Westers, N. J. (2024).
Psychotherapy, 61(3), 250–258.
Abstract
Beneficence and nonmaleficence are key ethical principles toward which psychotherapists consistently strive. When patients engage in nonsuicidal self-injury (NSSI) during the course of psychotherapy, therapists may feel responsible for visually assessing the severity of the NSSI wound in order to benefit their patients and keep them from harm. However, there are no guidelines for conducting these visual assessments, and there is no research exploring their effects on patients. This article considers the ethical implications of visually examining NSSI wounds; discusses psychotherapist scope of practice and competence; draws attention to relevant ethical standards; underscores risk management, liability, and standard of care; and addresses the risk of suicide or accidental death resulting from NSSI. It also provides ethical guidance for conducting effective verbal assessments of NSSI wounds and offers suggestions for navigating complex clinical situations, such as when patients routinely and spontaneously show their therapists their wounds and how psychotherapists should handle assessments and interventions related to NSSI scars. It ends with implications for training and therapeutic practice.
Impact Statement
Question: How should psychotherapists navigate assessment of nonsuicidal self-injury (NSSI) wounds, and how does this inform their work with auxiliary treatment team members such as medical professionals and parents?
Findings: This article discusses the scope of practice of psychology, individual psychotherapist competence, and risk management to critically evaluate if and how therapists should assess NSSI wounds.
Meaning: There may be times when briefly looking at NSSI wounds is appropriate in psychotherapy, but visually assessing NSSI wounds is not within the scope of practice of psychology and may not protect patients from harm.
Next Steps: Research should examine with patients if and how their psychotherapist conducted visual assessments of their NSSI wounds, by whom these assessments were initiated, how they affected the patient experience, and if they resulted in help or harm.
The article is paywalled.
Here are some thoughts:
Current research lacks data on the impact of visually or verbally assessing NSSI wounds on patients. This article argues that visual assessment of NSSI wounds is outside the scope of practice for psychologists and can be potentially harmful. Therefore, psychologists need to be aware of interpersonal boundaries, clinical literature, and ethical standards. Instead, verbal assessment is recommended as best practice. Effective verbal assessment techniques include open-ended questions about wound care, pain, and medical attention, while maintaining a respectful and curious demeanor. Therapists should prioritize patient safety and refer patients to medical professionals when necessary. Ultimately, a balance between patient care and ethical boundaries should guide clinical practice.
