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RESPONDING TO SELF-INJURY IN THE SCHOOLS JENNIFER J. MUEHLENKAMP, PH.D.

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Presentation on theme: "RESPONDING TO SELF-INJURY IN THE SCHOOLS JENNIFER J. MUEHLENKAMP, PH.D."— Presentation transcript:

1 RESPONDING TO SELF-INJURY IN THE SCHOOLS JENNIFER J. MUEHLENKAMP, PH.D.

2 DEFINING NSSI Purposefully inflicting injury upon oneself that results in immediate tissue damage, done without suicidal intent and not socially sanctioned within one’s culture nor for display. Usually engaged in to obtain relief from overwhelming distress. Suicide: – Intent is to die or end consciousness – Feel hopeless and helpless – Feel no better after attempt – Usually one primary method; typically different method than that of NSSI – High lethality, requiring medical attention NSSI: – Intent is to feel alive, cope with life, and/or avoid suicide – Experience periods of hope – Typically experience relief after the act – Multiple methods are often used – Low lethality, rarely requiring medical attention (Muehlenkamp, 2005; Walsh, 2012)

3 What Behaviors = NSSI? Most Common NSSI Behaviors

4  “Teen Disorder”  Age onset (minority early at 10yrs)  2 nd Peak is at years (freshman college)  Ethnicity  Caucasians > other ethnicities  Hispanic females also high  Gender  25% - 50% self-injurers are MALE  Sexual Orientation  GLBTQ significantly higher rates  SES  No reliable differences  Some suspect higher in middle/upper class Who is at Risk?

5 Shared Symptom Features Emotional Difficulties Aggression/Anger/Self-hatred Low frustration/distress tolerance Strong emotions intolerable; frightening Problem-Solving & Interpersonal deficits Feelings of powerlessness Perfectionistic Features / Need for Control Identity disturbances Collectively – Poor Coping & Connection

6 DETECTING NSSI IN SCHOOL “Peer Flagging” Go through peer who then tells adult in school ~60% told peer; less than 30% told adult Other Potential Signs Frequent unexplained injuries, bruises, scars Evidence of NSSI in work, journals, art samples, projects Refusing activities that involve showing skin (gym class) Socializing with known self-injurers Inappropriate use of clothing given weather

7 INITIAL RESPONSE IS ESSENTIAL COMPONENT # Persons Disclosed NSSI to (10pt scale) Muehlenkamp et al., in prep. Perceived Helpfulness of Response to Disclosure (3pt scale)

8 RESPONDING: INTERPERSONAL STYLE  Low Key, dispassionate demeanor  Non-judgmental approach  Respectful curiosity  Consultative with student  Validation  Show your concern: “I statements” Walsh, 2012

9 Introducing the Topic Place it in context of conversation Ask about behaviors performed Ask about effects/Context of referral

10 (OARSS) ASSESSING TO PROMOTE INTERVENTION (OARSS) Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change Alternative assessment models:  HIRE (Buser & Buser, 2013)  STOPS FIRE (Kerr, Muehlenkamp, & Turner, 2010) Westers & Muehlenkamp, in prep.

11 ONSET & FREQUENCY Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change  Why Interpersonal Theory of Suicide (Joiner, 2005)  How to ask When did you first injure yourself? When was the last time you self-injured? How many times a week/month do you self-injure? Have you found that you have begun to self-injure more often or more deeply than a year ago (or when you first started)? **Acquired Capacity** Suicide Attempt or Death Burdensomeness Thwarted Belongingness

12 AFTERCARE Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change  Why Infection, Scarring, Self-Care, Resources  How to ask How do you handle/manage the wounds afterward? Have you ever hurt yourself so badly that you could have used medical attention, like stitches? Does anyone else know about your self-injury? (after you hurt yourself?) If yes: How did s/he react? Was it helpful?  If you seen an injury upon assessment Do you have any other wounds? I need to assess your wounds so we can be sure to provide the proper care and avoid infection. (if you are medically trained)

13 REASONS Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change  Why Validation, Inform treatment plan, Severity  How to ask It sounds like this has been helpful for you. In what ways does it help you? What does it do for you? Tell me how self-injury works for you. How much physical pain do you typically feel? DISTRESS Act of NSSI RELIEF Negative Event Interpersonal Self-Relevant

14 SUICIDAL IDEATION  Why Risk of NSSI, Depression, and Suicide Attempts combined  How to ask Some people may think about suicide when they are self-injuring. Do you ever think about ending your life when you self-injure? Increased Suicide Attempt Risk # NSSI Methods Used # Years Engaged in NSSI Frequency of NSSI (>20 acts) Weaker & Slower Remission of Suicidal Ideation over 6-mo period Increasing Severity of Wounds Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change

15 STAGE OF CHANGE Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of Change  Why Transtheoretical Model of Change, Therapy referral/approach  How to ask Is this something you would like to stop? Have you ever considered stopping? On a scale from 1 ( no interest ) -10 ( desperate to stop ), how much would you like to stop this behavior or find something else instead of self-injury? Pre-Contemplation -no intent to stop, see no problem Contemplation -ambivalent about stopping Preparation -want to stop, small steps taken Action -actively trying to stop NSSI Maintenance -prevent relapse, no NSSI

16 MOTIVATING TOWARD CHANGE  Expressing Empathy  Suspend own opinions/advice: authentic listening  Reflect implicit meaning & emotion  Avoiding Argumentation  Emphasize choice to change: recognize may not be ready  Rolling with Resistance  Acknowledge pros, “go with it”  Supporting Self-Efficacy  Students need to feel able to change  Start where student is & what they feel can do  Developing Discrepancy  Collaborative, Socratic: look forward into future  Life they have w/NSSI: Life have w/o NSSI MOTIVATIONALINTERVIEWING PRINCIPLES PRINCIPLES & STATEGIES STATEGIES

17 PARENT CONTACT  Parent connection  strong role  Notifying Parents  Student in room with you  Collaborate on what you will say  Neutralize strong emotional responses  Greet parent with child in person (if can)  Proactive – Supportive Stance  Psychoeducation  Promote non-judgmental understanding  Differs from suicide & need for monitoring  Ways to support child

18 PARENT RESPONSES  Supportive  Rejecting  Fearful  Ambivalent

19 TREATMENT OPTIONS  Effective Treatments exist & being developed  Emotion Identification, Acceptance, Management  Cognitive Restructuring (self & body perceptions)  Delay / Distraction Behaviors  Problem Solving (esp. implementation)

20 CONTACT INFORMATION Office Phone: Questions & Discussion Slide 16

21 SOME RESOURCES Claes, L., & Muehlenkamp, J. J. (2013). Non-Suicidal Self-Injury in Eating Disorders: Advancements in Etiology and Treatment. Heidelberg, Germany: Springer. Walsh, B., & Muehlenkamp, J. J. (2013). Managing non-suicidal self-injury in schools: Use of a structured protocol to manage the behavior and prevent social contagion. School Psychology Forum: Research in Practice, 7, Walsh, B. W. (2012). Treating self-injury (2 nd edition): A practical guide. New York: Guilford. Klonsky, E. D., Muehlenkamp, J. J., Lewis, S. P., & Walsh, B. (2011). Nonsuicidal self-injury: Advances in psychotherapy-Evidence-based practice. Cambridge, MA: Hogrefe. Nixon, M. K., & Heath, N. L. (2009). Self-injury in youth: The essential guide to assessment and intervention. New York: Routledge. Nock, M. K. (Ed.) (2009). Understanding nonsuicidal self-injury: Origins, assessment, and treatment. Washington, DC: American Psychological Association. Nock, M. K. (Ed.) (2014). The Oxford handbook of Suicide and Self-Injury. New York, NY: Oxford University Press.   


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