JACKIE: So, Shawn, do you have any students right now that you’re concerned about?
SHAWN: Yeah… there’s a senior named Rene. She’s always been a little tense… But this year it’s gotten worse. And a friend of hers told me she thinks Rene is cutting herself. So I’ve been trying to figure out how to talk to her about it.
JACKIE: This is a profile of Rene. Let’s start with academics. It looks like Rene’s grades and class participation are really good.
SHAWN: Oh, yeah. She’s a great student. Really cares about her grades, and I know she studies hard.
JACKIE: When you’re ready to move on, hit the arrow to continue.
JACKIE: Here are some behaviors Shawn has noticed or heard from others. Shawn, take us through these.
SHAWN: Sure. Well, lately, every time she gets a B—or sometimes even an A- —she gets really upset. Last week she got a B-, and I literally thought she was going to cry.
And Ms. Sandifer, who co-sponsors the yearbook with me, had a similar problem. Every time she’d assign Rene a story, Rene would text her all the time, asking her questions and needing feedback.
JACKIE: Did Ms. Sandifer ever talk to Rene about it?
SHAWN: No, I don’t think so.
JACKIE: And tell us about the possible cutting.
SHAWN: Well, I haven’t seen any cuts on Rene, but her friend Tasha has. She asked me not to mention it to Rene, but I think I should.
JACKIE: What about Rene’s extracurricular life?
SHAWN: I’ve met her family a number of times and they’re all great. Her sister Reese was one of my favorite students when she was in school here. Friends, seem… normal. And Rene’s involved in a ton of extracurricular activities here at the school.
JACKIE: Anything worrisome about Rene’s appearance?
SHAWN: No. Nothing too unusual.
JACKIE: Here are a few warning signs that a student may be at-risk for psychological distress. Which of these did you notice in Rene’s profile?
On screen this list appears, with directions to check all that apply.
JACKIE: Here's what I noticed:
Shawn, when do you plan to talk to Rene?
SHAWN: I asked her to come by after school, before track practice.
JACKIE: Good. It’s important you don’t feel rushed and don’t have other students around.
What should be the goal of this conversation?
User decision: pick whichever choice seems to fit the question what the goal of this conversation should be:
ESTABLISH A RELATIONSHIP WITH RENE. Mr. Lyons already has a good relationship with Rene, as her teacher and yearbook advisor. Since he’s fairly certain that she’s at-risk, he should try to refer her to the counselor.
REFER HER TO THE COUNSELOR. Exactly. Since he already has a good relationship with Rene and is fairly certain she’s at-risk, he should refer her to the counselor. In some schools and districts, you may be required to report suspected cutting to a parent or school counselor. Be sure to know your school’s policies about responding to cutting and other types of non-suicidal self-injury.
TAKE HER TO THE COUNSELOR. It’s okay to do this, and your school’s policy may require it, but normally we wouldn’t force a student to go to the counselor unless we believe that student may be in a life-threatening or life-changing situation. Be sure to know your school’s policies about responding to cutting and other types of non-suicidal self-injury.
Now it’s time to begin your conversation with Rene. You’ll be guiding Mr. Lyons, deciding what he should say and ask. You should:
Mr. Lyons: So thanks again for coming in.
Rene: Oh, no problem. I don't have anything to do 'til track practice starts.
Mr. Lyons: So, how's everything with your family?
Rene: Oh, uh... fine. My sister, Reese, is doing really well at school.
Mr. Lyons: Yeah?
Rene: Yeah, she totally loves it. Last time I spoke to her she said to tell you, "Hi!"
Mr. Lyons: And how are you?
Rene: Me? Oh, I guess I'm fine.
Mr. Lyons: I've been concerned about you lately. You seem a little stressed.
Rene: Oh... I don't know. Maybe. Why?
Coach Text: Good. Expressing concern is a great place to start. Next, explain what's been noticed to cause this concern.
Mr. Lyons: Ms. Sandifer told me you seem worried about your yearbook articles, that you text her a lot of questions. Are you feeling more worried about your articles lately?
Rene: Well, I don't know. I guess I just want to do a good job.And when I ask her questions she's really helpful and gives me good advice. I think it makes the stories better.
Mr. Lyons: You seem to really care about doing well.
Rene: Well, of course. If I'm going to do something, I want to do it right. And sometimes Ms. Sandifer makes a lot of edits to my work, so I just want to know why so I can get better.
Mr. Lyons: Do you feel as much pressure to do well in your other activities? In track, and band, and everything else.
Rene: I guess so...
Mr. Lyons: I just worry sometimes that you put too much pressure on yourself... Maybe you end up not enjoying all these activities you do.
Rene: Oh, I do. I do like them. I like being on the yearbook staff. It's fun. And I think it looks good on my college applications, so... But I guess I know what you mean. Sometimes it is a lot to keep up with.
Mr. Lyons: Yeah, how do you manage it all?
Rene: Yeah, right?
Mr. Lyons: No really. How do you?
Rene: Oh. Well, yeah, sometimes it gets really busy. Like, every night it's something... track, homework, club stuff, yearbook... I'm really looking forward to this year being over.
Coach Text: Good job. Instead of judging Rene, you're showing you admire her ability to get everything done. Now she's opening up to you.
Mr. Lyons: Another reason I wanted to talk to you today is that... well, I know this may sound weird coming from me, but... I know sometimes people deal with stress by cutting themselves.
Rene: What?
Mr. Lyons: I'm worried that you might be doing this. I know some of your friends are worried about you, too.
Rene: What? Why are you saying that? Who said that?
Mr. Lyons: Well, someone who cares about you a lot mentioned to me that they were concerned.
Rene: Who?
Mr. Lyons: There are a lot of people here who care about you. What's important isn't who expressed concern. What's important is that you may be under a lot of pressure right now.
Rene: Never mind, I know exactly who it is. She had no business talking to you.
Coach Text: Good job. You avoided naming the friend and kept the conversation focused on the cutting itself, not who gave you the information.
Mr. Lyons: I know these are really difficult things to talk about. But if you are cutting yourself, that means you must be under a tremendous amount of pressure
Rene: No, come on... I mean... What, do you think I did it on purpose?
Mr. Lyons: I don't know. Did you?
Rene: I don't know. Like, it's not going to happen again. I just got a little... I got really stressed out. I don't want to get into any sort of trouble. I don't want anyone asking me any questions about it, you know?
Mr. Lyons: If you're so stressed out that you're hurting yourself... It sounds like you have a lot bottled up inside. And that's okay, but I bet it'd feel good to talk to somebody. That's why I think it's a good idea to talk to Ms. Caraway.
Rene: I guess you're right. I just... Like, what do I do? I just go in and say, "Hey, I'm Rene. I want to talk?" Isn't that weird?
Mr. Lyons: That's exactly what you do. And it's not weird at all. I'll tell her to expect you. Can I tell her you'll drop by tomorrow?
Rene: Um... Yeah, sure. I guess I can go by during second period
Mr. Lyons: Great, I'll let her know. Tell me how it goes, okay?
Rene: Alright, I will...
End Conversation
Mr. Lyons: So thanks again for coming in.
Rene: Oh, no problem. I don't have anything to do 'til track practice starts. So... what did you want to talk about?
Mr. Lyons: How did your track meet go the other day?
Rene: Oh, good... pretty good. The team did great.
Mr. Lyons: I saw you did pretty well, too.
Rene: Thanks. I didn't do that good, though.
Mr. Lyons: Why do you say that?
Rene: Well, there was a girl from the Cullen team... She beat me real bad in the 3200 meter. She's good, probably'll get a scholarship somewhere.
Mr. Lyons: Well, maybe track just isn't your thing. No one can be good at everything.
Rene: Hm... Is there something you want to talk about, Mr. Lyons? 'Cause I gotta meet my friend Nika in a few minutes.
Coach Text: Rene will be more comfortable with you and more receptive to the conversation if you remain positive and supportive. Pointing out her faults will only make her defensive.
Mr. Lyons: You seem really nervous lately.
Rene: No I don't. I mean... what are you talking about?
Coach Text: This is a broad criticism that's likely to make her defensive. A better approach is to gently express concern about specific behaviors, like her reaction to making a B or her need for feedback on her yearbook articles.
Mr. Lyons: Well, last week when you made a B on that exam... You asked a lot of questions about it, and your voice was shaking... I don't know, you seemed a little upset.
Rene: No. I mean, I just get upset when I mess up like that. It wasn't a hard test or anything; I just spaced out. I guess I didn't study enough, you know? I don't know what my deal is. I tried to study.
Mr. Lyons: I just don't understand. You have straight As in the class on your report card. What's there to be so worried about?
Rene: Well, maybe I make good grades because I worry about them. I mean, I need to worry about this. I've got to keep my grades high if I want to get into Stanford and get a scholarship. What do you expect, that I'm not going to worry about this?
Mr. Lyons: I know what you're saying. And you usually do make As. I know you do really well in my class.
Rene: I don't know. I could do better. I just need to focus.
Mr. Lyons: I think you need to toughen up a little. Otherwise, college is going to be a pretty rough time for you.
Rene: Uh, well, let me get into college first, okay? Look, I've got enough to worry about. I don't have time for this.
Coach Text: Telling Rene to "toughen up" isn't helpful. Instead, try to understand why she puts this pressure on herself and how the pressure affects her.
Mr. Lyons: Another reason I wanted to talk to you today is that... well, I know this may sound weird coming from me, but... I know sometimes people deal with stress by cutting themselves.
Rene: What?
Mr. Lyons: I'm worried that you might be doing this. I know some of your friends are worried about you, too.
Rene: What? Why are you saying that? Who said that?
Mr. Lyons: Your friend Tasha told me she saw cuts on your arms and legs.
Rene: What? Oh my gosh, just wait 'til I see her again.
Coach Text: I think you can discuss the cutting without revealing who gave you the information. This only distracts Rene from the point of the conversation and betrays Tasha's trust in you.
Mr. Lyons: Is it true, Rene? Have you ever hurt yourself like that?
Rene: Please stop, Mr. Lyons. I don't want to talk about it...
Mr. Lyons: Rene, you don't have to talk to me about this. But I do think you should talk with somebody. I'd like to take a walk down with you to see Ms. Caraway.
Rene: Ms. Caraway, the counselor? You want me to talk to her about... what? About this?
Mr. Lyons: Ms. Caraway's got a lot of experience working with students who want to do well and find themselves under a lot of pressure. I think it'll make you feel better to talk to someone, and she's the perfect person here at the school.
Rene: I don't know... that's kind of weird. I'm fine.
Mr. Lyons: Would it make it easier for you if I went with you? I could introduce you, and tell her a little about what we talked about today.
Rene: (nods) Yeah. I guess if you go with me, I'll do it.
Mr. Lyons: Good. Want to meet me here in the morning before school? And we'll walk down then? I'll let her know to expect us.
Rene: Okay. You sure she won't mind?
Mr. Lyons: I know she won't.
Rene: Alright, so... I guess I'll see you tomorrow.
End Conversation.
Once you identify any number of these worrisome behaviors, you need to intervene and approach: let the student know you’re concerned and trying to better understand why they’re behaving the way they are. Several things may happen when you approach a student:
These are some effective practices to bringing up sensitive topics, without the student reacting defensively:
if you ask too many questions in a row, a student can feel like they’re being interrogated, instead of feeling like an equal partner in the conversation. This can shut the student down. As in any conversation, you need to make statements, as well as ask questions; but your statements should encourage the student to continue sharing, not interrupt with your own advice or analysis.
This is also when reflecting statements are useful, where you reflect what you think the student is saying, thinking, or feeling to make sure you understand. We often use reflecting statements in casual conversations with friends and family, to clarify what the other person is saying. Notice how often you do this over the next few days. Then, try using it in conversations with students when you want to encourage them to continue sharing.
The way you bring up the student’s behavior makes a huge difference in how she’ll respond. Rene did eventually admit to having a lot of stress in her life. Then you referred her to the counselor. Here are some good referral techniques you may have used:
JACKIE: Finally, instead of telling a student that he should see the counselor, it’s often more effective to phrase it as a question, for example: “How would you feel about talking to the counselor?” This can increase the student’s ownership over the idea, which can make him more receptive to it.
Of course, if you fear the student may be a danger to himself or others, you must be very direct and act quickly—don’t let the student out of your sight until you’ve connected him with the counselor or another administrator who’s prepared to help.