Adolescents who self-injure: implications and strategies for school counselors

Professional School Counseling, Feb, 2004 by Victoria E. White Kress, Donna M. Gibson, Cynthia A. Reynolds

School counselors can advocate for students through faculty in-services and parenting groups, and speaking in health classes to students regarding self-injury. It is important to inform staff, parents, and students that self-injury does not mean someone is crazy, but can be understood as a means of attempting to help one's self. In particular, educating school faculty regarding the etiology and function of self-injury can help in dispelling the myth that people who self-mutilate are attention seeking. Dispelling myths can help students gain access to support and needed services both within the school and in the outside community. For example, a teacher who is aware a student is self-injuring may not report self-injury as he or she may perceive it as trivial or as a way for the student to receive attention. With education, the teacher may be more likely to seek help for the student and to make the school counselor aware of the situation.

Education of staff and teachers is one manner in which school counselors can advocate for students who self-injure. By educating faculty about self-injury, they should feel more comfortable in managing the issue of self-injury. Also, educating faculty on ways to approach or manage student self-disclosure of self-injury can be helpful. In particular, the physical education teacher and the school nurse may be of critical importance in identifying and monitoring students who self-injure.

Advocating for students by educating faculty about the fact that self-injury is not equated with suicidality is also very important. Strong personal reactions to self-injury can lead to reactionary stances and extreme measures such as unnecessary hospitalizations, pulling students out of school, or suspending students. Educating faculty and administrators on the differences between self-injury and suicide attempts can help in avoiding unnecessarily restrictive actions.

Prevention

Conterio et al. (1998) and Welch (2001) have noted that loss, childhood illness, physical and sexual abuse, marital violence, familial self-injury, peer conflict and intimacy problems, and impulse control problems are all related to self-injury. Thus, for the purposes of prevention, school counselors should consider these variables when targeting at-risk students. As with the issue of intervention, prevention efforts can include helping students to express and identify their feelings, while also developing healthy behavioral coping skills. Group counseling and counselor outreach activities that encourage at-risk students' development of these aforementioned skills may be helpful in preventing self-injury. Prevention efforts can also occur by providing pamphlets and handouts to students. Materials concerning self-injury can be distributed through health classes or directly through the school counseling office.

A sequence of events in which a person inflicts self-injurious behaviors and is imitated by others in the environment is referred to as contagion of self-injurious behaviors (Walsh & Rosen, 1985). The issue of contagion has received some attention in the research literature (Rosen & Walsh, 1989; Ross & McKay, 1979; Taiminen et al., 1998; Walsh & Rosen) Initial research indicated that in hospital and residential treatment settings, adolescents tend to imitate self-injurious behaviors. Self-injurious acts followed in 25 residents at a residential facility indicted that these acts are bunched or clustered in time across subjects, suggesting that adolescents in a residential setting trigger the self-injurious behaviors in each other (Walsh & Rosen). These findings suggest that a group process variable or social factors may contribute to the behavior in participants who already self-injure or are at risk for self-injuring. Walsh and Rosen noted that labeling self-injury as a behavior that is likely to be imitated actually decreases self-injury as many adolescents, for developmental reasons, do not want to be perceived as being imitative or be labeled as followers.