Deliberate self-harm and sexual abuse in adolescence

Helping a young person to render repeated self-injury redundant as a solution to problems connected with having been sexually abused requires a containing context which both supports autonomic healing in the patient and provides an experiential model for the restoration of relationship with adults as a safe (non-abusive) activity. In this paper a case study is presented and some treatment issues for individual psychotherapeutic work are addressed. These include ensuring that the power balance between patient and therapist is acknowledged by emphasizing the patient's self-determination, recognizing patterns of re-enactment within sessions, and addressing here-and-now behaviour and its link with the original trauma. This paper also examines the changing function of self-injurious behaviour and how it can be perceived as addictive after the establishment of a proper alliance between patient and therapist. the circular logic involved in avoiding identification with the abuse-perpetrator by way of self-injury is explored. the therapeutic relationship as an alternative to this is discussed.