The College Counseling Experiences of Young Women Who Self-Injure: A Qualitative Study
Laurie M. Craigen
Old Dominion University
Eastern Virginia Medical School
Laurie M. Craigen, Ph.D. is an Assistant Professor at Old Dominion University in the Department of Counseling and Human Services.
Rebekah Cole, Ph.D. is an instructor with Walden University in the College of Social and Behavioral Sciences.
Rebecca McBride-Cowan, Ph.D., is an assistant professor at Eastern Virginia Medical School in the Department of Family and Community Medicine
Correspondence concerning the content of this article can be addressed to Laurie Craigen at the following e-mail address: firstname.lastname@example.org.
This qualitative study examines the experiences of women who have a history of self-injury in the college environment. Themes and patterns that emerged from the data center around the college experience, including the pressures, the nature of being a woman in the college setting, and transitions into the college environment. Themes regarding the participants’ overall attitudes and suggestions for improving the college counseling experience likewise are described. Implications for treatment, training, and implications for future research are also included.
Keywords: College Counseling Center, Self-Injury, Women
The College Counseling Experiences of Young Women Who Self-Injure: A Qualitative Study
Self-injury is a complex and alarming phenomenon. Although multiple definitions exist, “self-injury” can be defined as a socially unacceptable, intentional harm of one’s body in order to ameliorate negative feelings or to gain a sense of control over one’s life (Craigen, Healey, Walley, Byrd, & Schuster, 2010; Favazza & Rosentahl, 1993; Simeon & Hollander, 2001; Wester & Trepal, 2005). While the most common act of self-injury involves cutting, other forms of self-injury include severe-scratching, skin burning, bone breaking, poisoning, and self-hitting (Favazza & Conterio, 1989; Hawton & Harris, 2008; Klonsky & Muehlenkamp, 2007, Levenkron, 1998; McAllister, 2003; Wester & Trepal, 2005; Zila & Kiselica, 2001). Individuals who self-injure are often divided into two groups: those who are injuring themselves with the intent to commit suicide, and those who are not suicidal but engaging in self-harm (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). In addition, numerous studies indicate that women are more likely than men to engage in self-injury (Gratz, 2001; Muehlenkamp & Gutierrez, 2007; Ougrin et al., 2012). However, Whitlock et al. (2011) found that females are more likely to report self-injury in the form of scratching or cutting their wrists, thighs, and arms, while men report hitting and punching various objects in order to purposefully injure themselves. It may therefore appear that women are more likely to engage in self-injury as these behaviors in men are often associated with outward aggression.
The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) does not include self-injury as a clinical diagnosis (American Psychiatric Association, 2000).
However, the clinical diagnosis of Non-Suicidal Self-Injury is being proposed for the DSM-V (Haberstroh, & Moyer, 2012). Therefore, it is imperative that counselors better understand how to identify, diagnose, and treat this phenomenon.
Self-Injury and Female College Students
Self-injury is an increasingly common phenomenon in the college student community (Wester & Trepal, 2005; Whitlock, Eells, Cummings, & Purington, 2009) and an increasingly important topic for the college counseling community to consider (Wester & Trepal, 2010). Compared to other age groups, the undergraduate college student population is at the highest risk for self-injury (White, Trepal-Wollenzier, & Nolan, 2002; Murray, Wester, & Paladino, 2008) and female college students are more likely to engage in self-injury than their male counterparts (Cheng & Mallinckrodt, Soet, & Sevig, 2010). This tendency may result from pressures placed on women, especially by their family members, schools, and Western society as a whole (Kokaliari & Berzoff, 2008). Although accurate statistics are difficult to attain due to the privacy and secrecy associated with self-injury, some reports indicate that up to 35% of college students reveal that they have previously self-injured (Gratz, 2001).
While the number of female college students who self-injure is increasing, the number of female college students who self-injure and are seeking help is not (Whitlock, Eckenrolde, & Silverman, 2006). Oftentimes, female college students who self-injure may be in counseling but may not disclose their self-injurious behavior to their counselor. This tendency may be due to the shame and secrecy associated with self-injury, or their fears of being expelled from their college (Craigen & Foster, 2009; Wester & Trepal, 2010). Women are more likely than men to self-injure in private (Whitlock et al., 2011), and may not seek treatment due to the pressure they feel to maintain their independence and perfection (Kokaliari & Berzoff, 2008).
College Counseling Centers
Due to the commonality of self-injurious behavior and other mental health issues on college campuses, college counseling centers are in an ideal position to play a critical role in helping students, specifically young women, who self-injure (Hodges, 2001; Wester & Trepal, 2005). Trained to help students with a variety of academic, social, and mental health issues, college counselors focus on meeting students’ individual needs (Hodges, 2001; White et al., 2002). College counselors are called to approach students with an open-minded and non-judgmental approach, making them an excellent resource for women, especially those who self-injure (Craigen & Foster, 2009; Hodges, 2001).
College counseling centers, due to their proximal location on a college campuses, are also in a valuable position for consultation with faculty members, residence hall directors, and other campus staff who may be aware of the female student’s presenting symptoms and struggles (Hodges, 2001; Wester & Trepal, 2010; White et al., 2002). College counselors can serve as educators to campus faculty and staff on ways in which to identify students who may self injure and guide them to the policies and procedures regarding these students. In addition to their outreach efforts, college counselors also serve as advocates for students’ needs (White et al., 2002).
While their collaborative, educational, and outreach potential is recognized, little is known about the role of college counseling centers in the treatment of self-injury (Cheng et al., 2010; Wester & Trepal, 2005; Wester & Trepal, 2010; Whitlock, Eells, Cummings, & Purington, 2009).
While recent literature has explored the characteristics of college students who self-injure (Serras, Saules, Cranford, & Eisenberg, 2010; Wester & Trepal, 2010), there is a paucity of research cited in the literature exploring the treatment experiences of female college students who self-injure (Craigen & Foster, 2009; Wester & Trepal, 2005; Wester & Trepal, 2010). The authors believe that working with this population is a much needed and challenging endeavor; therefore, more research on the counseling experiences of female college students who self-injure would undoubtedly prove valuable to the college counseling profession (Wester & Trepal, 2005). The purpose of this phenomenological qualitative study, therefore, is to explore the women participants’ experiences of being a college student with a history of self-injury. Thus, the central research question is: What is the experience of being a female college student with a history of self-injury?
A phenomenological qualitative study focuses on describing the lived experiences of individuals as they perceive, believe, remember, decide, feel, judge, and evaluate their world (Hays & Wood, 2011). In a phenomenological study, the researcher is interested in how the participants construct their social reality. For studies related to the therapeutic experience, the psychological approach to phenomenology, which focuses on extracting general meaning from individual experiences rather than group experiences, is particularly well-suited (Patton, 2002).
In a phenomenological research study, the primary aim is to understand and to portray how individuals make sense of their experiences (Hays & Wood, 2011).
Thus, participants are selected based on their knowledge or experience of a phenomenon. In this case, the phenomenon is self-injurious behavior. In qualitative research, this approach is referred to as purposeful sampling methods (Streubert & Carpenter, 1999). For this study, the sample included women ages 18-23 who volunteered to speak about their experiences in treatment related to self-injurious behavior. A convenience sample of ten participants from a small mid-Atlantic public university were interviewed for this study. Each of the participants had a varied past history with self-injury.
In order to recruit participants for this study, the researcher utilized several different strategies. For example, flyers were displayed throughout the college. The flyers included a brief purpose of the study along with the researcher’s personal contact information. This flyer was also posted online on the university’s personal website for students. Interested students contacted the researcher via phone or e-mail. During this initial contact, the researcher provided a detailed description of the study, explained the participant’s time and place commitments (two-hour long interviews), and took the time to answer any questions or concerns. At the conclusion of the discussion, the researcher set up the first interview at a place convenient for the student. All participants chose to conduct the interviews at the researcher’s office.
Prior to the first interview, each student participant signed a consent form. The consent form provided a detailed account of the study along with the explanation that participants’ identities would be protected at all times, with no participants’ names being used. It also stated that all records and tapes of interviews would be destroyed at the conclusion of the study. Additionally, the informed consent forms sought permission to record and publish this research in refereed journal articles.
Data Collection Techniques
The researcher conducted two face-to-face, semi-structured interviews (approximately 60-75 minutes long) with each participant. The second interview occurred in the same location, two to four weeks after the first interview. The researcher intentionally chose to conduct two interviews; the second interview allowed the researcher to gain an in-depth and meaningful understanding of young adult women’s experiences in counseling related to self-injury (Patton, 2002). Prior to the interviews, the researcher developed two interview guides. The interviews addressed the following topic areas: the participants’ experiences with self-injury, their experiences as a college-aged woman, and their experiences receiving treatment. Themes and patterns related to the women’s experiences with the college counseling center emerged from their responses. For all participants, the primary author conducted all interviews and completed each transcription.
After signing the informed consent documents, participants completed a brief demographics form. The demographics sheet contained questions regarding age, race, and family of origin questions, and additional questions related to the treatment such as one’s length of time actively engaging in self-injury, time in treatment, and type of treatment received.
Data Analysis and Strategies for Trustworthiness
The beginning steps in phenomenological data analysis are epoche and bracketing. Epoche refers to an ongoing analytic process wherein the researcher refrains, abstains, and sets aside judgment (Patton, 2002).
Bracketing, the process of phenomenological reduction, allows the researcher to set aside assumptions and judgments in order to focus on the true nature of the phenomenon being studied (Patton, 2002; Schwandt, 2001) and to create a rich description of the participants’ worldviews (Hays & Wood, 2011). After the data were bracketed, all elements of the data are treated with equal value, or “horizontalized” (Moustakas, 1994). Codes were developed as the researcher and the research team members searched for the ways in which people make meaning of their lives and their self-injury experiences; how they integrate or differentiate. Themes and patterns then emerged as a result of this coding process and were organized into a consolidated codebook (Hays & Singh, 2012). While identifying these themes and patterns, the researcher specifically looked for convergence and divergence across participants’ responses (Hays & Wood, 2011).
Throughout the entire process of data analysis, trustworthiness was established. First, because of the researcher threats inherent in qualitative research, the researcher maintained a reflexive journal throughout the entire research study in order to attempt to maintain her neutrality. The reflexive journal contributed to the trustworthiness of the data and included the researchers’ daily research schedule and logistics of the study, in addition to a personal diary consisting of reflections about her values, judgments, biases, and pre-conceptions (Hays & Singh, 2012). To add to the credibility and the confirmability of the data, the qualitative process of member checking also occurred as the participants were asked for feedback pertaining to the accurateness of their responses, and the interpretations made by the researcher at three separate points during the study (Hays & Singh, 2012). First, during each interview, the researcher asked for clarification or elaboration, when needed. Second, transcripts were given to the participants to review and correct as necessary.
Finally, the researcher gave each participant a draft of what she was planning to include in her results section. Again, participants’ corrections and clarifications were sought.
In addition to the use of the reflexive journal and member checking, several additional strategies were used throughout the study to increase trustworthiness. First, the collection and analysis of data was conducted alongside the primary researcher’s research team, who were well versed and experienced in the qualitative research process. After each interview was coded, the research team members and the primary researcher reached agreement through a series of meetings in order to reach a consensus on emerging themes and patterns. Themes were altered, changed, and restructured based on this process. The researcher likewise used a triangulation of multiple data sources including participant interviews, member-checking, and reflexive journaling in order to establish dependability and confirmability (Moustakas, 1994). In addition, a colleague, that was not a member of the research team, reviewed an audit trail maintained by the researcher. This audit trail included all the documents included in the data collection and data analysis process, ultimately contributing to the trustworthiness of the study.
During the process of data analysis, two themes emerged relevant to the research question: The College Experience and The College Counseling Center. For the first theme, the College Experience, analysis revealed the following sub-themes: pressures, being a college-aged woman, and transitions. For the second theme, The College Counseling Center, analysis revealed the following sub-themes: attitudes and suggestions.
Theme #1: The College Experience
Nine of the total ten women talked about their college experiences. This theme, College Experience, includes three sub-themes: pressures, being a college-aged woman, and transitions.
All of interviewed women talked about the pressures women face in college. Their comments fell into two separate groups: academic pressures and social pressures.
Social pressures. The majority of the participants talked about the challenges of behaving a certain way or “fitting in” socially in college. For P07, the “social pressures” or the “social scene” was one of the “hardest things” for her to negotiate. P06 also talked about the pressures of acting a certain way, or fitting the typical college student mold. She shared, “you are expected to be a certain way, to be interested in certain things. You know, hang out with certain people. For me, it was kind of hard to fit in exactly.”
The participants also described the social pressures related to being a woman in college. More specifically, they talked about the pressure to uphold a specific physical appearance, which, they argued, is often exacerbated on a college campus. P02 shared, “I think that there is a high expectation for women particularly on this campus to be attractive. Which includes being thin and fit at the same time.” P06 agreed. She stated, “being a college girl you are supposed to be attractive and thin and having a great you know, romantic or sexual life in addition to all your studies.” P07 echoed these remarks. She talked about the specific attire college women must adhere to in order to receive certain social privileges: You feel that you have to dress up and you have to show your cleavage and you
have to wear a short skirt. Because if you are not, then you aren’t going to get in the party, if you are not pretty enough.
Finally, P05 talked in depth about being a woman in a sorority. She experienced “a lot of pressure to act in a certain way and to associate with certain kinds of people.”
Academic pressures. Each of the participants also talked about the academic pressures they encountered in college. Almost, without exception, the women talked about the high standards they experienced at this specific college. P07 shared, “it stressful because everyone who is here got excellent grades in high school and expects to keep getting them and to be on top of their own performance level and usually on top of everyone else.”
P05, P01, and P03 talked about the intense workload they experienced in college. For P01, maintaining a standard of academic excellence with her work seemed challenging:
It has been a definite struggle. I guess academically and trying to stay focused has been
extremely difficult. And, there have been times when I haven’t wanted to do my work.
Where, I just feel like I literally can’t force my body to work anymore.
P03 also expressed her feelings of being overwhelmed with having to do some much school-work cramped into a short amount of time. Without a doubt, the stressors of the academic pressures impacted the lives of the interviewed participants.
Being a College-Aged Woman
Five of the interviewed participants mentioned the role of college-aged women in society. P10, P01, and P07 talked about the stereotypes and images that college-aged women encounter. For example, P10 talked about how college-aged women are stereotyped as women who are flamboyant and party excessively. She shared, “there is so much stereotyping and so many generalizations that are made about college aged women, stemming from things like “Girls Gone Wild”…When you think of college-aged women, you think of girls taking their tops off.”
On the other hand, P05 and P09 talked about the current societal and cultural influences upon women. P05 talked energetically about one specific societal trend:
Women from elite colleges are opting to stay home instead and how this is their new
mission in life to become mommies. And, because there is sort of this conservative
backlash throughout the country, it has sort of permeated all levels of society. Women
are thinking that, ok, I can go back to doing this and it is ok now.
P05 appeared to be disgusted with this trend and talked about her decision not to have a family. P09 talked about current cultural influences she experienced, as a Black woman. She shared,
Society sees me as an African-American female or Black woman. But, then in the Black Community I guess because I am educated and I don’t come from the same culture, they see me as not Black enough. So, I am kind of in this weird limbo. I have
never quite filled in either place.
Four of the participants spoke of issues related to transitions in college. Three of the women, P07, P10, and P02 talked about the significance of the transition from high school to their freshman year while P05 talked about her transition from college to her first year in graduate school.
P07, P10, and P02 each described in detail their freshman year in college and what the transition from home to school was like for them. For P07, her freshman year was isolating and she believed this transition ultimately contributed to her cutting. She also stated, in “college, especially like the first year, everything is so in flux. It is good to have something stable and I think that loss of stability contributed to my cutting. Both P07 and P02 noted improvements as they entered their sophomore and junior years in college.
For example, when asked what contributed to her improvement she shared, “I guess partly like it was my second year here and it wasn’t that big of a transition from home to college.” Unlike P07 and P02, P10 expressed a positive viewpoint about the transition from home to college. For her, she noted that the first year of college was a difficult transition for many. However, she believed that college is “is a good intermediary between high school, where you have to ask to use the bathroom and the real world, where no one cares where you are.” She also explained, college “is a really good bridge. You get to grow into yourself as a person, you get to discover yourself, emotionally, intellectually…it is a place of guided introspection.”
The College Counseling Center
Each of the interviewed women sought counseling at one time or another at the College Counseling Center. During the interviews, the participants talked specifically about the College Counseling Center in terms of their views and experiences.
P02 seem to possess an ambivalent view of the counseling center. “They were really overbooked and it was like filing people through. I mean it [the Counseling Center] wasn’t especially helpful or detrimental. It probably didn’t make much difference for me either way.” Three of the interviewed women talked specifically about their overall experiences at the college counseling center. At the time of the interview, P04 refrained from cutting for over two years. However, when she attended counseling sessions at the College Counseling Center, she felt that the counselors she worked with her hyper-focused on her self-injury:
I guess it was because it was my first semester here and they harped on this issue because they wanted to see if I was going to start again. But I was like, I am asking about a completely different topic.
This overall experience was frustrating for P04, who painted an overall negative picture of the College Counseling Center.
P05, with an extensive history of self-injury, attended counseling services at her undergraduate institution. She found the services to be limited. She shared, “the college counseling center was so overwhelmed with the amount of care that they had to provide to all of these people that they couldn’t really provide care to any person at a given time.” She also stated that her problems were possibly too extensive for the counseling center:
They were so unwilling to treat me because I had such a long history of let’s just say illness. It is very hard because of their limited resources. They do better with people who you know, their grandmother just died and they need like 6 weeks of therapy to talk about how much they miss their grandmother.
P04 echoed these comments remarking that the counseling center did not offer enough. For her, the appointments were every two weeks. She continued on stating, “But, you don’t see them enough to have that support. And they do have that crisis number you can call but really what are they going to do? They are going to send you to a Psychiatric Facility and we already know that.
P02 appeared to be annoyed that she was required to receive counseling services at the College Counseling Center. In fact, attending sessions was contingent for her to remain in college housing:
There is something in the handbook that if you are like causing or could be hurting yourself or causing danger to yourself than you are not allowed to stay in campus housing or something until you see a counselor and they refer you to somebody.
P08 also worked with a counselor from the counseling center during her freshman year in college. Working with this counselor, she was required to sign agreements that she would not hurt herself each week. She spoke about her view of these agreements:
I just felt it was all focused on the school’s’ liability and not focused on me. You know, it wasn’t about me when I was filing those out. It was just so that they could go on record for doing it.
In addition, P08 talked about the political aspects of the counseling center:
You know that you are there for counseling but you also have to have a strategy. Because the college system is, you know, political. It’s associated with the Dean’s office
and they all talk. And so, when you go to a college counseling center, you have to figure
out what your first priority is.
P07 continued on with this topic of consequences for her cutting. As a freshman, her Resident Assistant learned about her cutting and reported it to Dean of Students. As a senior looking back at her experiences, she stated:
I wish the Dean wouldn’t have been involved. I wish the RA just had the counseling center’s number. So, if someone cuts themselves call the counseling center, don’t call the dean. That was just way too scary for me. I was embarrassed…
For P07, getting the Dean involved complicated the situation and proved to be very “scary” for her. In time, she learned that the counseling center was a helpful place for her and she stated, “I think that a good thing would be for the counseling center to get more out there so that students aren’t afraid of it. Because I am sure that a lot of people are.”
P02 also had a similar experience and had to leave the college because of her self-injury. She mentioned:
I was kind of annoyed that I was required [to leave campus] by a clause in the handbook I can understand why they pay attention to people harming themselves or seriously endangering themselves…for liability. But, it did come across of kind of harsh and it happened to me.
P08 also talked about her experiences leaving campus because of her self-injury. She stated:
My final counselor here was part of my agreement to come back. I had to meet with a counselor as much as he thought was appropriate…But, if I had felt bad that week, I usually didn’t tell him about it because my first priority with that counselor was to let the school know that I wasn’t a liability anymore. So, I am sure that college counselors realize that their counselees are having to play that game a little bit.
P02 agreed. She said, “I kind of figured out that when I told them (the counselors) that I mostly stopped I found than they, I didn’t have to go as often.” This concept of liability also related to P05. She shared, “It was like a terrible, it was a cycle and their attitude was like if you were a current cutter they had to see you because you were like a liability, essentially, to the university.”
The participants spoke at length about their views of treatment related to their self-injury. The participants’ responses question what role college counseling centers should play with students who self-injure. Many of the women in this study felt like they were not viewed as individuals and felt that their counselor was working with them to protect the college rather than to provide counseling to themselves. Many of these women did not feel valued or supported.
In a seminal article on college counseling centers in the 21st century, Hodges (2001) argues that college counselors must appreciate the individuality that all students bring to the counseling relationship in order to effectively work with clients. White et al. (2002) expand on this comment by applying it to the population of college students who self-injure and call for the importance of honoring individuality when working with clients who self-injure.
Further, in order to work effectively with clients who self-injure, counselors must be trained to gain the knowledge, awareness, and skills to work with this population (Aizenman & Conover Jenen, 2007; Craigen, 2008; Craigen & Foster, 2009). Perhaps the women in this study would have had a different experience if their counselors had received specific training on self-injurious behavior. In addition, while this study was focused on counselors, it is imperative that all human service workers receive training on self-injurious behavior so that they can effectively work with clients who self-injure (Craigen & Hays, 2011). After all, it is often the human service professional that is the first point of contact for those who self-injure working as a case worker, residential staff member, intake interviewer, child advocate, or another front-line position (Craigen, 2008). Thus, while human service professionals may not provide in-depth therapeutic work like the counselors referred to in this study, they will undoubtedly encounter individuals who self-injure, and their knowledge and awareness of this issue is paramount to empathic support and linking these clients to appropriate services (Craigen & Hays, 2011).
The women also expressed a lack of comfort, or even fear, of talking with a counselor at the college counseling center. Thus, it may be helpful for college counseling centers to participate in outreach activities in the college community (Wester & Trepal, 2010). For example, the college counselors might participate in college/university events and speak about their services in residence halls.
While it is important that college counseling centers are meeting the diverse needs of its students (Hodges, 2001), the authors of this manuscript are not making the argument that all individuals who self-injure ought to be seen at a college counseling center. It is important, that when needed, that college counselors are able to make external referrals to community agencies so that their student can get the appropriate level of care needed.
Results from this study also bring to the forefront policies related to self-injurious behavior. One of the most heated debates within college counseling centers is related to mandatory withdrawals for the institution. This policy involves the student recovering from a major mental illness or recovering from a suicide attempt to withdraw from the campus for a specific length of time determined by either the dean of students or the director of counseling (Appelbaum, 2006). Self-injury generally falls in the grey area in regards to this policy. If schools believe that self-injury is synonymous with a suicide attempt or significant enough to qualify as a major mental illness, then they may be asked to withdraw from the university (Hodges, 2001). However, there does not appear to be a universal higher education policy related to self-injury. Nonetheless, it is vitally important for college counselors to communicate their school’s policy right from the start so the student understands the limits of confidentiality (Trepal & Wester, 2002). Clear policies and communicating these policies to your clients are not only necessary for college counseling centers. Rather, all community mental health agencies should have written policies related to working with clients who self-injure (Craigen, 2008).
The College Experience
The women in this study talked at length about their experiences as a woman on a college campus. They appear to have a strong awareness of the impact of social, societal, and academic pressures.
For these women, one of the main challenges was their initial transition from high school to college. Research shows that this transition is often accompanied by a myriad of “stressors and psychological distress including personal and emotional problems, global psychological stress, somatic distress, anxiety, low self-esteem and depression” (Hicks, 2008, p.143). Fortunately, college counseling centers are well-positioned to offer supports for incoming freshman. For example, college counseling centers could conduct workshops in the residence halls teaching freshman about what difficulties they may experience in their first year. They may also add to existing programs during freshman orientation to talk about the availability of the college counseling center for incoming freshman struggling with this transition. Additionally, college counseling centers may consider creating a support group for freshman who are having a difficult time navigating their transition from high school to college.
Recommendations for Future Research
Future research may expand on this qualitative study to include a larger, more diverse ethnic and racial sample of female participants. Future studies could explore the college counseling experiences of male students who self-injure as well. Furthermore, as this study was limited to participants from one college campus, future research studies might include students from different counseling centers in diverse geographical locations. A future study could also examine the treatment experiences of college-aged students in a community based setting, increasing the generalizability of the study. This study could include clients who have worked with diverse helping professionals; counselors, social workers, and other relevant human service professionals.
In addition, a quantitative research design might be utilized to explore the nature of the relationship between college counseling centers and students.
Data on the number of students who report self-injury and who are engaged in counseling and the number of times they are seen by a college counselor could be collected by the college counseling centers. Additionally, data could also be garnered in regards to legal issues and challenges that college counseling centers have faced in the past. This data might be then be used to examine the relationship between the counseling center’s existing policies and the reported experiences of college students seeking services.
Continuing with a quantitative research design, college counselors could be given a survey in order to analyze their confidence and self-perceived ability to successfully work with self-injurious students. These surveys could then be analyzed for a variety of factors including counselor demographic data, level of past training, and education in regards to self-injury. Finally, a mixed method study might compare interviews with students with the survey data collected from the counselors in order to explore the relationship between perceived counselor competence and the nature of the students’ experiences.
While the study focuses on a timely and noteworthy topic, there are several limitations that need to be addressed. First, there was little racial or cultural diversity; eight of the participants were Caucasian while one was African-American and another was Latina. This is partly due to the location of the study, where the majority of students who attend the campus are middle class and Caucasian. The primary researcher also used a convenience sample, recruiting all participants from a small public university in the Southeast United States.
With that being said, the authors believe that there still is a degree of transferability in the findings; the information shared about each participant provided sufficient information on each participant so that the readers can establish a degree of similarity between the participants included in this study and the true population of college-aged women who self-injure. A sample that recruited students from a variety of different colleges may show the participants’ views of counseling centers to be more diverse.
Aizenman, M. & Conover Jensen, M. (2007). Speaking through the body: The incidence
of self-injury, piercing, and tattooing among college students. Journal of College Counseling, 10(1), 27-43.
Appelbaum, P. (2006). Law & Psychiatry: “Depressed? Get out!” Dealing with suicidal
students on college campuses. Psychiatric Services, 57, 914-916.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(Revised 4th ed.). Washington, DC: Author.
Cheng, H., Mallinckrodt, B., Soet, J., Sevig, T. (2010). Developing a screening
instrument and at-risk profile for nonsuicidal self-injurious behavior in college
woman and men. Journal of Counseling Psychology, 57(1), 128-139. doi: 10.1037/90018206
Craigen, L. (2008). Working with self-injury: Ten guidelines for human service
professionals. Human Service Education, 27(1), 132-142.
Craigen, L., & Foster, V. (2009). A qualitative investigation of the counseling
experiences of adolescent women with a history of self-injury. Journal of Mental
Health Counseling, 31(1), 76-94.
Craigen, L., Healey, A., Walley, C., Byrd, R., & Schuster, J. (2010). Assessment and
self-injury: Implications for mental health professionals. Measurement and Evaluation in Counseling and Development, 43(1), 3-15. doi: 10.1177/074817561032237
Craigen, L. & Hays, D. (2011). Assessing the effectiveness of a pilot training program for self-
injury treatment. Journal of Human Services. 31(1), 71-82.
Craigen, L. & Cole, R. (2012). Self-injury and eating disorders in minors: When should the human service professional break confidentiality? Journal of Human Services, 32(1), 56-71.
Favazza, A.R., & Conterio, K. (1989). Female habitual self-mutilators. Acta Psychiatrica
Scandinavica, 79, 283-289. doi: 10.1111/j.1600-0447.1989.tb10259.x
Favazza, A.R., & Rosenthal, R.J. (1993). Diagnostic issues in self-mutilation. Hospital
and Community Psychiatry, 44, 134-140.
Gratz, K. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.
Haberstroh, S., & Moyer, M. (2012). Exploring an online self-injury support group: Perspectives
from group members. The Journal for Specialists in Group Work, 37(2), 113-132.
Hawton, K., & Harriss, L. (2008). Deliberate self-harm by under-15-yearolds: Characteristics,
trends and outcome. Journal of Child Psychology and Psychiatry, 49, 441–448.
Hays, D.G., & Wood, C. (2011). Infusing qualitative traditions in counseling research designs. Journal of Counseling and Development, 89(3), 288-295.
Hays, D. G., & Singh, A. A. (2012). Qualitative inquiry in clinical and educational settings. New York, New York: The Guilford Press.
Hicks, T. (2008). High school to college transition: A profile of the stressors, physical
and psychological health issues that affect the first-year-on campus college
student. Journal of Cultural Diversity. 15(3), 143-147.
Hodges, S. (2001). University counseling centers at the twenty-first century: Looking
forward, looking back. Journal of College Counseling, 4(2), 161-174.
Klonsky, D. & Muehlenkamp, J. (2007). Self-injury: A research review for the
practitioner. Journal of Clinical Psychology, 63(11), 1045-1056.
Kokaliari, E., & Berzoff, J. (2008). Nonsuicidal self-injury among nonclinical college women.
Journal of Women and Social Work, 23(3), 259-269.
Levenkron, S. (1998). Understanding and overcoming self-mutilation. New York:
McAllister, M. (2003). Multiple meanings of self-harm: A critical review. International
Journal of Mental Health Nursing, 12, 175-185. doi: 10.1046/j.1440-
Moustakas, C.E. (1994). Phenomenological research methods. Thousand Oaks, CA:
Muehlenkamp, J. J., & Gutierrez, P. M. (2007). Risk for suicide attempts among adolescents who
engage in non-suicidal self-injury. Archives of Suicide Research, 11, 69–82.
Ougrin, D., Zundel, T., Kyriakopoulos, M., Banarsee, R., Stahl, D., & Taylor, E. (2012).
Adolescents with suicidal and nonsuicidal self-harm: Clinical characteristics and
response to therapeutic assessment, Psychological Assessment, 24(1), 11-20.
Patton, M.Q. (2002). Qualitative research and evaluation methods. Newbury Park, CA:
Schwandt, T.A. (2001). Dictionary of qualitative inquiry (2nd ed.). Thousand Oaks, CA:
Serras, A., Saules, K.K., Cranford, J.A., Eisenberg, D. (2010). Self-injury, substance
abuse, and associated risk factors in a multi-campus probability sample of college students. Psychology of Addictive Behaviors, 24(1), 119-128. doi: 10.1037/a0017210
Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007).
Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and
suicidal behaviors. Part 1: Back-ground, rationale, and methodology. Suicide and Life-
Threatening Behavior, 37, 248–263. doi:10.1521/suli.2007.37.3.248
Simeon, D. & Hollander, E. (Eds.). (2001). Self-injurious behaviors, assessment, and
treatment. Washington, D.C.: American Psychiatric Association.
Streubert, H.J., & Carpenter, D.R. (1999). Qualitative research in nursing: Advancing the
humanistic imperative. Philadelphia, PA: Lippencott.
Wester, K., Trepal, H. (2005). Working with clients who self-injure: Providing
alternatives. Journal of College Counseling, 8, 180-189.
Wester, K, & Trepal, H. (2010). Coping behaviors, abuse history, and counseling:
Differentiating college students who self-injure. Journal of College Counseling, 13(2), 141-154.
White, V., Trepal-Wollenzier, H., Nolan, J. (2002). College students and self-injury:
Intervention strategies for counselors. Journal of College Counseling, 5(2), 105-
113. doi: 10.1300/J182v02n02_13
Whitlock, J.L., Eckenrolde, J.E. & Silverman, D. (2006). Self-injurious behavior in a
college population, Pediatrics, 117(6), 1939-1948. doi: 10.1542/peds.2005-2543.
Whitlock, J., Eells, G., Cummings, N., & Purington, A. (2009). Non-suicidal self-injury in
college populations; Mental health provider assessment of prevalence and need. Journal of College Student Psychotherapy, 23(3), 172-183. doi: 10.1080/87568220902794366
Whitlock, J., Muehlenkamp, J., Purington, A., Eckenrode, J., Barreira, P., Abrams, G. B.,
Marchell, T., Kress, V., Girard, K., Chin, C., & Knox, K. (2011): Nonsuicidal self-injury
in a college population: General trends and sex differences, Journal of American College
Health, 59(8), 691-698.Zila, L. M., & Kiselica, M.S. (2001). Understanding and counseling self-mutilation in
female adolescents and young adults. Journal of Counseling & Development, 79,
Demographics of Participants