The inability to manage distress would be problematic at any time; but it is especially problematic when distress is accompanied by (or made up of) feelings of rage, cruelty and self-hatred. I will argue here that people who self-harm are communicating rage and hostility to themselves and others in ways that often leave them frustrated and hopeless; and leave professional carers aghast. I will conclude with some ideas about psychological therapies that may help such people; drawing very much upon the work of colleagues in the forensic psychotherapy field: especially Anne Aiyegbusi (2004), Anna Motz (2008, 2009) and Estela Welldon (1992).