Narratives of Treatment Outcome

This article is based on the findings of an interview study that explored the discourses clinicians draw on in their narratives in relation to self-injury. More specifically, the study focused on the clinicians’ discourses of responsibility for treatment outcome, and how they construct concepts of success, failure, and partial failure. Eight mental health clinicians from various disciplines who employed a range of treatment modalities were selected using purposive sampling. An in-depth conversational-style interviewing approach was used. The findings of the study highlight the complexities and difficulties the clinicians encountered with regard to the evaluation of their clinical practice with self-injuring patients. It appears that clinicians have little or no systematic way of thinking or conceptualizing “progress” with regard to self-injury. In relation to who is responsible for treatment outcome, the clinicians occupied various discursive positions. These findings have implications for the education and training of clinicians in developing systematic indicators of progress with respect to self-injury and in creating spaces in which they can speak about and reflect on their clinical effectiveness and failures.