In this week’s ‘Practice Matters’, Rory speaks with Kate Day about working with clients who self-harm.

The key points of this discussion include:

• There can be many reasons why people might self-harm: self-punishment in response to self-loathing or anger, to gain a sense of control or self-regulation, to express their distress, dissociate or relieve unbearable tension.
• Those who are neurodivergent are particularly vulnerable.
• The experience and meaning of self-harm can differ greatly from person to person.
• When working with self-harm in therapy, think about what is going on underneath the behaviour – what is driving the harm?
• There are many different ways to self-harm, and it’s not always physical.
• Psychological-based self-harm - repeating harmful behaviours and patterns as a form of self-sabotage.
• Allow the client space and time to openly talk about their self-harm with a skilled and empathic practitioner.
• Remain non-judgemental.
• Facilitate change by working with and supporting the client, not by trying to ‘fix’ them.
• Practice coping strategies, see what works for them as an individual.
• When working with self-harm in therapy, find the underlying feelings.
• Listen to the client, pick up on non-verbal cues.
• Offer reassurance that their thoughts and anxieties are going to be taken seriously.
• If you feel there is a need to break confidentiality, be open and honest with the client, try to get their consent and help them to understand.
• The wound somebody may or may not have, doesn’t necessarily show the severity of how distressed a person is feeling inside.