Therapists’ experiences of witnessing the physical manifestations of self-injury: an interpretative phenomenological analysis.

A precise account of the prevalence of self-injury (S.I) is unachievable as many incidences remain unreported. However, its high prevalence suggests that psychotherapists will encounter S.I in their practice and benefit from an increased understanding of the strong emotions that can emerge when seeing and hearing explicit accounts of S.I. This Interpretative Phenomenological Analysis (I.P.A) study explored the lived experiences of therapists who have witnessed the physical manifestations of S.I with specific regard as to how witnessing the injuries impacted upon them both personally and professionally. The study concerned itself with what aspects of these presentations were most challenging for therapists and the supports they drew upon to sustain them in their therapeutic practice. It utilised in-depth one-to-one interviews with nine psychotherapists. Two superordinate themes emerged: ‘Feeling Shocked’ and ‘Sitting on the Edge of your Seat’. Theme 1 outlines the therapist’s initial sense of shock, disbelief and revulsion at the sight of the injuries. They grappled to manage this inner conflict/tension and struggled to conceal this response from their clients, believing that clients would perceive their reactions as a judgement. ‘Sitting on the Edge of your Seat’ highlights the fears, concerns and heightened sense of responsibility experienced by the participants. They were concerned that their clients may complete suicide or die accidently from their S.I and feared that they could be held accountable for any fatal outcome. The embodied, challenging and sensed aspects of self-injury are rarely discussed from the perspective of the therapist and this study highlights the challenges experienced by therapists as they witness the physical manifestations of S.I