Presentation on theme: "Responding to Self-Injury in the Schools"— Presentation transcript:
1Responding to Self-Injury in the Schools Jennifer J. Muehlenkamp, Ph.D.
2Defining NSSI Suicide: 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 consciousnessFeel hopeless and helplessFeel no better after attemptUsually one primary method; typically different method than that of NSSIHigh lethality, requiring medical attentionNSSI:Intent is to feel alive, cope with life, and/or avoid suicideExperience periods of hopeTypically experience relief after the actMultiple methods are often usedLow lethality, rarely requiring medical attention(Muehlenkamp, 2005; Walsh, 2012)
3Most Common NSSI Behaviors What Behaviors = NSSI?Most Common NSSI Behaviors
4Who is at Risk? “Teen Disorder” Ethnicity Gender Sexual Orientation Age onset (minority early at 10yrs)2nd Peak is at years (freshman college)EthnicityCaucasians > other ethnicitiesHispanic females also highGender25% - 50% self-injurers are MALESexual OrientationGLBTQ significantly higher ratesSESNo reliable differencesSome suspect higher in middle/upper class
5Who is at Risk? Shared Symptom Features Emotional DifficultiesAggression/Anger/Self-hatredLow frustration/distress toleranceStrong emotions intolerable; frighteningProblem-Solving & Interpersonal deficitsFeelings of powerlessnessPerfectionistic Features / Need for ControlIdentity disturbancesCollectively – Poor Coping & Connection
6Detecting NSSI in School “Peer Flagging”Go through peer who then tells adult in school~60% told peer; less than 30% told adultOther Potential SignsFrequent unexplained injuries, bruises, scarsEvidence of NSSI in work, journals, art samples, projectsRefusing activities that involve showing skin (gym class)Socializing with known self-injurersInappropriate use of clothing given weather
7Initial Response is Essential Component # Persons Disclosed NSSI to (10pt scale)Perceived Helpfulness of Response to Disclosure (3pt scale)Muehlenkamp et al., in prep.
8Responding: Interpersonal Style Low Key, dispassionate demeanorNon-judgmental approachRespectful curiosityConsultative with studentValidationShow your concern: “I statements”Walsh, 2012
9Introducing the Topic Place it in context of conversation Ask about behaviors performedAsk about effects/Context of referral
10Assessing to Promote Intervention (OARSS) Westers & Muehlenkamp, in prep.Onset & Frequency Aftercare Reasons Suicidal Ideation Stage of ChangeAlternative assessment models:HIRE (Buser & Buser, 2013)STOPS FIRE (Kerr, Muehlenkamp, & Turner, 2010)
11Onset & Frequency Why How to ask AftercareReasonsSuicidal IdeationStage of ChangeOnset & FrequencyWhyInterpersonal Theory of Suicide (Joiner, 2005)How to askWhen 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)?Thwarted BelongingnessBurdensomenessSuicide Attempt or Death**Acquired Capacity**
12Aftercare Why How to ask Infection, Scarring, Self-Care, Resources Onset & FrequencyAftercareReasonsSuicidal IdeationStage of ChangeAftercareWhyInfection, Scarring, Self-Care, ResourcesHow to askHow 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 assessmentDo 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)
13Reasons Why How to ask Validation, Inform treatment plan, Severity Onset & FrequencyAftercareReasonsSuicidal IdeationStage of ChangeReasonsWhyValidation, Inform treatment plan, SeverityHow to askIt 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?DISTRESSNegative EventInterpersonalSelf-RelevantAct of NSSIRELIEF
14Suicidal Ideation Why How to ask Onset & FrequencyAftercareReasonsSuicidal IdeationStage of ChangeSuicidal Ideation# NSSI Methods UsedWhyRisk of NSSI, Depression, and Suicide Attempts combinedHow to askSome people may think about suicide when they are self-injuring. Do you ever think about ending your life when you self-injure?Increasing Severity of WoundsIncreasedSuicide Attempt Risk# Years Engaged in NSSIFrequency of NSSI (>20 acts)Weaker & Slower Remission of Suicidal Ideation over6-mo period
15Stage of Change Why How to ask Transtheoretical Model of Change, Onset & FrequencyAftercareReasonsSuicidal IdeationStage of ChangeStage of ChangeWhyTranstheoretical Model of Change,Therapy referral/approachHow to askIs 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?Maintenance-prevent relapse, no NSSIAction-actively trying to stop NSSIPreparation-want to stop, small steps takenContemplation-ambivalent about stoppingPre-Contemplation-no intent to stop, see no problem
16Motivating Toward Change Expressing EmpathySuspend own opinions/advice: authentic listeningReflect implicit meaning & emotionAvoiding ArgumentationEmphasize choice to change: recognize may not be readyRolling with ResistanceAcknowledge pros, “go with it”Supporting Self-EfficacyStudents need to feel able to changeStart where student is & what they feel can doDeveloping DiscrepancyCollaborative, Socratic: look forward into futureLife they have w/NSSI: Life have w/o NSSIMOTIVATIONALINTERVIEWINGPRINCIPLES&STATEGIES
17Parent Contact Parent connection strong role Notifying Parents Student in room with youCollaborate on what you will sayNeutralize strong emotional responsesGreet parent with child in person (if can)Proactive – Supportive StancePsychoeducationPromote non-judgmental understandingDiffers from suicide & need for monitoringWays to support child
21Some Resources http://sioutreach.org/ http://www.selfinjury.com/ 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, 1-11.Walsh, B. W. (2012). Treating self-injury (2nd 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.