DIGEST-Volume-10-Issue-2-FULL ISSUE

7 TPC Digest I n light of current prevalence rates, it is very likely that clinicians will work with nonsuicidal self-injury (NSSI) in their clinical work. NSSI is distinct from suicidal behavior, given that NSSI is the intentional infliction of harm to the body without the intent to die. Indeed, primary motives for NSSI are emotion regulation, anti-dissociation, self-punishment, and a means of addressing interpersonal conflict. Rather than an attempt to end one’s life, NSSI often is used as a coping strategy to overcome emotional difficulty. N SSI can be influenced by social contagion, a form of social learning in which two or more members of a group or community engage in a similar behavior within a 24-hour timespan. NSSI contagion has been found to exist among adolescents in residential treatment centers as researchers have determined clustering of self-injurious acts. In addition to contagion in proximal groups, social networking sites could be a new vehicle for social contagion among online groups. Indeed, researchers have found that individuals use social media sites to share NSSI photos, stories, and videos, thus increasing the potential for social contagion. Given the prevalence of NSSI and current online considerations, we designed our study to learn from licensed clinicians about their clinical experiences with NSSI. Specifically, we wanted to know about frequency of addressing NSSI, characteristics of clients who self-injure, NSSI assessment practices, the role of the internet in NSSI behavior, clinicians’ beliefs pertaining to NSSI, and clinical training and competence. Our findings clearly revealed the prevalence of NSSI in counseling settings. The large majority of our participants reported working with at least one client with NSSI in the previous year and almost 10% of our sample reported working with 15 such clients or more. Although it appears that the majority of clients who engaged in NSSI were female, clinicians reported addressing NSSI with both male and transgender clients as well. Clinicians disclosed clients’ methods of NSSI, in which cutting was most prevalent, yet they also reported incidences of burning, hitting, scratching, and punching. Almost half of our sample disclosed that their intake form had an item inquiring about NSSI separate from suicidal behavior, indicating growing recognition that NSSI is distinct from a suicide attempt. The large majority of our sample confirmed that they conceptualize NSSI as an addictive behavior for some clients, and about a third of clinicians supported the inclusion of NSSI Disorder in the DSM proper (currently, it is listed as a condition in need of further study). Interestingly, almost half of our sample reported being unaware of whether or not their clients who self-injured utilized the internet to share and/or view NSSI content. It appears that many counselors do not currently inquire about the ways in which online behavior may contribute to NSSI. These results indicate an opportunity for increased training related to NSSI and online social contagion. Finally, our participants identified continuing education workshops as the most common modality for NSSI training followed by on-the-job training. Therefore, graduate school training programs could potentially benefit students by including more content and practice related to NSSI. Amanda Giordano, PhD, LPC, is an assistant professor at the University of Georgia. Lindsay A. Lundeen, MS, NCC, is a doctoral student at the University of Georgia. Chelsea M. Scoffone, MEd, is a doctoral student at the University of Georgia. Erin P. Kilpatrick, MS, NCC, LPC, is a doctoral student at the University of Georgia. Frank B. Gorritz, MS, NCC, is a doctoral student at the University of Georgia. Correspondence may be addressed to Amanda Giordano, 422G Aderhold Hall, 110 Carlton Street, Athens, GA 30602, a manda.giordano@uga.edu. Clinical Work With Clients Who Self-Injure Amanda Giordano, Lindsay A. Lundeen, Chelsea M. Scoffone, Erin P. Kilpatrick, Frank B. Gorritz A Descriptive Study |