Self harm describes any behaviour where you inflict some form of pain or harm upon your own body, usually as a way of coping with difficult or distressing emotions. It is commonly associated with acts such as cutting, burning, pinching or otherwise physically attacking yourself (self injury), but can also include drug and alcohol abuse (self poisoning) and eating disorders. Self harm can be a difficult behaviour to understand, and its causes can be complex.
Hurting yourself may feel like a quick fix, or even positive, solution to difficult situations and emotions in the short-term, but it doesn't address the underlying issues that are causing you to feel distress. The National Institute for Health and Care Excellence (NICE) recommends psychodynamic therapy as one of the most effective ways of treating those underlying issues at the root of self harm. We asked RSCPP therapists to explain what psychodynamic therapy is and how it can be used as a treatment for self harm.
Psychodynamic therapy involves a process of exploration undertaken by you and your therapist together, in order to gain an understanding of the unconscious processes that take place in your mind and are expressed in all your relationships. Your early experiences are important in shaping the way your mind works, and a large part of your mind operates outside of your conscious awareness. In the psychodynamic therapy sessions, you will be encouraged to reflect on whatever is uppermost in your mind. Feelings, thoughts, wishes, fears, memories and dreams can be explored within the relationship between you and your therapist. You will be helped to understand the unconscious processes that affect your conscious thinking and behaviour. In this way, psychodynamic therapy can gradually bring about self understanding, particularly about how past experiences can affect your current behaviour, and this enables you to find more appropriate ways of being, and of coping with difficulties.
Psychodynamic therapy aims to provide an opportunity for you to become more aware of the underlying emotions and motivations that may be driving your unhelpful or destructive patterns of behaviour. By becoming more aware of these processes, the assumption is that over time this will enable you to make a conscious, positive change. There is also usually an assumption that your early or childhood relationships play an important part in understanding the origin of your presenting problems. The relationship between you and your therapist is used as a way for you to become more aware of these processes. Your therapist will give you as much opportunity as possible to process and reflect on emotions as they arise in therapy.
Psychodynamic therapy tries to understand the unconscious and conscious motives and defences you may employ to protect yourself. Your therapist will want to understand what lies behind your self harming and the function it serves for you. They will want to gain an understanding of when the self harming started, and the triggers that lead you to self harm. Your therapist will be looking for patterns in your behaviour, and trying to understand how these patterns are repeated and played out. Ultimately, the aim of psychodynamic therapy is to bring the unconscious factors behind the self harm to your conscious mind.
There are usually two possible reasons why people may self harm, and some psychodynamic theorists suggest that self injury is essentially self-destructive in nature and is an externalised representation of an unconscious wish to end your life. In contrast, some clients view self-injury as a way of coping with life rather than ending it. A further theory suggests that self harm occurs when murderous wishes have been redirected from external objects towards the self. Therefore self harm may also be a method of coping with interpersonal difficulties when directly communicating your anger is difficult. A psychodynamic perspective suggests that self injury is an internally motivated response to difficult feelings, so that those feelings are instead expressed through self harm.
The length of time therapy lasts, and the number of sessions given, will vary greatly from client to client and also from therapist to therapist.
An initial assessment might give you a better idea of how long psychodynamic therapy is likely to last. Sessions are usually weekly and last around 50 minutes to an hour.
As a guide, NICE recommends 3-12 sessions of psychodynamic therapy as a treatment for self harm.
Psychodynamic therapy is suitable for anyone who, during their initial assessment, shows a capacity to reflect on their difficulties.
In particular, psychodynamic therapy can be helpful for people who would like time and space to process and understand their emotions in the context of their past and present relationships.
By becoming more aware of your underlying emotions, you can then understand them more and therefore choose how to respond to them, rather than be governed by reflex or unconscious drives. You will have the opportunity to develop a different relationship with painful emotions, so the need to get rid of them or block them out through self harm becomes less of a necessity. Like other therapy models, if you can engage in the therapy process and feel you can trust your therapist, there is every reason to expect a positive outcome.
Ultimately, the outcome of psychodynamic therapy is hopefully a full recovery from your symptoms, but this very much depends on individual clients and will be affected by factors including: how long the self harming behaviour has been occurring, your age, and your motivation to stop self harming.
All therapists on rscpp.co.uk are accredited, registered or chartered by a UK professional body. Therapists who offer psychodynamic therapy will in addition have completed a course in psychodynamic practice.