1. BACP CYPF Conference 9th February 2019
RESPONDING THERAPEUTICALLY TO YOUNG PEOPLE WHO SELF-HARM
Jeanine Connor, MBACP, MSc, BSc (Hons) Child & Adolescent Psychotherapist

2. This poses dilemmas for the counsellor/therapist
Introduction
Working with a child or young person who self-harms is always about working with risk
This poses dilemmas for the counsellor/therapist
Today we will explore the risk and think about how to manage the dilemmas…

3. Session aims Explore fantasies Dispel fears Reframe thinking
Assess and manage risk
Reflect on professional obligations
Enable us to respond confidently, safely and therapeutically

4.  Explore fantasies
What are the common beliefs/fantasies about children & young people who self-harm?  

5. Common fantasies Self-harm is attention-seeking
Self-harm is a fad they will grow out of
People who self-harm have usually been abused
It’s mostly girls who self-harm
People self-harm because their friends do it
All young people self-harm; it’s normal
Self-harm is a precursor to suicide

6. Dispel fears
What are the common fears about working therapeutically with children & young people who self-harm?

7. Common fears I might not be able to get them to stop
They might seriously hurt themself
It will be my fault if they do
I will have to tell their parent/carer
It’s too risky for me to work with
They might die
I will be responsible for their safety

8. Reframe thinking
Self-harm is a communication about a child or young person’s state of mind
What might they be trying to say?

9. Communication I am hurting I have been hurt I deserve to be hurt
I don’t have the words
Help me
Notice me
I want to be looked after
I want to live

10. Managing risk
Working therapeutically with children & young people who self-harm involves a balance between holding risk and exploring meaning

11. Professional obligations
Ethical dilemmas
Safeguarding
Confidentiality

12. Ethical dilemmas Can I manage the risk? Am I professionally competent?
What if I’m shocked by what I see/hear about?
Who should I tell?
What should I say?
What if I make things worse?
What if I damage the therapeutic relationship?

13. Safeguarding Assess ‘here-and-now’ risk Assess context
Assess ordinary age-appropriate behaviour
Apply knowledge
Access support
Apply clinical decision making
Explain your decision

14. Confidentiality Is the information confidential?
Do I have/need consent to share it?
What is the purpose of sharing the information?
Is sharing information in the best interests of the child or young person?
Is there a legal requirement to share information?
What is the most appropriate way to share the information?

15. BACP ethical framework
Work to professional standards by: working within our competence, and … collaborating with colleagues
Act in the best interests of the child
When the safeguarding of our clients from serious harm takes priority over our commitment to putting our clients’ wishes and confidentiality first, we will usually consult with our client (in the first instance)
We will use our supervision and any other available professional resources to support and challenge how we respond
We will take responsibility for considering how best to act and will be ready to explain why we decided to respond in the way we did

16. Our response Respond confidently Respond safely
Respond therapeutically

17. Final review Have your fears been dispelled?
Have you reframed your thinking?
Do you feel better equipped to manage risk?
Are you aware of your professional obligations?
Do you feel more able to respond confidently, safely and therapeutically to children & young people who self-harm?

18. Presentation prepared by Jeanine Connor All images copyright free
Goodbye and thank you
Presentation prepared by Jeanine Connor
All images copyright free