Individuals with disabilities are at elevated risk for engaging in non-suicidal self-injury (NSSI). As the prevalence of NSSI increases, it is likely that in their professional tenure, certified rehabilitation counselors (CRCs) will interact with clients who have engaged in NSSI. The purpose of this study was to examine factors associated with CRCs’ self-efficacy for working with clients engaging in NSSI. CRCs practicing in the United States were recruited to participate in an online survey study (N = 91). Hierarchical regression analysis was used to analyze factors associated with CRCs’ self-efficacy to work with clients with NSSI. Results indicated that training (β = .31) and stigma (helping attitude; β =.39) were significant predictors of CRCs’ self-efficacy for working with clients experiencing NSSI, with the total model explaining 33% of the variance in self-efficacy. CRCs who received NSSI training in the past reported more positive attitudes and perceived themselves as more capable to work with clients who engaged in NSSI. This study is among the few to examine specific factors impacting CRCs’ self-efficacy in working with NSSI. Implications for practice and research will be discussed.
AngermeyerM. C.MatschingerH.CorriganP. W. (2004). Familiarity with mental illness and social distance from people with schizophrenia and major depression: Testing a model using data from a representative population survey. Schizophrenia Research, 69(2–3), 175–182. https://doi.org/10.1016/s0920-9964(03)00186-5
2.
BanduraA. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13(4), 623–649. https://doi.org/10.1080/08870449808407422
3.
BarnesA. J.EisenbergM. E.ResnickM. D. (2010). Suicide and self-injury among children and youth with chronic health conditions. Pediatrics, 125(5), 889–895. https://doi.org/10.1542/peds.2009-1814
4.
BergerE.HaskingP.ReupertA. (2014). “We’re working in the dark here”: Education needs of teachers and school staff regarding student self-injury. School Mental Health, 6, 201–212. https://doi.org/10.1007/s12310-013-9114-4
5.
BergerE.ReupertA.HaskingP. (2015). Pre-service and in-service teachers’ knowledge, attitudes and confidence towards self-injury among pupils. Journal of Education for Teaching, 41(1), 37–51. https://doi.org/10.1080/02607476.2014.992633
6.
BradleyV.HiersteinerD.RotholzD.MaloneyJ.LiH.BonardiA.BershadskyJ. (2018). Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour. Journal of Intellectual Disability Research, 62(12), 1043–1057. https://doi.org/10.1111/jir.12518
7.
CarterT.LatifA.CallaghanP.ManningJ. C. (2018). An exploration of predictors of children’s nurses’ attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm. Journal of Clinical Nursing, 27(13), 2836–2846. https://doi.org/10.1111/jocn.14361
8.
CodutiW. A.HayesJ. A.LockeB. D.YounS. J. (2016). Mental health and professional help-seeking among college students with disabilities. Rehabilitation Psychology, 61(3), 288. https://doi.org/10.1037/rep0000101
9.
Commission on Rehabilitation Counselor Certification. (2022). Code of professional ethics for rehabilitation counselors.
10.
CondronS. D.GarrazaL. G.WalrathC. M.McKeonR.GoldstonD. B.HeilbronN. S. (2015). Identifying and referring youths at risk for suicide following participation in school-based gatekeeper training. Suicide and Life-threatening Behavior, 45, 461–476. https://doi.org/10.1111/sltb.12142
11.
CookS. H.ClancyC.SandersonS. (2004). Self-harm and suicide: Care, interventions and policy. Nursing Standard, 18, 43–52. http://dx.doi.org/10.7748/ns2004.07.18.43.43.c3642
12.
CorriganP.MarkowitzF. E.WatsonA.RowanD.KubiakM. A. (2003). An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior, 44, 162–179. https://doi.org/10.2307/1519806
13.
CorriganP. W.GreenA.LundinR.KubiakM. A.PennD. L. (2001). Familiarity with and social distance from people who have serious mental illness. Psychiatric Services, 52(7), 953–958. https://doi.org/10.1176/appi.ps.52.7.953
14.
CorriganP. W.KerrA.KnudsenL. (2005). The stigma of mental illness: Explanatory models and methods for change. Applied & Preventive Psychology, 11, 179–190. http://dx.doi.org/10.1016/j.appsy.2005.07.001
15.
CrawfordT.GeraghtyW.StreetK.SimonoffE. (2003). Staff knowledge and attitudes towards deliberate self-harm in adolescents. Journal of Adolescence, 26(5), 619–629. https://doi.org/10.1016/s0140-1971(03)00060-5
16.
De StefanoJ.AtkinsS.NobleR. N.HeathN. (2012). Am I competent enough to be doing this? A qualitative study of trainees’ experiences working with clients who self-injure. Counselling Psychology Quarterly, 25(3), 289–305. https://doi.org/10.1080/09515070.2012.698981
17.
EbertD. D.MortierP.KaehlkeF.BruffaertsR.BaumeisterH.AuerbachR. P.AlonsoJ.VilagutG.MartínezK. I.LochnerC.CuijpersP.KuechlerA. -M.GreenJ.HaskingP.LapsleyC.SampsonN. A.KesslerR. C.; World Mental Health-International College Student Initiative Collaborators. (2019). Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative. International Journal of Methods in Psychiatric Research, 28(2), Article e1782. https://doi.org/10.1002/mpr.1782
18.
EmersonE.KingT.LlewellynG.MilnerA.AitkenZ.ArciuliJ.KavanaghA. (2019). Emotional difficulties and self-harm among British adolescents with and without disabilities: Cross sectional study. Disability and Health Journal, 12(4), 581–587. https://doi.org/10.1016/j.dhjo.2019.04.007
19.
FaulF.ErdfelderE.BuchnerA.LangA. G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods, 41(4), 1149–1160.
20.
FergusonM. S.ReisJ. A.RabbettsL.AshbyH. J.BayesM.McCrackenT.RossC.ProcterN. G. (2017). The effectiveness of suicide prevention education programs for nurses. Crisis, 39, 96–109. https://doi.org/10.1027/0227-5910/a000479
21.
FranklinJ. C.RibeiroJ. D.FoxK. R.BentleyK. H.KleimanE. M.HuangX.MusacchioK. M.JaroszewskiA. C.ChangB. P.NockM. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187. https://doi.org/10.1037/bul0000084
22.
GagnonJ.HaskingP. (2012). Australian psychologists’ attitudes towards suicide and self-harm. Australian Journal of Psychology, 64, 75–82. http://dx.doi.org/10.1111/j.1742-9536.2011.00030.x
23.
GaoQ.XiangH.XiangY. T.ZhuH. (2019). Deliberate self-harm among children with disabilities in China: A matched case-control study. Pediatric Research, 85(3), 275–282. https://doi.org/10.1038/s41390-018-0258-7
24.
GibbS. J.BeautraisA. L.SurgenorL. J. (2010). Health-care staff attitudes towards self-harm patients. Australian and New Zealand Journal of Psychiatry, 44, 713–720. http://dx.doi.org/10.3109/00048671003671015
25.
HamzaC. A.RobinsonK.HaskingP. A.HeathN. L.LewisS. P.Lloyd-RichardsonE.WhitlockJ.WilsonM. S. (2021). Educational stakeholders’ attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study. Journal of American College Health, 71, 2140–2150. https://doi.org/10.1080/07448481.2021.1961782
HubandN.TantamD. (1999). Clinical management of women who self-wound: A survey of mental health professionals’ preferred strategies. Journal of Mental Health, 8(5), 473–487. https://doi.org/10.1080/09638239917175
28.
IsaacM.EliasB.KatzL. Y.Shay-LeeB.DeaneF. P.EnnsM. W.SareenJ. (2009). Gatekeeper training as a preventative intervention for suicide: A systematic review. Canadian Journal of Psychiatry, 54, 260–268. https://doi.org/10.1177/070674370905400407
29.
JefferyD.WarmA. (2002). A study of service providers’ understanding of self-harm. Journal of Mental Health, 11(3), 295–303. https://doi.org/10.1080/09638230020023679
30.
KarmanP.KoolN.PoslawskyI. E.van MeijelB. (2015). Nurses’ attitudes towards self-harm: A literature review. Journal of Psychiatric and Mental Health Nursing, 22, 65–75. http://dx.doi.org/10.1111/jpm.12171
31.
KiblerJ. (2009). Self-injury in the schools: An exploratory analysis of Midwest school counselors’ knowledge and experience. North American Journal of Psychology, 11(2), 309–322.
32.
KiekensG.HaskingP.ClaesL.BoyesM.MortierP.AuerbachR. P.CuijpersP.DemyttenaereK.GreenJ. G.KesslerR. C.Myin-GermeyI.NockM. K.BruffaertsR. (2019). Predicting the incidence of non-suicidal self-injury in college students. European Psychiatry, 59, 44–51. https://doi.org/10.1016/j.eurpsy.2019.04.002
33.
KoolN.MeijelB. K. G.KoekkoekB.BijlJ. V. D.KerkhofA. J. F. M. (2014). Improving communication and practical skills in working with inpatients who self-harm: A pre-test/post-test study of the effects of a training programme. BMC Psychiatry, 14, Article 64. https://doi.org/10.1186/1471-244X-14-64
34.
KozinaK.GrabovariN.StefanoJ. D.DrapeauM. (2010). Measuring changes in counselor self-efficacy: Further validation and implications for training and supervision. The Clinical Supervisor, 29(2), 117–127. https://doi.org/10.1080/07325223.2010.517483
35.
LarsonL. M.ClarkM. P.WeselyL. H.KoraleskiS. F.DanielsJ. A.SmithP. L. (1999). Videos versus role plays to increase counseling self-efficacy in prepractica trainees. Counselor Education and Supervision, 38(4), 237–248. https://doi.org/10.1002/j.1556-6978.1999.tb00574.x
36.
LawG. U.Rostill-BrookesH.GoodmanD. (2009). Public stigma in health and non-healthcare students: Attributions, emotions and willingness to help with adolescent self-harm. International Journal of Nursing Studies, 46(1), 108–119. https://doi.org/10.1016/j.ijnurstu.2008.08.014
37.
LeatherJ. Z.O’ConnorR. C.QuinlivanL.KapurN.CampbellS.ArmitageC. J. (2020). Healthcare professionals’ implementation of national guidelines with patients who self-harm. Journal of Psychiatric Research, 130, 405–411. https://doi.org/10.1016/j.jpsychires.2020.08.031
38.
LloydB.BlazelyA.PhillipsL. (2018). Stigma towards individuals who self harm: Impact of gender and disclosure. Journal of Public Mental Health, 17(4), 184–194. https://doi.org/10.1108/JPMH-02-2018-0016
39.
Lloyd-RichardsonE. E.PerrineN.DierkerL.KelleyM. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. https://doi.org/10.1017/S003329170700027X
40.
LundE. M.SchultzJ. C.NadorffM. R.GalbraithK.ThomasK. B. (2017). Experience, knowledge, and perceived comfort and clinical competency in working with suicidal clients among vocational rehabilitation counselors. Rehabilitation Counseling Bulletin, 61(1), 54–63. https://doi.org/10.1177/0034355217695776
41.
LundE. M.SchultzJ. C.NadorffM. R.ThomasK. B.ChowdhuryD.GalbraithK. (2018). Experiences with and knowledge of non-suicidal self-injury in vocational rehabilitation support staff. Journal of Applied Rehabilitation Counseling, 49(1), 32–39. https://doi.org/10.1891/0047-2220.49.3.4
42.
LundE. M.SchultzJ. C.ThomasK. B.NadorffM. R.ChowdhuryD.GalbraithK. (2020). “It’s awful when we get it wrong”: An exploratory qualitative study of vocational rehabilitation counselors’ perspectives on suicide. Omega-Journal of Death and Dying, 81(4), 551–566. https://doi.org/10.1177/0030222818783933
43.
MaddoxB. B.TrubanovaA.WhiteS. W. (2017). Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder. Autism, 21(4), 412–422. https://doi.org/10.1177/1362361316644731
McCarthyL.GijbelsH. (2010). An examination of emergency department nurses’ attitudes towards deliberate self-harm in an Irish teaching hospital. International Emergency Nursing, 18(1), 29–35. https://doi.org/10.1016/j.ienj.2009.05.005
46.
MitchellS. M.TaylorN. J.JahnD. R.RoushJ. F.BrownS. L.RiesR.QuinnettP. (2020). Suicide-related training, self-efficacy, and mental health care providers' reactions toward suicidal individuals. Crisis, 41(5), 359–366. https://doi.org/10.1027/0227-5910/a000647
47.
MuehlenkampJ. J.ClaesL.QuigleyK.ProsserE.ClaesS.JansD. (2013). Association of training on attitudes towards self-injuring clients across health professionals. Archives of Suicide Research, 17(4), 462–468. https://doi.org/10.1080/13811118.2013.801815
48.
NielsenE.TownsendE. (2018). Public perceptions of self-harm—A test of an attribution model of public discrimination. Stigma and Health, 3(3), 204. https://doi.org/10.1037/sah0000090
49.
NockM. K. (2008). Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors. Applied and Preventive Psychology, 12(4), 159–168. https://doi.org/10.1016/j.appsy.2008.05.002
50.
NockM. K.FavazzaA. (2009). Nonsuicidal self-injury: Definition and classification. In NockM. (Ed.). Understanding non-suicidal self-injury: Origins, assessment and treatment (pp. 9–18). American Psychological Association.
51.
NockM. K.JoinerT. E.Jr.GordonK. H.Lloyd-RichardsonE.PrinsteinM. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. https://doi.org/10.1016/j.psychres.2006.05.010
52.
OordtM. S.JobesD. A.FonsecaV. P.SchmidtS. M. (2009). Training mental health professionals to assess and manage suicidal behavior: Can provider confidence and practice behaviors be altered?Suicide and Life-threatening Behavior, 39(1), 21–32. https://doi.org/10.1521/suli.2009.39.1.21
53.
PattersonP.WhittingtonR.BoggJ. (2007). Measuring nurse attitudes towards deliberate self-harm: The Self-Harm Antipathy Scale (SHAS). Journal of Psychiatric and Mental Health Nursing, 14(5), 438–445. https://doi.org/10.1111/j.1365-2850.2007.01102.x
54.
PennD. L.CoutureS. M. (2002). Strategies for reducing stigma toward persons with mental illness. World Psychiatry, 1(1), 20.
55.
PennD. L.GuynanK.DailyT.SpauldingW. D.GarbinC. P.SullivanM. (1994). Dispelling the stigma of schizophrenia: What sort of information is best?Schizophrenia Bulletin, 20(3), 567–578. https://doi.org/10.1093/schbul/20.3.567
56.
PumpaM.MartinG. (2015). The impact of attitudes as a mediator between sense of autonomy and help-seeking intentions for self-injury. Child and Adolescent Psychiatry and Mental Health, 9(1), 1–9. https://doi.org/10.1186/s13034-015-0058-3
57.
SaundersK. E.HawtonK.FortuneS.FarrellS. (2012). Attitudes and knowledge of clinical staff regarding people who self-harm: A systematic review. Journal of Affective Disorders, 139(3), 205–216. https://doi.org/10.1016/j.jad.2011.08.024
58.
SchmitzW. M.AllenM. H.FeldmanB. N.GutinN. J.JahnD. R.KleespiesP.MSimpsonS. (2012). Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology Task Force report addressing serious gaps in US mental health training. Suicide and Life-threatening Behavior, 42, 292–304. https://doi.org/10.1111/j.1943-278X.2012.00090.x
59.
StanilandL.HaskingP.BoyesM.LewisS. (2020). Stigma and nonsuicidal self-injury: Application of a conceptual framework. Stigma and Health, 6(3), 312–323. https://doi.org/10.1037/sah0000257
60.
TsengY. C.DitchmanN. (2024). Suicidal and nonsuicidal self-injury behaviors: A primer for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 55(1), 17. https://doi.org/10.1891/JARC-2023-0017
WalshB. W. (2012). Treating self-injury: A practical guide. Guilford Press.
63.
WhisenhuntJ. L.DuFresneR. M.StargellN. A.RovnakA.ZoldanC. A.KressV. E. (2017). Supporting counselors after a client suicide: Creative supervision techniques. Journal of Creativity in Mental Health, 12(4), 451–467. https://doi.org/10.1080/15401383.2017.1281184
64.
ZetterqvistM.LundhL. G.DahlströmÖ.SvedinC. G. (2013). Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Journal of Abnormal Child Psychology, 41(5), 759–773. https://doi.org/10.1007/s10802-013-9712-5
