1. Non Suicidal Self Injury

2. Agenda What is Self Injury? Responding to Self Injury
Supporting Self Injury Cessation
Contagion and Prevention
Best Practice Guidelines for BSD
Resources and Questions L

3. Self Injury Basics L
Ask questions to participants. What dos self injury mean to you?

4. What is it?
Terms: self-harm, cutting, self-mutilation, & non-suicidal self-injury (NSSI)
NSSI: “the deliberate destruction of one’s own body tissue without the intent of death” (Taylor, Peterson, & Fischer, 2012).

5. Self Injury Facts
The majority of young people use multiple methods to self injure
In many cases, self injury can become an addiction
1 in 5 young people will injure themselves more severely than they expect to
Parents and youth serving providers underestimate the number of lifetime incident and methods used
Habituation/addiction can make it very hard to quit even when someone wants to. Needing to injure more severely for same effect. Injuring without triggering incident. Importance of early intervention (to prevent addiction) and framing self injury as addiction can inspire compassion and patience

6. Myths Only females self Injure
Self injury is a suicide attempt or failed suicide attempt
Only teenagers self injure
Self injury is just attention seeking
People who self injure are manipulative
Self Injury is untreatable P

7. More Myths
All people who self injure have borderline personality disorder
People who self injure only cut themselves
People who self injure enjoy the pain or can’t feel it
There’s nothing I can do to help
All people who self injure have been abused
Someone who self injures is a danger to others

8. WHO?
If we were to base our assumptions on media representations, most of us would assume Self Injury is the domain of middle and upper class white girls.

9. •Initial self-injurers •Most predictable demographic of self-injurers
•No single profile
•Gender differences
Numbers
Type of injury
Setting
•Initial self-injurers
•Most predictable demographic of self-injurers
•Related challenges
•Rates of college students, secondary students

10. Why do People Self Injure?
Emotional regulation
Social communication
Why continue? P
Coping, numbness, etc

11. Detection- What are we looking for?
1. Direct observation
Wounds, scars;
Other signs
2. Direct verbal disclosure
3. Indirect verbal disclosure
Useful information: recency, chronicity, lethality P

12. Responding to Self Injury
First Aid
Assessing for suicide L

13. Differentiating between Suicide and Self Injury
Suicidal Behavior
NSSI
Reaction of others
Most others express concern and support; move towards protection
Ongoing NSSI may be condemned, judged negatively
Restriction of means?
Often an important preventive intervention
Often ill-advised, counterproductive

14. Responding
Respectful Curiosity
Probing Questions

15. Responding Liability Parent/Guardian communication
Linkage to support services and follow up
Document

16. Group Activity?
Discuss challenges and strategies for communicating Self Injury to parents/guardians
Prepare to share L

17. Why Change? Understanding the Recovery Process
The most essential ingredient in stopping NSSI is wanting to stop and being ready to find other ways of coping. L

18. When it will end depends on:
Frequency
Number of reasons for injuring
Level of psychological distress (feeling chronically high levels of depression and/or anxiety makes it harder to stop) L

19. Other ways of coping with emotion (more ways of coping makes it easier to stop)
Recognizing that it is a problem in life (makes it easier to stop)
Feeling socially supported (makes it easier to stop)
Having a sense of meaning in life and/or having higher levels of life satisfaction (makes it easier to stop)

20. STAGES OF CHANGE
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
It’s important to note that the stages of
change are non-linear.
Any movement is a sign of progress.

21. Supporting Self Injury Cessation. •Being here
Supporting Self Injury Cessation •Being here! •Allow autonomy •Empathy, compassion, patience •Understand reasons for SI •Take NSSI behavior seriously P

22. Cont Cessation •Assess & respect readiness for change
•Clear expectations
•Support cognitive flexibility
•Focus on strengths
•Celebrate success! P

23. Supporting the Growth Mind Set
•Foster hope
•Foster love of learning
•Reframe experiences
•Encourage service to others ?

24. Prevention & the Importance of School Culture

25. Prevention Teach students more adaptive coping skills
Decrease self-injury by educating students and the school community about risk factors, clinical implications, and outcomes associated with self- injury.
Encourage help-seeking among students – either for themselves or on behalf of a friend.
Help school staff make the key distinction between self-injury and suicide

26. Coping Skills Cognitive Flexibility Tolerate Negative Emotions
Identify Feelings
Regulate Impulse Control
Connectedness
Service L

27. Controlling Contagion
•Divide & assess individually
•Identify “alpha” students
•Be clear about expectations/boundaries
•Protocols for alerting parents
•No groups—deal with students individually P

28. How Do We Do This? DO Connect with calm, compassion
Understand coping skills
Refer
Discover student’s strengths P

29. How do we do this? (cont) DON’T Tell the student to stop SI
Act shocked, overreact
Cause guilt, shame
Agree to hold SI behavior in confidence

30. District Guidelines – Self Harm
Determine if First Aid is necessary
Assess for suicide
Develop plan with student for parent/guardian contact
Recommend outpatient mental health treatment to guardian, if not engaged. Social Worker can help with this
Have guardian and/or student sign Release of Information for therapist
Communicate concerns with therapist!
Be available and follow up with student
Communicate to teachers, as appropriate
Document
L & P

31. Table scenarios or other discussion?
Small group – What will you do differently in your practice to prevent and support those who self injure? L

32. Questions? PD needs Resources:
The Cornell Research Program for Self-Injury Recovery contains a wealth of handouts for counselors, psychologists, teachers, parents, self-injuring individuals, friends