Just cut it out: legal and ethical challenges in counseling students who self-mutilate

Professional School Counseling, April, 2004 by Janet Froeschle, Mike Moyer

Myth #3. Self-mutilators are dangerous and will probably harm others. Self-mutilation is usually secretive and is most often performed in isolation. The behavior is not performed in an attempt to harm but rather to vanquish emotional pain. Violence is not directed toward others (McLane, 1996).

Myth #4. Self-mutilators just want attention. Most self-mutilators perform their ritual and symbolic acts in private. They are often humiliated about their scars and keep them private (Levenkron, 1998).

THE PROFILE

The profile of a self-mutilator has been researched by counselors, those in the medical field, educators, and psychiatrists. School counselors and other personnel need to become acquainted with typical responses in order to make accurate risk assessments. Presented below are some of the typical behaviors, thinking patterns and motivations, and personality traits to aid the counselor with awareness.

Behavior and Personality Traits

Self-mutilating behavior generally begins in adolescence (Kehrberg, 1997) and may be accompanied by distinguishing behaviors. Girls who mutilate often do it to determine if somebody does actually care. Smith (1989) found that incest survivors who self-mutilate are more likely to be shy, have lower self-esteem, and may feel less bound by societal rules. Accepting help from others may be difficult for these subjects since they are unfamiliar with bonding. They rely only upon themselves and have few friends (Zila & Kiselica, 2001).

Verbal Cues

Verbal cues can provide hints that self-destructive behaviors are occurring (Schneidman, Farbverow, & Litman, 1976). Girls will voice concerns that they are patronized and others do not listen. This perception may lead girls to violate themselves in order to feel heard (Machoian, 1998). They rarely discuss their violations because of shame, and in order to maintain the secret, distance themselves from others (Zila & Kiselica, 2001). These verbal cues should be evaluated in conjunction with behaviors and personality traits to assess a course of action.

Thinking Patterns and Motivations

When a subject recalls a painful event from the past, feelings of rejection, anger, shame, and low self-worth arise. Previous efforts to communicate this pain have been kept secret due to embarrassment and the unspoken familial code of silence. Pain becomes hard to communicate and victims use mutilation as a way to express overwhelming emotions. Cutting becomes a desperate ploy to obtain empowerment, control, and self healing. After cutting, mutilators feel a sense of calm having found a unique method of organizing the psyche. An all encompassing pain is ended in one moment allowing the victim this feeling of control (McLane, 1996).

BEST PRACTICES

School counselors must be prepared to handle situations appropriately before, during, and after self-injury. School counselors may be the first professional seen by a self-mutilating student. The actions taken by the school counselor may determine if and when students receive additional help from other professionals and must coincide with laws and ethical codes. Following are descriptions of best practices to be implemented by schools in handling cases of self-mutilation.