Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr. Margarita Holmes.

Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in three continents, he has been training with Dr. Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives.

Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons.

Dear Dr Holmes and Mr Baer:

I’ve been a high school counselor for 3 years now. One of the most difficult situations I have to handle is when a student self harms. 

Non-suicidal self-injury seems to be prevalent among teens nowadays, or at least in my school.

Apparently, making shallow cuts on their wrists or thighs help them shift the emotional pain into a physical one. It becomes their coping mechanism whenever faced with difficulties.

Naturally, I would be worried despite how shallow it is. Because I can never predict when they’ll start to need to cut deeper or maybe even accidentally do so. 

As far as ethics goes, I HAVE to immediately report the self-harming behaviors to their parents because it poses a danger to the student. The problem is, I can’t help but feel guilty whenever they beg me not to tell their parents. I will still do so, especially if the cuts look fresh, but I would feel bad that they took up so much courage to finally open up to me but I’ll break their trust. 

No matter how much I understand that that’s just how the process goes, it keeps me up at night thinking how their parents talk to them at home after that because some parents react quite terribly. They view it as attention seeking and don’t try to look at the root cause of the behavior.

They would even go as far as scolding them for the embarrassment of being called to the guidance office for such a trivial reason. This leads to the students just hiding their cuts in a more private area and avoiding opening up to me or their parents.

Is there any way that I can handle future cases like this better? How else can I make parents understand that scolding their children won’t make them stop doing it? Cora

Dear Cora,

To be effective requires a careful balance between your job, your legal obligations, your duty to protect, and empathy towards your students. It therefore helps to develop a viable framework within which to operate.

To start with, and before reporting, you need to have a detailed conversation with the students about the whole reporting process. They need to understand that reporting comes from a place of care, not punishment. They also need help preparing for potential parental reactions so perhaps the counselor can offer to be present during initial conversations with parents or help draft a communication strategy, perhaps with some role play.

It is of course critical that parents have a good understanding both of the problem and their role in finding a solution. In coordination with the school, it is therefore important to provide structured parent workshops focusing on self-harm, information about teenage mental health, teach communication strategies that support rather than shame, and provide details of resources for family counseling and professional mental health support, emphasizing that self-harm is a symptom of emotional distress, not attention-seeking behavior.

While the initial intervention is of course vital, equally vital is continuity so a follow-up procedure needs to be put in place to ensure students continue to have a safe space to discuss feelings, receive ongoing counseling from school psychologists and access alternative coping mechanisms.

Parallel to all this, other school staff need to recognize early warning signs so develop school-wide mental health awareness programs, create peer support and find ways to reduce stigma around seeking mental health support.

Potential escalation is a valid concern and proactive approach can be life- saving. Mandatory reporting and compassionate, strategic intervention can address both immediate safety and long-term emotional well-being which may potentially be life-changing.

Clearly the above may only be partly realizable and partly aspirational, depending on available resources, both human and material. Hopefully it will provide at least a framework within which to operate.

All the best,

JAFBaer

Dear Cora:

Thank you very much for your letter.   First, I think I know something fairly close to how you feel.  When I first started my column, I would get so discombobulated when a letter writer would say something to the effect: “Please help me. If I don’t get any help soon, I will commit suicide”

I realized I couldn’t help everyone who wrote me a similar letter and assuaged myself (finally!!) by reminding myself that a column is not therapy, something I had mentioned in my column several times, and it was never meant to be. In effect, answering all and sundry who wrote similar letters of (seeming or actual) desperation it was not really my responsibility.  That sounds harsh, I know, but I had to be harsh to myself or I would spend my waking hours writing to people. I had to be harsh or I would never get over the guilt.

I am in no way comparing your important job of helping the counselees who come to you face to face for help. However, I feel that the guilt you feel might be similar (no matter how well founded your guilt was compared to mine.). The thing about guilt is, oftentimes it is irrational, and oftentimes no amount of logic will help.

But I did my research, hoping that some “hard core information” might help you.  Not only is there a clear directive in every school that, should the counselee who comes to you seem in any way in danger, you are to tell the administrators (?) and also the counselee’s parents. This is backed up by Philippine law.

“STANDARD OPERATING PROCEDURES IN PREVENTING SUICIDAL SITUATION WITH LEARNERS” 

 “(with) Threat of self harm, contact parent or guardian immediately. If child expresses risk if the parent is  told, contact another individual — a trusted adult or an adult family member identified by the student.”

In my experience, it is hard to get the names of other adults the student trusts. 

Remember also that you are a counselor hired by your school. First and foremost, you have to protect yourself and the school which hired you.   

What might help your counselees not to consider you yet another adult who has betrayed them are the following:

Telling the students (before their sharing) that you are duty bound to tell both the school and their parents should there be a threat of harm. 

Perhaps suggest (if you are fairly sure they would welcome this) that you are willing to be with them when they their parents if the counselee thinks it would help.

Another option is, when you tell the counselee’s parents (without the counselee) you suggest they come to you first with or without their child.  

This is actually the rationale of family therapy: the realization that oftentimes the IP (identified patient) is not the real problem. The IP is usually a family member (usually your counselee) who is often unconsciously selected as the cause of family conflict and who brings the family into therapy. The IP is simply responding to the chaos within their family.

Oh, Cora, it is not an easy situation you are in. I hope this column has helped, if only as a start to the heavy journey you must undertake dealing with such problems.

All the very best,

MG Holmes 

– Rappler.com

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