The role of the social environment in non-suicidal self-injury among LGBTQ youth: A mixed methods study

Non-suicidal self-injury (NSSI), such as cutting and burning, is a widespread social problem among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Extant research indicates that this population is more than twice as likely to engage in NSSI than heterosexual and cisgender (non-transgender) youth. Despite the scope of this social problem, it remains relatively unexamined in the literature. Research on other risk behaviors among LGBTQ youth indicates that experiencing homophobia and transphobia in key social contexts such as families, schools, and peer relationships contributes to health disparities among this group. Consequently, the aims of this study were to examine: (1) the relationship between LGBTQ youth's social environments and their NSSI behavior, and (2) whether/how specific aspects of the social environment contribute to an understanding of NSSI among LGBTQ youth. This study was conducted using an exploratory, sequential mixed methods design with two phases. The first phase of the study involved analysis of transcripts from interviews conducted with 44 LGBTQ youth recruited from a community-based organization. In this phase, five qualitative themes were identified: (1) Violence; (2) Misconceptions, Stigma, and Shame; (3) Negotiating LGBTQ Identity; (4) Invisibility and Isolation; and (5) Peer Relationships. Results from the qualitative phase were used to identify key variables and specify statistical models in the second, quantitative, phase of the study, using secondary data from a survey of 252 LGBTQ youth. The qualitative phase revealed how LGBTQ youth, themselves, described the role of the social environment in their NSSI behavior, while the quantitative phase was used to determine whether the qualitative findings could be used to predict engagement in NSSI among a larger sample of LGBTQ youth. The quantitative analyses found that certain social-environmental factors such as experiencing physical abuse at home, feeling unsafe at school, and greater openness about sexual orientation significantly predicted the likelihood of engaging in NSSI among LGBTQ youth. Furthermore, depression partially mediated the relationships between family physical abuse and NSSI and feeling unsafe at school and NSSI. The qualitative and quantitative results were compared in the interpretation phase to explore areas of convergence and incongruence. Overall, this study's findings indicate that social-environmental factors are salient to understanding NSSI among LGBTQ youth. The particular social contexts in which LGBTQ youth live significantly influence their engagement in this risk behavior. These findings can inform the development of culturally relevant NSSI interventions that address the social realities of LGBTQ youth's lives.

Asking For Help: Vulnerability within Consultative Assessment A Couples Therapy Example.

In many different ways psychologists are challenged to evaluate their work and be accountable when therapy is not progressing. One time honored approach to addressing the lack of progress is to seek formal psychological assessment to gain a better diagnostic understanding as well as treatment recommendations. The perspective on the purpose of the assessment seems to have changed however. Historically, the presumption was that there was some kind of pathology that the clinician was not seeing, where currently the perspective seems to be shifting more towards a focus on what might not be working in the therapeutic process. This shift in focus has led to new styles of collaborative and consultative assessment such as Therapeutic Assessment. Therapeutic Assessment was developed by Stephen Finn and has shown a great deal of promise helping clients and therapists gain valuable insight and move toward meaningful life changes (1998). Amidst the promise of consultative assessment also lie potential challenges for the referring clinician. This paper will explore the nature of consultative relationships in the field of mental health and the current thoughts about the advantages and challenges of these relationships. Using a case study format, it will discuss and illustrate issues of professional vulnerability that can arise during these relationships and postulate that a similar vulnerability could be present during a consultative assessment. Recommendations are made for maximizing the success of this type of assessment, and ideas for future research are reviewed. Through the lens of a couples Therapeutic Assessment case, this paper will examine what it is about this unique kind of professional relationship that garners such powerful potential and pitfalls.