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In discussing the role of school counselors, Baker (2001) stated that their scope of practice primarily includes the intervention and prevention of mental and emotional disorders, but not the diagnosis and treatment of disorders. Thus, school counselors play an important role in the referral of students to qualified professionals. School counselors can make either a partial or a complete referral (Baker). A complete referral would involve dissociating from the student's case, and a partial referral would involve some continued involvement with the student while he or she works with outside mental health professionals. A referral for inpatient or out-patient treatment would be appropriate, and should be done in a sensitive manner so that the student does not feel abandoned or refuses to go. School counselors need to be knowledgeable of the practitioners and treatment centers that have specific training in the management of self-injury. If possible, the school counselor might use an in-service day to visit local treatment facilities and determine the steps a student would go through in receiving treatment. When counselors are aware of what the treatment process is like, they can better help students and their families in making decisions and developing intervention plans.

Once the student begins work with a community mental health professional, the counselor can collaborate with the community professional and can continue to play a role in the student's treatment process (e.g., being a safe person the student can talk to when wanting to injure). If the student goes for inpatient treatment, the school counselor could be involved in continuing the educational process through arranging in home tutoring or collaborating with the educational tutor at the residential center or hospital.

Advocacy and Education

Advocating for students, and educating school personnel are important roles of school counselors (Baker, 2001). Through advocacy and education, school counselors can help to dispel myths and break down stereotypes regarding self-injury.

School counselors can advocate for students through faculty in-services and parenting groups, and speaking in health classes to students regarding self-injury. It is important to inform staff, parents, and students that self-injury does not mean someone is crazy, but can be understood as a means of attempting to help one's self. In particular, educating school faculty regarding the etiology and function of self-injury can help in dispelling the myth that people who self-mutilate are attention seeking. Dispelling myths can help students gain access to support and needed services both within the school and in the outside community. For example, a teacher who is aware a student is self-injuring may not report self-injury as he or she may perceive it as trivial or as a way for the student to receive attention. With education, the teacher may be more likely to seek help for the student and to make the school counselor aware of the situation.

Education of staff and teachers is one manner in which school counselors can advocate for students who self-injure. By educating faculty about self-injury, they should feel more comfortable in managing the issue of self-injury. Also, educating faculty on ways to approach or manage student self-disclosure of self-injury can be helpful. In particular, the physical education teacher and the school nurse may be of critical importance in identifying and monitoring students who self-injure.

Advocating for students by educating faculty about the fact that self-injury is not equated with suicidality is also very important. Strong personal reactions to self-injury can lead to reactionary stances and extreme measures such as unnecessary hospitalizations, pulling students out of school, or suspending students. Educating faculty and administrators on the differences between self-injury and suicide attempts can help in avoiding unnecessarily restrictive actions.

Prevention

Conterio et al. (1998) and Welch (2001) have noted that loss, childhood illness, physical and sexual abuse, marital violence, familial self-injury, peer conflict and intimacy problems, and impulse control problems are all related to self-injury. Thus, for the purposes of prevention, school counselors should consider these variables when targeting at-risk students. As with the issue of intervention, prevention efforts can include helping students to express and identify their feelings, while also developing healthy behavioral coping skills. Group counseling and counselor outreach activities that encourage at-risk students' development of these aforementioned skills may be helpful in preventing self-injury. Prevention efforts can also occur by providing pamphlets and handouts to students. Materials concerning self-injury can be distributed through health classes or directly through the school counseling office.

A sequence of events in which a person inflicts self-injurious behaviors and is imitated by others in the environment is referred to as contagion of self-injurious behaviors (Walsh & Rosen, 1985). The issue of contagion has received some attention in the research literature (Rosen & Walsh, 1989; Ross & McKay, 1979; Taiminen et al., 1998; Walsh & Rosen) Initial research indicated that in hospital and residential treatment settings, adolescents tend to imitate self-injurious behaviors. Self-injurious acts followed in 25 residents at a residential facility indicted that these acts are bunched or clustered in time across subjects, suggesting that adolescents in a residential setting trigger the self-injurious behaviors in each other (Walsh & Rosen). These findings suggest that a group process variable or social factors may contribute to the behavior in participants who already self-injure or are at risk for self-injuring. Walsh and Rosen noted that labeling self-injury as a behavior that is likely to be imitated actually decreases self-injury as many adolescents, for developmental reasons, do not want to be perceived as being imitative or be labeled as followers.

Similar to Walsh and Rosen (1985), Talminen et al. (1998) have suggested adolescents' weak egos and diffuse identities make them susceptible to various forms of identification including self-injuring and refer to this phenomena as "rites of togetherness" (p. 215). Through intensive study (i.e., interviewing methods and empirical observation), Rosen and Walsh (1989) came to similar conclusions. They stated that adolescents in a residential setting engaged in contagious self-injury as a "concrete display of affinity between two people" (p. 657). Rosen and Walsh observed the following: (a) individuals involved in contagious self-injury are highly enmeshed; (b) they have difficulty with conventional forms of intimacy; (c) they find deviate acts (e.g., shared self-injury) to be compelling and exciting. Rosen and Walsh concluded that when contagious self-injury occurs, it is important to use interventions that target specific dyads. It is important to help the adolescents express emotions and negotiate intimacy in more normative ways. When this is not possible, it may be necessary to isolate the person being modeled from the rest of the group.

While the aforementioned studies all involved adolescents in residential treatment settings, Fennig, Carlson, and Fennig (1995) described their experiences consulting in a public school setting regarding a situation where an outbreak of self-mutilation occurred. They expressed concerns that this phenomenon may be more frequent in educational systems than reported. In describing their experiences they made the following observations: (a) the majority of students involved in the outbreak did not demonstrate any overt psychopathology and were not identified as emotionally disturbed; (b) the only overt sign of problems associated with self-injury was a drop in grades; (c) several initiators with more severe psychopathology seemingly induced the behavior in more passive students and all had anxiety and depressive related traits; (d) isolation of the more severely disturbed initiators was most effective in lowering the severity and frequency of the phenomenon.

While these suggestions are narrative and have not been empirically scrutinized, school counselors facing similar situations can use this information. Combined, the research related to contagion implies that social factors may contribute to the development and maintenance of self-injurious behavior. A related issue is to differentiate initiation self-mutilating behaviors of gangs or cliques from self-injuring behaviors related to psychopathology. Although both types of behaviors are significant, intervention and referral can take different directions. If an ostensible contagion situation occurs, consultation with other professionals may be necessary.

PERSONAL REACTIONS

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