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

Similar to Walsh and Rosen (1985), Talminen et al. (1998) have suggested adolescents' weak egos and diffuse identities make them susceptible to various forms of identification including self-injuring and refer to this phenomena as "rites of togetherness" (p. 215). Through intensive study (i.e., interviewing methods and empirical observation), Rosen and Walsh (1989) came to similar conclusions. They stated that adolescents in a residential setting engaged in contagious self-injury as a "concrete display of affinity between two people" (p. 657). Rosen and Walsh observed the following: (a) individuals involved in contagious self-injury are highly enmeshed; (b) they have difficulty with conventional forms of intimacy; (c) they find deviate acts (e.g., shared self-injury) to be compelling and exciting. Rosen and Walsh concluded that when contagious self-injury occurs, it is important to use interventions that target specific dyads. It is important to help the adolescents express emotions and negotiate intimacy in more normative ways. When this is not possible, it may be necessary to isolate the person being modeled from the rest of the group.

While the aforementioned studies all involved adolescents in residential treatment settings, Fennig, Carlson, and Fennig (1995) described their experiences consulting in a public school setting regarding a situation where an outbreak of self-mutilation occurred. They expressed concerns that this phenomenon may be more frequent in educational systems than reported. In describing their experiences they made the following observations: (a) the majority of students involved in the outbreak did not demonstrate any overt psychopathology and were not identified as emotionally disturbed; (b) the only overt sign of problems associated with self-injury was a drop in grades; (c) several initiators with more severe psychopathology seemingly induced the behavior in more passive students and all had anxiety and depressive related traits; (d) isolation of the more severely disturbed initiators was most effective in lowering the severity and frequency of the phenomenon.

While these suggestions are narrative and have not been empirically scrutinized, school counselors facing similar situations can use this information. Combined, the research related to contagion implies that social factors may contribute to the development and maintenance of self-injurious behavior. A related issue is to differentiate initiation self-mutilating behaviors of gangs or cliques from self-injuring behaviors related to psychopathology. Although both types of behaviors are significant, intervention and referral can take different directions. If an ostensible contagion situation occurs, consultation with other professionals may be necessary.

PERSONAL REACTIONS

Counselors may have many strong feelings when faced with student self-injurious behaviors. Alderman (2000) stated that the typical clinician treating a client who self-mutilates is often left feeling a combination of helplessness, guilt, anger, betrayal, disgust, and sadness. Self-injury has been identified as the most distressing client behavior encountered in clinical practice and the behavior that many professionals find most traumatizing to encounter (Gamble, Pearlman, Lucca, & Allen as cited in Deiter & Peralman, 1998).