Nonsuicidal self-injury (NSSI) has become increasingly common among teens and emerging adults. An individual may engage in NSSI for a variety of reasons from coping with emotional pain or as a distraction from difficult thoughts and painful memories. Although NSSI is a common presenting concern, those in supportive roles of clients struggle to understand the motivations to self-injure as well as how to include appropriate supportive family members in the counseling process for long-term healing. The purpose of this article is to (a) review attachment styles in conceptualizing NSSI, (b) discuss the value of including supportive caregivers/family members in treatment, and (c) provide an evidence-based summative list of suggestions for counselors to provide to caregivers. A case illustration is provided.
AdlerA. (1956). The individual psychology of Alfred Adler (AnsbacherH. L.AnsbacherR., Eds.). New York, NY: Basic Books.
2.
AinsworthM. D. S.BellS. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49–67.
3.
AizenmanM. B. (2009). College counseling for self-injurious behavior: A case study. Journal of College Counseling, 12, 182–189.
4.
BlochL. (2007). The attachment frame is the thing: Emotion-focused family therapy in adolescence. Journal of Couple & Relationship Therapy, 10, 229–245.
5.
BowenM. (1978). Family therapy in clinical practice. New York, NY: Jason Aronso.
6.
BowlbyJ. (1969). Attachment and loss. New York, NY: Basic Books.
7.
BuserT. J.BuserJ. K. (2013). Conceptualizing nonsuicidal self-injury as a process addiction: Review of research and implications for counselor training and practice. Journal of Addictions & Offender Counseling, 34, 16–29.
8.
ChengH.MallinckrodtB.SoetJ.SevigT. (2010). Developing a screening instrument and at-risk profile for non-suicidal self-injurious behavior in college women and men. Journal of Counseling Psychology, 57, 128–139.
9.
CraigenL. M.FosterV. (2009). “It was like a partnership of the two of us against the cutting”: Investigating the counseling experiences of young adult women who self-injured. Journal of Mental Health Counseling, 31, 76–94.
10.
DavidsonS.IrelandC. A. (2009). Substance misuse: The relationship between attachment styles, personality traits, and coping in drug and non-drug users. Drug and Alcohol Today, 9, 22–27.
11.
Dellinger-NessL. A.HandlerL. (2007). Self-injury, gender, and loneliness among college students. Journal of College Counseling, 10, 142–153.
12.
FavazzaA. R. (1998). The coming age of self-mutilation. Journal of Nervous and Mental Diseases, 186, 259–268.
13.
FujimoriA.WadaY.YamashitaT.ChoiH.NishizawaS.YamamotoH.FukuiK. (2011). Parental bonding in patients with eating disorders and self-injurious behavior. Psychiatry and Clinical Neurosciences, 65, 272–279.
14.
GollustS. E.EisenbergD.GolbersteinE. (2008). Prevalence and correlates of self-injury among university students. Journal of American College Health, 56, 491–499.
15.
HallabL.CovicT. (2010). Deliberate self-harm: The interplay between attachment and stress. Behaviour Change, 27, 93–103.
16.
HoffmanR.HinkleM. G.KressV. W. (2010). Letter writing as an intervention in family therapy with adolescents who engage in nonsuicidal self-injury. The Family Journal, 18, 24–30.
17.
JohnsonS. M. (2004). The practice of emotionally focused therapy (2nd ed.). New York, NY: Brunner-Routledge.
18.
JohnsonS. M.MaddeauxC.BlouinJ. (1998). Emotionally focused family therapy for bulimia: Changing attachment patterns. Psychotherapy, 35, 238–247.
19.
KasselJ.WardleM.RobertsJ. (2006). Adult attachment security and college substance abuse. Addictive Behaviors, 32, 1164–1176.
20.
KressV. E.HoffmanR. (2008). Non-suicidal self-injury and motivational interviewing: Enhancing readiness for change. Journal of Mental Health Counseling, 30, 311–329.
21.
RossouwT. I.FonagyP. (2012). Mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1304–1313.
22.
SatirV. (1983). Conjoint family therapy (3rd ed.). Palo Alto, CA: Science and Behavior Books.
23.
SawickaA.OsuchowskaJ. W.KosznikK.MederJ. (2009). The phenomenon of dual diagnosis in the light of attachment theory: A case study. Archives of Psychiatry and Psychotherapy, 4, 57–64.
24.
SchadeL. C. (2013). Non-suicidal self-injury (NSSI): A case for using emotionally focused family therapy. Contemporary Family Therapy, 35, 568–582.
25.
TikkaD. L.RamD.DubeyI.TikkaS. K. (2014). Socio-emotional factors in alcohol dependence. Indian Journal of Psychological Medicine, 36, 153–160.
26.
TrepalH. C.WesterK. L.MacDonaldC. A. (2006). Self-injury and postvention: Responding to the family in crisis. The Family Journal, 14, 342–348.
27.
TuiskuV.KiviruusuO.PelkonenM.KarlssonL.StrandholmT.MarttunenM. (2013). Depressed adolescents as young adults: Predictors of suicide attempt and non-suicidal self-injury during 8-year follow-up. Journal of Affective Disorders, 152, 313–319.
28.
WesterK. L.TrepalH. C. (2005). Working with clients who self-injure: Providing alternatives. Journal of College Counseling, 8, 180–189.
29.
WhitlockJ.EellsG.CummingsN.PuringtonA. (2009). Nonsuicidal self-injury in college populations: Mental health provider assessment of prevalence and need. Journal of College Student Psychotherapy, 23, 172–183.
30.
WichstromL. (2009). Predictors of non-suicidal self-injury versus attempted suicide: Similar or different?Archives of Suicide Research, 13, 105–122.
31.
YipK. (2005). A multi-dimensional perspective of adolescents’ self-cutting. Child and Adolescent Mental Health, 10, 80–86.
