Self-Injury and the Role of the School Counselor
Self-injury is distinct from self-harm or cutting (International Society for the Study of Self-Injury, 2007). Self-harm encompasses a broad category of behaviors, including self-injury, eating disorders, and risk-taking behaviors. Self-injury includes cutting, as well as other forms of body tissue destruction, such as scratching, burning, head banging, and hitting oneself. According to Self-Injury Outreach and Support (SiOS), between 14-20% of adolescents have engaged in self-injury at least once.
Adolescents self-injure as a means to interrupt overwhelming negative emotions (Seattle Children’s Hospital, 2012). The specific reason why an adolescent self-injures varies by individual (International Society for the Study of Self-Injury, 2012). Some adolescents are triggered to engage in self-injury after a trauma or loss. Sometimes, deeper emotional issues, such as anxiety or depression, cause self-injury. For others, self-injury is triggered by environmental stress, such as academic demands, peer conflict/isolation, or family stress. It is important to note that self-injury is not necessarily indicative of suicidal intentions. However, those who self-injure are more likely to attempt suicide than those who do not self-injure, especially if the roots of self-injury go untreated.
As school counselors, we need to effectively respond to, prepare for, and prevent self-injury (Educators and Self-Injury, 2009). When a student discloses that she is self-injuring, school counselors must respond with care and kindness, assess the self-injurious behavior, and remind the student of the limits of confidentiality. The school counselor can help the student create a No-Harm Contract. A Self-Injury No-Harm Contract should not force the adolescent to quit self-injuring. Rather, it specifies that the adolescent will not bring sharp objects to school, and identifies supportive adults. After the adolescent discloses self-injury, the school counselor must decide whether it is necessary to break confidentiality and call the student’s parent (Stone, 2005). To decide this, the school counselor should consider the severity of the self-injury and consult the school’s policy.
In providing ongoing counseling, the school counselor can help the student reduce environmental stress, and help the student identify and practice coping skills. Dialectical Behavioral Therapy (DBT) could be a useful tool if the adolescent is ready to change her self-injurious behaviors (Hollander et al., 2007). Participating in a group might also be helpful for an adolescent, especially if the self-injury is, in part, triggered by peer isolation. Groups should not be comprised solely of students who self-injure. Within the context of a group, I would introduce Relational Cultural Therapy (RCT). This theoretical approach could help students form authentic relationships and gain communication skills (Trepal, 2010).
In addition to responding to self-injury, school counselors must prepare their schools for incidents of self-injury (Self-Injury Outreach and Support). According to the reports of 443 school counselors practicing during the 2002-2003 school year, 90% of their schools had a protocol for students considering suicide, while only 23% had a protocol in place for students who are self-injuring (Roberts-Dobie & Donatelle, 2007). The school counselor plays an important role in initiating and participating in the development of a school wide protocol for self-injury.
Furthermore, school counselors can prepare students for self-injury by teaching classroom guidance lessons in a health class (Roberts-Dobie & Donatelle, 2007). The school counselor can empower students as peer-referral agents. In addition, we can support students by preventing self-injury. Through classroom guidance, the school counselor can teach students the skills they need to regulate their emotions, practice social skills, and manage stress in healthy ways.
Future Directions and Trends
As the research base on self-injury grows, several trends are emerging. One emerging trend is a growing awareness of social contagion in schools (Cornell Research Program). Social contagion occurs when self-injury is glamorized in schools and spreads within peer groups. School counselors and administration are learning that showing graphic movies or glamorizing self-injury in assemblies is causing the harm to spread, rather than abate.
Another trend in self-injury is the growing awareness that self-injury is not confined to Caucasian teenage girls. Rather, self-injury is equally prevalent across genders (Self-Injury Outreach and Support). Slowly, we are becoming more aware that within community samples, boys self-injure to the same extent as girls. However, it looks different among boys. Boys are more likely to show signs of self-injury in the form of bruises, rather than scars from cuts. It is critical that school counselors be aware of, and support our male students who self-injure. In addition, the research is illuminating the fact that self-injury occurs equally across ethnicity, race, and socioeconomic statuses. However, non-Caucasian students are more likely to report. This means that school counselors need to be hyper-vigilant in reaching out to non-Caucasian students, building trusting relationships, and asking the right questions to support these students.
An additional trend is the growing awareness that self-injury is more prevalent among LGBTQ youth. Because self-injury is a sign of significant emotional distress, school counselors must ask why these students are enduring a heightened level of distress compared to their peers. It is worth reexamining the culture of the school and ensuring that LGBTQ students feel just as safe and welcome as cisgender heterosexual students.
| Self Injury and the ASCA Equity Statement |
| Table of Contents |
| self-injury.pptx |
| References |
Resources for School Counselors
| Articles |
| Web Resources |
Self-Injury and Classroom Guidance
| Background Information on Classroom Guidance |
| Example Classroom Guidance Lesson |
Self-Injury and Counseling Activities
| Background Information on Counseling Interventions |
| Counseling Worksheets |
