Client Non-Suicidal Self-Injurious Behavior: Considerations for Clinical Supervisors

Hoffman, Rachel M.; Kress, Victoria E.

doi:10.1080/07325220802221561

Cited by 5 publications

(6 citation statements)

References 37 publications

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“…school counsellor) and not the specialist will be providing treatment to this population. Yet this reality seems to have evaded the attention of clinical training and supervision (Hoffman & Kress, 2008). That our trainees have a rudimentary, intellectual understanding of NSSI and used only the basic relational skills in their work could potentially be seen as a deficiency.…”

Section: Discussionmentioning

confidence: 98%

Am I competent enough to be doing this?: A qualitative study of trainees’ experiences working with clients who self-injure

Stefano¹,

Atkins²,

Noble³

et al. 2012

Counselling Psychology Quarterly

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This study examined the experiences of counsellors in training working with clients who present with non-suicidal self-injury (NSSI) as a basis for understanding how trainees react to and resolve the challenges presented by difficult counselling cases. A qualitative data analysis using consensual qualitative research . A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517-572] was conducted on 12 transcribed interviews of Master's level trainees who had recently worked with at least one client who self-injured. Three general themes were reflected by the data. Specific to NSSI the findings revealed that trainees created an intuitive model of NSSI that reflected some understanding of the phenomenon despite little or no prior exposure to it. With regard to the work involved in these challenging cases, trainees reported a number of personal struggles and tasks that they needed to resolve while trying to be helpful to these clients. These tasks included managing their emotional reactivity and resolving ethical and confidentiality issues. Engaging in these two tasks heightened their feelings of uncertainty yet also focused them to be highly intentional in their work. Whereas supervision often serves novices well when they struggle, participants reported that supervision only partly alleviated the difficulties they faced. Implications and limitations of these findings are discussed.

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Section: Discussionmentioning

confidence: 98%

Am I competent enough to be doing this?: A qualitative study of trainees’ experiences working with clients who self-injure

Stefano¹,

Atkins²,

Noble³

et al. 2012

Counselling Psychology Quarterly

View full text Add to dashboard Cite

show abstract

“…Trainees with little or no experience working with individuals who engage in NSSI report experiencing anxiety and doubt (De Stefano et al, 2012; Hoffman & Kress, 2008). Because there has been no explicit guidance until now that we should not conduct visual assessments of NSSI wounds because it is outside our scope of practice as psychotherapists, trainees may have received conflicting direction from supervisors about how, or if, such assessments should be completed.…”

Section: Training Implicationsmentioning

confidence: 99%

“…Based on unconscious power dynamics, trainees may believe it is their responsibility as the care provider and “professional” to both visually examine NSSI wounds and get the patient to stop engaging in NSSI. Feeling responsible for patients’ NSSI cessation is a common experience among both seasoned psychotherapists and those in training, and making cessation the psychotherapist’s agenda in treatment can paradoxically lead to worsening of the behavior (Fleet & Mintz, 2013; Hoffman & Kress, 2008). If psychotherapists find themselves feeling increasingly frustrated that their patients are continuing to engage in NSSI while still in treatment or calling the behavior “manipulative” or “gamey,” they may have taken too much responsibility for their patient’s behavioral change and/or hold negative beliefs about the behavior and those who engage in it.…”

Section: Training Implicationsmentioning

confidence: 99%

“…Although many find the general support and encouragement of their supervisors helpful, most feel unheard (O’Connor & Surgenor, 2023) and let down by the lack of specific guidance for how to address NSSI and improve their own knowledge as psychotherapists (De Stefano et al, 2012). When treating individuals who engage in NSSI, trainees may benefit from more structured and directive supervision (De Stefano et al, 2012; Hoffman & Kress, 2008). For example, to combat unconsciously taking on responsibility for patients’ NSSI behavior, supervisors can discuss with trainees the dialectical and ethical tension of accepting a patient’s right to engage in NSSI while simultaneously exploring with the patient their motivation and reasons for change/cessation.…”

Section: Training Implicationsmentioning

confidence: 99%

“…When deciding to conduct visual assessments of NSSI wounds, psychotherapists may default to General Principle A (Beneficence and Nonmaleficence) of the APA Ethics Code, in which psychotherapists “strive to benefit those with whom they work and take care to do no harm” (APA, 2017, p. 3). NSSI is itself an act of harm, and some professionals may believe that, consistent with General Principle A, it is their duty to visually assess NSSI wounds and help patients desist from self-harming behaviors such as NSSI (Fleet & Mintz, 2013; Hoffman & Kress, 2008; Long et al, 2016), especially when the identified patient is a minor (O’Connor & Surgenor, 2023). However, the means to this end may conflict with General Principle E (Respect for People’s Rights and Dignity) if a patient does not want or feel ready to cease NSSI.…”

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Should psychotherapists conduct visual assessments of nonsuicidal self-injury wounds?

Westers

2024

Psychotherapy

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Beneficence and nonmaleficence are key ethical principles toward which psychotherapists consistently strive. When patients engage in nonsuicidal self-injury (NSSI) during the course of psychotherapy, therapists may feel responsible for visually assessing the severity of the NSSI wound in order to benefit their patients and keep them from harm. However, there are no guidelines for conducting these visual assessments, and there is no research exploring their effects on patients. This article considers the ethical implications of visually examining NSSI wounds; discusses psychotherapist scope of practice and competence; draws attention to relevant ethical standards; underscores risk management, liability, and standard of care; and addresses the risk of suicide or accidental death resulting from NSSI. It also provides ethical guidance for conducting effective verbal assessments of NSSI wounds and offers suggestions for navigating complex clinical situations, such as when patients routinely and spontaneously show their therapists their wounds and how psychotherapists should handle assessments and interventions related to NSSI scars. It ends with implications for training and therapeutic practice. Clinical Impact StatementQuestion: How should psychotherapists navigate assessment of nonsuicidal self-injury (NSSI) wounds, and how does this inform their work with auxiliary treatment team members such as medical professionals and parents? Findings: This article discusses the scope of practice of psychology, individual psychotherapist competence, and risk management to critically evaluate if and how therapists should assess NSSI wounds. Meaning: There may be times when briefly looking at NSSI wounds is appropriate in psychotherapy, but visually assessing NSSI wounds is not within the scope of practice of psychology and may not protect patients from harm. Next Steps: Research should examine with patients if and how their psychotherapist conducted visual assessments of their NSSI wounds, by whom these assessments were initiated, how they affected the patient experience, and if they resulted in help or harm.

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The hidden emotions of therapists: An autoethnographic exploration of working with clients who self‐injure

Naxton

2024

Couns and Psychother Res

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IntroductionThis paper explores how working with clients who self‐injure generates significant emotional reactions in therapists, often difficult to manage. Drawing on my clinical experience as a researcher and counsellor, I provide an evocative autoethnographic account, highlighting hidden, forbidden or taboo feelings. The aim was to deepen understanding of therapists' emotional realities and contribute to the limited literature on this subject.MethodThrough journaling, sketching, metaphor and field notes, I detail personal experiences with clients who self‐injure. This autoethnography explores my emotions and reactions. A case vignette illustrates my experiences, promoting critical and empathic consideration of how therapist emotions are experienced.Data AnalysisI use autoethnographic methods to analyse the emotional impact and existential reflections of working with clients who self‐injure, employing layers of qualitative interpretation from various personal data sources.ResultsFindings reveal that working with clients who self‐injure forces me to confront my mortality, evoking deep existential reflections and intense emotions like vulnerability and fear. This disrupts my sense of immortality, highlighting my role's limitations and evoking shame and self‐doubt about my ability to alleviate suffering.Implications for PracticeThis paper advances research on self‐injury and emphasises autoethnography as a valuable avenue for counsellors engaging in research. Grounded in PhD study, this paper makes an original contribution to knowledge. Integrating discussions on mortality and emotional vulnerability into supervision and training is crucial, alongside comprehensive training that addresses emotional and unconscious issues. Accessible supervision fosters growth, reduces stigma and supports therapists working with clients who self‐injure.

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Client Non-Suicidal Self-Injurious Behavior: Considerations for Clinical Supervisors

Cited by 5 publications

References 37 publications

Am I competent enough to be doing this?: A qualitative study of trainees’ experiences working with clients who self-injure

Am I competent enough to be doing this?: A qualitative study of trainees’ experiences working with clients who self-injure

Should psychotherapists conduct visual assessments of nonsuicidal self-injury wounds?

The hidden emotions of therapists: An autoethnographic exploration of working with clients who self‐injure

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