Sunday, March 1, 2015

Self Injury Resources for the Clueless School Counselor

Sunday, March 1, 2015



During my time as a school counselor, I have been surprised at how many school counselors are uncomfortable with the topic of self harm.  In fact, I must admit that I have not always been confident in working with students who injure themselves. What made the difference in my level of confidence?  Training, training, and more training!  

One of my first experiences with a self harming student was a young girl who disclosed that she was having issues at home.  Although she never disclosed it, I believe she was inappropriately touched by her stepfather.  One day, we were talking and she pulled up her sleeve and I saw a bright red row of cuts on her arm.  I don't think she was aware of what she had done and my eyes instantly focused on the cuts.  Fortunately, she was open to getting help, but at first I was really nervous about addressing the issue.

Of course, cutting is not the only method of self harm.  One of the most extreme types of self harming behaviors that I have encountered was a freshman who banged her head on the table when she was angry.  Her behavior was so out of control that we had to call her mother every time she lost control.

Girls are not the only ones who self harm, but boys also exhibit self harming behaviors in not so obvious ways.  I have seen boys burn themselves with erasers, hit their fist into the wall, and one diabetic student withheld insulin when he was experiencing depression. 

So my point is that self harming behaviors are not unusual or only behaviors experienced by girls.  Let's go into more details about self harm, self mutilation, or self injury.

What is self injury?

What is the difference between self harm and self injury? Self harm is an "umbrella term" that includes a number of behaviors that cause harm or damage.  Researchers believe that self injury is used to relieve stress and feel relief.  Self harm includes behaviors like drug use, eating disorders, and at-risk behaviors. The onset of self injury in students is between the ages of 11-15 and if left untreated can continue into adulthood. 

According to Lifesigns, self injury is a coping mechanism where the person harms their body to deal with their emotional pain or to stop the numbness by feeling physical pain. See the diagram below showing different methods of self harm.





Self Harming Map

The Science Behind Self Injury

People who self injure are not just "weird" people who don't know how to deal with life.  Apparently, there is actually a science behind their chosen method to deal with stress and frustration.  Most people choose to exercise, talk to a friend, listen to music, or play a video game to escape their problems; however, self injurers cope by cutting, burning, or hitting themselves.  Because many teens who self injure have experienced trauma, the hippocampus which is part of the limbic system is impacted. The limbic system, which is responsible for emotions, releases neurotransmitters to produce endorphins responsible for the sensation of pleasure. The act of self injury causes the release of these endorphins which reduces the sensation of pain and produces a temporary high. 

Joseph Franklin gives an excellent example how self injury works:

Let's say you go to the doctor and he informs you that your lab work comes back with a terminal illness.  Immediately, you experience intense emotional pain (I would too!!). A few days later the doctor calls you and informs you that the there was a mix up in the lab results and you are not going to die!!  Hip Hip Hooray...instant relief!!  Not only is it instant relief that lasts for a moment, but it is emotional relief that lasts for days.  

This example demonstrates that there may be a similar correlation between emotional and physical pain relief.   Therefore, there are some people who use the relief from physical pain to manage because traditional healthy methods of coping do not work for them. So, what's the problem if this works for them?  What's the big deal?

Problem With Self Injury

One of the biggest issues with self injury is the increased risk for non intentional suicide.  Although teens are not trying to die when they self harm, they are at-risk for an increased rate of suicide.  In addition, there may be an unidentified mental health disorder behind the self injurious behaviors, like depression or borderline personality disorder. People suffering from these mental health disorders often have suicidal thoughts and attempts.  Therefore, if you have a student who is self injuring, it is important that you refer them to a mental health clinician. 

How Can School Counselors Help Students Who Self Injury?

Although we cannot provide therapy to students who self injury, there are many ways we can help!!

1.  Provide awareness about self injury and educate parents, students, and staffs and the myths surrounding self injury. 

2.  Know how to identify the precursors and signs of self injury. Before a student chooses to self injure, they often experience hyper arousal, confusion, and become overwhelmed.  Next, there is a trigger or an event that upsets the student so much that they want to escape. The trigger is not the event that causes the behavior as the emotions have been building for days, weeks, or months.  After the trigger, the student chooses to act and harms him or herself which then may lead him or her to a state of dissociation. In the state of dissociation, the student may often separate from life, emotions, and the body.  A dissociative state is when the student becomes numb, unfeeling and can even experience a state of psychosis. 


3.  Listen to them!  I can't emphasize this enough!!  Don't act surprised or shocked, but allow the student to talk to you about his or her feelings and shame.  Remember, it takes a lot of courage for someone to talk about his or her self injurious behaviors so it is helpful if you congratulate the student on sharing his or her secret with you!!

4.  Help the student identify triggers and healthy distractions.  Lifesigns provides a list of healthy alternatives to self injury that you can share with your students who self injure. 

Some examples include:
  • 15 minute rule - I really like this idea!  For a duration of 15 minutes, the student should distract him or herself until the urge passes.
  • Remember the term HALT or Hungry, Angry, Lonely or Tired.  This is a term I use a lot for self care and it really works.  If we don't recognize our basic needs, we often get overwhelmed which causes us to implode or even explode.
  • Create a distraction box with your students by filling it with objects to help them distract from the urge to self injure.  Some object include: stress ball, chain of paper clips, rubber bands, blanket, or even lavender.   
  • Impulse Log -help the student to monitor self injurious thoughts and behaviors.
    Adapted from Lifesigns
5. Help the parents and friends of those who self injure understand self injury.  You can download lots of fact sheets and resources from Lifesigns. 
Fact sheet for Parents
Fact sheet for Friends

 

Fact sheet for Teachers


6. Give information on how to reduce or minimize scars.  This is helpful for students who have stopped self injury and want to reduce the severity of their scars or even camouflage them.  Some tips include:
  • Massaging scars to reduce their hardness and vividness. Students should do this everyday.
  • Use a moisturizer like Bio-Oil, Vitamin E, or Cocoa Butter.
  • For raised, red scarring, students can use silicon strips.
  • Camouflaging makeup from Dermablend for the body. This is a fantastic covering for scars, birthmarks, and tattoos.  Check out this picture!
    Power of Dermablend
7. Help students seek treatment for their self injurious behaviors. The most common types of therapies for SI include: 
  • Cognitive Behavioral Therapy, identifying unhealthy, negative thoughts that lead to behaviors;  
  • Dialectical Behavioral Therapy, teaching behavioral skills to tolerate and manage emotions; 
  • Psychodynamic Psychotherapy, identifying past experiences, memories, or issues at the root of self injurious behaviors;
  • Mindfulness, helping student appropriately perceive the thoughts and actions of others around them to reduce anxiety.

8. Get training!!  See videos and resources for school counselors below.
9. Follow recommendations by ASCA:
  • No Harm Contract: The school counselor can make an agreement with the student that clearly specifies what behaviors will require the school to take action. For example, the contract may stipulate that the student may not bring sharp objects to school; limit self injury on school property; prohibit the sharing of sharp objects with others; or outline healthy distracting behaviors.
  • Develop a School Policy on Self Injury:  A school policy can clarify any confusion about what is self injury and when it should be reported.
1.  Specifies when school staff should report self injurious behaviors;
2.  Designates to whom the staff should report the self injurious behaviors;
3.  Specifies the extent of administrator, counselor, school nurse involvement;
4.  Outlines how to notify parents and their responsibilities.
Cornell University: Developing & Implementing School Protocol


Adapted from Cornell University @ http://www.selfinjury.bctr.cornell.edu/documents/schools.pdf
10. Prevent social contagion-Cornell University refers to social contagion as a behavior that spreads among members of a group. Sometimes contagion can be reinforced by outside forces, like adults. To prevent contagion schools can:
  • Reduce communication about self injury; 
  • School staff, like the school nurse, can help the self injuring student manage his or her scars. Visible scars and wounds should be discouraged;
  •  Students should be educated to not give the explicit details about their self injurious behaviors particularly when in a group;
  • Counseling in schools should be done on an individual basis rather than in a group.
11. Raise awareness during the month of March - Self Injury Awareness 

Self Injury Awareness Ribbon
 Video About Self Injury Awareness


 Resources for School Counselors

Kaye Randall: See My Pain Webinar

Workbook for School Counselors

Videos by Kati Morton (no relation LOL)



The Extraordinary Counselor Blog-Self Injury Resources 

SAFE Alternatives to Self Harm

Non-Suicidal Self Injury: A Training Developed for School Personnel 

Bibliography on Self Injury

Resources for Schools

Resources for Students

Self Injury Assessment

Adolescent Self Injury Foundation

SAFE Alternatives Self Injury Blog for Students

Love to hear your ideas about how you work with students who self injure!!