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Countertransference and self-injury: a cognitive behavioural cycle

Rayner, G, Allen, SL and Johnson, M 2005, 'Countertransference and self-injury: a cognitive behavioural cycle' , Journal of Advanced Nursing, 50 (1) , pp. 12-19.

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    Abstract

    Countertransference and self-injury: a cognitive behavioural cycle Aim. This paper discusses the emotional, cognitive and behavioural effects of selfinjury on nurses as helpers, and shows the usefulness of a cycle that can affect care provision for this group of people. Background. People self-injure for many different reasons, such as feeling angry, sad, guilty or frightened and these emotions are often linked to feeling helpless, powerless or out of control. Self-injury has often been reported as a coping strategy to gain control. Psychoanalytic and cognitive behavioural concepts have been used to understand why people self-injure and also inform intervention strategies. Unfortunately, negative emotional responses in professionals may interfere with the effectiveness of any therapeutic relationship. Discussion. Negative emotional responses from nurses can affect the way they think about and behave towards clients who self-injure. During clinical supervision or education, nurses’ thoughts can be challenged to become less negative, so that their resulting behaviour can also become less punitive. Non-punitive or more positive behaviour can in turn challenge some of the negative self-beliefs of clients. Conclusions. Knowledge about countertransference when working with people who self-injure may reduce nurses’ negative thoughts and behaviours, which may result in improved client care.

    Item Type: Article
    Uncontrolled Keywords: self-injury, self-harm, nurse countertransference, cognitive behavioural approach, interpersonal processes, personality disorder
    Themes: Subjects / Themes > R Medicine > RT Nursing
    Subjects / Themes > B Philosophy. Psychology. Religion > BF Psychology
    Health and Wellbeing
    Subjects outside of the University Themes
    Schools: Colleges and Schools > College of Health & Social Care > School of Nursing, Midwifery, Social Work & Social Sciences > Centre for Nursing, Midwifery & Social Work Research
    Colleges and Schools > College of Health & Social Care
    Colleges and Schools > College of Health & Social Care > School of Nursing, Midwifery, Social Work & Social Sciences
    Journal or Publication Title: Journal of Advanced Nursing
    Publisher: Wiley-Blackwell
    Refereed: Yes
    ISSN: 0309-2402
    Depositing User: Dr Gillian Rayner
    Date Deposited: 26 Nov 2009 09:51
    Last Modified: 20 Aug 2013 17:01
    References: Allen S. & Beasley S. (2001) Suicide/self-harm. In Forensic Nursing and Mental Disorder in Clinical Practice, Chapter 5 (McClelland N., Humphreys M., Conlon L. & Hillis T., eds), Butterworth- Heinemann, Oxford. Arnold L. (1994) Understanding Self-injury. Bristol Crisis Service for Women, Bristol. Babiker G. & Arnold L. (1997) The Language of Injury: Comprehending Self-mutilation. The British Psychological Society, Blackwell Publishing, Oxford. Beck A. & Freeman A. (1990) Cognitive Therapy of Personality Disorder. Guilford Press, New York, London. Clarke L. & Whittaker M. (1998) Self-mutilation: culture, contents and nursing responses. Journal of Clinical Nursing 7, 129–137. Cleary M. (2003) The challenges of mental health care reform for contemporary mental health nursing practice: relationships, power and control. International Journal of Mental Health Nursing 12, 139–147. What is already known about this topic • People self-injure as a coping strategy to deal with difficult emotions and situations. • Nurses’ have found psychoanalytic and cognitive behavioural approaches useful when working with people who self-injure. • Professionals often feel angry, sad, rejected or ‘a failure’ when working with people who self-injure. What this paper adds • Consideration of nurses’ countertransference reactions to people who self-injure. • An illustration of psychoanalytic concepts in cognitive behavioural terms. • A cognitive behavioural cycle for understanding how clients’ and nurses’ emotions, cognitions and behaviours may influence each other. G.C. Rayner et al. 18 2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(1), 12–19 Connors R. (2000) Self-injury: Psychotherapy with People Who Engage in Self-inflicted Violence. Aronson, New York. Davidson K. (2000) Cognitive Therapy for Personality Disorder: A Guide for Therapists. Butterworth-Heinemann, Oxford. Fieldman M.D. (1988) The challenge of self-mutilation: a review. Comprehensive Psychiatry 29, 252–269. Fincham F.D. & Emery R.E. (1998) Limited mental capacities and perceived control in attribution of responsibility. British Journal of Social Psychology 27, 193–207. Fletcher P. & Hogg C. (2001) Should nurses always intervene when patients self-harm? Nursing Times 97(49), 16. Gabbard G.O. & Wilkinson S.M. (2000) Management of Countertransference with Borderline Clients. Jason Aronson Inc., Northvale, New Jersey, London. Hallberg I.R., Berg A. & Arlehamn L.T. (1994) The parallel process in clinical supervision with a schizophrenic client. Perspectives in Psychiatric Care 30(2), 26–32. Jeffery D. & Warm A. (2002) A study of service providers’ understanding of self-harm. Journal of Mental Health 11(3), 295–303. Kelly M.P. & May D. (1982) Good and bad clients: a review of the literature and a theoretical critique. Journal of Advanced Nursing 7(2), 147–156. 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    URI: http://usir.salford.ac.uk/id/eprint/2560

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