Academic journal article Journal of Mental Health Counseling

"It Was like a Partnership of the Two of Us against the Cutting": Investigating the Counseling Experiences of Young Adult Women Who Self-Injure

Academic journal article Journal of Mental Health Counseling

"It Was like a Partnership of the Two of Us against the Cutting": Investigating the Counseling Experiences of Young Adult Women Who Self-Injure

Article excerpt

Self-injury is an increasing phenomenon among young adult women. This qualitative study explored the counseling experiences of 10 young adult women with a history of self-injurious behavior: It examined the nature of the client-counselor relationship and how self-injury was treated. It also accessed the participants' thoughts and feelings about their experiences in counseling. Implications for training and treatment are set out, as are recommendations for research.


Self-injury is a pervasive and dangerous problem, especially among adolescents and young adults (Nock & Prinstein, 2005; Nock, Teper, & Hollander, 2007). Self-injury typically occurs within the age range of 13-23, a period of developmental significance (Favazza & Conterio, 1989). An estimated 35% of college students report a history of self-injurious behavior (Gratz, 2001), and the prevalence of self-injury in adolescent community samples appears to range from 14% to 39% (Nock & Prinstein, 2005).

The incidence of self-injury has been found to be three to four times more common in women than men (McAllister, 2003). According to Shaw (2002), "self-injury is a gendered and developmental phenomenon" (p. 192), shaped and constructed within the context of multiple forms of gender oppression. Young women are subject to intense sociocultural forces throughout their lives, particularly throughout adolescence and young adulthood (Parker, Bermudez, & Neusitifter, 2007). Images of unattainable physical ideals, the emphasis upon sexual attractiveness and sexual availability, and restrictive power differentials of gender all shape identity formation in conflicting contexts. Simultaneously, young women struggle to learn how "to hear and trust one's own voice at the same time that one attends to the voices of others" (Knudson, 2004, p. 40).

Feminist perspectives have "recast theories of clinical disorders, focusing particularly on problems of high prevalence among women" (Marecek, 2001, p. 306). A social and contextual construction of gender relocates women's problems from the individual and internal to the social and external. This relocation shows how women's problems or symptoms can be understood as methods of coping and surviving rather than as signs of dysfunction or mental illness (Foster & May, 2003). Shaw (2002) argued that direct destruction of the body is symbolic of the struggle against the dominant cultural story of what it means to be female. Thus, the act of self-injury may be a means of expressing feelings of discontent and anger and a form of psychological resistance articulating a need to be heard and to be taken seriously.

In spite of the research on women and self-injury, little is known about self-injury among young women in marginalized or nondominant groups. While many contend that self-injurious behavior may be more common among White European American women (e.g., Bhugra, Singh, Fellow-Smith, & Bayliss, 2002), similarly high rates of self-injury have been found in samples of minority and disenfranchised groups (Marshall & Yasdani, 1991; Whitlock, Eckenrode & Silverman, 2006).


Self-injury presents considerable challenges to the mental health counselor because there is a lack of empirical data to support specific treatment protocols (Muehkenkamp, 2006; Trepal & Wester, 2002), and it has been identified as a behavior resistant to treatment. Treating self-injury may be particularly time-consuming and potentially frustrating for mental health counselors, who may feel unable to either form a therapeutic relationship with a client who self-injures or make an impact on the behavior (Dieter & Nichols, 2000; Kiselica & Zila, 2001; Stone & Sias, 2003). Mental health counselors' reactions, if void of empathy specific to self-injury, can have deleterious psychological and emotional effects upon self-injuring clients (Levenkron, 1998; Nafisi & Stanley, 2007). …

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