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Product Spotlight :: Site Licenses

Looking to share a product from One-Stop Counseling Shop with all your colleagues at your organization? Rather than having to purchase an additional license for each person, you can just purchase this site license instead. It’s good for an unlimited number of coworkers and never expires!

For Single Products:One-Stop Counseling Shop Site License

For Bundle Products:

One-Stop Counseling Shop Site License

Let me know if you have any questions!

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Tips & Tricks :: Strategies for Working With Students Who Self-Injure

Self Injury Awareness

Last week, I talked about several myths surrounding self-injury. This week, I want to follow that up with some information about some of the warning signs of self-injury, as well as what you can help students who self-injure.

Warning Signs of Possible Self-Injury

  • Self-Injury Interventions & SupportsUnexplained wounds or scars from cuts, bruises, or burns. Scars are most often seen on the wrists or arms, but can be in other locations as well.
  • Frequent “accidents.” Someone who self-harms may claim to be clumsy or have many mishaps, in order to explain away injuries.
  • Covering up. A person who self-injures may insist on wearing long sleeves or long pants, even in hot weather.
  • Needing to be alone for long periods of time, especially in the bedroom or bathroom.
  • Isolation and irritability.
  • Pervasive difficulties in interpersonal relationships
  • Persistent questions about personal identity, such as “Who am I?” “What am I doing here?”
  • Behavioral and emotional instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness

Starting the Conversation

Talking to a student who you believe to be self-injuring may feel very uncomfortable for one of both of you. Many students compare it to the process of “coming out.” Sometimes, a teacher notices some of the warning signs above and asks me to talk to the student. If I have a relationship with them already, it can still feel difficult. However, if I don’t know the student, the conversation can be VERY awkward. “So…yeah…uh, so you don’t know me at all, but tell me about your injuries.” This is why when possible, I prefer to have the teacher or another adult the student trusts breach the topic and then come talk to me with the student. Sometimes, bringing up self-injury can make a student feel the need to be defensive or make excuses if they don’t feel comfortable with the adult talking to them. I want to avoid that as much as possible!

Here are some conversation starters I’ve found to be helpful before. This list is in no way exhaustive and may not be beneficial for every student. Use your professional judgement!

– I’ve noticed __________________. Can you tell me about that?
– Your teacher has noticed _______________. Can you tell me about that?
– Do you want to change your self-injury behaviors? We can’t force anyone to do anything. We can only provide they help that they want and make sure that they are safe.
– How can I help you with your self-injury?
– Sometimes people have things happen to them in life that are really difficult to deal with and hurt themselves to try to cope. Has that ever happened to you before?

Strategies and Interventions

  • Self-Injury Interventions and SupportsListen and affirm. After a student discloses self-injury, listen. Admitting self-injury takes a great deal of courage and risk on the part of the student. Acknowledge this courage in asking for help and reaffirm their worth as a person. Make sure to remind them that self-injuring does not have to define them. But most importantly, validate the feelings they are experiencing.
  • Assess for suicidality. Although many people who self-injure are not suicidal, there is a link. Ask if they’ve thought about killing themselves and if they have a plan, but if they haven’t/don’t, don’t dwell on it. If they have/do, be sure to refer them to appropriate mental health services immediately. Confidentiality must be breached if you are concerned a student is a danger to themselves or someone else.
  • Less may be more. If a student does not want to talk about their self-injury, don’t force them. As a school employee, you have a professional responsibility to make sure they are safe, but you don’t need to find out everything about them and incident that happens. Refer them to a medical professional if you are concerned about current injuries, but be brief in your conversation if they don’t want to talk. If a student is not in immediate danger, give them some places they can find help if they need it and offer your support in the future.
  • Help the student to identify self-harm triggers. Many students who self-harm first seek information and help on the internet. Fortunately, there is a lot of good information available to students, including what self-injury is, how to talk to someone, and other more positive ways to deal with strong emotions. Unfortunately, there are also a lot of personal stories which may show pictures and delve into great detail regarding injuries people received and how they injured. This information can be intensely triggering for individuals who self-harm. Students should be made aware of good places online to get help, as well as the implications of viewing triggering information.
  • Teach coping skills for stress, anger, or sadness. Often, I have students make lists of alternative activities to self-injury, stress-relieving activities, or distractions they can use if they feel as though they need to self-injure. Many of my students who self-injure choose to use coping strategies such as journaling, drawing, or listening to music. However, one size does not fit all. Have your student determine what they think will work for them.
  • Identify external supports for the student outside of school. More than likely, triggers to self-harm probably occur after school hours. So as much as you’d love to be able to have the student come talk to you when they feel as though they need to self-injure, it not practical. It’s also better for the student to find support in their life outside of school for when they move on to another school or graduate. Their friends and family will be with them a lot longer than you probably will. Depending on the age of the student and your state/district regulations, you may be required to notify a student’s parent. Sometimes I help students write letters to their parents, or call them on the phone. Ultimately, you should encourage the student to communicate with others in whatever way is most comfortable for them.
  • Encourage the student to keep a record of certain emotions or behaviors that led to them wanting to self-harm, as well as what they did instead. You can use a free impulse control log here. Keeping track allows students to better see patterns that emerge, and can provide a good starting point for you or another counselor to help them address their antecedents to self-harm.
  • Refer to community resources. Most of the time, I unfortunately don’t have the resources available to address issues of self-harm exclusively in the school setting. 30 minutes once a week (minus days off of school, meeting days, field trips, standardized testing, etc.) is just not enough to meet the needs of my students who self-injure. As a result, I often recommend they receiving counseling outside of the school setting. Follow your school guidelines as far as referrals are concerned, but be prepared for the fact that the needs of those who self-injury often go beyond the resources that are available in the school setting.

Self-Injury HelpNeed help?

If you self-injure and need help, but don’t knowwhere to turn, call the S.A.F.E. Alternatives information line in the U.S. at (800) 366-8288 for referrals and support for cutting and self-harm. For a suicide helpline outside the U.S., visit Befrienders Worldwide.

In the middle of a crisis?

If you’re feeling suicidal and need help right now, call 9-1-1 or the National Suicide Prevention Lifeline in the U.S. at (800) 273-8255.

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Awareness :: Nonsuicidal Self-Injury

Self Injury Awareness

Today is Self-Injury Awareness Day. Many people choose to wear an orange ribbon, write “Love” on their arms, or draw a butterfly on their wrist. The ultimate goal of the day, however, is to break down the common stereotypes surrounding self-injury and to educate people about the condition. Because I work in the school setting, I’m going to be focusing on implications for teachers and staff. Most teachers, staff, and administrators receive little to no training about Nonsuicidal Self-Injury (NSI). Unfortunately, this leads many well-intentioned adults to make assumptions about their students who self-injure and can have harmful effects as a result.

Myth #1: Self-Injury Isn’t that Common
Fact: Self-Injury rates vary dramatically depending on what definition and sample are used, but Klonksy (2011) & Zetterqvist (2013) found that 17-35% of adolescents report a single NSI episode and 6.7% reported 5 or more self-injury episodes. For adults, 5.9% reported a single NSI episode and 2.7% reported 5 or more. However, regardless of the actual percentages, NSI is extremely common and chances are good you will encounter a student who self-injures at some point in your career. That being said, NSI is not just a “white teenage girl problem,” as is the common stereotype. People who self-injure can be guys, girls, age 60, age 12, and of any ethnicity.

Myth #2: Self-Injury is just another word for “cutting”
Fact: While cutting is one of the most popular ways people self-injure, NSI covers a range of behaviors including scraping/scratching, burning, healing prevention, breaking limbs, and many other behaviors. The word “Self-Injury” is the preferred term because it encompasses all of these methods. In addition, professionals should avoid calling someone a “Cutter” because it dehumanizes them, defining the person by a behavior rather than who they are.

Myth #3: The best way to make sure a student isn’t self-injuring is to do “body checks”
Fact: I never recommend that parents or school staff do “body checks.” It is a huge invasion of privacy and as such is best left up to medical professionals for the purpose of ensuring student safety, treating infections, etc. – NOT for parents or teachers to make sure their son/daughter/student isn’t injuring. Unfortunately, if someone is going to self-injure, they’re going to self-injure. Constantly checking their arms and legs for injuries will most likely lead them to injure in more discrete places – thighs, genitals, etc.

Myth #4: Nonsuicidal self-injury is a re-enactment of abuse
Fact: Klonsky & Moyer (2008) found that through a meta-analysis of over 40 studies, there was a very small association between NSI and childhood sexual abuse. Only about 1/3 of patients in their study indicated prior abuse. So while abuse is common in people with NSI, it is in no way a given.

Myth #5: Self-Injury is attention-seeking

Fact: This one really gets to me. Too often, I’ve heard parents or teachers tell a student they were hurting themselves for attention and needed to cut it out. I’ve never had this advice help a student I worked with and generally it only makes them feel more isolated and misunderstood. Self-injury is usually very private and personal, and people who self-injure often go to great lengths to cover up their injuries (such as wearing long sleeves or pants, even in winter). Most people self injure for many of the following reasons:

  • Emotional Regulation (“Self-injuring calms me down.”)
  • Interpersonal Influence (“If I’m hurt, people will know the extent of my pain inside.”)
  • Anti-Dissociation (causing pain so as to stop feeling numb)
  • Self-Punishment (“I deserve this because I am worthless.”)
  • Anti-Suicide (to halt suicidal thoughts)
  • Sensation Seeking (adrenaline rush)
  • Bonding (fitting in with peers who self-injure or participate in risky behaviors)
  • Marking Distress (my outside pain matches my inside pain now)
  • Self-Care (caring for a physical pain is easier than caring for emotional pain)
  • Toughness (“I self harm to see if I can stand it.”)
  • Revenge (get back at someone)
  • Autonomy (“I don’t need to rely on anyone. I can take care of myself.”)

Generally, the most common reason people self-injure is for emotional regulation and self-punishment. However, most people who self-injure report injuring for several of the reasons listed above. Only a few people self-injure for attention-related reasons such as Bonding or Interpersonal Influence.

Myth #6: People who self-harm are suicidal
Fact: Most people who self-injure are usually trying to do the opposite of kill themselves, as shown by the “Anti-Suicide” reason above. For most, self-injuring is a coping mechanism to deal with pain, not a way to die. However, there is a relationship between self-injury and suicide and some people who self-injure also have suicidal feelings. In addition, some forms of self-injury can lead to accidental death, so it’s important that people who self-injure learn safer coping strategies. That being said, it’s always a good idea to assess a student for suicidality if you have discovered that they self-injure, but not assume they are suicidal.

Myth #7: Teenagers who self-injure will grow out of it
Fact: While there is not much long-term research to shed light on how many teenagers who self-injure grow up to be adults who self-injure, self-injury is an indication that an individual is experiencing extreme emotional distress that needs to be addressed. There are many teenagers in the world who do not self-injure – it’s not “just a typical teenage thing!”

DSM-5Myth #8: People who self-injure have Borderline Personality Disorder (BPD)
FACT: Although NSI was mentioned in the DSM-IV as a symptom of Borderline Personality Disorder, experts argue that not everyone with BPD self-injures, and not all people who self-injure have BPD. NSI can be a feature of BPD, but only in the presence of a complex set of other symptoms.

Myth #9: People who self-injure could stop if they really wanted to
Fact: NSI is an incredibly addictive and reinforcing behavior. Injuring distracts a person from emotional pain and releases endorphins in the body which numbs pain. Telling someone just to “stop it,” only serves to further alienate them. Individuals who self-harm need to learn appropriate strategies for coping with their emotional pain, not just to “toughen up” or “stop it!”

Myth #10: If the wounds aren’t “bad,” self-injure isn’t a serious problem
Fact: The severity of the self-inflicted wounds has very little to do with the level of emotional distress an individual is experiencing. Different people have different methods of self-injury and different pain tolerances. The only way to find out how much distress someone is in is to ask them.

Come back next week, when I’ll be sharing ideas and strategies you can use with students who self-injure.

Need help?

If you self-injure and need help, but don’t knowwhere to turn, call the S.A.F.E. Alternatives information line in the U.S. at (800) 366-8288 for referrals and support for cutting and self-harm. For a suicide helpline outside the U.S., visit Befrienders Worldwide.

In the middle of a crisis?

If you’re feeling suicidal and need help right now, call 9-1-1 or the National Suicide Prevention Lifeline in the U.S. at (800) 273-8255.