Countertransference and self-injury: a cognitive behavioural cycle

Rayner, G; Allen, S; Johnson, M

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.

Citation

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

• Journal Article Type: Article
• Publication Date: Jan 1, 2005
• Deposit Date: Nov 26, 2009
• Journal: Journal of Advanced Nursing
• Print ISSN: 0309-2402
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 1
• Pages: 12-19
• Keywords: self-injury, self-harm, nurse countertransference, cognitive behavioural; approach, interpersonal processes, personality disorder
• Additional Information: 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. Klein M. (1946) Notes on some schizoid mechanisms. International Journal of Psycho-Analysis 27, 99–110. Linehan M.M. (1993) Cognitive Behavioural Treatment of Borderline Personality Disorder. Guilford Press, New York, London. Malin A. & Grotstein J.S. (1966) Projective identification in the therapeutic process. International Journal of Psycho-Analysis 47, 26–31. McAllister M. & Walsh K. (2003) CARE: a framework for mental health practice. Journal of Psychiatric and Mental Health Nursing 10, 39–48. McAuliffe C., Keeley H.S & Corcoran P. (2002) Problem-solving and repetition of parasuicide. Behavioural and Cognitive Psychotherapy 30(4), 385–397. National Institute for Clinical Excellence (2004) Self-harm – The Short Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. Clinical guideline 16. National Institute for Clinical Excellence, London. National Institute for Mental Health in England (2003) Personality Disorder: No Longer a Diagnosis of Exclusion – Policy Guidance for Development of Services for People with Personality Disorder. Department of Health Publications, London. O’Kelly G. (1998) Countertransference in the nurse–patient relationship: a review of the literature. Journal of Advanced Nursing 28(2), 391–397. Ogden T.H. (1982) Projective Identification and Psychotherapeutic Technique. Jason Aronson, New York. Pao A.N. (1969) The syndrome of delicate self-cutting. British Journal of Psychology 42, 195–206. Pembroke L.R. (1996) Self-harm: Perspectives from Personal Experience. Survivors Speak Out, London. Racker H. (1957) The meanings and uses of countertransference. Psychoanalytic Quarterly 26, 303–357. Rayner G. & Warner S. (2003) Self-harming behaviour: from lay perceptions to clinical practice. Counselling Psychology Quarterly 16(4), 305–329. Richards B.M. (2000) Impact upon therapy and the therapist when working with suicidal clients: some transference and countertransference aspects. British Journal of Guidance and Counselling 28(3), 325–337. Thompson J.E. (1990) Finding the borderlines border: can Martha Rogers help? Perspectives in Psychiatric Care 26(4), 7–10. Winship G. (1995) The unconscious impact of caring for acutely disturbed clients: a perspective for supervision. Journal of Psychiatric and Mental Health Nursing 2(4), 227–231. Young J.E. (1999) Cognitive Therapy for Personality Disorders: a Schema-focused Approach, 3rd edn. Professional Resource Press, Florida.