INTRODUCTION
1. Background
Non-suicidal self-injury (NSSI) refers to the deliberate infliction of physical harm without suicidal intent, including behaviors such as cutting or scratching [1]. Globally, 22.0% of adolescents report engaging in NSSI [2]. In Korea, 1.7% of adolescents reported engaging in NSSI within the past two weeks, equating to approximately 17 per 1,000 student [3]. These figures highlight the urgency of addressing NSSI as a major adolescent mental health issue.
NSSI serves as both a maladaptive coping mechanism and a form of social communication, including signaling distress, seeking attention, and avoiding stressful situations [4]. Its consequences extend beyond the individual, affecting family relationships and imposing substantial burdens on healthcare and social support systems due to medical costs, counseling services, and lost productivity [5]. Therefore, a comprehensive approach to understanding NSSI is necessary, particularly one that considers the interplay between individual behaviors and family dynamics.
Multiple studies indicate that adolescent females exhibit significantly higher rates of NSSI than males. A 2024 meta-analysis across 17 countries found that female adolescents are approximately 1.6 times more likely to engage in NSSI than their male counterparts [6]. National studies further confirm this trend, with 36.3% of female adolescents in Sweden reporting a history of NSSI, compared to 16.0% of males [7]. In South Korea, the one-year prevalence of NSSI was reported at 13.4% among adolescent girls, markedly higher than the 4.7% observed in boys, indicating that female adolescents were nearly 2.8 times more likely to engage in self-injury [8]. These findings underscore the need for a gender-sensitive approach to NSSI research, particularly one that examines the unique vulnerabilities of adolescent girls.
Given their tendency to internalize emotional distress, adolescent girls often rely on NSSI as a maladaptive coping mechanism, making maternal support a crucial factor in both onset and recovery [7]. In this context, gender differences in parent-child relationships also play a crucial role in NSSI vulnerability, emphasizing the need for research specifically on adolescent girls. Compared to boys, adolescent girls tend to form stronger emotional bonds with their mothers and engage in more frequent and in-depth self-disclosure [9,10].
The heightened emotional closeness and frequent selfdisclosure in mother-daughter relationships, combined with adolescent girls’ tendency to internalize distress, make maternal support a pivotal factor in understanding both the onset and recovery of NSSI. Mothers frequently serve as primary caregivers, facilitating access to professional help and supporting their daughters’ emotional recovery. Research suggests that maternal warmth, open communication, and emotional responsiveness serve as protective factors against NSSI, while maternal criticism, emotional neglect, or over-involvement are linked to an increased risk of self-injurious behaviors [11].
To better understand the subjective experiences of adolescents engaging in NSSI, qualitative research is necessary [4,12]. Of various qualitative approaches, narrative inquiry was selected due to its strength in capturing the evolving and relational aspects of lived experience [13]. In contrast to traditional qualitative methods that typically center on isolated events or singular perspectives, narrative inquiry enables a deeper understanding of motherdaughter dynamics within the context of NSSI. Therefore, narrative inquiry was chosen, particularly the three-dimensional framework proposed by Clandinin and Connelly, for its strength in capturing the three dimensions (temporality, sociality, place) of lived experiences. This approach is especially appropriate for interpreting the evolving emotional and interpersonal dynamics involved in recovery from NSSI. It also allows participants to structure their own experiences and articulate the meaning they assign to their relationships, thereby providing richer insights into the complex emotional and social dimensions of NSSI recovery [14,15]. However, few studies have examined the shared and interactive experiences of self-injurious adolescents and their mothers, particularly through the lens of mother-daughter relationships.
This study aims to address this gap by analyzing shared narratives to uncover how maternal support influences adolescent girls' NSSI experiences and recovery processes. Unlike studies that focus solely on either adolescent or parental perspectives, this research highlights the evolving nature of mother-daughter relationships in the context of NSSI and recovery, shedding light on their interactive and adaptive dynamics [14].
2. Objectives
This study explores the narratives of adolescent girls who have engaged in NSSI and their mothers to understand how their experiences have shaped their lives and relationships, with particular attention to the role of maternal support in the recovery process.
• To explore how mother-daughter relational dynamics contribute to the onset, continuation and transformation of NSSI
• To interpret how they lived experiences of both mothers and daughters evolve over time and context, using the three-dimensional narrative framework of temporality, sociality, and place.
• To understand maternal strategies and responses that support daughters’ recovery from NSSI
METHODS
1. Research Design
This study adopted a narrative inquiry approach to explore the recovery process of adolescent girls with a history of NSSI and their mothers. Narrative inquiry facilitates the reconstruction of lived experiences into meaningful narratives, offering rich insight into participants’ perspectives, emotions, and relational contexts [15].
The study followed five iterative stages, which often overlapped cyclically, refining the understanding of mother-daughter relationships in NSSI recovery [15].
1) Being in the field
Prior to data collection, the researcher conducted preliminary meetings with potential participants to establish rapport and explain the study’s purpose and procedures. She also engaged in self-exploration as a daughter and reflected on her experiences as a psychiatric nurse to foster empathy. Having worked in a psychiatric ward for five years, the researcher frequently encountered adolescent patients with severe self-injurious behaviors, often accompanied by their mothers. Many mothers expressed distress over their inability to control their daughters' behaviors, alongside emotional exhaustion. These experiences highlighted the role of maternal support in adolescent NSSI recovery and reinforced the need for a qualitative approach capable of capturing complex personal narratives.
To build trust and reduce emotional barriers, the researcher engaged in relational work before and during the interviews. During the initial meeting, the researcher maintained a warm, non-judgmental tone and gave participants ample time to ask questions or express concerns. Rather than immediately starting with formal interview questions, each session began with informal conversation, allowing participants to relax and feel safe. The researcher also paid close attention to participants’ emotional cues and adjusted the pace or depth of questioning as needed, ensuring psychological safety throughout the process.
2) Transitioning to field texts
To explore the recovery process in depth, data were collected through three rounds of in-depth interviews per participant, following an initial meeting for informed consent and explanation of the study’s aims. Semi-structured interview guides were developed to ensure consistency while allowing participants the flexibility to narrate their experiences in their own words. The first interview focused on coping with self-injury, the second explored deeper meanings and relational interpretations, and the third addressed previously omitted details and facilitated reflection. The full set of guiding questions is presented in Table 1. These questions were constructed based on prior literature and clinical insights to elicit nuanced narratives regarding NSSI and mother-daughter dynamics.
Each mother and daughter participated in a total of four sessions over four consecutive weeks. The first session was a preliminary meeting in which the researcher explained the study purpose, provided written information, and obtained informed consent. This was followed by three weekly interviews conducted at 7-day intervals, each lasting approximately 60 minutes. Interviews were held individually in private and comfortable settings such as a hospital seminar room, university research office, or church counseling room.
Joint interviews were intentionally avoided to protect the participants’ psychological safety and ensure candid expression. Participant observations were also conducted to capture non-verbal cues such as emotional tone, body language, and environmental context. Follow-up communication via phone or text was used to clarify ambiguous content. Data collection took place between January and May 2024.
3) Composing field texts
Following data collection, interview recordings, field notes, and analytical memos were carefully reviewed and organized. The researcher cross-checked written notes with audio recordings to capture subtle emotional cues, such as moments of silence or visible tears, which might not have been evident in transcripts alone. Through iterative narrative analysis, recurring themes and relational patterns were identified. These emergent insights formed the foundation for constructing the initial research texts that reflected the participants’ lived experiences in a coherent narrative structure.
4) Transitioning from field texts to research texts
The researcher reconstructed each participant's story, emphasizing family interaction, particularly the motherdaughter relationship, in NSSI and recovery. The analysis was guided by a three-dimensional narrative inquiry framework, focusing on time, interaction, and place as key elements in understanding participants’ experiences. This process formed the foundation of the research texts.
5) Composing research texts
Based on the analyzed field texts, the researcher finalized the research narratives in alignment with the study’s purpose and interpretive framework. Rather than reorganizing findings again, the final texts retained participants’ voices and emotional depth while maintaining coherence with the thematic configuration presented in the Results. Credibility was reinforced through participant confirmation and supervisory review.
2. Participants
1) Eligibility criteria
This study included two daughters, one in adolescence and the other in early adulthood, who had engaged in NSSI and their respective mothers, resulting in a total of four participants. The inclusion criteria were follows. First, participants were required to have a history of NSSI behavior, primarily in the form of cutting, lasting at least six months. Second, they needed to report an abstinence period from NSSI of six months or longer. Third, they had to be capable of participating in verbal interviews. These criteria were derived from prior studies that emphasized sustained NSSI engagement [16,17], and self-perceived recovery following a minimum abstinence period [18,19].
Exclusion criteria included the presence of severe psychiatric symptoms, such as major depressive episodes or intellectual disabilities, that might hinder conversational participation.
2) Recruitment Procedure
Participant recruitment was conducted in accordance with procedures approved by the Institutional Review Board (IRB) of Inha University Hospital (IRB No. 2023-09-028-007). The recruitment design was informed by strategies used in previous qualitative studies on NSSI and suicidality, including expert referrals [20], and recruitment through notices posted in Inha University Hospital, Inha University website, and mental health-related web communities [21].
The recruitment notice was approved by the IRB prior to posting. It included the researcher’s contact information, a brief introduction to the researcher, the purpose of the study, inclusion and exclusion criteria, study procedures, potential risks, and a link to a questionnaire through which individuals could express their willingness to participate. The notice was posted in the lobby and outpatient psychiatry department of Inha University Hospital, as well as on a mental health-related web community. Additional recruitment was also conducted through clinical and academic networks based on referrals from a psychiatry professor and a psychiatric nursing professor.
Through the recruitment notice, four mother-daughter dyads who were interested in the study voluntarily contacted the researcher to express their willingness to participate. All underwent an initial screening process. Of these, three dyads consisted of daughters receiving outpatient psychiatric care at Inha University Hospital and their mothers, while one dyad learned about the study through the online recruitment notice. During screening, two dyads were excluded for not meeting the predefined criterion of a six-month abstinence period from self-injury. One had self-injured four months prior and the other two weeks before screening.
Ultimately, two mother-daughter dyads participated in the study. Background information on the participants is presented in Table 2.
3. Ethical Considerations
This study was approved by the IRB and conducted in accordance with the Declaration of Helsinki (2013 revision) and the International Conference on Harmonisation - Good Clinical Practice (ICH-GCP) guidelines.
Participants were fully informed of the study’s purpose, procedures, potential risks, and their rights, and written informed consent was obtained. The consent form and information sheet included contact information for the IRB and the Clinical Research Protection Center of Inha University Hospital, enabling participants to raise concerns independently of the researcher. It was clearly stated that participation would not affect treatment and could be refused or withdrawn at any time. For the minor participant, written consent was obtained from the legal guardian, and the participant signed the form by hand.
During the screening stage, the researcher read the consent form aloud line by line and provided a copy for review. Prior to the first interview, the form was reviewed again, and the participant signed it in person. The researcher encouraged participants to ask questions and ensured they fully understood the study.
No physical risks or adverse effects were expected. However, due to the sensitive nature of some questions, participants could experience emotional discomfort during the interviews. In such cases, the session was to be paused or adjusted. To prepare for any self-injurious behavior, emergency supplies at the Inha University College of Nursing or Inha University Hospital were to be used, and participants could be promptly referred to the nearest emergency department. No self-injury occurred during the study.
All data were pseudonymized by removing identifiable information and securely stored as encrypted files in a locked research office. Upon completion of the study, all materials will be destroyed in accordance with ethical research standards.
4. Researcher Preparation
The researcher completed qualitative research training and workshops as part of a master’s program in nursing, alongside five years of psychiatric ward experience. The researcher’s interest in NSSI recovery stemmed from observing mothers struggling to support their self-injurious daughters in clinical settings.
To maintain objectivity, the researcher actively employed bracketing (epoche) to prevent assumptions about NSSI and mother-daughter relationships from influencing interpretations. e study was conducted under continuous supervision from an academic advisor specializing in psy-chiatric nursing and qualitative research, ensuring methodological rigor.
5. Ensuring Rigor in the Study
To ensure methodological rigor, this study applied the four trustworthiness criteria proposed by Lincoln and Guba: credibility, transferability, dependability, and confirmability [14]. Credibility was strengthened through repeated interviews and member checking, allowing participants to review and confirm the accuracy of their reconstructed narratives. Transferability was ensured by providing rich contextual descriptions of participants’ backgrounds and experiences. Dependability was maintained by documenting analytic decisions and keeping an audit trail of reflective memos. Confirmability was supported through regular peer debriefing with the research advisor, minimizing potential researcher bias and supporting interpretive accuracy.
RESULTS
1. Participants’ Narratives
1) Pink
Pink experienced psychological isolation due to bullying and ostracization by her peers during elementary school. Unable to find a means to cope with her emotional distress, she encountered self-injury on the internet and began using it as a maladaptive coping mechanism. When her mother, Purple, first became aware of this behavior, she responded with strictness and dismissed Pink's emotions, further deepening the emotional disconnect between them.
During middle school, Pink's self-injurious behaviors escalated significantly, ultimately leading to a suicide attempt that necessitated hospitalization. This event compelled Purple to recognize the severity of her daughter's suffering, prompting her to abandon her previously rigid approach and adopt a more emotionally supportive stance. Purple resigned from her job to fully devote herself to Pink’s care, tending to her wounds daily and demonstrating unwavering commitment. These changes gradually restored Pink’s trust in her mother. With the addition of counseling therapy, she developed healthier emotional expression strategies and embarked on the path to recovery.
2) Purple
Purple raised Pink with high expectations, shaped by her own childhood experiences. She placed significant emphasis on her daughter’s academic achievements and dismissed Pink’s expressions of distress as mere defiance. However, upon witnessing Pink’s severe self-injury and subsequent emergency hospitalization, she realized the ineffectiveness of her approach.
Determined to facilitate her daughter’s recovery, Purple resolved to change her parenting style. She made the consequential decision to resign from her job to prioritize her daughter’s recovery. Initially, her efforts centered on monitoring Pink’s self-injury, but over time, she transitioned toward a more understanding and accepting approach. Ultimately, Purple’s emotional support played a crucial role in helping Pink discontinue self-injury and adopt healthier methods of emotional regulation.
3) Turquoise
Turquoise experienced severe depression and panic attacks because of academic stress and bullying in middle school. Deprived of opportunities to express her emotions, she gradually turned to self-injury as a means of emotional release. Her mother, Lime, adhered to a rigid parenting style, believing that Turquoise needed to endure hardships independently. This approach further isolated Turquoise and exacerbated her distress.
A pivotal moment occurred when Lime discovered a knife under Turquoise’s pillow. Confronted with the severity of her daughter’s condition, Lime was forced to acknowledge the depth of Turquoise’s emotional turmoil. Through the guidance of a church teacher, Turquoise was able to communicate her emotions to her mother, initiating a transformation in their relationship. Subsequently, Lime participated in counseling sessions with Turquoise and modified her parenting style. As a result, Turquoise acquired healthier emotional regulation strategies and successfully ceased self-injurious behaviors.
4) Lime
Lime was raised under an authoritarian mother and replicated a similarly strict parenting approach with Turquoise. Following her divorce, she assumed sole financial responsibility for the family, which heightened her expectations for her daughter. This pressure placed a significant emotional burden on Turquoise.
Upon discovering that Turquoise had contemplated extreme actions, Lime reflected on the impact of her parenting style on her daughter's distress. She then actively engaged in counseling sessions with Turquoise and gradually transitioned to a more emotionally supportive approach. Through faith and therapy, Turquoise was able to discontinue self-injury, and the mother-daughter relationship evolved into one characterized by mutual understanding and emotional closeness.
2. Three-Dimensional Narrative Space: Integrated Recovery Stories of Mothers and Daughters
This study applied the three-dimensional narrative inquiry framework proposed by Clandinin and Connelly, focusing on temporality, sociality, and place [15]. To reconstruct the recovery experiences of four mothers and daughters who have experienced NSSI. These dimensions are not treated as separate analytical categories but as interwoven aspects that shaped the participants lived experiences. In the results presented below, we explore how emotional and relational transformations unfolded over time, through shifting relationships, and within changing environments.
Figures 1 and 2 illustrate the daughters’ and mothers’ experiences across pre-injury, injury, and recovery phases. This approach provided a comprehensive understanding of their emotional and psychological recovery.
1) In a world where wounds remained silent
The silence was long and heavy. In homes where emotions had no vocabulary, Pink and Turquoise carried wounds no one could see. Their pain began not with blood, but with the suffocating absence of understanding. Pink, bullied in elementary school, found no solace at home; instead, she stumbled upon self-harming communities online. Turquoise, overwhelmed by loneliness and academic pressure, began to hurt herself in secret corners of her room. The world around them valued obedience and achievement; their mothers, Purple and Lime, responded with fear masked as control. “I didn’t have anyone to talk to,” Pink remembered. “So, I found people online who felt like me.”
Their mothers watched but didn’t truly see. Purple said, “I scolded her harder because I didn’t know what else to do.” Emotions in the home were disciplined, not discussed. Behind closed doors, daughters cried quietly into pillows while mothers misread silence as rebellion. The disconnect grew, each side retreating further into their own interpretation of pain.
2) The moment the blade was seen
Then came the moment. A bloodstained sleeve. A hidden blade. The unmistakable sight of a wound that demanded attention. These discoveries did not solve anything, but they cracked the silence.
Reflecting on this turning point, Turquoise later said, “I was exhausted. I didn’t want to die, but I didn’t want to keep living like that either.”
For Purple, it was like the ground shifting: “I realized she wasn’t trying to make things difficult. She was begging to be understood.”
Mothers stood at a crossroads, either continued reacting in fear or begin reaching out. Purple chose to pause, listen, and for the first time, admit she was also afraid. Lime, who had long parented alone, whispered to herself that maybe strength meant asking for help. These were quiet shifts, not dramatic transformations, but they marked the beginning of a shared path.
3) From Parallel Pain to Shared Healing
Healing did not arrive quickly. It unfolded in hesitant conversations and awkward apologies. Pink found courage in counseling rooms, while Turquoise felt seen in the words of her church mentor.
One mother quit her job to spend more time at home. Another allowed her daughter to redesign her room. These gestures, small and often unnoticed, created new meaning in familiar spaces.
It was in these shared acts—washing dishes together, walking the family dog, sitting through the silence—that understanding began to take root.
“She doesn’t cry alone anymore,” Purple said. “Now, she calls me. Sometimes, we cry together.”
The girls began using words instead of wounds. The mothers responded not with discipline, but with presence.
4) A home rearranged
The houses changed. Not drastically, but deep. Pink’s home now held softer light, more warmth, and the gentle presence of a rescue dog.
Turquoise no longer locked her door. Lime rearranged the furniture to make space for shared meals. Purple set aside her planner to just sit beside her daughter after school.
These weren’t renovations; they were restorations—of connection, of attention, of emotional refuge.
It wasn’t always smooth. Arguments still happened. Doubts returned. But there was movement, not stillness; there was dialogue, not silence. And that made all the difference.
5) The thread that holds
Looking back, each mother and daughter could trace the arc of rupture and repair. Their stories do not end in resolution, but in continuation. Healing, they realized, is not a destination but a rhythm—one that requires patience, grace, and repetition.
“Sometimes I still hurt,” Turquoise admitted, “but now I know how to speak that hurt, not just show it.”
The three dimensions did not operate in isolation. They wove together to create a shared narrative space where recovery became possible.
In tending their wounds together, these families began to write a new story—one of pain met with presence, of silence replaced by voice, and of healing lived in everyday moments.
3. Analysis of the Mother-Daughter Relationship and Recovery Process
1) Pink and purple
Pink's self-injury began during her elementary school years when she experienced exclusion and bullying from her peers. Feeling isolated and lacking the skills to express her emotions or seek help, she turned to self-injury as a maladaptive coping mechanism. Initially, when she confided in her mother, Purple, the response was dismissive and severe, reinforcing Pink’s belief that her emotions were invalid and deepening the emotional distance between them. As a result, Pink withdrew further, choosing to suppress her emotions rather than share them, which contributed to the escalation of her self-injury into more severe and frequent episodes during middle school.
As Pink’s self-injury became increasingly dangerous, culminating in a suicide attempt that necessitated hospitalization, Purple was forced to confront the reality of her daughter’s suffering. Initially, Purple reacted with frustration and confusion, questioning the motivations behind Pink’s actions and struggling to comprehend the depth of her distress. However, a defining moment occurred when Pink directly revealed her self-inflicted wounds to her mother, prompting a profound emotional response from Purple. This moment served as a catalyst for change, making Purple recognize the ineffectiveness of her previous approach and motivating her to adopt a more supportive and empathetic stance.
Determined to aid her daughter's recovery, Purple implemented significant changes in her lifestyle. She left her job to devote herself to Pink’s care, engaging in daily routines that included tending to her wounds and providing unwavering emotional support. This consistent care played a crucial role in reestablishing trust between them, forming the foundation for the restoration of their relationship. Over time, Purple transitioned from imposing rigid rules to encouraging open communication and emotional validation. In response, Pink gradually developed healthier emotional regulation strategies through therapy, leading to a gradual but sustained improvement in their relationship. Ultimately, these adjustments contributed to Pink’s long-term recovery and reinforced the importance of parental support in overcoming self-injurious behaviors.
2) Turquoise and lime
Turquoise suffered from severe depression and recurrent panic attacks, largely attributed to academic pressures and childhood bullying. With limited opportunities to express her emotions, she resorted to self-injury as a means of emotional relief. However, this behavior gradually evolved into a habitual response to stress. Her mother, Lime, adhered to a rigid and authoritarian parenting style, believing that emotional resilience should be cultivated through perseverance rather than emotional expression. Consequently, Turquoise felt constrained, unable to articulate her emotional struggles, which further exacerbated her depressive symptoms and led to an increase in self-injurious behaviors.
A pivotal turning point in their relationship occurred when Lime discovered a knife hidden under Turquoise’s pillow. Though she instinctively removed the knife, this discovery forced Lime to acknowledge the severity of her daughter’s mental state. To regain control of the situation, Lime initially considered enrolling in Turquoise in a boarding school to enhance her academic focus. However, with the intervention of a church teacher, Turquoise managed to communicate her emotional distress to her mother, compelling Lime to reassess the impact of her parenting style on her daughter’s well-being.
Following this realization, Lime actively participated in counseling sessions with Turquoise and made concerted efforts to modify her approach. She gradually shifted from enforcing high expectations to fostering an emotionally supportive environment where her daughter could feel validated and heard. This shift allowed Turquoise to express herself more freely, facilitating the healing process and reinforcing their relationship. Over time, the mother-daughter dynamic transformed from one dominated by conflict and control to one characterized by emotional openness and mutual understanding.
Through therapy, Turquoise developed deeper selfawareness and adopted healthier coping mechanisms. Additionally, the support of her faith community and meaningful interactions with a trusted teacher played a vital role in her emotional recovery. Lime’s decision to prioritize emotional support over rigid discipline proved to be instrumental in Turquoise’s long-term improvement, demonstrating the critical role of parental adaptability in the recovery journey of individuals struggling with NSSI.
Following the analysis of the two mother-daughter dyads, Table 3 presents a synthesized summary of maternal behaviors observed across both cases, along with their effects and their impact on the recovery process.
DISCUSSION
This study examined the recovery process of two mother-daughter dyads with experiences of NSSI using Clandinin and Connelly’s three-dimensional narrative inquiry framework. The findings indicate that maternal emotional support, psychological counseling, psychiatric treatment, and environmental modifications played significant roles in the recovery process. In this discussion, the findings are interpreted through a comparative lens with existing literature, highlighting key factors that shape the recovery process and suggesting implications for practice and future research.
First, sustained maternal emotional support emerged as a central component of recovery. The daughters expressed being moved by their mothers’ physical and symbolic acts of care, which restored emotional connection and rebuilt trust. Behaviors such as crying together, applying ointment to self-injury wounds, and offering heartfelt apologies went beyond simple comfort and served as concrete practices of relational repair. These findings align with prior research that emphasizes how emotionally responsive parenting contributes to effective NSSI recovery, and they highlight the practical significance of maternal engagement in emotional care [22,23].
Both cases involved concurrent psychiatric treatment and psychological counseling, which supported emotional regulation and expression. Pink learned emotional regulation strategies through counseling, while Turquoise reported that she was able to stop suppressing her feelings and express them constructively. The integration of psychiatric and psychological interventions allowed for simultaneous attention to the emotional and behavioral dimensions of NSSI. While counseling contributed to selfawareness and the development of adaptive coping strategies, psychiatric care provided pharmacological support and clinical stability. These outcomes support the clinical utility of multidimensional interventions and demonstrate the effectiveness of an integrated treatment environment within institutional settings [22].
In addition to psychological interventions, environmental restructuring also played a critical role in supporting recovery. Both families made meaningful changes, including adjustments in caregiving priorities, redesign of physical spaces, and the introduction of emotional anchors such as pets. These modifications contributed to the stabilization of the home environment and reduced emotional distress. Prior studies have suggested that pet companionship and caregiving reprioritization can enhance emotional regulation and reduce anxiety, reinforcing the therapeutic value of environmental modifications [24].
The mothers’ transformation in emotional perception and parenting strategies also warrants attention. Despite not participating in formal parenting programs, Purple gradually altered her perspective through conversations with her husband, while Lime drew support from her church community. These informal support systems facilitated a shift from initial reactions of avoidance and control to more emotionally engaged and empathetic parenting. As caregivers received validation and emotional guidance from external sources, they became better able to respond sensitively to their children’s distress. This echoes findings in previous research, which suggest that community-based support and spousal communication can improve caregivers’ emotional regulation and parenting confidence [11,25].
Through engagement with their communities and reflections on their own upbringing, both mothers came to recognize that their parenting styles had been shaped by their childhood experiences. This awareness enabled them to adopt more open and empathetic communication with their daughters, moving away from emotionally suppressive disciplinary patterns. The process of dismantling intergenerational emotional inhibition became a foundational element of recovery. These findings support the idea that lasting recovery requires not only behavioral intervention but also relational and intergenerational transformation within the family system [26].
From a cultural perspective, South Korean society places strong emphasis on academic achievement while discouraging open emotional expression [27]. This environment may lead adolescents to internalize shame, selfblame, and emotional suppression. In this study, both daughters experienced psychological distress associated with academic pressure and emotional disconnection from caregivers. Pink reported feelings of neglect due to repeated comparisons with her academically successful sibling, while Turquoise withheld emotional expression to fulfill the expectations of being a problem-free daughter in a single-parent household. When Lime recommended that Turquoise enroll in a competitive boarding school, Turquoise expressed resistance that revealed cumulative emotional strain and unmet psychological needs. These relational patterns are consistent with previous findings that associate authoritarian parenting, performance pressure, and limited emotional communication with self-injurious behaviors among Korean adolescents [8,28,29]. During the recovery process, Lime acknowledged her role in setting high standards, which led to an emotional release in Turquoise. This interaction contributed to the restoration of trust and suggests that emotionally responsive caregiving within a safe family environment can support recovery from NSSI.
In summary, this study demonstrates that recovery from NSSI is not a linear or isolated process. Rather, it is shaped by the interplay of maternal emotional support, clinical intervention, environmental restructuring, and relational transformation. Recovery extends beyond the cessation of self-injury and is made sustainable when caregivers engage in self-reflection and foster emotional availability within the family. Future intervention strategies should promote caregiver emotional attune and reparative parenting through family-centered approaches. Moreover, multi-level interventions are needed to prevent the intergenerational transmission of emotional suppression and maladaptive coping patterns.
Limitations and Implications
This study has several limitations. First, the sample was limited to only two mother and daughter dyads, which restricts the generalizability of the findings. While narrative inquiry emphasizes depth rather than breadth, future studies should involve participants from a wider range of family structures, socioeconomic backgrounds, and cultural contexts to enhance transferability.
Second, both cases involved either the absence or emotional unavailability of fathers, limiting insight into the paternal role in the recovery process from NSSI. Further studies should include families in which the father is a primary caregiver, or the mother is absent from exploring diverse caregiving dynamics.
Third, although the researcher made efforts to apply bracketing and maintain a neutral stance, her professional background as a psychiatric nurse may have inadvertently influenced participants’ disclosures or the interpretive process. This highlights the need for continued reflexivity and the use of methodological triangulation in qualitative studies.
Fourth, the study was conducted within a Korean sociocultural context shaped by Confucian values, which may limit the applicability of the findings to other cultural settings. Cultural emphasis on academic achievement, obedience, and gendered family roles may have affected both the participants’ experiences and how they interpreted their own narratives. Therefore, future research should investigate adolescent self-injury in non-Confucian contexts, explore gender differences in NSSI patterns, and examine how cultural ideologies intersect with mental health and caregiving practices.
In addition, this study exclusively involved female adolescents, and participants did not explicitly articulate perspectives on gender roles. Certain behaviors such as emotional suppression, concealment of self-injury, and the pursuit of being a good daughter may reflect the influence of gendered social norms. However, these interpretations are based on the researcher's perspective and should be approached with caution. Future studies should include male adolescents or young adult males to explore how expressions of self-injury and family recovery processes may differ by gender.
Lastly, quantitative studies with larger samples would be useful to test the prevalence and patterns suggested by this study's findings and to explore measurable associations between parenting responses and recovery outcomes in adolescents who engage in NSSI.
Despite these limitations, this study provides meaningful implications for both nursing education and clinical practice. In the field of education, the findings underscore the need for structured parent training programs tailored to caregivers of adolescents who self-injure. In clinical settings, the study highlights the importance of relational and emotional presence in family-centered mental health care. Moreover, the narrative data presented here may serve as a foundation for developing therapeutic guidelines and community-based family interventions aimed at supporting adolescents and their families in the context of NSSI recovery.
CONCLUSION
This study employed a narrative inquiry approach to examine the recovery process from non-suicidal self-injury (NSSI) within two mother-daughter dyads, with a focus on the relational dynamics shaping both the onset and transformation of self-injurious behavior. The findings demonstrate that NSSI frequently functions as a maladaptive coping mechanism for emotional distress, and that recovery is best supported through an integrative framework encompassing maternal emotional responsiveness, professional psychological and psychiatric interventions, and environmental adjustments.
Maternal emotional support emerged as a particularly salient factor in the recovery trajectory. Although both mothers initially responded with avoidance or control, their gradual shift toward emotionally attuned and responsive caregiving facilitated improved communication and relational trust. This transformation enabled the daughters to engage in healthier emotional regulation and contributed to the re-establishment of secure relational bonds.
In parallel, the integration of psychiatric treatment and psychological counseling provided structured therapeutic support that addressed both the emotional and behavioral dimensions of NSSI. Environmental and social influences, including increased maternal presence, home modifications, and community-based support, further contributed to emotional stabilization and recovery.
These findings underscore the complex and relational nature of recovery from NSSI. Sustainable recovery was found to be contingent upon the interplay of reflective parenting, professional intervention, and socio-environmental support. The central role of the mother-daughter relationship suggests that family-centered and emotionally responsive care should be prioritized in both clinical interventions and community-based mental health strategies. This study contributes to the growing body of literature emphasizing the importance of relational healing in adolescent NSSI and offers practical implications for nursing education and mental health practice.
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