Counsellors' perceptions of client progression when working with clients who intentionally self-injure and the impact such work has on the therapist

Abstract

Over thirty years ago the issue of intentional self-harm was viewed as exceptionally challenging for practitioners providing care for clients who engaged in this behaviour and today counsellors continue to struggle with this complex phenomenon. This study explores counsellors' perceptions of client progression when working with clients who intentionally self-injure and the impact such work as on the therapist. This qualitative phenomenological research study employed semi-structured interviews and utilised the constant comparative method to analyse the data. Findings indicate that counsellors experience intense emotions in response to clients intentional self-injury, including shock, sadness, anxiety, anger and frustration. Although participants indicated there was a requirement to work in a client-centred way, they all had either an explicit or implicit agenda for change to stop this behaviour. Participants also struggled to manage the tensions between the multiple dualities relating to the complexity of the phenomenon and the ambiguous nature of the counselling process. In addition there were various views of client progression yet all particpants stated that progression was not simply about stopping the self-harm. The shocking and visible consequences of self-injury and ambiguity relating to the xounselling process, combined with the additional necessary requirements of the counsellor to provide effective therapy, exacerbates therapist anxiety. It is suggested that further research especially within the counselling field, focusing on the ambiguous nature of the issue may enlighten understanding with regards to the complexity of the subject which may help to reduce therapist anxiety by communicating the message that there is more than one way of conceiving and working with the issue of intentional self-harm.