Self-harm is a complex and often misunderstood behaviour and is a serious public health issue. In 2010-2011 there were more than 26,000 hospitalizations across Australia as a consequence of self-harm. There will be thousands more instances not included in statistics because individuals don’t seek medical or mental health assistance. While the prevalence of self-harm is greater in girls and women, it is also a significant problem in boys and men.
Self-harm is most often carried out in secrecy and accompanied by feelings of intense shame and self-loathing. It is a behaviour that generates strong reactions in therapists, ranging from tremendous fear for client safety, to anger or helplessness when best attempts to assist the client may fail. Meanwhile, the dilemma for the client is it, “hurts so good”. In the supermarket of choices to manage feelings, memories, disconnect or reconnect, self-harm is an effective consumer choice. Clients self-harm because like alcohol or drugs, it works instantly.
The issue of self-harm can easily transition to unchecked counter-transference resulting in unproductive rescue attempts or angry blaming and rejection of the client. On the other hand, the client carries not only the physical scars but feelings of shame, fear of rejection and a sense of powerlessness to resist overwhelming urges. Fear of, or actual judgment by the therapist may cause self-harming behaviour to go ‘underground’. The consequence may be an escalation of self-harming behaviour and more serious injury.
This one day workshop based on a trauma informed understanding of the impact of trauma and abuse on attachment and self-regulation capacities, will focus on self harming behaviour in adults survivors with complex trauma presentations such as borderline personality disorder (BPD) and dissociative disorders (DD).
Through a theoretical understanding of trauma, practical strategies and clinical vignettes, Naomi will explore the process of the therapist learning to ‘tolerate’ the clients self-harming behaviour, while the client learns new strategies to remain present to painful feelings and reality on the road to healing.
Participants will be able to:
- describe the impact of trauma on attachment and self-regulation
- understand the complex dynamics of postraumatic transference and countertransference
- describe the various functions of self-harm
- learn how to ask about self-harm
- identify common forms of self-harming behaviour
- recognize the difference between self-harm and suicidality
- stay off Karpman’s triangle with the client who self-harms
- teach clients alternatives to self-harm as they develop tolerance to intense affect