TPC Journal-Vol 10- Issue 2-FULL ISSUE

181 Amanda Giordano, Lindsay A. Lundeen, Chelsea M. Scoffone, Erin P. Kilpatrick, Frank B. Gorritz Clinical Work With Clients Who Self-Injure: A Descriptive Study Nonsuicidal self-injury (NSSI) is a common clinical concern. We surveyed a national sample of 94 licensed clinicians to better understand their work with clients who self-injure. Our data revealed that over the past year, 95.7% ( n = 90) of the sample reported working with at least one client who self-injured. Thirty- six clinicians (38%) reported that most or all of their clients who self-injured were adolescents, 61 (64.9%) reported that most or all clients who self-injured were female, and 43 (45.7%) reported that most or all clients who self-injured engaged in cutting as the primary NSSI method. About 35% ( n = 33) of the clinicians in our sample indicated they have never asked clients who self-injured about their online activity related to NSSI. The majority of our participants ( n = 78; 83%) supported the notion that NSSI could be an addictive behavior for some clients and less than half ( n = 42; 44.7%) received NSSI training in their graduate coursework. Keywords: nonsuicidal self-injury, NSSI, licensed clinicians, training, behavioral addiction Nonsuicidal self-injury (NSSI) is a complex phenomenon. Favazza (1998) defined NSSI as “the deliberate, direct destruction or alteration of body tissue without conscious suicidal intent” (p. 260). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ; American Psychiatric Association [APA], 2013) noted that NSSI is intentional and self-inflicted body damage that is not socially sanctioned (e.g., piercings or tattoos) and lacks suicidal intent. The fact that NSSI is intentional and direct distinguishes it from unplanned or indirect forms of self-harm such as disordered eating or substance abuse (Favazza, 1998; Walsh, 2012). Furthermore, although a relationship exists, NSSI is distinct from suicide attempts in that it is a means of seeking relief and coping, thereby sustaining rather than ending one’s life (Walsh, 2012; Wester & Trepal, 2017). NSSI has been conceptualized as a behavioral addiction (Buser & Buser, 2013) given that some clients demonstrate a loss of control over NSSI, continued engagement despite negative consequences, craving to engage in NSSI, and compulsivity, which are hallmarks of addiction. Also, researchers have found evidence for NSSI contagion, in which the behavior is imitated by others in a specific community (Walsh, 2012; Walsh & Rosen, 1985). Given these complexities, it is imperative that clinicians are adequately trained to assess and treat NSSI. In light of previously published prevalence rates, it is likely that most clinicians will work with clients who self-injure at some point in their careers. Indeed, 21%–80% of inpatient clients and 22%– 40% of outpatient clients have reported engagement in self-injurious behavior (Wester & Trepal, 2017). Moreover, in a national sample of 74 clinical practitioners, 60 (81%) reported working with clients who self-injured (Trepal & Wester, 2007), and among 443 school counselors, 357 (81%) reported working with at least one student engaged in self-injury (Roberts-Dobie & Donatelle, 2007). Much has changed, however, in the social landscape related to self-injury, including the popularity of sharing NSSI images online; television shows, movies, and songs depicting NSSI; and celebrities disclosing NSSI behavior. Thus, we sought to investigate licensed clinicians’ experiences working with clients who self-injure to provide updated information and better inform the profession of counseling. 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, amanda.giordano@uga.edu. The Professional Counselor™ Volume 10, Issue 2, Pages 181–193 http://tpcjournal.nbcc.org © 2020 NBCC, Inc. and Affiliates doi:10.15241/ag.10.2.1