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This paper offers a perspective on self-harm as encountered by psychotherapists and counsellors practising in non-institutional settings. The author notes that the background of epidemiological information, which might inform clinical practice with these clients, is far from satisfactory. Difficulties in establishing an accurate epidemiology of self-harm are considered. Some common responses to incidents of selfharm are then explored, with particular reference to countertransference issues and the lack of containment (Bion 1962) available to practitioners in some professions.
A brief overview of theoretical perspectives on self-harm is followed by a more detailed account of the contributions of Welldon (1988), Bion (1962, 1967) and Winnicott (1949, 1962, 1967). The author describes and discusses her work with clients who harm themselves, drawing primarily upon the concepts of ‘projective identification’ (Klein 1946), ‘containment’ (Bion 1962) and ‘psychosomatic indwelling’ (Winnicott 1967).