Tuesday, June 25, 2013

Secret Pain

Tuesday, June 25, 2013

The first time I experienced self injury was in the 90's.  I was teaching a history course and one of my students was always using objects to carve on himself. One day I noticed that he was using an eraser and rubbing it wildly on his skin.  After I called attention to his behavior, he amped it up a little more by taking a paper clip, carving various adjectives in his skin (I cannot repeat them), and blowing ink into the bloody cuts. I was horrified!!

In those days there was little information for teachers about self harm so I truly thought he was just a disturbed kid and I limited my contact with him. Now fast forward seven years, I have my counseling degree and secured my first high school counseling gig.  Suddenly, I went from viewing students from an instructional to a personal-social perspective.  In my new position, I noticed a lot of kids who exhibited the same types of behaviors as my former student.  Being curious, I knew that I needed to learn a lot more about more about this phenomenon!

As a school counselor, my first real case of working with a student who self injured was with a young girl who was known to cut.  The girl was rather open to me about her cutting and even exposed them to me.  Red lines covered her arms, legs, and feet.  She told me the reason she cut herself was so that she would not take out her anger on her mom who had married a man she loathed. I often suspected there was sexual abuse by her stepfather, but she never revealed that to me.  A year later, I had another young girl who was in a turbulent relationship with her boyfriend.  She was often kicked out of class and she would show up in my office crying and upset.  Most days she would be able to pacify herself, but other days she tried to harm herself in my office by smashing her head on the table or the wall.  Talk about stressful! I would have to call her mother to come pick her up so she could go to her therapist. The last situation I would like to share involved me talking to a former student who called me in the middle of the night to tell me that she was going to harm herself.  She told me that she had a razor, who she had named Ernie, and that he was the only one that made her feel better.  While I had my daughter dial 911, I tried to persuade her to put Ernie in another room while we spoke.  She told me years later that while we were talking she was cutting herself deeper and deeper...this is truly chilling!

I could go on and on about the other cases that I have experienced as a school counselor, but I think it is important to know a little about why students self harm and what you need to do if you suspect or realize a student is involved in self injury.  The first time you experience a self injury situation it can be overwhelming. As a school counselor, it is imperative that you receive training from an experienced therapist/practitioner and gather great resources to help you work with these students. A great website to use for resources and information is S.A.F.E. Alternatives.

In regards to training, one practitioner who I admire is Kaye Randall. Kaye Randall is a licensed professional counselor from South Carolina who provides training and resources for school counselors in the area of self injury.  From her seminar about self injury from Developmental Resources, called See My Pain,  I learned how to identify the characteristics of self injury, the reasons for this behavior in students, and strategies any school counselor can use in schools.


Origin of Self Injury

Randall believes that self harm is an addictive behavior that has emerged from our "quick fix" culture.  Students who self injury tend to use harmful behaviors to manage emotions that are too painful to express.

Characteristics of Americans Who Self Injure
  • 3 million Americans engage in self-injury
  • Many experience abuse such as sexual abuse or neglect
  • 40% are males
  • The age of self harm is steadily decreasing
  • Potential loss of a parent either through divorce or death
  • Have a tense or abusive relationship with parent(s)
Personality Characteristics of Those Who Self Injure

Perfectionist qualities
Negative body image
Inability to cope with strong emotions
Inability to express emotions
Frequent mood swings

Screening for Mental Health-Characteristics of Adolescents Who Self Injure

Signs that a Student is Injuring Himself or Herself (Smith &  Segal, May, 2013):

Unexplained cuts and scratches
Blood stains on tissues or clothing
Possession of sharp objects
Frequent "mishaps"
Wearing long sleeves during hot weather and/or wearing lots of bracelets
Frequent trips to the bathroom
Irritability and isolation













Help Guide for Those Who Self Injure

Cycle of Self Harm (This can be put on an index card and shared with student)

Cycle of Self Injury


Why do Students Self Harm?

According to Randall, some of the reasons why students self harm include:
  • Relief from feelings
  • Only coping skill they have acquired
  • Preventing dissociation
  • Physically expressing pain
  • A method of communication
  • To self nurture-ritual of action and then nursing the wound
  • Self punishment
  • Reacting previous abuse
  • Establishing control by determining the when, where, how deeply
Why Teens Self Harm

Methods of Self Injury

Five major techniques of self injury:

1. Cutting
2. Burning
3. Burning
4. Hitting self
5. Hair pulling













10 Ways Teens Self Harm

Misconceptions about Self Injury

According to Cornell University researchers, Caicedo & Whitlock, there are 15 misconceptions about self harm:

1. Only females harm themselves- 30-40% of males are self injurers.
2. Self harm is a failed suicide attempt- in reality, self harm is an attempt to avoid suicide.
3. Only teens self harm- although over 50% of those who self injure are teens, studies have found that children as young as seven and even adults self injure.
4. Self harm is attention seeking- while some may seek attention, the majority of those who self injure hide their behavior.
5. People who harm themselves are crazy- self harm is a coping mechanism that is not understood by the majority of people in society.
6. It is untreatable-  there are many therapies and medications used to treat self injurers. The important thing is that the behavior must be replaced with another coping mechanism.
7. People who self harm are manipulators- self injury is more about relieving stress and tension than attention.
8. People who self harm have a personality disorder- most people who self injure have no mental health issues.
9. Self injurers only cut themselves- some people pull their hair, pick their skin or burn themselves.
10. People who self harm are "goths" or "emo"- anyone from any ethnic background, gender, socio-economic group, age, or social group can self injure.
11. People who self injure enjoy the pain or don't feel it- people who harm themselves often feel pain which reconnects them to their bodies.
12. No one can help a person who self injures- the best help is mainly to listen.
13. All people who self harm have been abused- reasons for self injury are multifaceted.
14. Someone who self harms can stop at anytime- self injury can be an addiction.
15. Self injurers are a danger to others- generally self injury is a private practice which is never revealed to others.

15 Misconceptions About Self Injury

Strategies for School Counselors:

At the beginning of the school year, it is important to train your staff regarding self injury protocols. The website, Educators and Self Injury, provides copious resources for educators and a sample protocol for schools.

Educators and Self Injury Resources

It is important to remember that self injury cannot be treated in an school environment; therefore, it is important to have a list of mental health agency referrals on hand for students and parents. Also, it is important to have resources for parents so that they can educate themselves about this behavior.

Parent Information About Self Harm

Techniques by School Counselors

Counselors can provide additional strategies for students when they feel like harming themselves:

1. No Harm Contracts-ASCA Ethical Standards suggest that school counselors notify parents and students of behaviors that schools associate with school harm.

ASCA Article on School Counselor and Ethical Considerations for Students Who Self Harm

2. Students can keep a trigger log on days that they harm and don't harm.  Discuss with students what worked on the days they did not cut, what triggered the event, and the significance about the times they self harm.
Impulse Log

3. Use props to show how important it is to talk about feelings rather than letting them build up inside.  One activity includes blowing up a balloon (each breath is an issue) until it will not go any further.  Illustrate that cutting is like popping the balloon, but talking lets the problems slip away one by one.

4. Have students keep a journal or blog.  Students can join a positive online website like
S.A.F.E. Alternatives.

5. Put together a comfort kit for students:
  • Index cards with next steps.
  • Small journal
  • Hand lotion
  • Names of people they can talk to at school, home, etc.
  • Sand timer
  • Object representing strength
  • Handout of eight questions to ask yourself before you self injure
  • Distraction techniques
6. Prevention Strategies

The Mayo Clinic found that there is no way to prevent self injurious behavior, but there are ways to reduce self harm:
  • Identify students who are most at risk and offer help-students can be taught resiliency skills. Nan Henderson's website on resiliency is an excellent resource to use.  See her Resiliency Wheel for students in crisis.
  • Encourage social interactions like clubs and social groups.
  • Raise Awareness to educate staff and students.  Each year, school counselors can raise awareness through Self Harm Awareness activities.












  • Promote programs that encourage students to seek help-Peer Helping programs are a great resource to help students get information and seek assistance.                                    National Association of Peer Program Professionals
  • Reduce the harmful impact of social media-there are several websites that promote self injury and students should be taught critical thinking skills to know how identify harmful social media sites.


Distraction Techniques (Kilburn & Whitlock; National Self Harm Network):
  • Reach out to others (students can call 1-800-DONT-CUT).
  • Express yourself creatively though a journal, a song, or drawing, or writing poetry.
  • Nurture yourself by taking a bubble bath, watching a funny movie, listen to music, or take a shower.
  • Find constructive activities like cooking, cleaning, doing homework, organizing your room or dying your hair.
  • Do something fun like finger painting, going to the movies, playing on the computer, or going out for ice cream.
  • Physical activity-exercise, dancing, deep breathing exercises, scream, or punch a pillow.
  • Displacement-draw a red line on yourself, snap a rubberband on your risk, put bandaids on where you want to self harm, take a photo of yourself and write how you feel on it.
  • Reinforcement-think about not wanting scars in the summer or set a target time of how long you will not self harm. 
Distraction Techniques

Feel free to tell me about your successes and challenges with working with SI students and any resources you use in your practice.

Here are some additional resources that you can explore...

Resources:

Self Alternatives












National Self Harm Network Resources
SOS Self Injury Packet
Self Injury and Related Issues
Mirror Mirror
Tips for Teachers
Responding to Students Who Self Mutilate
Self Injury Posters