I recently conducted a series of interviews for a research project where a number of the participants were adolescents. While speaking with the youth it was hard not to notice how many of these individuals presented with major scarring up and down their arms from what I assume, were repeated engagements in self-harming behaviours. This observation was the impetus for investigating the role of the school counsellor in the prevention and intervention of self-harming behaviours. In the literature, self-harming behaviour is most often referred to as non-suicidal self-injury (NSSI) and is defined as the intentional destruction of body tissue that is not culturally sanctioned and is without conscious suicide intent. The most common forms of NSSI are reported as self-cutting, scratching, burning and hitting. North American prevalence rates for NSSI in the adolescent population range from 15-28% with the age of onset ranging between 13-15 years (Heath, Baxter, Toste, & McLouth, 2010).
The Interdisciplinary National Self-Injury in Youth Network Canada has listed a number of factors associated with NSSI that may help school counsellors identify those adolescents at risk. These factors include being female, having symptoms of depression, anxiety, impulsivity, or disruptive disorders, low self-esteem, increased emotional distress, problems with anger control and anger discomfort, and drug misuse (Ross & Heath, 2002; Laye-Gindhu & Schonert-Reichi, 2005; Nixon et al, 2008; De Leo & Heller, 2004). It is essential that school counsellors have an awareness of the factors associated with NSSI as a recent study by Heath et al. (2010) noted that only 13.5% of adolescents surveyed were willing to access support through school-based programming. Of the 13.5% that were willing to access support from a school, the majority of those students were in the lower age range at the middle school level. The numbers declined into high school in the higher age range. The same study reported that of those students engaging in NSSI, the preferred support was a friend. This information raises the question of how school counsellors might consider peer support programming as a means of reaching these adolescents.
Dialectical Behaviour Therapy (DBT) is a therapy that has had success in treating adolescents engaging in NSSI. DBT is a therapeutic intervention where skills are acquired, strengthened, and generalized through the combination of skill development, phone coaching, in vivo coaching, and homework assignments. The four primary skill sets include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness (Lynch, et al., 2007). The DBT skills and support are believed to equip the adolescents with the necessary tools to create positive change.
The Interdisciplinary National Self-Injury in Youth Network Canada has a web site with more information for school counsellors on the subject of NSSI, including offering an online training program. www.insync-group.ca
Heath, B., Baxter, A., Toste, J., McLouth, R. (2010). Adolescents’ Willingness to Access School-Based Support for Nonsuicidal Self-Injury. Canadian Journal of School Psychology, 25, 260-276; De Leo D, Heller ST. Who are the kids who self-harm? An Australian self-report school survey. Med J Aust 2004;181:140-4; Laye-Gindhu A, Schonert-Reichl K. Nonsuicidal self-harm among community adolescents: understanding the “whats” and “whys” of self-harm. J Youth Adolesc 2005;34:447-57; Nixon M K, Cloutier P, Jansson M. Nonsuicidal self-harm in youth: a population-based survey. Canadian Medical Association Journal 008;178(3):306-312.Ross S, Heath N. A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 2002;31:67-77. Lynch, T., Trost, W., Salsman, N., & Linehan, M. (2007). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology, 3, 181-205.
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA