Feelings of blame and shame seemed to figure significantly in the interactional patterns of some families seen within the self‐harm intervention family therapy (SHIFT) trial. Taking the SHIFT manual as a starting point, we elaborate the links between blame, shame, emotional regulation and adolescent self‐harm, drawing on various theoretical models. We note the importance of attending to these emotional processes both in the family and the therapy team, arguing that these unhelpful patterns of interaction, emotion and meaning‐making may also signal a motivation for change. We offer some ideas about using blame and shame as platforms for understanding and intervention in the context of adolescent self‐harm and illustrate the application of these ideas with case vignettes. Practitioner points Consider offering the young person and parents parallel sessions to scaffold better communication in family sessions. If you can, work with a team to help reflect on your own emotional responses and their meanings. When attempts to lessen blame provoke more, try to understand what underlies blaming behaviour. When a family's reported lack of difficulties seems incongruent with the presence of self‐harm, consider the possible silencing effect of shame. 和有青少年自残行为的家庭讨论责备和羞愧的发生 责备和羞愧似乎常出现在自残干预类家庭治疗案例中的一些家庭的相互作用中。以SHIFT手册作为转折的起点, 应用各种理论模型, 我们阐释了责备, 羞愧和情感约束和青少年自残之间的关系。我们注意到这些情绪过程在家庭以及治疗中的重要性, 认为这些无益的交互模式, 情绪, 以及意义构建可能也预示了转变的动机。我们提供了一些关于应用责备和羞愧作为理解的平台以及有关青少年自残背景下的干预的想法, 并阐释了这些想法在案例场景中的应用。 对实践者有用的几点建议 考虑提供年轻人和家长平行进行的的治疗会面用于支持更好的家庭会面时的交流。 如果可以的话, 和一个团队一起工作以帮助反思你自己的情绪性回复和背后的意义。 当试图减少责备更多地出现的时候, 试图理解责备行为背后隐藏的是什么。 当一个家庭报告出和自残行为的存在不一致的家庭状态时(不同在困难), 考虑可能是羞愧的沉默效果。 关键词：责备, 羞愧, 儿童和青少年精神健康, 自残, 家庭治疗