A calm, non-judgemental place to talk about self-harm, with an accredited therapist who has heard it before, by secure video.
Self-harm is one of the hardest things to say out loud. A lot of people carry it quietly for years, telling nobody, half expecting that the first person they tell will panic. If that is where you are, it is worth knowing that therapists who work with this hear it often, and it does not shock them.
This page covers what to do if you need help right now, what self-harm often does for people, and how online therapy can help. Sessions here take place by secure video, wherever in Ireland you are.
Online therapy is not an emergency service. If you have injured yourself badly, taken an overdose, or you feel in immediate danger, you need help today rather than an appointment next week.
| Situation | What to do |
|---|---|
| Serious injury, an overdose, or immediate danger | Call 112 or 999, or go to your nearest emergency department |
| Urgent, but not life-threatening | Contact your GP, or your out-of-hours GP service. The HSE guidance on getting help for self-harm sets out the routes |
| You need to talk, at any hour | Samaritans, freephone 116 123, 24 hours a day |
| Suicidal thoughts or self-harm | Pieta, freephone 1800 247 247, or text HELP to 51444 |
| You would rather text than talk | Text HELLO to 50808, free, any time |
At an emergency department, staff will treat the physical injury first. After that, you would usually be offered a mental health assessment, which is a conversation about what happened, how you are feeling now and what support you have. It is not a punishment and it is not a lecture.
Can online therapy work if you are having suicidal thoughts? Sometimes, yes, but not on its own and not without a proper look at the situation first. A therapist will assess whether ongoing video sessions are safe and suitable for you, and if they are, that work sits alongside a clear plan for the difficult moments, and often alongside your GP. If your risk level needs more than weekly sessions can hold, an honest therapist will tell you so and help you find the right service.
Self-harm means deliberately hurting yourself. That is the whole definition. It is not attention-seeking and it does not make you a certain type of person.
Self-harm and a suicide attempt are not the same thing. Many people who self-harm are trying to survive a feeling rather than end their life. That said, self-harm is linked with a higher risk of suicide, so it is always worth taking seriously, in yourself or in someone you love.
People describe it doing different jobs for them:
It is not always tied to depression. Plenty of people who self-harm are functioning, working, and holding things together on the outside.
Signs vary a lot and none of them are proof on their own. Unexplained cuts, burns or bruises, keeping arms or legs covered even in warm weather, pulling away from friends, or mood that swings sharply can all be worth noticing. So can a young person who suddenly wants a lot more privacy.
Self-harm happens at every age, though hospital data from the National Self-Harm Registry Ireland consistently shows the highest rates among adolescents and young adults.
A first session is just a conversation.
It can. The work is less about making you promise to stop and more about understanding what the self-harm is doing for you, then building something that does a similar job with less cost.
Practical parts of that usually include:
Doing this by video has real advantages. You are in your own space, nobody sees you arrive anywhere, and you are not travelling home raw after a hard session. If you live somewhere with no local service, or a long waiting list, it may be the difference between getting help and not.
Be realistic, though. Progress is rarely a straight line, setbacks happen and they are not failure. Online therapy may also need to sit alongside your GP, a psychiatrist, or in-person care.
How does it compare with seeing someone in a room? For most common difficulties, research finds the two broadly comparable. What matters more is your level of risk, whether you and the therapist work well together, whether you have somewhere private to talk, and the quality of the service itself.
The first session is mostly listening, with some questions. Your therapist will want to understand what is happening now, whether you have injuries that need medical attention, what tends to set things off, how you have been feeling, whether suicidal thoughts are part of it, and who else is around you.
Then you agree where to start. Nobody will ask you to promise to stop by Friday.
Ordinary sessions after that tend to involve:
Progress gets measured across several things, not one. Urges may soften before incidents stop. Distress may drop while the behaviour is still there. Sleeping, eating, and answering your phone again all count.
| Approach | What it focuses on |
|---|---|
| CBT | The links between a thought, a feeling, a trigger and what you do next, and building a different response |
| DBT | Getting through distress without harm, steadying strong emotions, mindfulness and managing relationships. Often used where urges are frequent or intense |
| Psychodynamic or integrative counselling | The feelings, experiences and relationship patterns underneath the behaviour |
The NICE guideline on self-harm recommends psychological therapy specifically shaped around self-harm, with dialectical behaviour therapy considered for young people who self-harm often. Guided therapy delivered over the internet also looks promising, including for adolescents, as in this Karolinska Institutet research summary. Which one suits you comes out of the assessment, not off a list.
Medication does not treat self-harm directly. A GP or psychiatrist may prescribe for something sitting alongside it, such as depression or anxiety.
There are three usual routes:
Before you book privately, check a few things: that the therapist is accredited with a recognised body such as the IACP, that they have experience with self-harm specifically, that they work with your age group, that they are clear about what happens if you are in crisis, and that they can see people in the Republic of Ireland.
Waiting times vary widely. Private appointments are often available within days; HSE services depend on need and local capacity.
If you are reading this about someone else, the useful things are simple. Listen without reacting with horror. Do not issue ultimatums or ask for promises. Say you will help them find support, and if their safety is at risk, get urgent help.
Private fees vary between therapists, so check the fee before you book rather than assuming. Two things are worth knowing: some health insurance policies contribute towards counselling with an approved therapist, and HSE-funded options may be free if you are eligible. Pieta’s services are free of charge.
Yes, with the same limits that apply in any therapy room. Your therapist may need to break confidentiality if there is serious risk to your life or someone else’s, and they will explain those limits at the start rather than spring them on you. Sessions run on an encrypted video link, not an ordinary video call.
Teenagers can, and many do well with it. For under-18s, a parent or guardian is involved in setting things up and consent is needed, while the content of sessions stays confidential to the young person within safeguarding limits. Younger children, or a teenager whose self-harm is frequent and high risk, may need CAMHS or a specialist service instead, and an assessment will tell you which.
If you want to start, book an initial online consultation and say briefly what has been happening. That first session is partly to check that this is the right level of support for you.
You do not have to have it all worked out before you talk to someone. That is what the first conversation is for.
When you're ready, we're here.
Booking takes about two minutes, and you can reschedule any time up to 24 hours before.
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