Working with individuals who self-harm. SCOTTISH Personality Disorder Network. Outline. Working with self-harming clients; what are we working with? Encountering dilemmas Supporting staff Managing ourselves and others Reflection and returning to work. Self-harm.
Personality Disorder Network
“ …. an individual intentionally damaging a part of his or her own body, apparently without a conscious intent to die”
“…intentional self-poisoning or injury, irrespective of the apparent purpose of the act”
“…a deliberate act to damage yourself, without intending to die. This varies according to the situation, the individual carrying out the act and is a means of getting away from intolerable thoughts or feelings” HOTUSH
No definitive description:
Mental Health Foundation, 2004
50% of the 4000 people who commit suicide each year will have self-harmed at some time in the past.
Good creatures do you love your lives
And have you ears for sense?
Here is a knife like other knives,
That cost me eighteen pence.
I need but stick it in my heart
And down will come the sky,
And earth’s foundations will depart
And all you folk will die.
Housman, cited by Hale 2008
Self-harm can be understood as;
Both require a ‘host’ or ‘other’
Self-harm and attempted or completed suicide take place within a relationship:
“By opening up the surface of the skin, aspects of the dynamics of the internalised experience are repetitiously evoked, though not consciously recollected”
“External figures are often recruited in ways which support the internal psychic structures”
The patient may launch “an attack on any mental process that might threaten to bring awareness of human need and potentially healthy dependency”
“Even the most bloody examples of self-destructive provocative behaviour may be an attempt to prevent some catastrophe which the patient perceives as even more destructive to his or her own integrity – engulfment, psychosis, violence or complete despair”Campling, 1996
Some level of anxiety is required to be able “to recognise, appreciate and react to actual situations of danger in external situations”
Containment as “the need for the ‘vessel’ in the form of the community and the worker to be able not only to hold on to the disturbance but to digest and process it”