Self-injury, sexual self-concept, and a conservative Christian upbringing: an exploratory study of three young women's perspectives.

In this exploratory study we used qualitative methods to examine possible relations between young women's self-injurious behaviors, sexual self-concept, and a conservative Christian upbringing. Structured interviews were conducted with three young women fitting these characteristics from a private Christian university in the Northeastern United States. Phenomological data analysis revealed themes for these women that support a relation between their SIB and the development and expression of both their spirituality and sexuality. Implications for counseling practice include the need for a thorough assessment of past and present spirituality and the inclusion of sexual self-concept into counseling discussions.

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The body of literature regarding deliberate self-injury has burgeoned since Favazza and Conterio's (1989) seminal article profiling the typical self-injurer as a female in her late 20s who started self-injuring as an adolescent. Self-injurious behavior (SIB) is best described as, "the deliberate, direct destruction, or alteration of body tissue without conscious suicidal intent, that results in injury severe enough for tissue damage to occur" (Gratz, 2006, p. 241). While reliable statistics are difficult to collect and vary widely, recent studies estimate that between 1-15% of the U.S. population (2-8 million individuals) engage in SIB (Deiter, Nicholls, & Pearlman, 2000; Ross & Health, 2002; Purington & Whitlock, 2004).

Several studies have examined root causes for SIB, particularly among adolescents, finding invalidating environments, attention seeking, past trauma, depression, substance abuse, violence, and sexual abuse as precursors (Crouch & Wright, 2004; Denov, 2004; Nicholson, 2004; Nixon, Cloutier, & Aggarwal, 2002; Olfson, Gameroff, & Marcus, 2005; Strong, 1998). Of these causes, researchers have noted that the leading indicator of deliberate SIB appears to be an invalidating environment that also involves a history of sexual abuse (Linehan, 1993; Saxe, Chawla, & van der Kolk, 2002). Young people who continue SIB into late adolescence or college often replace the impulsivity of the act with a chronic need for emotional regulation (White Kress, 2003). Specific risk factors for college students include insecure attachment, childhood separation, emotional neglect, sexual abuse, and dissociation (Gratz, Dukes, Conrad, & Roemer, 2002). In addition, research suggests a correlation between the level of a women's self-objectification and her negative body image, which then often leads to both increased symptoms of depression and incidents of self-injury (Muehlenkamp, Swanson, & Brausch, 2005). Despite significant increases in the understanding of SIB, self-injury currently remains a "burgeoning area of research with many questions yet to be answered" (Purington & Whitlock, 2004, p. 3).

One area of study that is just beginning to be explored is the possible relation between female sexuality and SIB. The few studies conducted in this area seem to suggest that a woman's sexual self-concept (or schema) may play a role in SIB (Alexander & Clare, 2004; McKay, Gavigan, & Kulchycky, 2004; Skegg & Nada-Raja, 2003; Whitlock, et al., 2006a). A large online study found that people with a history of SIB were more likely to be female and bisexual or questioning their sexual orientation (Whitlock, Powers, & Eckenrode, 2006b). A specific study of females diagnosed with Borderline Personality Disorder (BPD) who self-injured found these women to have undifferentiated sex roles (i.e., less likely to identify with either masculine or feminine sex roles) while the women with BPD who did not engage in SIB primarily identified with more masculine sex roles (McKay, Gavigan, & Kulchycky, 2004). The relation between SIB and sexuality was further supported by a study that found that one quarter of deliberate self-injury among men and one sixth among women was potentially attributable to same sex attraction (Skegg & Nada-Raja, 2003). The authors suggested that one reason for this correlation was the belief that same sex attraction may be viewed as troubling, stigmatizing or thought of as "wrong" by some women as a result of environments that fail to validate the sexual identity of these women. This lack of sexual validation and its subsequent effect on SIB in some women was also supported by a qualitative study of 16 lesbian or bisexual women who self-injured. These women reported that they had not felt validated and were not allowed to express their emotions about their sexuality or about other personal things. The investigators also noted that when these women continued to feel unaccepted or different, they continued to self-injure (Alexander & Clare, 2004). These few studies seem to suggest that for some women self-injury may be related to unaccepted or invalidated sexual feelings and/or sexual identity.

Some women raised within a conservative Christian religious environment may have similar experiences related to sexual identity and sexual expression because several studies have indicated that views of sexuality within this culture tend to be restrictive when compared to majority culture (Bassett, Smith, Newell, & Richards, 1999; Bassett et al., 2002). Religious and spiritual support in general, however, has been found to have moderating effects upon both physical and psychological health, as well as enhancing the coping abilities and social support of individuals (Koenig, McCullough, & Larson, 2001; Lingren & Coursey, 1995; Pargament, 1997). The influence, therefore, of a conservative Christian upbringing on SIB is not clear but a relation may exist for some individuals.

The research reviewed indicates that there may be a relation for some women between SIB, sexual self-concept, and a conservative Christian upbringing. In order to explore if this relation exists, a small qualitative study was designed to begin to tentatively examine these concepts. The purpose of the research was to gain a better understanding of how these three aspects of the person and the environment might impact one another and influence the beliefs, behaviors, and experiences of a small sample of women.

METHOD

Participants

Participants for this study included three Caucasian Christian women ranging in age from 18 to 25, who attended a small, private, Christian university in the Northeast. Each of these women had sought counseling at the university's counseling center previously for issues relating to SIB and were recruited based on their fitting the criteria of the study (i.e,. history of self-injury, college-aged, female) as part of a purposeful sampling seeking to better understand the reasons behind their SIB (Groenewald, 2004). The women's names and any identifying personal information have been changed to protect their identities. The first woman (Holly, age 18) had been treated for depression and at the time of the interview identified herself as single, heterosexual, and with no history of romantic relationships. The second interviewee (Susan, age 22) had a family history of mental illness had experienced multiple childhood traumatic events but had not obtained counseling prior to college. At the time of the interview Susan identified herself as a bisexual swinger in a committed but open heterosexual relationship. The third woman (Nicole, age 25) had been treated previously for depression and suicidal gestures (e.g., statements, mild overdose of aspirin). At the time of the interview, she was married and identified herself as heterosexual. Each of the women had several predisposing factors for SIB present in their lives including at least one traumatic event during childhood, chronic depression, and suicidal ideation. Each also indicated that their SIB started in adolescence and was now used as a primary aid for emotional regulation.

Procedure

The goal of this study was to explore possible relations between SIB, sexual self-concept, and the conservative Christian upbringing of three young women. Given the subjective nature of these areas, and the exploratory nature of this study, a phenomenological design was employed. This approach places intentional emphasis upon gathering and giving voice to the individuals' perspective of their experiences. It is well suited for purposeful sampling because it allows the participants to fully explore their experiences in relation to the phenomena in question (Lincoln & Guba, 1985; Patton, 2002).

The primary investigative tool for this study was a semi-structured qualitative interview consisting of seventeen open ended questions (Appendix A). The questions were designed to allow participants to discuss their history with SIB while also clarifying how their sexual self-concept and conservative Christian upbringing might either moderate or intensify their SIB. Interviews lasted approximately one hour and were tape recorded in a clinical setting. Narrative responses were later transcribed verbatim and assessed using techniques consistent with the Consensual Qualitative Research (CQR) approach (Hill, Thompson, & Williams, 2005). The specific analysis included developing domains (identifying broad topic areas), constructing core ideas (summarizing statements to capture main ideas in each domain), and cross analyzing (assessing consistency of themes across cases). Core themes were examined and agreed upon by the team, the first a female doctoral student and the second a male doctoral level counselor educator. Given the exploratory nature of this study some aspects of CQR were deviated from. In particular, while two researchers conducted each step of analysis independently no external auditor was employed. Secondly, given the low sample size (3) one of the researchers also conducted the interview. Both researchers for this study identified as Christian and were employed by conservative Christian universities at the time of the interview.

RESULTS

Participants in this study were asked several questions regarding the relations between their self-injurious behaviors, spirituality, and sexual self-concept. The results of these interviews yielded five primary themes. First, the women perceived that their Christian upbringing was connected to past feelings of unworthiness. Second, part of their upbringing included a negative or limited view of sexuality and sexual education within the home. Third the women indicated that their self-injurious behaviors were related to relational stress, particularly with the opposite sex. Finally, the women noted that exploration and then development of both their personal spirituality and their sexuality helped to moderate their level of SIB. These five themes are described in more detail below along with direct quotations from the women.

#1. A conservative Christian upbringing connected to past feelings of unworthiness

The women were raised in conservative Christian religious homes, which they described. Nicole, "Going to church 2 to 3x/week, every week ... we also went to Sunday school and youth group of course." Holly, "since birth" being "involved in Sunday school, part of a small group for young women and teaching Sunday school." Susan remembered strict rules where, "children were to be seen and not heard and do what you were told. Follow the rules of the house and if you didn't you were punished for it." Although these activities may be considered common in conservative Christian religious homes, the women in this study felt that religion was overemphasized and that the overall atmosphere was unhealthy.

The negative aspects of their conservative religious upbringing often caused these women to feel unworthy and cut off from others and from God. For Holly this included the belief, "If you don't fit the church's mold of the perfect person ... they don't want to have anything to do with you." She indicated that these experiences led her to wonder, "Am I good enough to be a Christian?" and at times caused her to, "Have a hard time connecting with God because [she didn't] feel worthy." Susan described how she linked SIB and conservative Christian religiosity, "I think my religion played a big role with the self-injury just because of the whole guilt thing ... I felt guilty even about the things going on in my head that I wasn't doing!" SIB combined with religious guilt feelings to trigger a vicious cycle for Holly where she felt unable to connect with God, which in turned caused her to feel, "further and further from God ... because [she felt] dirty and unworthy." Subsequently, she had difficulty, "reading the Bible because I didn't feel worthy to be taking up His time." Recognizing this pattern she stated, "God never lets people down ... I believe He's there for me. God always stays the same; it's you who turns your back." Nicole, reflected similar feelings following an episode of SIB, "I never felt like the Lord abandoned me--I felt like I abandoned Him."

#2. Negative and limited sexual education

Sexual education for each participant was only briefly addressed in early adolescence and always in a negative manner. For Holly this consisted of instruction around traditional values such as, "the belief that sexual stuff is between number one a man and a woman and number two in marriage" along with the teaching, "from the time I was in utero until now that, 'all men are scum.'" Nicole's father told her, "sex is really bad ... Wait until you're married, until then we're not going to talk about it" while Susan recalled, "We never really talked much about it; we didn't know much about it. Obviously we weren't allowed to watch things on TV." Despite the lack of explicit conversations sexuality was present. Nicole remarked, "I lived in a very sexual home, even though it was a bad thing, I saw a lot and there were books and videos about how bad sex is." Susan's youth group participated in an exercise where:

   They had one boy chew gum. Then the leader told the boy to give it
   to the boy next him and said 'Now you chew it' but he didn't want
   to. Then she said 'Well, that's your virginity, if you give it away
   to one person then somebody else isn't going to want it and it's
   never the same again.' It was a huge negative thing."

While perhaps done to shelter the girls, their naivete clearly caused personal confusion and anxiety about their sexuality. Susan commented about the first time she attended public school in junior high. She said she was:

   'Headbutted' into all of it [sexuality]. I didn't know anything
   about the outside world basically ... I didn't know how to handle
   it! I sort of knew what sex was but it had never been explained to
   me and I had many, many misconceptions of a lot of sexual terms and
   what they were and how they were played out but I learned quickly,
   both through experience and through friends ... It sounds really
   stupid and I feel really stupid [but one time] I looked up all the
   sexual terms I was aware of in the dictionary and I wrote them out
   so I would know what they were.

#3. SIB related to relational stress with opposite sex

Each participant also noted that their SIB often tied in with strong feelings toward their fathers or early boyfriends. Susan, reflecting on the connection remarked, "My dad was a huge factor with my self-injury, the conflicting emotions that came when he called or I saw him. I hated him but I loved him." For Nicole it meant, "Cutting whenever I had an argument with my dad or I tried to talk to one of my boyfriends ... I felt so much anger, sadness, and grief all at the same time and I didn't know what to do with it." Susan also remembered a strong fear surrounding her sexuality during late adolescence stating, "I didn't want to get pregnant; I didn't want to go to hell because I didn't save it for marriage." Holly indicated that, "If I do show interest in a boy, I am horribly embarrassed with myself and just can't believe I did that, and I get really upset with myself and angry."

#4. Developing a personal spirituality seems to moderate SIB

Looking back on her religious upbringing Nicole now believes her parents forced Christianity on her. She states that they didn't, "really help me understand why people believe different things. I wasn't ever given the choice, it was just like, 'This is the truth and you're going to believe it or else you're gonna go to hell. So, deal with it.'" Susan concurred, stating:

   They never taught you the one important thing, which is take care
   of yourself first! That's where the whole self-injury thing came
   in--I gave myself the attention I wanted, those were the dreams
   that got me to sleep, either sex or self-injury and sometimes both
   in the same instance.

These restrictive environments seem to have hindered the women's emotional and spiritual exploration during adolescence but no longer. Now on their own, the women appear invested in exploring their personal spirituality. For Nicole this development has meant backing away from both religious institutions and group labels:

   Basically I have a relationship with God through Christ. I still
   have a tug of war between my faith and organized religion because
   of my upbringing. I feel guilty if I skip church one Sunday but
   then I remember--that's not what being a Christian is.

Susan, who has also distanced herself from organized religion noted:

   I don't attend church anymore because I don't want other people
   telling me what to do, what to believe and how to do it. I get
   confused enough as it is. I also try to stay open minded; I try not
   to judge people. I try to understand. I also have an open
   mindedness about religion and who God is.

Holly too, "questions a lot of things about faith" due to experiences where she found church leaders to be, "Hypocritical, judgmental, and unaccepting of people who weren't perfect."

In conjunction with a retreat from externalized religion, the women have adopted a more open stance toward spirituality, including personal times of worship and reflection. Within their personal relationship with God, each has also found a way to balance their self-injury within the realm which once confined them. Reflecting on these two areas, Susan remarked:

   I felt I was a bad person and like God looked down on me. Now that
   I've been having my own relationship with Him instead of having a
   relationship with Him and the church, I don't think He looks down
   on me. He may not agree with everything I do but that is something
   He and I can work out together. I don't need somebody else always
   telling me exactly what is right and what is wrong. I feel His love
   and understanding versus all the rules ... I feel God understands
   when I do make mistakes.

#5. Exploration and expression of personal sexuality seems to moderate SIB

For Nicole and Susan, the shift towards a meaningful personal spirituality occurred in their early 20s during a period when they were also developing a greater personal acceptance of their sexual selves. For Susan, this meant exploring her sexuality to the place where she was comfortably bisexual. She remarked, "I like girls and I like guys, I'm very comfortable with where I am. I'm not necessarily comfortable with everything I've done but I'm comfortable with where I am." Nicole remarked, "My religion gave me a lot of guilt over things I had done and a lot of condemnation, to the point where I felt I was dirty. I couldn't see how sex was supposed to be used in marriage; now that I'm with someone I love though, I understand it is a gift."

Nicole and Susan also commented on the period of their initial sexual expression and experiences. For Susan this phase involved the exploration of her sexuality in depth through the Internet and other means. After a period of approximately three months she met her current boyfriend and recalled, "After a couple dates I wanted to have intercourse so, we had sex. After that Pandora's Box was open and I wanted to do everything and experience everything." Nicole, also discussed this surge of sexuality particularly during the early months of her dating relationship with her future husband, stating, "I remember being with my future husband, I wanted to have sex but he was like 'Whoa--what are you doing to me--stop that!' I was so bad." Within the context of a committed relationship characterized by acceptance, validation, and free sexual expression both Nicole and Susan noted less of a need or desire to self-injure and had not engaged in SIB for several months. Holly, who had not been in a relationship and struggles to express her sexuality, was still wrestling with SIB. Susan described the overall connection between her sexuality and self-injury like this, "I think before my sexuality made me feel very guilty and made me want to cut, but now, with my sexuality, I just do what I want. If I do sexual things, I don't feel the need to cut."

DISCUSSION

The results of this study seem to confirm previous research on SIB, which has identified the impact of an invalidating environment and the use of SIB for emotional regulation. In addition, narratives from the three participants revealed a home life pattern of conservative Christian religiosity, which they described as rigid, inflexible, and unhealthy. This unhealthy use of faith is consistent with Fromm's (1950) notion of authoritarian religion (i.e., a system where individuals are demeaned versus empowered) and Allport's (1966) distinction between intrinsic and extrinsic religion (i.e., a 'lived' faith versus one 'used' by the individual for personal gains). For these women, this structure seemed to create feelings of unworthiness, guilt, and disconnection, and fostered the emergence of SIB as one form of relief.

The narratives also suggest that the use of fear based parenting strategies, especially regarding sex education, were detrimental. As the women matured into adolescence, these stringent teachings collided with the emergence of their own sexual feelings and urges. Expression or discussion of these sexual feelings was viewed as unacceptable and may have aggravated the SIB. The sexual feelings caused confusion and anxiety reinforcing their sense of ambivalence and alienation. The results seem to support the idea that women's self-injury may at times be related to feelings about identity and sexuality, especially in regard to unexpressed, unaccepted, or invalidated feelings (Alexander & Clare, 2004: McKay et al., 2004; Skegg & Nada-Raja, 2003; Whitlock et al., 2006b).

The women's sexual self-concepts seem consistent with a model developed by Andersen and Cyranowski (1994, 1998). Susan and Nicole, who have had more sexual experience, displayed more coschematic traits (i.e., simultaneously high views of sexual desire and sexual anxiety) (Andersen & Cyranowski, 1994, 1998). While Holly displayed traits consistent with a negative sexual schema (i.e., embarrassment and conservativism) and aschematic women, who hold a neutral view of sexual desire, avoid intimacy and exhibit low levels of relational commitment and satisfaction. Such anxious or avoidant patterns of relating to others have been previously linked to SIB (Gratz, 2006; van der Kolk, Perry & Herman, 1991; Wright, Briggs, & Behringer, 2005).

During adolescence and college, the women described a struggle to understand and express their sexuality and spirituality. The two older women reported that expression of their sexuality within an accepting and validating relationship has lessened their desire to self-injure. Spiritually, the women have also begun to question some aspects of their conservative religious upbringing. As they have separated psychologically from their parents, they have begun to develop a personal spirituality, moving away from religious structures towards a more internalized spiritual faith. Such a progression is in line with Fowler's Stages of Faith model (1981), in particular, movement from stage 3 (Synthetic-Conventional Faith) where faith expression is largely based on conforming and honoring religious expectations to stage 4 (Individuative-Reflective Faith) where religious expression and spirituality become more personally authentic. This transition, which is often arduous, involves critically evaluating and then choosing personal beliefs, values, and commitments while also taking responsibility for these choices (Cook & Hillman, 2006; Leak, 2003; Lee, 2002; Love, 2003).

RECOMMENDATIONS

The results of this study, although limited in generalizability, suggest several possible implications for mental health counselors, particularly for those working with younger women raised in conservative Christian religious environments. First, in working with similar women it is appropriate and may be very helpful to assess their spirituality. This is in keeping with the 2000 AMHCA guidelines for ethical mental health practice and with the best practices in assessment as suggested by others within the profession (Cashwell & Young, 2004; Miller, 1999). In particular, it is important to determine whether the spiritual teachings within the woman's home environment were functional (e.g., validating, open, encouraging, empowering, etc.) or dysfunctional (e.g., unsupportive, invalidating, constrictive, restrictive). Clinicians may find Fromm's (1950) and/or Allport's (1966) previously mentioned theories helpful in this regard. Ascertaining the client's current faith stage, using Fowler's (1981) Faith Development Model or other appropriate framework is also encouraged. Secondly, for those working with young adult women it may be helpful to discuss normal developmental growth in this area that reflects a shift away from honoring expectations and roles to a place where relationship with God is more authentic and personal. Including a model that incorporates spiritual principles into skill building such as Dialectical Behavior Therapy (DBT) could also prove useful with this population, particularly if they carry a concurrent diagnosis of BPD (Linehan, 1993; Linehan, Comtois & Murray, 2006; Nee & Farman, 2005). It appears that assessing and exploring spiritual issues with SIB women may lesson SIB but the results also suggest that addressing their sexuality may also moderate this behavior.

The statements of this sample of women regarding sexual repression and lack of expression seem to indicate that it may prove helpful to provide similar woman with a therapeutic environment of acceptance that encourages and empowers them to find their voice (Gilligan, 1982). Such a relationship, as some recent research suggests, may be more important than any particular treatment method in helping to reduce self-injury (Muehlenkamp, 2006; Trepal & Wester, 2007). This type of environment would give young women raised in excessively rigid conservative Christian environments the opportunity to explore and appropriately express issues pertaining to their sexuality. This exploration could be facilitated by using Andersen and Cyranowski's (1994, 1998) broad female sexual schema framework, which explores past and current sexual behaviors and responses in conjunction with the woman's temperament and individual differences. Such therapeutic discussions may lead to exploration of early attachment experiences which have been found to influence individual's sexual self-concept and are correlated with lower levels of self-regulation and increased instances of SIB (Gratz, 2006; Muehlenkamp, et al., 2005). An accepting and empowering therapeutic environment which fosters exploration and appropriate expression of sexuality may therefore lesson the SIB of some women.

The results of this study suggest helping young women with SIB by fostering an accepting environment that allows for exploration and expression of both individual spirituality and sexuality. While not part of the research outcomes of this project, mental health professionals have noted other grounded intervention techniques that work with self-injurers. For instance, Muehlenkamp (2006) offers Problem Solving Therapy (PST) along with DBT as effective approaches for treatment of SIB due to their time-limited, structured approach. Other researchers in the field also support the use of standard CBT techniques such as thought stopping, thought replacement and cognitive distractions such as relaxation techniques in helping to reduce SIB (Lader & Conterio, 1998; Strong, 1998). Incorporation of behavioral interventions found in the Rational Emotive Behavior Therapy (REBT) framework including shame attacking exercises, minimization of self-disturbance along with the disputing of irrational beliefs and negative self-statements may be valuable tools for clients seeking to decrease SIB (Beck, 1975; Ellis, 1975).

Other interventions that have demonstrated effectiveness with the general SIB population include the use of grief work, group work, Eye Movement Desensitization and Reprocessing (EMDR) and psychotropic medications (Lader & Conterio, 1998). In addition, the use of a bi-modal treatment approach that combines the individual strategies, with a family systems approach to help identify the relational and systemic dynamics that may be impacting the situation may help to moderate the individual's SIB (Stone & Sias, 2003). Finally, employing narrative techniques such as deconstmcting the client's dominant cultural (e.g., religious) narratives, externalizing the problem, reauthoring the story, and providing a context for a new, preferred life narrative are also encouraged (White & Epston, 1990). Overall, as Muehlenkamp (2006) stated, "mental health professionals must be ready to respond with creative, innovative and effective treatments" (p. 180). For mental health counselors working with women similar to those in this study, we encourage the exploration of spiritual development and sexual self-concept as potential productive coping mechanisms to replace SIB and empower these women towards holistic development and acceptance.

LIMITATIONS

There are several limitations to this study underscoring the need for subsequent research. Most importantly, the sample selected for this study consisted of a very select group of women from a conservative Christian upbringing who had sought services previously for issues related to SIB. Selection of these participants was purposeful based on the specific demographics mentioned in order to examine interactions that might exist between the areas of self-injury, sexuality and a conservative Christian upbringing. By exploring these areas in depth we hoped to determine what commonalities might exist leading to SIB. Given that the sample constituted a small minority of Christian females, the findings of this study clearly may not reflect how typical females of the same or different religious backgrounds, or those from a nonreligious home might express their sexuality and or desire for self-injury. Further, in-depth studies with diverse young adults from different group memberships (e.g., gender, race, ethnicity, sexual orientation, etc.) are encouraged. Although the main goal for the current project was to explore possible relation between a conservative Christian upbringing, sexual self-concept and SIB it may be helpful for future research to compare between group differences of those from nonspiritual versus spiritual homes or those from either group who self-injure versus those who do not. The results should also be interpreted with caution as they reflect exploratory research. Finally, future research should also incorporate larger sample sizes and implement quantitative methodologies to help increase the generalizability of results.

CONCLUSION

The growing use of self-injury within adolescent and college aged women underscores the need for comprehensive research in this area to inform theory and competent practice. Results from this exploratory study tentatively indicate that for certain young women from conservative Christian upbringings, a relation may exist between their SIB and the development and expression of both their sexual self-concept and their spirituality. Incorporating spirituality into the assessment of these clients and discussing sexual development and expression may prove beneficial in helping to moderate the individual's SIB. In addition, identifying whether young women's spiritual and sexual beliefs involve themes of invalidation or inflexibility seems critical. Helping young women to explore and come to terms with their personal spirituality and sexual self-concept may prove effective in reducing self-injurious behaviors and provide a path towards personal health and wholeness.

APPENDIX A

Qualitative interview Questions

"--is of course a Christian school and I am interested in spirituality and its meaning to you before we discuss self-injury and some related issues so I'd like to start by asking you a few general questions about faith."

1. How would you describe your religious/spiritual upbringing (including the beliefs and practices of your family as well as any training you received)?

2. In what ways have various people shaped your religious/spiritual identity whether positively or negatively?

3. What experiences, (for example conversion, mystical events etc.) and/or crises have shaped your religious/spiritual identity whether positively or negatively?

4. You shared about your spiritual upbringing but, how would you describe your personal religion/spirituality currently?

5. How would you describe God? What two adjectives would you use to describe God today?

6. How do you personally experience God? How do you experience God on a day to day basis?

"Now that I have a sense where you are spirituality I'd like to talk a little about self- injury, how it relates to your personal history and its impact on your life. For the purposes of this interview self-injury is defined as: deliberate, repetitive mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing your emotions."

7. Please tell me a little about your personal history and how you arrived at the point where you sought out counseling?

8. Please describe the patterns of self- injury you have seen in your life that you are aware of such as when it began, what self-injurious behaviors you have used and your current self-injurious behaviors.

9. What do you think is your primary purpose for using self-injurious behaviors? What have others told you are the reasons? What do you think of those perspectives?

10. As you think about it are there any specific experiences, events, and/or people who cause you to want to self- injure? How do these experiences, events, or people contribute to your self- injurious behaviors? Why do you think this happens?

"Thirdly, I want to ask you a few questions about your sexuality if that will be ok with you? Sometimes this can be uncomfortable but your honesty in this area will be most helpful."

11. What messages about sexuality do you think you received while growing up-give examples, from your parents, siblings, boyfriends, church etc.

12. How do you feel about your sexuality at this time? How would you describe your sexuality today?

13. How would you say your past sexual experiences, whether positive or negative, affect how you feel today? How do they affect your thinking? What about your behaviors?

"I would like to wrap up our time together with just a few summary questions that talk about the about possible interactions between the three areas we've just discussed."

14. How do you think your religion/spirituality affect your sexuality and vice versa?

15. How do you think your religion/spirituality affects your self-injurious behaviors and vice versa?

16. How do you think your sexuality affects your self- injurious behaviors and vice versa?

17. Is there any other information you feel would be helpful to share regarding any of the areas we have just discussed (e.g., self-injury, sexuality, religion/spirituality).

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Joyce Wagner is director of the counseling center at Robert Wesleyan College. Mark Rehfuss is affiliated with the School of Psychology and Counseling at Regent University. Correspondence regarding this article can be addressed to Joyce Wagner at Robert Wesleyan College, 2301 Westside Dr. Rochester, IVY 14624. E-mail: [e-mail].