Working with the risk of suicide and acts of self-harm is one of the most demanding and challenging aspects of therapeutic work. Not only is the therapist confronted by the stark negativity and destructiveness of the patient at such times, but also by their own anxiety, frustration, outrage and impotence. This can result in the therapist either entering into a paralysed state of constant alarm or, conversely, becoming complacent and dismissive about the self-destructive potential with which they are presented.
This workshop aims to provide a clear framework for:
- appraising and understanding the function of such self-injurious and risk-taking behaviours
- responding to such behaviours with the seriousness that they deserve without them dominating the therapeutic encounter and paralysing the therapist
- addressing issues of trust/distrust, hope/despair and collaboration/sabotage
- understanding ‘the battle of the self’
- maintaining therapeutic optimism in the face of potential destructiveness
The workshop will draw on the presenter’s 25+ years’ experience of working in secure and acute psychiatric wards, intensive day units and community mental health services with ‘difficult to engage’ and ‘high-risk’ patients. Drawing on core psychoanalytic principles, field-work research and his own published material, the presenter aims to provide an accessible approach for tolerating the risks, challenges and opportunities for profound change that we can encounter in such work.
Pete Holloway is a Consultant Psychological Practitioner and Locality Lead for secondary care psychological therapies in an NHS mental health service in Kent. He is also a Senior Lecturer in Psychology at Roehampton University. Over the last 25 years he has integrated insights from his experience in forensic psychotherapy, systemic psychotherapy and drama-therapy in order to treat patients with diagnoses of personality disorder and histories of complex trauma.