AJ, Myhre M, Walby FA, Grøholt B, Rossow I. Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents. Eur J Public Health. 2020;30(4):688-692. doi: 10.1093/eurpub/ckaa042
- Griep SK, MacKinnon DF. Does nonsuicidal self-injury predict later suicidal attempts? A review of studies. Arch Suicide Res. 2022;26(2):428-446. doi: 10.1080/13811118.2020.1822244
- Kothgassner OD, Goreis A, Robinson K, Huscsava MM, Schmahl C, Plener PL. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychol Med. 2021;51(7):1057-1067. doi: 10.1017/S0033291721001355
- Liu W, Li G, Wang C, Yu M, Zhu M, Yang L. Can fluoxetine combined with cognitive behavioral therapy reduce the suicide and non-suicidal self-injury incidence and recurrence rate in depressed adolescents compared with fluoxetine alone? A meta-analysis. Neuropsychiatr Dis Treat. 2022;18:2543-2557. doi: 10.2147/NDT.S367931
- Morthorst B, Olsen MH, Jakobsen JC, et al. Internet based intervention (emotion regulation individual therapy for adolescents) as add-on to treatment as usual versus treatment as usual for non-suicidal self-injury in adolescent outpatients: The TEENS randomised feasibility trial. JCPP Adv. 2022;2(4):e12115. doi: 10.1002/jcv2.12115
- Olsen MH, Morthorst B, Pagsberg AK, et al. An internet-based emotion regulation intervention versus no intervention for non-suicidal self-injury in adolescents: A statistical analysis plan for a feasibility randomised clinical trial. Trials. 2021;22(1):456. doi: 10.1186/s13063-021-05406-2
- Xue Y, Zhou X, Fan Z, Wu Q, Liu H. Application of family participatory acceptance and commitment therapy in the adolescent patients with non-suicidal self-injury. Chongqing Med. 2022;51(7):1131-1134. doi: 10.3969/j.issn.1671-8348.2022.07.01
- Qu D, Wen X, Liu B, et al. Non-suicidal self-injury in Chinese population: A scoping review of prevalence, method, risk factors and preventive interventions. Lancet Reg Health West Pac. 2023;37:100794. doi: 10.1016/j.lanwpc.2023.100794
- Guo F, Hanley T. Adapting cognitive behavioral therapy to meet the needs of Chinese clients: Opportunities and challenges. Psych J. 2015;4(2):55-65. doi: 10.1002/pchj.75
- Zeng WS. Culture and appropriate psychotherapy for Chinese. Chin Ment Health J. 2011;25(04):241-243.
- Sun YY, Zhou S, Liu N, et al. Reanalysis of the theoretical elements of cognitive behavioral therapy: Based on Li Zehou’s philosophy. Med Philosophy. 2019;40(17):37-40. doi: 10.12014/j.issn.1002-0772.2019.17.10
- Wang L, Zou H, Yang Y, Hong J. Adolescents’ attitudes toward non-suicidal self-injury (NSSI) and their perspectives of barriers to seeking professional treatment for NSSI. Arch Psychiatr Nurs. 2023;45:26-35. doi: 10.1016/j.apnu.2023.04.016
- Liang ML, Wang C, Zhang P, Zhang N. A review of dialectical behavior therapy in non-suicidal self-injury. Chin Ment Health J. 2020;34(5):398-402. doi: 10.3969/j.issn.1000-6729.2020.5.003
- Fu X, Yang J, Liao X, et al. Parents’ attitudes toward and experience of non-suicidal self-injury in adolescents: A qualitative study. Front Psychiatry. 2020;11:651. doi: 10.3389/fpsyt.2020.00651
- Gao Y, Wang Y, Wang Z, et al. Family intimacy and adaptability and non-suicidal self-injury: A mediation analysis. BMC Psychiatry. 2024;24(1):210. doi: 10.1186/s12888-024-05642-1
- Zhou SC, Zhou Z, Tang Q, et al. Prediction of non-suicidal self-injury in adolescents at the family level using regression methods and machine learning. J Affect Disord. 2024;352:67-75. doi: 10.1016/j.jad.2024.02.039
- Waals L, Baetens I, Rober P, et al. The NSSI family distress cascade theory. Child Adolesc Psychiatry Ment Health. 2018;12:52. doi: 10.1186/s13034-018-0259-7
- Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. doi: 10.1186/1471-2288-13-117
- Bürger A, Von Schoenfeld C, Scheiner C, et al. Universal prevention for non-suicidal self-injury in adolescents is scarce - a systematic review. Front Psychiatry. 2023;14:1130610. doi: 10.3389/fpsyt.2023.1130610
- Baer MM, Tull MT, Forbes CN, Richmond JR, Gratz KL. Methods matter: Nonsuicidal self-injury in the form of cutting is uniquely associated with suicide attempt severity in patients with substance use disorders. Suicide Life Threat Behav. 2020;50(2):397-407. doi: 10.1111/sltb.12596
- Kindsvatter A, Desmond K. Addressing parent-child conflict: Attachment-based interventions with parents. J Couns Dev. 2013;91(1):105-112. doi: 10.1002/j.1556-6676.2013.00078.x
- Martin J, Bureau JF, Yurkowski K, Fournier TR, Lafontaine MF, Cloutier P. Family-based risk factors for non-suicidal self-injury: Considering influences of maltreatment, adverse family-life experiences, and parent-child relational risk. J Adolesc. 2016;49:170-180. doi: 10.1016/j.adolescence.2016.03.015
- Wang Y, Zhang M, Chen H. Self-injury among left-behind adolescents in rural China: The role of parental migration and parent-child attachment. Front Psychol. 2019;9:2672. doi: 10.3389/fpsyg.2018.02672
- Wichstrøm T, Wichstrøm L. Childhood predictors of nonsuicidal self-injury in adolescence: A birth cohort study. J Am Acad Child Adolesc Psychiatry. 2024;63(11):1114-1122. doi: 10.1016/j.jaac.2023.12.013
- Wang YJ, Li X, Ng CH, Xu DW, Hu S, Yuan TF. Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis. EClinicalMedicine. 2022;46:101350. doi: 10.1016/j.eclinm.2022.101350
- Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Curr Dir Psychol Sci. 2009;18(2):78-83. doi: 10.1111/j.1467-8721.2009.01613.x
- Lee JS, Kim S, Lee JH, et al. A latent profile analysis on adolescents’ non-suicidal self-injury related to intrapersonal and interpersonal factors. Child Adolesc Psychiatry Ment Health. 2024;18(1):120. doi: 10.1186/s13034-024-00801-4
- Gardner KJ, Paul E, Selby EA, Klonsky ED, Mars B. Intrapersonal and interpersonal functions as pathways to future self-harm repetition and suicide attempts. Front Psychol. 2021;12:688472. doi: 10.3389/fpsyg.2021.688472
- Zhang Y, Huang K, Cong H, Wang M. Effects of group psychological counseling on nonsuicidal self-injury (NSSI) behaviors of college students with depression. Psychiatr Danub. 2022;34(2):229-235. doi: 10.24869/psyd.2022.229
- Becker M, Correll CU. Suicidality in childhood and adolescence. Dtsch Arztebl Int. 2020;117(15):261-267. doi: 10.3238/arztebl.2020.0261
- Tighe J, Nicholas J, Shand F, Christensen H. Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: Systematic review. JMIR Ment Health. 2018;5(2):e10732. doi: 10.2196/10732
- Berk MS, Starace NK, Black VP, Avina C. Implementation of dialectical behavior therapy with suicidal and self-harming adolescents in a community clinic. Arch Suicide Res. 2020;24(1):64-81. doi: 10.1080/13811118.2018.1509750
- Miller AL. Introduction to a special issue dialectical behavior therapy: Evolution and adaptations in the 21(st) century. Am J Psychother. 2015;69(2):91-95. doi: 10.1176/appi.psychotherapy.2015.69.2.91
- Wang Q, Xiong Y, Liu X. Family unity or money? The roles of parent-child cohesion and socioeconomic status in the relationship between stressful life events and nonsuicidal self-injury among Chinese left-behind children. Suicide Life Threat Behav. 2020;50(5):963-974. doi: 10.1111/sltb.12650
- Jacobson CM, Mufson L. Interpersonal psychotherapy for depressed adolescents adapted for self-injury (IPT-ASI): Rationale, overview, and case summary. Am J Psychother. 2012;66(4):349-374. doi: 10.1176/appi.psychotherapy.2012.66.4.349
- Myles P, Shafran R. The CBT Handbook. London: SAGE Publications Ltd.; 2012. p. 45-46.
- Cao YP, Zeng J, Zhang YL. Chinese taoist cognitive psychotherapy. In: Moodley R, Lo T, Zhu N, editors. Asian Healing Traditions in Counseling and Psychotherapy. California: Sage Publishings, Inc.; 2018. p. 131-142.
- Zhang WX, Yuan YG. A case report on effects of balancing psychotherapy on an adolescent patient with major depressive disorder. Med Philosophy. 2018;39(10):67-69. doi: 10.12014/j.issn.1002-0772.2018.10b.19