Working with clients who engage in self-harming behaviour: experiences of a group of counsellors

This study aimed to explore the experiences of a group of counsellors regarding working with clients who engage in self-harming behaviour, in order to gain an understanding of what it is like to work with this client group. A series of six individual, semi-structured qualitative interviews were carried out, which were then transcribed and analysed using thematic analysis. Counsellors' experiences were characterised by a number of themes, including the nature of self-harm, in terms of severity and vividness of description, stopping self-harm, incorporating social norms and therapeutic outcome, and organisational issues around balancing expectations from the agency, managing risk, and the counsellors' own working. Findings suggest that working with clients who self-harm raises significant challenges for counsellors in relation to organisational policy and/or context, the impact that working with this client group may have on the therapist themselves, while the issue of stopping self-harm, and how this might be communicated to the client, raises implications for the therapeutic relationship. Here, the supervisory relationship may offer an invaluable resource.