Assisting Students at Risk for and
Engaging in Self Injurious Behavior:
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.
2. Teach 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 emotions.
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.
4. Screen: As seen with depression and anxiety, screening for SIB may
be developed in consultation with outside mental health experts.
1. If SIB was discovered at school, with ethical and legal considerations in mind, the school counselor notifies
all relevant parties (administrator, school nurse, parent/guardian).
2. Consultation 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.
4. 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
http://www.selfinjury.com Great resource
on self injury and has a lot of info and a video for parents who have children who are engaging in SI
Walsh, B.W. (2008) Treating Self Injury: A Practical Guide
American Academy of Child and Adolescent Psychiatry: www.aacap.org/page.ww?name=Self-Injury+In+Adolescents§ion=Facts+for=Families
American Association for Marriage and Family Therapy,
American Self Harm Clearinghouse, www.selfinjury.org/
S.A.F.E. Alternatives, http://www.safe-alternatives.com/
Self-Injury and Related Issues, www.siari.co.uk/
Self-Injury Information and Support: www.psyke.org
Self Injury: A Struggle, http://self-injury.net/
Helping Teens Who Cut: Understanding
and Ending Self-Injury - Michael Hollander PhD
See My Pain! Creative Strategies and Activities for Helping Young People Who Self-Injure - Susan Bowman and Kaye Randall
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