Consulting with churches for adolescents who self-injure (SIB)

1. Chris Buckingham Ashleigh Bruns Susan Childers Jonathan Impellizzeri Sara Wood Consulting with churches for adolescents who self-injure (SIB) Regent University School of Psychology and Counseling CES 763 Supervision and Consultation Consultation Project– April 23, 2009

2. Psycho-educational Component Definition of Self Injury Behavior (SIB) Any self harming or injuring behavior whose intention is not suicide but whose origins are in the attempt to ground, to ameliorate emotional pain, or to manage affect. This can include behaviors such as cutting, burning, carving words or pictures into skin, excessive tattooing and piercing (Derouin, A. & Bravenda, T., 2004; Whitlock, J., Powers, J. & Eckenrode, J., 2006). Developmental Issues of Adolescents and Teens A time of increased feelings of distress & more ways to cope with stress independent of parents [(Arnett, 1999; Compas, 1987; Petersen, Kennedy & Sullivan, 1991) Whitlock ,et al.] . Life stage stressors include establishing caring, meaningful relationships, finding acceptance and belonging in social groups ,and establishment of interpersonal intimacy: • Eriksonian Adolescence stage (identity vs. role confusion), increased decision making responsibility ranging from risky to competent (Berg, 2005; Erikson) • Freudian psychosexual Genital stage: Includes puberty, with sexual interest in opposite sex, sexual pleasure through genitals (Freud) • Responsible for self, pushes for independence from parents (Erikson) • Develops sexual identity, the ability to love, and the desire to work (Erikson; Freud)

3. Identifying at Risk Teens & Psycho-educational Procedures • What to look for: • Adolescents who engage in SIB tend to defy easy categorization • Teenagers who are at a higher risk are: 1. females 2. those who have experienced sexual abuse or trauma 3. those with eating disorders 4. personality disorders 5. teenagers who have friends who self injure (Plante, 2007) • Empowering the church to address SIB: • (1) Clergy • (2) Youth Group Leadership • (3) Youth Group

4. Church SIB ProtocolHow to handle teens who are engaged in SIB • First Line of Prevention • Student Waiver Form Signed by Parents • Youth Workers Being First Aid Trained • Delegate a church member outside of the Youth Ministry to serve as a point of contact (POC) i.e. Minister of Pastoral Care and Counseling • Suspicion and Reporting Protocol • Report all suspicions to the POC and Youth Minister • POC will contact parents/guardians and provide referrals • POC will handle the mandated reporting when applicable • Actively Engaging and Reporting Protocol • Complete a safety check and contact emergency services if necessary • DO NOT LEAVE YOUTH ALONE • Contact POC to handle parent/guardian contact, referrals, and any mandated reporting • Youth Group Participation Protocol (for those actively engaging) • Employ a 3 month probationary period and Safety Contract (including a release for POC and counselor) overseen by POC • Utilize adult chaperones as designated by parents/guardians

5. Issues of Disclosure & Limits of Confidentiality • Our church is located in Colorado as an example, Colorado clergy are not required to report privileged communication without consent from both the clergy and the parishioner. (Colorado Revised Statute (CRS) Ann. ｧ 13-90-107(1)(c) and Colo. Stat. Ann. ｧ 19-3-304(2)(aa))(Pike, 2008). You would need to check your state’s codes to determine the state by state variations. • CRS 27-10-103 would inherently exclude a church counselor (MA in Counseling or Social Work) from being a person able to provide counseling to a minor 15 years of age without informing the parents first of their actions. In the case of SIB the appointed person (Pastor of Pastoral Care and Counseling) would need to inform the teens parents immediately (Lane, 2007). • Mandated reporting will be handled by the POC • ACA Code of Ethics • (B.1.b.) - Respect for privacy-Counselors respect client rights to privacy. Counselors solicit private information from clients only when it is beneficial to the counseling process. • (B.1.c.) - Respect for Confidentiality-Counselors do not share confidential information without client consent or without sound legal or ethical justification • (B.2.a.) - Danger and Legal Requirements-The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.

6. Christian Integration • Possible relationship between self-injurious behavior, sexual self-concept, and spirituality (Wagner & Rehfuss, 2008). • During SIB, the emotion of shame, originating from family of origin, is reenacted to cause harm to the individual • The self is deceived into thinking not even God could love me • Impacts self-worth, sexuality, and relationship with God (Watts, 2000). • What is the church to do? • SIB believers - have own responsibility (Eph. 4, Romans 12:2, James 5:16); the church has the responsibility to treat the individual with gentleness and compassion (Eph. 4:2, Col. 3:12, 1 Thes. 2:7, 1 Peter 3:8, Eph. 4:32) • SIB unbelievers - the church needs to reach out in love, move towards healing & spiritual reconciliation, and witness if given the chance (Mark 12:28-31, 1 Peter 2:24, John 14:6, Acts 4:12, Eph. 2:8-9, Romans 5:6-11) • 7 points for Christian response to self-injurers (Watts, 2000): • 1. Eyes of Understanding – witness to suffering and counter invisibility • 2. Ears that can hear – listen as a way to move silence into speech • 3. A need for re-membering and remembering – walk alongside to remember • 4. A need for Christian story telling – learn to love and co-create a new story • 5. Liturgy, ritual, and sacrament – suggest expressiveness through the Body • 6. Develop other ways of binding – teach centering prayer • 7. A need to counter isolation through a caring network – develop support

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