Yesterday we posted the following question on self-harm, and today we have the answer and rationale for you!
A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST?
A. Discuss voluntary hospitalization with the client
B. Teach the client coping skills to utilize in moments of intense emotion
C. Explore the thoughts and feelings that preceded the client’s self-injury
D. Refer the client to an MD to take care of the client’s injuries
After reading through the question and possible answers for this question, what answer did you come up with? This is a good example of a question that could show up on either of the ASWB practice exams to determine whether you are able to differentiate between the steps you would take with a client engaging in self-harm versus one who is actively suicidal. Let’s go through each of the answer options one at a time and think about them.
- Answer A: does the client need to be hospitalized? Not at this time. Nothing in the question stem indicates that the client is having suicidal thoughts or is a risk to herself. The question stem specifies that the client engages in non suicidal self injury, meaning, she is engaging in self harm without the intent of killing herself. Further, the cuts are on her forearm and are described as shallow and healing normally, so there is no medical emergency that would indicate a need for hospitalization. Especially for therapists inexperienced with self-injury, seeing a client’s self-inflicted injuries can be alarming and upsetting. From a place of concern and wanting to make sure our clients are safe, we can jump to too extreme of interventions, such as unnecessary hospitalization.
- Answer B: does the client need concrete coping skills to help her cope during moments of intense emotion? Definitely. This is something you would want to do, but is not necessarily what you would do.
- Answer C: should we explore the thoughts and feelings the client had before engaging in self-injury? Yes! This answer option allows us to stay in the moment and respond to what the client has shared. Exploring her thoughts and feelings leading up to her self-injury will help us gain a better understanding of the precipitating factors and triggers for this behavior. From there we could discuss various coping skills for the thoughts and emotions that triggered this behavior (B).
- Answer D: does the client need a medical evaluation? Probably not. The question indicates that the cuts were shallow and healing normally. Nothing else in the question stem indicates a need to seek medical attention.
Which answer did you choose? Does the rationale fit with your understanding of self-injury, or did you learn something new with this scenario? If you have any further questions, we encourage you to check in with a TDC Coach. We are here to support you! And if you came up with the same answer-great job! You are on the right track to getting licensed.
Still haven’t signed up for an exam preparation program? We look forward to helping you PASS your exam with confidence! Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. . Once you pay for the program, we are with you until you pass: extensions are always free, materials are structured and comprehensive, and you have access to a coach for 1:1 support. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.