Assisting Students at Risk for and Engaging in Self Injurious Behavior:
Currently there are few proven prevention or intervention methods
for reducing suicidal and non-suicidal SIBs. Some evidence points to the fact that Cognitive Behavioral Therapy and problem
solving treatment approaches are effective. Most school counselors report feeling unprepared or underprepared to deal with
SIB. Many claim that the support they offer at school comes more from their own professional experience plus intuition vs
relying on evidence based or well documented school counseling activities and services. SIB is obviously a dangerous condition
and is beyond the scope of the school counselors general practice and must be referred to a highly trained therapist.
1. Start Early: beginning with early elementary school children and later reinforced in secondary students,
counselor educational activities should address the development of emotion regulation (ER) skills. This may well serve to
prevent later emotional disorders such as SIB.
fundamental emotional regulation skills. Because ER (emotional regulation) is closely linked with emerging healthy psychosocial
functioning as well as early academic success (Graziano, Reavis, Keane and Calkins, 2007), students need to learn effective
strategies to identify and manage their levels of stress and emotionality. In particular, classroom guidance and small groups
should address with students how to manage and cope more productively with increasing levels of arousal, anxiety and confusing
3. Strengthen educator -student relationships:
Elementary and secondary school counselors need to work closely with educators to enhance the student teacher relationships.
Evidence suggests that students with better ER skills have more positive and caring relationships with educators and exhibit
fewer behavioral problems. In other words the quality of the student-teacher relationship seems to mediate the relation between
children's ER skills and academic achievement.
Screen: As seen with depression and anxiety, screening for SIB may be developed in consultation with outside mental health
SIB was discovered at school, with ethical and legal considerations in mind, the school counselor notifies all relevant parties
(administrator, school nurse, parent/guardian).
and referral: Then with all appropriate people, a referral is made that day to a mental health professional, who has extensive
experience with students with SIB. Depending upon the severity of the wounds, a physician may also be contracted. Diagnosis
and prognosis are left to trained mental health professionals. It helps when determination of the student showing signs of
non-suicidal self injury or suicidal self injury is shared with the school counselor, so that appropriate care and follow
up can happen. Make sure that the outside professional has written consent from parents or guardians to regularly connect
with the school counselor.
3. Collaboration: Team up with
the mental health professionals, family and school nurse as well as relevant educators to provide an accommodating and safe
school environment. Teachers have often significant influence on students who engage in SIB the teacher-student interaction
patterns should be "monitored". It is important that classroom academic and behavioral expectations are set and
maintained. The school counselor can act as a coordinator of support services, working to create school environments where
self injury is more likely to be identified early on by school staff, students, and parents and students in early stages of
SIB will receive outside counseling sooner. An action plan is devised with the help of the school counselor which helps when
a student returns to school following any type of in-patient treatment facility. Until the student is in a solid stage of
recovery, school personnel should try to minimize stressful experiences.
Follow up meetings: Periodic "check ins" with students and families are recommended. With family and student authorization,
continue to provide support to other educators (teachers,coaches) on how to best assist the student. Follow up on the plan
and modify it if necessary. Assuming the students continues with outpatient therapy while attending classes, consult with
the outside professional to determine if additional support services are needed.
5. Individual supportive counseling: Several counseling skills, when meeting one on one, have been
found to be most supportive: respectful attending, empathic understanding, and acting as a friend, which means establishing
a positive personal connection with the student. What doesn't work and can be harmful is to show a lack of care and/or to
force views on clients.
Self Injurious Behavior
Great resource on self injury and has a lot of info and a video for parents who have children who are engaging
Walsh, B.W. (2008) Treating Self
Injury: A Practical Guide
American Academy of Child and Adolescent
American Association for Marriage and Family Therapy, www.aamft.org/families/Consumer_updates/Adolescent_Self_Harm.asp
American Self Harm Clearinghouse, www.selfinjury.org/
S.A.F.E. Alternatives, http://www.safe-alternatives.com/
and Related Issues, www.siari.co.uk/
Information and Support: www.psyke.org
Injury: A Struggle, http://self-injury.net/
on the subject
Helping Teens Who Cut: Understanding and Ending Self-Injury (Paperback)
See My Pain! Creative Strategies
and Activities for Helping Young People Who Self-Injure (Paperback)
Treating Self-Injury: A Practical Guide
(Paperback) ~ Barent W. Walsh PhD (Author) (working with self injurers since the 1970's)
Mental Health Interventions for School Counselors by Christopher Sink (2011 Brookes/Cole)
Stopping the Pain: A Workbook for teens who cut and self injure by Lawrence Shapiro, PH.D