Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Counseling and Psychological Services

First Advisor

Catharina Y. Chang, Ph.D.

Second Advisor

Greg Brack, Ph.D.

Third Advisor

Jonathan Orr, Ph.D.

Fourth Advisor

Lisa Adams, Ph.D.


Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.