Self-Injury Resources for Schools

As a licensed clinical social worker who has worked for 20+ years with teens and adults who self-injure, I have been moved by the increase in self-destructive behaviors of our adolescents and rising suicide rates. So many of our clients at S.A.F.E. ALTERNATIVES® report having grown up with a sense of being alone and misunderstood often suffering in silence with depression and anxiety. In the case of our clients, they then turned to self-injury in an effort to deal with their intense emotional pain. With parents and teachers who were either unaware or turned a blind eye, they frequently tell us that they longed for someone to notice and intervene.

Teachers are in a unique position on the front line of everyday experiences to actually make a life-saving difference in a student’s life. Giving them the resources and knowledge to speak up, to say what they see and know, begins to address the problem at the heart of the matter.

S.A.F.E. (Self Abuse Finally Ends) ALTERNATIVES ® Programs utilize a combination of treatment approaches to address impulsive behaviors and self-injury, which is sometimes the effect of having been bullied.  Cognitive-behavioral therapy uses contracts, behavior logs, and journals to help individuals understand and manage destructive thoughts and behaviors.  In conjunction with this, interpersonal therapy assists adolescents and their families to gain the insights and skills necessary to build healthy relationships.  Individual and group therapy explores issues underlying destructive behaviors.

Educators are often the first adults to know of a child’s self-destructive behavior. We hope to supplement the protocol you already have in place in your school and increase your awareness and insight into impulsive behaviors.  Additionally, we hope to help your students become healthy functioning members of society, free of all destructive behaviors.


  • Low self-esteem
  • Overwhelmed by feelings
  • Inability to function at home, school or work
  • Inability to maintain stable relationships
  • Wearing long pants and sleeves in warm weather
  • Unexplained frequent injuries, including cuts and burns

When to Seek Specialized Treatment

  • When outpatient or generalized inpatient therapy has failed to decrease the intensity and/or frequency of the self-destructive behavior.
  • When the student is new to self-injury but the behavior is escalating rapidly and/or dangerously.
  • When the destructive behavior negatively impacts one or more aspects of life (school, work, or relationships.
  • When the student displays an inability to cope with daily stressors without resorting to poor coping skills such as self-injury.
  • When the student has been working in treatment, voices a desire to change, but has been unable to enact any meaningful change in behavior or quality of life.


To schedule a presentation for school professionals/parents/students as part of your staff development requirements, please contact Michelle Seliner MSW, LCSW at

More Information

The following information has been adapted from Self-Injury: A Manual for School Professionals

School professionals such as teachers, nurses, and counselors are frequently the first adults to know of a student’s self-injurious behavior. They may notice wounds or may be notified by another student. On occasion, a student will decide to disclose to a teacher whom they trust. When a staff member notices that a student has wounds, suspects that a student is injuring, or has the behavior brought to their attention by another student, the situation must be addressed and not ignored. One of the most important things to remember is that the tone of your response can be equally, or even more important than your actual words. The goal is to respond in a calm, non-judgmental fashion.

Self-injury is an attempt to cope with a problem and not the problem itself. It is often a cry for help (either conscious or unconscious). Most self-injurers experience themselves as being invisible. Ignoring the behavior only validates this belief, possibly causing them to become even more dangerous to themselves. The key is to focus on the underlying feelings and issues rather than focusing on the behavior itself

Don’t be afraid to state, “I’ve noticed injuries that appear to be self-inflicted, I care about why you might be doing that” or “it appears you have hurt yourself, do you want to talk about it?”. Even if the student denies that the wounds are self-inflicted, the fact that the behavior was attended to and addressed directly is the first step towards healing. You have made it clear that they are not invisible and that you are available when the student is ready to seek help.

If you believe that a student is self-injuring, let them know that you want to aid them in getting the help they need. It is most important to be empathic with the student. Remember, the self-abuser may be feeling shame and you do not want to further this shame. Please DO NOT reprimand or send the student to the principal as a behavioral problem. Instead, your concerns should be brought to the attention of the school counselor if one is available to you. If your school does not have access to a school counselor, then another school professional (depending on your school’s protocol) will need to assess the student for safety, especially if suicidal thoughts accompany the self-injurious behavior.

You will also need to follow your school’s protocol with regards to letting the parents of the student know what is happening with their child. It may be best to encourage the student to tell their parent(s) or guardian about their self-injury. Giving the student the option to do so, prior to you telling a parent/guardian, allows the student to have a greater measure of control over the situation. If the student fails to tell their parent, then it would be up to the individual to follow the protocol set forth by the school.

If the student has fresh wounds, they will need to be assessed by the school nurse and/or emergency room to determine the severity and to make sure that the wound is properly treated. Our practice is to not focus on the injury, but rather on the events, feelings, and thoughts preceding and following injuring.

If the student has been injuring a long time or is injuring severely, it may be time to consider some intensive treatment. If self-injury is having a negative impact on the student’s life and therapy does not seem to be working, there is more intensive help available.

Intervention Tips:

Unstable, unpredictable, or invalidating environments contribute to adolescent anxiety and frustration, which, in turn, can contribute to an increase in self-injurious impulses and injury. Therefore, stability and empathy are among the most important ingredients for success in working with self-injurers. Everyone in the system is responsible for providing a caring environment. Some descriptors of a caring environment are:

  • Neutral (i.e., non-judgmental and non-punitive).
  • Accepting. Staff can validate self-injurers’ emotions. (A common theme among self-injurers is that their emotions were not validated during early family life).
  • Amenable to staff contact. Since we want to encourage students to talk to staff about self-injurious impulses, staff can demonstrate openness to listening to them.
  • Calm. Staff serve as models for emotional control, conflict resolution, and problem-solving skills.
  • Dependable, structured, and predictable (schedules, individual sessions, group time, consequences, and/or expectations).
  • Consistent (staff remains neutral: rules, rewards, and consequences are the same each day). Further, staff members display a consistent “personality” each day.
  • Confidential and private. Staff refrains from discussing students when others are around and refrains from discussing sensitive issues with students (i.e., diagnosis, family conflict, etc.) in public (i.e., hallways, classrooms).
  • For more specific directions on how to intervene with students who injure and helping them disclose to parent(s)/guardian(s), please see Self-Injury: A Manual for School Professionals.

S.A.F.E. Resources


school resource

Self-Injury:  A Manual For School Professionals                                                         

To identify the various forms and purposes of self-injury, the DO’S and DON’TS for counselors, nurses, and teachers, how to assess for self-injury and suicide, specific intervention techniques and tools, how to talk to parents about self-injury, to identify resources and referrals for self-injurers who are in need of services outside of school, how to create a smooth transition for students returning to school from hospitalization or other forms of intensive treatment, and so much more…


student manual

Student Workbook – The Student Workbook is designed to accompany “Self-Injury: A Manual for School Professionals” (above)

This Workbook can be used as an individual intervention (e.g., given to a student to complete on their own and then review with a staff member) or as a format for a more in-depth individual session with a counselor or in a group setting. The exercises can be used randomly or in order. It is possible to “pick and choose” the parts of exercises that are relevant at a given time.


Can you See My Pain DVD

“Can You See My Pain”- DVD includes personnel stories as well as expert testimonials and comments by Karen Conterio and Wendy Lader, Ph.D., founders of S.A.F.E. ALTERNATIVES®.  Through first-hand accounts, this program gives self-injurers a chance to tell their stories and talk about what they are doing to stop self-injuring themselves. These poignant stories are punctuated by comments from clinicians from S.A.F.E. ALTERNATIVES®, the first in-patient program in the country specifically designed to help self-injurers.  An excellent resource for self-injurers, families, private practitioners, schools and healthcare providers.  Running time: 30 minutes.



Bodily Harm book cover

Bodily Harm:  The Breakthrough Healing Program for Self-injurers by Karen Conterio and Wendy Lader, Ph.D.

This is an authoritative examination of the behavior of self-injury. Written by the founders of S.A.F.E. ALTERNATIVES® (Self Abuse Finally Ends), it clearly defines what self-injury is and explains the kind of emotional trauma that can lead to self-injurious behaviors.  Bodily Harm, offers a course of treatment based on years of experience, compassion, advice, and hope for the afflicted and their loved ones.  An excellent resource for schools, the self-injurer, their families, friends, and therapists.


Bodily Harm book cover

“Daño Corporal” es la traducción al español de nuestro libro más popular, “Bodily Harm”, (“Bodily Harm” translated into Spanish)

“Daño Corporal: el innovador programa de recuperación para quienes se autolesionan”, cuyas autora son Karen Conterio y Wendy Lader, Ph.D., es un análisis bien documentado sobre la conducta autolesiva.  Este libro que ha sido escrito por las fundadoras de S.A.F.E. ALTERNATIVES® (sigla que proviene de la frase en inglés “finalmente termina el auto abuso”) claramente define que es la autolesión y explica los tipos de traumas emocionales que pueden conducir hacia conductas autolesivas.

Healing Self Injury by Janis Whitlock can you pull the description from the ’store’



Book cover

Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones by Janis Whitlock and Elizabeth E. Lloyd-Richardson

As many as one out of every four young people engage in non-suicidal self-injury, defined as the deliberate destruction of body tissue without suicidal intent. Parents who uncover this alarming behavior are gripped by uncertainty and flooded with questions–why is my child doing this? Is this a suicide attempt? What did I do wrong? What can I do to stop it? And yet basic educational resources for parents with self-injuring children are sorely lacking.