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087 – Counselling Self Harm Clients

087 – Self-Harm – ‘Shrinking’ People – Smart Placement Searching

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In episode 87 of the Counselling Tutor Podcast, Ken Kelly and Rory Lees-Oakes look at the complex issue of self-harm. In ‘Practice Matters’, Rory describes how to ‘shrink’ people. Last, the presenters provide guidance on looking for a counselling placement.

Free Download: Shrinking the Past in Therapy

Self-Harm (starts at 2.58 mins)

Rory describes a study on self-harm that was reported by the British Medical Journal, a high-quality UK periodical for the medical profession. This research found that there has been a sharp rise in self-harm for girls aged 13 to 16 since 2011. Self-harm is a prevalent issue that it is important to be aware of as a counsellor. It could affect a client directly (if they self-harm) or indirectly (if they have a friend or family member who does so).

Self-harm can take various forms, for example cutting with sharp objects, biting, poisoning or trichotillomania (hair-pulling). Above all, it is important to show the client compassion, empathy and understanding, accepting them as they are and not telling them they must stop. In the past, this was far from the case, with A&E practitioners even stitching such wounds without anaesthetic as a way of deterring self-harm.

Exploring with the client what they get from self-harming is key. For example, self-harm may be a cry for help, a distraction from emotional pain, or an attempt to have control over something when other things feel out of control. Other people gain satisfaction from seeing blood. Self-harm may go in a cycle, for example from cutting to feeling remorse to feeling better to cutting again. The client may be most likely to approach a counsellor for help during the remorse part of this cycle.

Last but not least, consider the physical-health implications of self-harm. The damage may be concealed under clothing and could be infected. Safe self-harming practices may be useful – for example, Rory suggests putting an elastic band on the wrist and flicking it to cause pain (as this is much less likely to cause serious harm).

There will be a new lecture coming to the Counselling Study Resource (CSR) later this academic year on self-harm.

‘Shrinking’ People (starts at 18.17 mins)

By ‘shrinking’ people, Rory refers to reducing the significance of people who have caused harm in the past. He describes seeing a frail old man shopping and realising he was a teacher who – in his youth – hurt him with painful corporal punishment. It helped Rory to reconceptualise the athletic young teacher as his current ‘shrunken’ form. Similarly, an adult who was abused as a child may feel that their abuser is still larger than them (as of course they were at the time).

Part of the role of a counsellor is to help clients see themselves as they are in the here and now, and so help them not feel overwhelmed by difficult figures from the past. Rory offers a range of tips on how to work with a client who feels vulnerable when talking about a past abuser in the counselling room. These are detailed on his handout, which can be downloaded here and is also available in the Handouts Vault and CSR.

Free Download: Shrinking the Past in Therapy

Smart Placement Searching (starts at 25.17 mins)

Getting a counselling placement can feel daunting, but it doesn’t need to be with Ken and Rory’s hints on how to be smart in your search. After all, it’s important not just to find a placement but to find the right placement for you. Here’s how you can do this:

  • Ask your tutor for advice: colleges should have close links with local counselling agencies.
  • Find out when second-year students are likely to be around, and introduce yourself, asking where they are doing their placements.
  • Google ‘charities counselling [place name]’, inserting your location, and see what results come up.
  • Get into the right mindset, remembering that counselling placements are mutually beneficial; the agency isn’t simply doing you a favour by offering you one. You will be helping them too.
  • Ask questions when you go to your interview, for example on whether you can view the rooms (would you feel comfortable if you were a client there?), what their policy is on recording sessions (Ken asserts that this can be a really helpful learning tool, as Carl Rogers suggested), and whether you could speak to some placement counsellors there before you decide.
  • Be persistent – if you leave a message at an agency and don’t hear back, contact them again – and again if need be. If you don’t get a call back, try writing to them: don’t give up!
  • Think about the best times of year to apply. Rory suggests that November/December and June/July are good months to look.

In conclusion, don’t succumb to the rumours that placements are rare and so hard to find: if you approach the task with determination and organisation, and follow the tips above, you will find the right one for you.

Would you like Ken and Rory to offer a workshop on finding placements? Do let us know whether that would be useful for you. You can do so via the Counselling Tutor Facebook group, or by emailing us at [email protected] or [email protected].

Links and Resources

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