From cycles of shame in self-harm to compassionate psychotherapy groups.

Transcription

1 From cycles of shame in self-harm to compassionate psychotherapy groups. D R G I L L I A N R A Y N E R S E N I O R L E C T U R E R U N I V E R S I T Y O F S A L F O R D

2 Aims of the research Interpersonal processes and self injury The aim of this study was to provide a rich exploration of what happens between clients and staff when self-injury occurs.

3 What did I do? Three pairs of clients and staff were interviewed about a specific incident of self-injury, with a focus on thoughts feelings and behaviours before during and after the self-injury. The data from the interviews was thematically analysed and then synthesised.

4 Research methodology Qualitative research McLeod (1996) considers Bricolage as a pieced together solution to research that is unique to each research experience. A methodological bricolage containing the use of narrative, phenomenological philosophy, critical incident technique and the use of the self as data by using reflexivity.

5 Key points from the research 1) The importance of looking at client and staff experiences together to recognise interpersonal issues. 2) Self-injury can become a cycle of shame avoidance and shame induction to manage and induce interpersonal conflict. Worthless with added shame on top 3) Staff were able to avoid rushing into action and cope with not-knowing and containment. These are essential skills for helpers. Published in the Journal of Psychiatric and Mental Health Nursing.

6 Shame Crowe (2004) states that the signs of shame include; The persons description of themselves with negative global evaluations, such as I m bad, faulty or inferior. The person feels a need to hide themselves away from others who they see as evaluating them. The person may express hostility to others who they perceive to be evaluating them. The person expresses a sense of powerlessness or worthlessness. The person may be sensitive to the opinions of others.

7 Nathanson (1989) stated that people who have experienced shame tend to have two routes for managing these feelings; 1)An interpersonal withdrawal, a shrinking experience, hiding from the shame eliciting situation. (private self injury) 2)Reactivating their devaluing self through otherdirected anger and externalising the blame onto others. (help seeking in A&E)

8 Example-self-injury 1)Self-injury was reported to facilitate a withdrawal for the clients. The incidents discussed occurred in private. The self-injury resulted in the numbing experience which helped them to avoid internal shame. This then induced a blaming and devaluing reaction from others that confirmed their shameful self-beliefs. 2)After the self-injury, the clients reported that the anger became externalised towards the A&E staff or MH staff. They were then able to express this. Following humiliation in A&E clients were able to express anger at everyone else. This may also be endorsed by the staff by expressing other-directed anger and blame towards the staff in A&E.

9 It could be argued that shame traps the person into thinking they are a failure and worthless. This in turn may generate an experience of self-rejection and rejection by others. This can lead to a sense of helplessness, inferiority vulnerability and loss of control. Thus self-injury; the cycle of shame

10 Self-injury: the cycle of shame Triggered by interpersonal conflict Self-injury Shame Anger Numbness Shame avoidance Causing further interpersonal conflict and confirmation of negative beliefs Rejection from others (shame inducing) Help seeking

11 CBT and Compassion Focused Therapy (shame and guilt) I have created an Integrated approach of Cognitive Behavioural Therapy (Sutton, 2007) and Compassion Focused Therapy (Gilbert, 2010) in a twenty session psychotherapy group. (2hrs per week). Within this group we will also be using my research on interpersonal issues and self-injury to explore the process of self-injury and the possible role of shame in order to create new interactions that avoid exacerbation of self-harm.

12 Plans This approach has been created and then staff and students will be trained how to use this and supervised in practice. I have two experts by experience to advise and co-facilitate some sessions (art and poetry). We hope to run free psychotherapy groups in our new counselling and psychotherapy suite and research the impact using mixed methods research. We hope to recruit group members as co-researchers to evaluate the impact. Questionnaires for quantitative change and qualitative focus group for detailed feedback.

13 CBT/CFT Psychotherapy group for people who self-harm Weekly mindfulness practice with a focus on compassion What is self-harm? Why do people do it? Why do we do it? Personal Formulation on functions of self-harm (using cards). CFT model education Creating a compassionate other Compassionate flow Interpersonal issues and self-harm; interpersonal functions and effects, understanding other peoples reactions to our self-harm Cycle of shame formulation game (Puzzle) Coping strategies that work Maintenance factors that keep us stuck Fear of compassion (questionnaire discussion) Giving compassion, Self-compassion, Receiving compassion Using all senses compassionately Compassionate soothe box Future compassionate plans when in difficulty

14 Further reading Crowe, M. (2004). "Never good enough-part 1 : Shame or borderline personality disorder." Journal of Psychiatric and Mental Health Nursing 11: Gilbert, P (2010) The Compassionate Mind. Constable and Robinson, London. Nathanson, D. (1989) "Understanding what is hidden: Shame in sexual abuse."psychiatric Clinics of North America 12: McCleod (1996)The humanistic paradigm. In R. Woolfe & W. Dryden (Eds),Handbook of Counselling Psychology. (pp ). London: Sage. Rayner, G. and Warne, T. (2016), Interpersonal processes and self-injury: a qualitative study using Bricolage. J. Psychiatric and Mental. Health Nursing., 23: doi: /jpm Sutton, J. (2007) Healing the Hurt Within: 3rd edition: Understand Self-injury and Self-harm, and Heal the Emotional Wounds. How to Books limited Oxford.