The following information has been adapted from "Self-Injury: A Manual for School Professionals".
School professionals such as teachers, nurses and counselors are frequently the first adults to know of a student's self-injurious behavior. They may notice wounds, or may be notified by another student. On occasion, a student will decide to disclose to a teacher whom they trust. When a staff member notices that a student has wounds, suspects that a student is injuring or has the behavior brought to their attention by another student, the situation must be addressed and not ignored. One of the most important things to remember is that the tone of your response can be equally, or even more important than your actual words. The goal is to respond in a calm, non-judgmental fashion.
Self-injury is an attempt to cope with a problem and not the problem itself. It is often a cry for help (either conscious or unconscious). Most self-injurers experience themselves as being invisible. Ignoring the behavior only validates this belief, possibly causing them to become even more dangerous to themselves. The key is to focus on the underlying feelings and issues rather than focusing on the behavior itself.
Don't be afraid to state, "I've noticed injuries that appear to be self-inflicted, I care about why you might be doing that" or "it appears you have hurt yourself, do you want to talk about it?". Even if the student denies that the wounds are self-inflicted, the fact that the behavior was attended to and addressed directly is the first step towards healing. You have made it clear that they are not invisible and that you are available when the student is ready to seek help.
If you believe that a student is self-injuring, let them know that you want to aid them in getting the help they need. It is most important to be empathic with the student. Remember, the self-abuser may be feeling shame and you do not want to further this shame. Please DO NOT reprimand or send the student to the principal as a behavioral problem. Instead, your concerns should be brought to the attention of the school counselor if one is available to you. If your school does not have access to a school counselor, then another school professional (depending on your school's protocol) will need to assess the student for safety, especially if suicidal thoughts accompany the self-injurious behavior.
You will also need to follow your school's protocol with regards to letting the parents of the student know what is happening with their child. It may be best to encourage the student to tell their parent(s) or guardian about their self injury. Giving the student the option to do so, prior to you telling a parent/guardian, allows the student to have a greater measure of control over the situation. If the student fails to tell their parent, then it would be up to the individual to follow the protocol set forth by the school.
If the student has fresh wounds, they will need to be assessed by the school nurse and/or emergency room to determine severity and to make sure that the wound is properly treated. Our practice is to not focus on the injury, but rather on the events, feelings and thoughts preceding and following injuring.
If the student has been injuring a long time, or is injuring severely, it may be time to consider some intensive treatment. If self injury is having a negative impact on the student's life and therapy does not seem to be working, there is more intensive help available. S.A.F.E. Alternatives, LLC has a residential treatment program specifically for the intensive treatment of the many forms of self injury.
Unstable, unpredictable or invalidating environments contribute to adolescent anxiety and frustration, which, in turn, can contribute to an increase in self-injurious impulses and injury. Therefore, stability and empathy are among the most important ingredients for success in working with self-injurers. Everyone in the system is responsible for providing a caring environment. Some descriptors of a caring environment are:
- Neutral (i.e., non-judgmental and non-punitive).
- Accepting. Staff can validate self-injurers' emotions. (A common theme among self-injurers is that their emotions were not validated during early family life).
- Amenable to staff contact. Since we want to encourage students to talk to staff about self-injurious impulses, staff can demonstrate openness to listening to them.
- Calm. Staff serves as models for emotional control, conflict-resolution and problem- solving skills.
- Dependable, structured and predictable (schedules, individual sessions, group time, consequences and/or expectations).
- Consistent (staff remains neutral: rules, rewards and consequences are the same each day). Further, staff members display a consistent "personality" each day.
- Confidential and private. Staff refrains from discussing students when others are around and refrains from discussing sensitive issues with students (i.e., diagnosis, family conflict, etc.) in public (i.e., hallways, classrooms).
- For more specific direction on how to intervene with students who injure and helping them disclose to parent(s)/guardian(s), please see "Self-Injury: A Manual for School Professionals".
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