Working with Self-Injuring Adolescents: The Experiences and Perceptions of Mental Health Professionals

Background and Purpose: Unique relationships develop between self-injuring adolescents, their parents, and the social workers providing services. While social workers are trained to attend to the needs of self-injuring adolescents and their parents alike, they frequently experience feelings of anxiety and uncertainty in response to nonsuicidal self-injury (NSSI). The relationship between NSSI and parenting confidence and wellbein is reciprocal: instances of NSSI negatively impact parenting confidence and wellbeing, which subsequently affect parents’ ability to provide necessary support when adolescents are struggling with the intrapersonal factors that lead to NSSI. Research studies have typically left out the role of social workers in this reciprocal relationship, which may be due to assumptions of competency, familiarity, and comfort on the part of such professionals. However, gaps in education may lead social workers to experience an analogous loss of confidence and emotional distress when treating self-injuring clients. In this study, I sought to understand the experiences of mental health professionals working with self-injuring adolescents by measuring their perceptions of NSSI, symptoms of emotional distress, and accompanying protective factors. I hypothesized that symptoms of emotional distress would be inversely correlated with protective factors.

Methods: Demographic and clinical information was collected through self-report measures from 36 mental health professionals, as well as their perceptions of 23 facts and misconceptions of NSSI (e.g., “Depression is common in people who self-injure” versus “Self-injury is an attention-seeking behavior”). Participants were master’s level mental health professionals with an average of 10.26 years of experience (SD = 8.67) and 10.12 years of experience working with self-injuring adolescents (SD = 7.68).  Most participants identified as heterosexual (n = 35) and female (n = 28), and all participants identified as white.

Results: Participant responses yielded descriptive data regarding their perceptions of NSSI. Although their responses indicate they are familiar with common clinical correlates of NSSI (e.g., NSSI is associated with depression, anxiety, and emotion dysregulation), they also frequently endorsed misconceptions of NSSI (e.g., NSSI is primarily an attention-seeking behavior). I found that trait mindfulness is inversely correlated with anxiety (r = -.433, p = .007), stress (r = -.343, p = .041), and overall emotional distress (r = -.422, p = .010). Similarly, savoring capacity is inversely correlated with depression (r = -.578, p < .001.), anxiety (r = -.371, p = .026), stress (r = -.390, p = .019), and overall emotional distress (r = -.556, p = < .001).

Conclusions and Implications: Taken altogether, these data speak to the appropriateness of increasing education, training, supervision, and support of social workers providing services to self-injuring adolescents. Given the emotionally and clinical demands of assessing and treating NSSI, integrating NSSI-specific education into mental health training programs should curtail the anxiety and feelings of inadequacy social workers are likely to experience when working with self-injuring adolescents. Additionally, incorporating practices that increase trait mindfulness and savoring capacity into mental health training programs should act as protective factors for the emotional distress symptoms social workers may experience when working with high-risk populations.