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Students who self-injure: school counselor ethical and legal considerations.



This article explores ethical considerations that school counselors A school counselor is a counselor and educator who works in schools, and have historically been referred to as "guidance counselors" or "educational counselors," although "Professional School Counselor" is now the preferred term.  may need to address when providing counseling services to self-injurious students. Ethical issues related to student confidentiality, responsibilities to parents and to the school, and professional competence are discussed in relation to the American School Counselor Association's (2004) Ethical Standards for School Counselors. Implications and recommendations for school counselors working with self-injurious students are provided.

**********

Self-injury is an issue that has received increased attention in the recent literature (Austin & Kortum, 2004; Froeschle & Moyer, 2004; Kress, 2003; Kress, Gibson, & Reynolds, 2004; White, McCormick, & Kelly, 2003) and has become more visible in the school setting with many educators and school counselors feeling frustration and confusion as to how to best address student self-injurious behaviors (Austin & Kortum). Estimates of self-injury vary depending on the population sampled and the definition of self-injury (Suyemoto & Kountz, 2000), but current estimates of self-injury range from 1 percent to 4 percent (Briere & Gil, 1998) of the general population. With regard to the adolescent population, a recent study indicated that 13% of surveyed adolescents reported engaging in self-injurious behavior (Ross & Heath, 2002).

With an ostensible Apparent; visible; exhibited.

Ostensible authority is power that a principal, either by design or through the absence of ordinary care, permits others to believe his or her agent possesses.
 recent increase in self-injury prevalence in the adolescent population, it is important that school counselors recognize the signs and symptoms of self-injury and have the knowledge needed to appropriately intervene and best help these students (Kress et al., 2004). On average, people who self-injure typically begin this behavior during middle adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes.  (i.e., about age 14 or the freshman year of high school) and will continue the behavior into their late twenties (Austin & Kortum, 2004; Favazza & Conterio, 1989; Herpertz, 1995; Ross & Heath, 2002); thus school counselors are in a position to provide early identification, intervention, prevention, and advocacy for students who self-injure (Kress et al, 2004).

As student self-injurious behavior is complex and multifaceted mul·ti·fac·et·ed  
adj.
Having many facets or aspects. See Synonyms at versatile.

Adj. 1. multifaceted - having many aspects; "a many-sided subject"; "a multifaceted undertaking"; "multifarious interests"; "the multifarious
, school counselors should be aware of the many ethical issues associated with counseling self-injurious students. The purpose of this article is to first provide a brief overview of self-injurious behavior, and to then address the ethical considerations, as defined by the American School Counselor Association's (ASCA ASCA American School Counselor Association
ASCA Australian Shepherd Club of America
ASCA Arab Society of Certified Accountants
ASCA American Swimming Coaches Association
ASCA American Society of Consulting Arborists
ASCA Association of State Correctional Administrators
) Ethical Standards for School Counselors (2004), that school counselors should be aware of when working with students who self-injure. More specifically, ethical issues associated with student confidentiality, responsibilities to parents and to the school, and professional competence will be addressed and practical suggestions for how school counselors can best manage these issues will be provided. As many school counselors have had little, if any, training in managing issues associated with student self-injury, this article is an attempt to increase school counselors' ability to integrate the ASCA Ethical Standards for School Counselors into their work with the growing self-injurious population.

OVERVIEW OF SELF-INJURIOUS BEHAVIOR

Before addressing the ethical issues involved in counseling self-injurious students, it is first important that school counselors have an awareness of self-injurious behavior, and an ability to recognize these behaviors. More specifically, school counselors should be aware of what defines self-injury, and the correlates/risk factors associated with self-injury. This section provides a brief overview of the aforementioned a·fore·men·tioned  
adj.
Mentioned previously.

n.
The one or ones mentioned previously.


aforementioned
Adjective

mentioned before

Adj. 1.
 issues (readers are encouraged to review additional sources for more in-depth information about self-injury, e.g., Conterio, Lader, & Bloom, 1998; Favazza, 1996; Kress, 2003; Simeon & Hollander, 2001).

Definitions of self-injurious behavior vary, but in general self-injury has been defined as an intentional in·ten·tion·al  
adj.
1. Done deliberately; intended: an intentional slight. See Synonyms at voluntary.

2. Having to do with intention.
 act with the objective to do harm to the body without leading to a result of death (Simeon & Favazza, 2001; Yarura-Tobias, Neziroglu, & Kaplan, 1995). Self-injury can include, but is not limited to, scratching, branding, cutting, self-hitting, burning, and biting biting

pertaining to the characteristic behavior of performing a bite.


biting louse
see species of the insect suborder mallophaga.

biting midge
insects of the family ceratopogonidae.
 (Patterson & Kahan, 1983). Despite the various methods of self-injury, cutting is the most prevalent method (Briere & Gil, 1998; Gallop gallop /gal·lop/ (gal´op) a disordered rhythm of the heart; see also under rhythm.

atrial gallop  S

diastolic gallop  S

presystolic gallop  S

, 2002; Ross & Health, 2002; Taiminen, Kallio-Soukainen, Nokso-Koivisto, Kaljonen, & Helenius, 1998). Self-cutting is usually done with instruments such as razor blades ra·zor·blade also ra·zor blade  
n.
A thin sharp-edged piece of steel that can be fitted into a razor.

razor blade nhoja de afeitar

razor blade 
, or knives knives  
n.
Plural of knife.


knives
Noun

the plural of knife

knives knife
 (Austin & Kortum, 2004), and the severity of the cuts can range from superficial scratches to deep gouges (Conterio et al., 1998).

Self-injury is usually performed on the arms, wrists, and legs, but the breasts, thighs, stomach, and genitals gen·i·tals
pl.n.
Genitalia.
 are also sites where people self-injure (Conterio et al., 1998). Most people who self-injure hide their injuries (e.g., wearing long-sleeved pants or shirts even on a warm day; Conterio et al.), and they will avoid injuring themselves in the presence of other people (Gallop, 2002).

Self-injury can serve a variety of functions or purposes. People who self-injure typically have difficulty expressing strong negative emotional experiences such as pain, hurt, or anger and self-injury is often considered a form of emotional regulation (Favazza, 1996). The adolescent's self-injury may be a way to avoid overwhelming emotions through a focus on physical pain (Austin & Kortum, 2004; Dallam, 1997; Levenkron, 1998). Self-injury may be a method of gaining control over a situation in which the adolescent feels he or she does not have any control (Austin & Kortum; Dallam). In addition to the expression of emotions, adolescents may use self-injury in order to decrease dissociation dissociation, in chemistry, separation of a substance into atoms or ions. Thermal dissociation occurs at high temperatures. For example, hydrogen molecules (H2 , depersonalization depersonalization /de·per·son·al·iza·tion/ (de-per?sun-al-i-za´shun) alteration in the perception of self so that the usual sense of one's own reality is temporarily lost or changed; it may be a manifestation of a neurosis or another , and derealization derealization /de·re·al·i·za·tion/ (de-re?al-i-za´shun) a loss of the sensation of the reality of one's surroundings.

de·re·al·i·za·tion
n.
, and relieve feelings of emptiness and numbness numbness /numb·ness/ (num´nes) anesthesia (1).
Numbness
Loss of feeling or sensation.

Mentioned in: Topical Anesthesia
 (Dallam; Simeon & Favazza, 2001).

There are several life experiences that correlate with self-injurious behavior including losing a parent, family violence, childhood sexual abuse or rape, a childhood illness, and a history of self-injury in the family (Conterio et al., 1998; Deiter, Nicholls, & Pearlman, 2000). Two of the best predictors of self-injury are childhood sexual abuse and/or family violence (Deiter et al.). As children who experience sexual or physical abuse are in a state of constant emotional dysregulation Emotional dysregulation (or affect dysregulation) is a term used in the mental health community to refer to an emotional response that is not well modulated. This means that an individual does not respond to a person, place, thing, or event in a manner that would generally , and they do not yet have the skills necessary to regulate these intense emotional experiences, they may engage in self-injury in an attempt to regulate strong emotions (Levenkron, 1998).

ETHICAL CONSIDERATIONS AND PRACTICE RECOMMENDATIONS

School counselors have an important role to play in ensuring that students are safe, and that they have the resources they need to develop both academically and personally (Dahir, Sheldon, & Valiga, 1998). As school counselors are often among the first to be made aware of students' self-injurious behaviors, they are in a position to effectively intervene with self-injurious students (Kress et al., 2004). However, in the process of intervening, providing referrals, and advocating for self-injurious students, school counselors may be faced with many complicated ethical issues. In the following sections, some of these ethical issues are reviewed, and suggestions for how school counselors might handle these situations are provided.

Confidentiality and Responsibilities to Students

School counselors are ethically obligated ob·li·gate  
tr.v. ob·li·gat·ed, ob·li·gat·ing, ob·li·gates
1. To bind, compel, or constrain by a social, legal, or moral tie. See Synonyms at force.

2. To cause to be grateful or indebted; oblige.
 to keep student-reported information confidential unless disclosure is required to prevent clear and imminent danger to the counselee or others (ASCA, 2004). The following vignette Vignette

A symbol or pictorial representation of the corporation on a stock certificate. Usually a complicated and artistic design, it is meant to make the counterfeiting of stock certificates as difficult as possible.
 provides an example of the challenges that school counselors must address with regard to self-injury and students' confidentiality rights.
   Vignette 1. A teacher noticed that despite the
   warm weather, Jennifer was wearing long-sleeve
   shirts and pants. The teacher became
   concerned, and later overheard Jennifer telling
   her friends that she wore these clothes so that
   her parents and teachers would not see the
   cuts that she made on her arms and legs. The
   teacher referred Jennifer to the school counselor.
   The counselor told Jennifer that their
   conversation would be kept confidential
   unless she was at risk of harming herself or
   others. After initial introductions, the counselor
   stated that she was concerned that
   Jennifer was engaging in self-injurious behavior.
   Jennifer quickly replied that she was not
   suicidal. Jennifer disclosed that she has been
   cutting delicate marks into her arm and legs
   with a razor blade. Jennifer told the counselor
   that the self-injury helps her to relieve the tension
   and stress accompanied with her full
   schedule of Advanced Placement classes.

   The counselor, who was unfamiliar with
   self-injurious behaviors, immediately considered
   the self-cutting to be a suicidal action. At
   the end of the counseling appointment, the
   counselor told Jennifer that she felt she was at
   risk of seriously harming herself and that she
   had to report this behavior to her parents.
   After contacting Jennifer's parents, the counselor
   documented the nature of the counseling
   session and placed the documentation in
   Jennifer's student file.


Vignette 1 brings to the forefront various ethics-related questions and ethical standards for school counselors to consider: Did the counselor break confidentiality (ASCA, 2004, Standard, A.2f), or did the counselor have a duty to warn duty to warn AIDS A legal concept indicating that a health care provider who learns that an HIV-infected Pt is likely to transmit the virus to another identifiable person must take steps to warn that person  others because the student was a danger to herself (ASCA, Standard A.2b)? What additional information might the school counselor have gathered to more adequately assess the situation, and to have engaged in appropriate ethical decision-making? Suppose the counselor decided that Jennifer was not in danger of seriously harming herself, does the school counselor still have a responsibility to contact the student's parents (ASCA, Standard B. 1a)?

Remley, Hermann, and Huey (2003) stated that the extension of privacy rights belongs to the parent (even in cases when the child requests confidentiality), and judicial decisions have historically protected parental rights (Isaacs & Stone, 1999). Thus, the school counselor should consider reporting self-injurious behavior even in cases where the counselor does not perceive the student is in imminent danger. Counselors' interpretations of the kind of circumstances worthy of breaching confidentiality are varied (Isaacs & Stone), and the Vignette 1 example provides an instance where there may be considerable variability in decisions or judgments related to breaking confidentiality. Despite this, in a situation such as Vignette 1 where the counselor is not clear as to the need to break student confidentiality and report student self-injury to parents, it is recommended that school counselors seek legal consult with the school district attorney.

Favazza (1996) stated that by definition, the intent of the person who is engaging in self-injurious behavior is not of a suicidal su·i·cid·al
adj.
1. Of or relating to suicide.

2. Likely to attempt suicide.
 nature. Some even have stated that self-injury may prevent suicide by serving as a coping strategy (Austin & Kortum, 2004). While it is important for school counselors to be aware that most people who engage in self-injurious behavior make a clear distinction between suicidal ideation suicidal ideation Suicidality Psychiatry Mental thoughts and images which hinge around committing suicide. See Suicide.  and intention, and deliberate self-injurious behaviors without the intention to die (Allen, 1995), the school counselor must consider the serious consequences and liability that may occur by withholding Withholding

Any tax that is taken directly out of an individual's wages or other income before he or she receives the funds.

Notes:
In other words, these funds are "withheld" from your wages.
 this information from parents. As previously mentioned, school counselors should consider consulting with the school administration and their district's attorney about these types of issues.

As self-injurious behavior has been found to be one of the most disturbing behaviors encountered by helpers (Gamble, Pearlman, Lucca, & Allen, 1994), it is important that school counselors monitor their personal reactions to disclosures of self-injury and make decisions based on student-reported experiences and intentions rather than transference TRANSFERENCE, Scotch law. The name of an action by which a suit, which was pending at the time the parties died, is transferred from the deceased to his representatives, in the same condition in which it stood formerly.  reactions such as fear or a desire to control the student's behavior (White et al., 2003).

It is also recommended that school counselors complete a thorough assessment of the student's self-injurious behaviors. This will help the counselor in assessing the severity of the self-injury (Kress, 2003). Some of the issues to consider inquiring inquiring,
v to draw information from a client—whether by verbal questioning or physical examination—to assess the person's state of health.
 about, when a student discloses self-injury (Kress; Simeon & Favazza, 2001), are the age of onset The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder.

Diseases are often categorized by their ages of onset as congenital, infantile, juvenile, or adult.
 of the self-injury, course of the behavior (i.e., has it been steady or has it decreased or increased in frequency), current frequency of self-injury, change in self-injurious behaviors over time, medical complications (e.g., stitches, surgeries, infections, corrective cor·rec·tive
adj.
Counteracting or modifying what is malfunctioning, undesirable, or injurious.

n.
An agent that corrects.


corrective,
n
 surgeries), what types of tools does the student use to self-injure, does the student engage in appropriate wound care, does the student share self-injury apparatuses with other people or use dirty or rusty rust·y  
adj. rust·i·er, rust·i·est
1. Covered with rust; corroded.

2. Consisting of or produced by rust.

3. Of a yellowish-red or brownish-red color.

4.
 tools, emotional states when injuring, triggers leading to the self-injury, immediate and more long-term aftermath of injuring, does the student's family or friends know about the self-injury, and finally, recent life experiences, past traumas, or current life stressors that may be relevant to understanding the student's context and situation.

A thorough suicide assessment and self-injury assessment will help the counselor determine if the student is in imminent danger, assess for any additional risk-management issues, and ultimately determine what actions should be taken.

Finally, the counselor in Vignette 1 documented the nature of the counseling session and placed the client notes in her student file. Since student files are generally available to almost all school personnel, it is likely that the counselor, by including her case notes in the student's file, did not secure records necessary for rendering professional services (job) professional services - A department of a supplier providing consultancy and programming manpower for the supplier's products.  to the counselee as required by confidentiality guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
 (ASCA, 2004, Standard A.8). In addition, Isaacs and Stone (1999) pointed out that counselors are in a precarious position because they work with other educators who do not have the same obligations to protect a student's privacy as a counselor. Thus, another suggestion related to confidentiality and self-injury is for school counselors to follow all ethical guidelines when sharing information about a student's self-injurious behavior through written or verbal communications.

Student Confidentiality and Responsibilities to Parents and School Systems

School counselors are in a unique and challenging position in that not only do they have responsibilities to students, but they also have responsibilities to parents and the school (ASCA, 2004; Glosoff & Pate, 2002). In addition, "unless privilege or confidentiality law exists in a state, confidentiality based on adherence to an ethical code Noun 1. ethical code - a system of principles governing morality and acceptable conduct
ethic

system of rules, system - a complex of methods or rules governing behavior; "they have to operate under a system they oppose"; "that language has a complex system
 is legally subordinate to employer policy" (Tompkins & Mehring, 1993, p. 3). The school counselor must consider at what point parents and school administrators have the right to demand access to confidential information Noun 1. confidential information - an indication of potential opportunity; "he got a tip on the stock market"; "a good lead for a job"
steer, tip, wind, hint, lead
. The following vignette exemplifies the challenge of managing confidential student information with the responsibilities school counselors have to parents and school administrators.
   Vignette 2. Three of Rebecca's friends came to
   the school counselor's office because they
   were concerned by her recent strange behavior.
   They reported to the counselor that
   Rebecca picks the skin on her arms until it
   bleeds. Rebecca's friends said that this behavior
   has been occurring for the past 3 months.
   When the counselor met with Rebecca, she
   admitted to picking her skin and said it helps
   her deal with the stress of her parents' divorce.
   The counselor did not see any visible scarring
   on Rebecca's arms; however, she told Rebecca
   that she needed to contact her parents to
   inform them of this issue. The counselor
   informed Rebecca that school policy states
   that parents/guardians must be called if a student
   is at risk of harming himself or herself.
   The school counselor called Rebecca's mother
   with the intention of setting up an appointment
   to meet and discuss Rebecca's self-injury.

   When Rebecca's mother stated she was
   unable to come in for a meeting and that
   Rebecca was hurting herself for "attention,"
   the counselor felt she had no choice but to
   report Rebecca's behavior to the school principal.
   The counselor told the principal of
   Rebecca's alleged self-injurious behavior and
   her mother's unwillingness to attend a meeting
   with her daughter. The principal immediately
   called Rebecca into his office for a meeting
   with the counselor at which time the principal
   called Rebecca's mother.


Rebecca's case provides an example of the difficulties in balancing the confidentiality rights of minors, the counselor's responsibility, to act in a minor's best interest, and the legitimate rights and concerns of parents and the school (Isaacs & Stone, 1999).

In considering this vignette, the following question is pertinent: Was it necessary to break Rebecca's confidentiality (by informing the school principal of Rebecca's self-injurious behavior)? While ASCA (2004) states that the professional school counselor "informs appropriate officials in accordance Accordance is Bible Study Software for Macintosh developed by OakTree Software, Inc.[]

As well as a standalone program, it is the base software packaged by Zondervan in their Bible Study suites for Macintosh.
 with school policy of conditions that may be potentially damaging to the school's mission, personnel and property while honoring the confidentiality between student and counselor" (Standard D.1b, p. 2), this case does not fall into that category. Rather, the counselor in this vignette might have consulted another counselor and/or the principal (without revealing the student's name) to get objective perspectives on this case before breaking the student's confidentiality. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently
, the counselor could have provided the principal with "accurate, objective, concise and meaningful data necessary to adequately evaluate, counsel and assist the student" (ASCA, Standard C.2b, p. 2) without violating her confidentiality rights.

The counselor in this vignette believed that it was the parents' right to be aware of Rebecca's self-injurious behavior and attempted to establish a collaborative relationship with Rebecca's mother (ASCA, 2004, Standard B.1a). The counselor in this vignette did not contact Rebecca's father, which did not follow ASCA's ethical standards that state that a good-faith effort should be made to keep both parents informed with regard to information about children (Standard B.2d).

Professional Competence

The Ethical Standards for School Counselors (ASCA, 2004) states that the professional school counselor functions within the boundaries of individual professional competence and accepts responsibility for the consequences of his or her actions (Standard E.1a). According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 the American Counseling Association The American Counseling Association (ACA) is a non-profit, professional organization that is dedicated to the counseling profession. ACA is the world's second largest association exclusively representing professional counselors.  (ACA ACA - Application Control Architecture ) and ASCA ethical codes, counselors are to practice only within the boundaries of their competence, based on their education, training, and experience (ACA, 1995, Standards C.1 & C.2; ASCA, Standard E.1b). The following vignette describes the complexity involved in understanding professional competence.
   Vignette 3. Ms. Williams, a first-year high
   school counselor in a suburb of Chicago,
   believed that her graduate school training prepared
   her well for her new position. When the
   director of school counseling asked her if she
   would be wilting to run a support group for
   students who self-injure, she eagerly complied.
   Although Ms. Williams had no experience
   with this population, she recalled learning in
   her graduate work that self-injurious behavior
   was increasing in prevalence among high
   school students. She spent a month doing
   research on working with this population, and
   she developed a group counseling plan.

   During her first group, four female students
   attended and shared their history with self-injurious
   behavior. Each girl had a different
   way of self-injuring--cutting, biting, bruising,
   and burning. Each of the girls appeared to
   have numerous complex issues, and after several
   sessions, Ms. Williams noted that each of
   the girls had experienced, or were currently
   experiencing, some sort of physical, emotional,
   or sexual abuse. The intensity of the group,
   and the issues surrounding the group members'
   abuse, started to overwhelm Ms.
   Williams. With little direct supervision, Ms.
   Williams turned to a veteran school counselor
   for consultation. The counselor suggested that,
   in addition to the group counseling, Ms.
   Williams meet with each of the girls for individual
   counseling. Ms. Williams wondered if
   she was able to provide this level of service,
   and she became fearful that she had overcommitted
   herself.


One of the primary roles of school counselors is to facilitate the personal and social development of all students (Schmidt, 1999). School counselors cannot be competent in all areas or all student-presented issues. School counselors thus have an ethical responsibility to assess whether they have the knowledge and skills to help the student explore concerns, examine alternatives, make appropriate decisions, and act accordingly (Schmidt). Students who self-injure require skilled counselors who are educated on the etiology etiology /eti·ol·o·gy/ (e?te-ol´ah-je)
1. the science dealing with causes of disease.

2. the cause of a disease.
 and functions of self-injury, as well as appropriate interventions (White et al., 2003). White et al. stated that it is important for counselors working with self-injurious students to achieve competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
     2.
 in this area, or to refer clients to counselors who are competent to work with this population. The counselor in Vignette 3 did seek out consultation from another counselor, which is consistent with the ASCA standard of Sharing Information with Other Professionals (ASCA, 2004, Standard C.2a).

Another recommendation related to competence is to have a specified person knowledgeable about self-injurious behavior who can be consulted when student self-injury issues arise. Also, as education of school faculty on the topic of self-injury is an important charge of school counselors (Kress et al., 2004), school counselors who believe they are not competent in this area might invite knowledgeable guest speakers to talk to the school community about this topic.

A final recommendation is that school counselors be aware of several community mental health professionals who specialize spe·cial·ize
v.
1. To limit one's profession to a particular specialty or subject area for study, research, or treatment.

2. To adapt to a particular function or environment.
 in self-injury and use these processionals as a student referral source. It is suggested that the school counselor maintain regular contact with the student's mental health professional, and work closely with this person. Some of the issues that the school counselor may want to collaboratively work with the student's mental health professional on are developing a safety plan or a list of alternatives to self-injury that the student can use when wanting to self-injure while at school, and developing a no-harm contract (Conterio et al., 1998). Regular communication with the student's mental health professional also can serve to help the school counselor stay abreast of the student's progress and the status of the self-injury.

ADDITIONAL RECOMMENDATIONS FOR PRACTICE

No-Harm Contracts

Ethical standards require school counselors to inform appropriate authorities when a student's behavior is indicative of clear and imminent danger to the student or others (ASCA, 2004, Standard A.7a). It is recommended that counselors assess this danger with careful deliberation deliberation n. the act of considering, discussing, and, hopefully, reaching a conclusion, such as a jury's discussions, voting and decision-making.


DELIBERATION, contracts, crimes.
, and consult with other school counselors with regard to ethical decision Real life ethical decisions are studied in sociology and political science and psychology using very different methods than descriptive ethics in ethics (philosophy). Not ethics proper  making (ASCA).

As school counselors have a duty to protect their clients and other students, the development of a no-harm contract (Conterio et al., 1998) that clearly specifies what behaviors will require the school counselor/faculty/staff to take what actions may be helpful in clarifying to the student, parents, and school personnel the boundaries associated with the self-injurious behavior. For example, in a no-harm contract, a school counselor might specify that a student cannot bring sharp objects/cutting implements to school and if he or she does, certain actions will be taken by the school faculty/staff. Besides the issue of bringing sharp or dangerous objects to school, other possible issues that may be addressed in a no-harm contract are discussing the limits of self-injuring while on school property, the sharing of self-injurious objects/implements while at school, and wound care while at school. The no-harm contract might also address acceptable alternative behaviors that the student will engage in when having impulses to self-injure while at school.

School Policies on Self-Injurious Behaviors

A final recommendation related to students and self-injurious behavior is for school counselors to develop a school policy that addresses this topic. School polices related to student self-injurious behavior might address some or all of the following issues: when should school faculty/staff report suspected student self-injurious behaviors, to whom should faculty/staff report these behaviors, to what extent is the school administration involved with students who self-injure, to what extent are the school counselors involved, what is the school nurse's involvement, and finally what is the policy on parental notification and involvement. A cautionary suggestion is that the school policy should have built-in flexibility as there is a great deal of variability in the underlying dynamics, issues, and needs of students who self-injure. An overly strict or rigid policy may not serve the best interests of some students. For example, a help-seeking 17-year-old senior student who engages in delicate self-cutting, is from an emotionally neglectful ne·glect·ful  
adj.
Characterized by neglect; heedless: neglectful of their responsibilities. See Synonyms at negligent.



ne·glect
 and disengaged dis·en·gage  
v. dis·en·gaged, dis·en·gag·ing, dis·en·gag·es

v.tr.
1. To release from something that holds fast, connects, or entangles. See Synonyms at extricate.

2.
 family, has appropriate wound care, and denies any history of suicidal ideation or intention to seriously harm herself will have different needs than a 12-year-old student who engages in severe self-injury (including burning and head banging), does not utilize appropriate wound care, and is not help-seeking.

CONCLUSIONS

This article has provided a brief overview of self-injurious behavior, and ethical issues in relation to ASCA's Ethical Standards for School Counselors (2004). General practice recommendations for school counselors are to be aware of the self-injury-related literature, monitor possible reactions to control students or to force them to stop injuring, become familiar with the relationship between suicide and self-injury and implement and document a thorough suicide assessment when working with this population to avoid overreaction o·ver·re·act  
intr.v. o·ver·re·act·ed, o·ver·re·act·ing, o·ver·re·acts
To react with unnecessary or inappropriate force, emotional display, or violence.
 or underreaction to self-injury, implement no-harm contracts that clearly specify what behaviors are and are not acceptable while on school property, and develop a school policy that addresses self-injurious behavior. School counselors also are advised to seek supervision and/or consultation concerning self-injury-related issues, and to have referral sources that are knowledgeable about self-injury.

Anticipating ethics-related concerns will help prevent ethical problems when working with self-injurious students. ACA's (1995) Code of Ethics Code of Ethics can refer to:
  • Ethical code, a code of professional responsibility, noting what behaviors are "ethical".
  • Code of Ethics (band), a 90's Christian New Wave/Pop band
 and Standards of Practice and ASCA's (2004) Ethical Standards for School Counselors are two resources available to help school counselors manage ethical issues in their counseling relationships (Glosoff & Pate, 2002). To be effective advocates for their students' rights, school counselors must have knowledge about the legal status of minors and their parents, and the ethics of privacy, confidentiality, privileged communication privileged communication
 or confidential communication

In law, communication between parties to a confidential relation such that the communication's recipient is exempted from disclosing it as a witness.
, and informed consent (Glosoff & Pate).

School counselors, to a greater degree than counselors who practice in other settings, are continually challenged with legal and ethical problems because their clients are of a minor status, they have responsibilities to numerous constituents (e.g., school administrators, parents), they have a large number of students to counsel, and they work in a setting that requires compliance with many federal and state statues (Remley, 2002). Isaacs and Stone (1999) suggested that school counselors be prepared to deal with the many ambiguous ethical scenarios that may occur prior to their occurrence, by being aware of current laws as well as district policies pertaining per·tain  
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.

2.
 to breaching confidentiality; establishing in advance the kinds of behaviors that might warrant breach of confidentiality; establishing a network of peers who can be consulted when situations arise; and educating stakeholders Stakeholders

All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government.
 concerning the rationale for confidentiality.

In this article, ethical issues related to student confidentiality, responsibilities to parents and to the school, and professional competence were discussed in relation to ASCA's (2004) Ethical Standards for School Counselors. This article has provided a brief overview of and orientation to this topic. Future researchers might further explore additional ethical issues associated with students who engage in self-injurious behavior.

References

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The psychiatric study, treatment, and prevention of emotional and behavioral problems, especially of those that arise during early development.
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Conterio, K., Lader, W., & Bloom, J. K. (1998). Bodily harm The medical idea of (grievous) bodily harm is more specific than legal ideas of assault or violence in general, and distinct from property damage.

It refers to lasting harm done to the body, human or otherwise, although in its legal sense it is exclusively defined as lasting
: The breakthrough healing program for self-injurers. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
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A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician.
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Favazza, A. R. (1996). Bodies under siege siege, assault against a city or fortress with the purpose of capturing it. The history of siegecraft parallels the development of fortification and, later, artillery. : Self-mutilation and body modification Body modification (or body alteration) is the permanent or semi-permanent deliberate altering of the human body for non-medical reasons, such as spiritual, various social (markings), BDSM "edgeplay" or aesthetic. It can range from the socially acceptable decoration (e.g.  in culture and psychiatry psychiatry (səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety.  (2nd ed.). London: John Hopkins.

Favazza, A. R., & Conterio, K. (1989). Female habitual Regular or customary; usual.

A habitual drunkard, for example, is an individual who regularly becomes intoxicated as opposed to a person who drinks infrequently.
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adj.
Of or relating to psychiatry.


psychiatric adjective Pertaining to psychiatry, mental disorders
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1. acting in the place of another or of something else.

2. occurring at an abnormal site.


vi·car·i·ous
adj.
1.
 traumatization and burnout Burnout

Depletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage.
 among Connecticut psychologists: Empirical findings. Paper presented at the annual meeting of the Connecticut Psychological Association, Waterbury, CT.

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n.
1. The study of the origin, development, and manifestations of mental or behavioral disorders.

2. The manifestation of a mental or behavioral disorder.
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n. pl. no·sol·o·gies
1. The branch of medicine that deals with the classification of diseases.

2. A classification of diseases.
 characteristics in subtypes of self-injurers. Acta Psychiatrica Scandinavica, 91, 57-68.

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Remley, T. P., Jr., Hermann, M. A., & Huey, W. C. (2003). Ethical and legal issues in school counseling. Alexandria, VA: American School Counselor Association.

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Schmidt, J. J. (1999). Counseling in schools: Essential services and comprehensive programs (3rd ed.). Boston: Allyn and Bacon.

Simeon, D., & Favazza, A. R. (2001). Self-injurious behaviors: Phenomenology phenomenology, modern school of philosophy founded by Edmund Husserl. Its influence extended throughout Europe and was particularly important to the early development of existentialism.  and assessment. In D. Simeon & E. Hollander (Eds.), Self-injurious behaviors: Assessment and treatment (pp. 1-28).Washington, DC: American Psychiatric Press.

Simeon, D., & Hollander, E. (Eds.). (2001). Self-injurious behaviors: Assessment and treatment. Washington, DC: American Psychiatric Press.

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Taiminen, T. J., Kallio-Soukainen, K., Nokso-Koivisto, H., Kaljonen, A., & Helenius, H. (1998). Contagion Contagion

The likelihood of significant economic changes in one country spreading to other countries. This can refer to either economic booms or economic crises.

Notes:
An infamous example is the "Asian Contagion" that occurred in 1997 and started in Thailand.
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An important antecedent to the specialty of child psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with
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Yarura-Tobias, J. A., Neziroglu, F. A., & Kaplan, S. (1995). Self-mutilation, anorexia anorexia /an·orex·ia/ (-rek´se-ah) lack or loss of appetite for food.

anorexia nervo´sa
, and dysmenorrhea dysmenorrhea

Pain or cramps before or during menstruation. In primary dysmenorrhea, caused by endocrine imbalances, severity varies widely. Irritability, fatigue, backache, or nausea may also occur.
 in obsessive compulsive disorder Obsessive compulsive disorder (OCD)
Disorder characterized by persistent, intrusive, and senseless thoughts (obsessions) or compulsions to perform repetitive behaviors that interfere with normal functioning.

Mentioned in: Tourette Syndrome
. International Journal of Eating Disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. , 17, 33-38.

Victoria E. White Kress and Nicole Drouhard are with the Department of Counseling, Youngstown State University Youngstown State University, at Youngstown, Ohio; coeducational; est. 1908 as a department of the Youngstown Association School sponsored by the Young Men's Christian Association. , Youngstown, OH. E-mail: vewhite@ysu.edu Amanda Costin is with the School of Human Services, Capella University Capella University is a private for-profit distance institution of higher learning. Capella University offers bachelor's, master's and doctoral (PhD and PsyD) degrees in business, technology, education, human services and psychology. , Florence, MA.
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