Self-Harm and Suicidality

The theme of working with destructively enacted forms of aggression, this time turned inwards against the body, is continued in this chapter. Two patterns of self-harm are described and illustrated with case examples: communicative/other-regulatory and secretive self-regulatory. Verbatim notes are used to show key moments in a session with an adolescent self-harmer, alongside the therapist’s inner conversation. Transforming enacted destructive self-regulation into healthier forms of mentalised self-and-interactive emotional regulation is the therapeutic direction of travel. Facilitating emotional regulation between the child and the primary caregivers is seen as the biggest challenge. The chapter concludes with comments on the future of family therapy for child and adolescent self-harm.