Table Of ContentNon-Suicidal Self-Injury
Throughout the Lifespan
A comprehensive guide for clinicians working with patients engaging in self-
injury, this book provides information on clinical conceptualization, risk and
protective factors, ways to assess for NSSI, treatment approaches and strategies,
and early intervention and prevention strategies.
Focusing on ethical and cultural considerations unique to schools, clinical
agencies, and private-practice settings, the authors provide a practical and
in-depth discussion of clinical theory. Procedures for determining risk and the
potential problems with risk assessment, especially concerning suicide risk, are
addressed. In addition to numerous exercises, examples, and suggestions for
practical interventions, the book includes a variety of detailed worksheets and
resources to expand readers’ level of understanding, monitor emerging trends,
and provide a context for extended training. Several case studies are discussed
and analyzed in order to highlight specific aspects of clinical conceptualization
and treatment strategies.
Drawn from a wide range of treatment populations and issues, this book is a
valuable resource for clinicians and supervisors. The authors integrate outcomes-
based research strategies and evidence-based tools to help clinicians work with
clients from diverse backgrounds.
Kelly Emelianchik-Key, PhD, LMHC, NCC, ACS, is a licensed clinical mental
health counselor and assistant professor in the counseling department at Florida
Atlantic University. She has completed extensive research and training in teen
dating violence, non-suicidal self-injury, and sexuality issues.
Amanda La Guardia, PhD, LPCC-S, NCC, is a licensed professional clinical
counselor supervisor and assistant professor for the counseling program at the
University of Cincinnati. She has completed extensive research and training
in the areas of non-suicidal self-injury and suicide, gender-related issues, and
professional development.
“This book is a vital addition to the literature on non-suicidal self-injury
(NSSI). Our profession has been riddled with misunderstanding about this
behavior in clients we serve. This text offers clarity on the subject and also
offers us multiple treatment plans and interventions. It outlines NSSI across
life development stages, which offers a unique perspective in the discussion of
self-injurious behaviors. The case studies provide information and assistance
that will be vital in working with clients who have a relationship with NSSI. I
applaud these authors and have deep appreciation for what they have added to
the literature in our field.” — Patricia E. Robertson, EdD, professor emerita,
East Tennessee State University, USA
“Emelianchik-Key and La Guardia have produced thorough and timely guide
for practitioners and students who need effective guidance in treating the com-
plicated issue of non-suicidal self-injury. With practical tools, detailed case stud-
ies, and thorough treatment strategies, this guide will become an important
reference tool for any clinician.” — Paul R. Peluso, PhD, LMHC, LMFT, pro-
fessor and chair of the Department of Counselor Education, Florida Atlantic
University, USA
“NSSI is one of the most pervasive and destructive activities among adolescents
and young adults, so you would think that there would be a ton of useful
information on the people and processes, both individual and systemic, that
are affected by this problem. Sadly, this was not the case—until now. This book
brings all of us up to date on the problem and its treatment in a very readable
text that is loaded with case studies. As a person who has experienced this with
a family member, I can say without hesitation that I wish this book had been
available ten years ago.” — James Robert Bitter, EdD, NCC, past president of
the North American Society of Adlerian Psychology, professor of counseling
and human services, East Tennessee State University, USA
“Emelianchik-Key and La Guardia expertly guide readers through the com-
plexities of NSSI, weaving in available best practices, resources, and scholar-
ship from across the helping professions. The authors provide an innovative,
thoughtful, and case-based approach for assessing and treating diverse clients
across the lifespan with NSSI. This text is a must-have clinical resource!”
— Danica G. Hays, PhD, professor of counselor education and executive asso-
ciate dean, University of Nevada, Las Vegas, USA
Non-Suicidal Self-Injury
Throughout the Lifespan
A Clinician’s Guide to
Treatment Considerations
Kelly Emelianchik-Key and
Amanda La Guardia
First published 2020
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2020 Kelly Emelianchik-Key and Amanda La Guardia
The right of Kelly Emelianchik-Key and Amanda La Guardia to be
identified as author of this work has been asserted by him in accordance
with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. The purchase of this copyright material confers
the right on the purchasing institution to photocopy pages which bear
the photocopy icon and copyright line at the bottom of the page. No
other parts of this book may be reprinted or reproduced or utilised in
any form or by any electronic, mechanical, or other means, now known
or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book
ISBN: 978-0-8153-7134-2 (hbk)
ISBN: 978-0-8153-7135-9 (pbk)
ISBN: 978-1-351-20359-3 (ebk)
Typeset in Goudy
by Nova Techset Private Limited, Bengaluru & Chennai, India
Kelly—This book is dedicated to all of the clients I have worked with over
the years. Your bravery to share your stories and the courage you show is
inspirational in more ways than you will know. I am appreciative of the amazing
colleagues and mentors that I continue to learn from and work with, especially
my co-author and friend Mandy. One of my favorite Robert Frost poems has a
line that says, “Two roads diverged in a wood, and I, I took the one less traveled
by, and that has made all the difference.” To my husband and family, thanks
for always giving me support, love, and encouragement to take the road less
traveled. Thank you to my kids; your presence and love motivate me to make
a difference.
Mandy—This book would not be possible without the tireless efforts of my
co-author and the experiences I’ve had with colleagues and clients over the years.
I hope this book honors the stories of the clients I have had the distinct privilege
of working with and learning from. Special thanks to Patricia Robertson, who
helped me to understand the importance of self-reflective empathy and cultural
humility when working with self-injurious clients; thank you for encouraging me
to grow as a practitioner and, foremost, as a person. Thank you to my daughter
Aria, with whom I get to practice being my better self.
Contents
Preface ix
List of figures, tables, cases, and textboxes xi
Key terminology xiii
Ethics statement xix
Authors xxi
PART I
Introduction to client case scenarios
1 Non-suicidal self-injury in childhood 3
KELLY EMELIANCHIK-KEY
2 Non-suicidal self-injury in adolescents and young adults 23
AMANDA LA GUARDIA
3 NSSI in adulthood and aging populations 41
AMANDA LA GUARDIA
PART II
Assessment and screening for non-suicidal self-injury
4 Risk and protective factors 57
KELLY EMELIANCHIK-KEY
5 Assessment and diagnosis 75
KELLY EMELIANCHIK-KEY
6 Gender and cultural considerations 103
KELLY EMELIANCHIK-KEY
viii Contents
PART III
Ethics and treatment of non-suicidal self-injury
7 Ethical considerations when working with NSSI 121
KELLY EMELIANCHIK-KEY AND MARIAH DERN
8 Non-suicidal self-injury and suicide 141
AMANDA LA GUARDIA
9 Prevention and treatment strategies in educational settings 153
ELLEN K. CHANCE
10 Treatment in community settings 167
ADRIANA LABARTA AND BRIDGET GLASS
11 Future research and directions 189
KELLY EMELIANCHIK-KEY AND AMANDA LA GUARDIA
PART IV
Worksheets and resources
Appendix A: Resource list 201
Appendix B: Elementary safety plan 205
Appendix C: Narrative storyboard 207
Appendix D: Cognitive mapping 209
Appendix E: Adapted DBT youth meditation 211
Appendix F: Bronfenbrenner worksheet 215
Appendix G: Chain analysis of NSSI behavior 217
Appendix H: Checklist for working with youth 219
Appendix I: Building support circles 223
Appendix J: Taking your emotional temperature 225
Appendix K: Voice of reason 227
Appendix L: My impulse control log 229
Appendix M: My life of purpose and meaning 231
Appendix N: Wheel of influence 233
Appendix O: Self-care wheel 235
Appendix P: My house 237
Index 239
Preface
We decided to write this book in response to a growing need for clinically
focused, easily understood guide for treating individuals engaging in non-suicidal
self-injury (NSSI) that includes an interdisciplinary perspective. Through our
work, we have noticed the increasing need for more practical ways to approach
NSSI and to help clinicians working with challenging cases that can be difficult
to conceptualize. NSSI is a complex issue, and no two cases are identical. Due
to this diversity, it can be challenging to produce consistent findings in research
studies, which means evidence-based practices are difficult to pinpoint.
Through this book, we hope to offer some information that will be helpful for
clinicians as they attempt to address the concerning treatment issues related to
self-directed violence to include NSSI and suicidal behaviors. In this preface, we
intend to define important constructs related to self-directed violence that will
give you some background information on the terminology that is important
in NSSI research. This book will be broken up into three main sections. Each
section intends to highlight issues that may intersect with specific developmental
concerns across the lifespan. Many complex client issues are presented in cases
within the first three chapters of this book, which we will follow throughout
the other chapters.
