Therapeutic Community Principles Guide Systemic Responses to Student Self-Injurious Behavior

A view of self-injurious behavior (SIB) informed by trauma theory and therapeutic community principles provides a framework to guide clinical practice, promote a safe living and learning environment, and inform policy development to support a collaborative university response to SIB. A dual emphasis of concern for the safety of the individual who self-injures and the impact of the behavior on the living and learning environment of others is illustrated in a case example. Much has been written about the rise of mental health concerns on college campuses (Benton, Robertson, Tseng, Newton, & Benton, 2003; Hoover, 2003; Kitzrow, 2003; Voelker, 2003). Some mental health issues are manifested in a range of self-injurious behaviors (SIBs) that are harmful to the individual student who self-injures as well as to others through disruption to their living and learning environment (Juhnke, 1994). White, Trepal-Wollenzier, and Nolan (2002) proposed a range of interventions to address student SIB: assessment, counseling, prevention, outreach, education, and advocacy. A systemic response that involves collaboration with a variety of campus offices is recommended rather than a sole reliance on college counseling centers for crisis management (Hernandez & Fister, 2001; Pace, Stammler, Yams, & Lee, 1996). Responses to student SIB are often explained using an administrative language and perspective that ensure the development of clear policies, procedures, and guidelines; invite a collaborative effort from participants across university offices; and follow legal and ethical standards concerning confidentiality and legislation with regard to mental health and disabilities (Amada, 1994; Francis, 2003; Pavela, 1985). Although an administrative response that includes the aforementioned components is sound practice, it may leave clinicians wondering if this type of response has a therapeutic impact for the student. College counselors are in a unique position to advocate for policy, procedures, and clinical practices to address the needs of students who self-injure (White et al., 2002). The International Association of Counseling Services (IACS; 2000) endorsed the counselor's role of working collaboratively with campus officials when managing distressed students. This article proposes a framework that can be used by college counselors to assist in the development and implementation of a campus wide intervention that is congruent with sound clinical and administrative practices. A view of SIB informed by trauma theory espouses clinical treatment and a community response that has a dual focus: the safety of the individual who self-injures and the impact of the behavior on the living and learning environment of others. Therapeutic community principles provide a framework to create and maintain a living and learning environment conducive to the health and healing of students, guide clinical practice, and inform the development of policies and procedures that support a collaborative university response to intervene when students self-injure. A case example illustrates the integration of university policy, a collaborative campus response, and sound clinical practice in an intervention with a student who self-injured. College counselors are encouraged to use a multifaceted approach in their work with students who self-injure. A View of SIB SIB is defined as a volitional act to harm oneself without any intent to die (Yaryura-Tobias, Neziroglu, & Kaplan, 1995). Simeon and Favazza (2001) have developed a classification system for organizing and categorizing SIB into four types: stereotypic SIB, major SIB, compulsive SIB, and impulsive SIB. Stereotypic SIB behaviors, such as head banging, self-biting, and hair pulling, are most typically seen in individuals with organic mental disorders. Major SIB includes more potentially life-threatening behaviors, such as castration and limb amputation. Compulsive SIB includes mild to moderate behaviors, such as repetitive hair pulling and skin picking. …