This paper offers a perspective on self‐harm as encountered by psychotherapists and counsellors practising in non‐institutional settings. The author notes that the background of epidemiological information, which might inform clinical practice with these clients, is far from satisfactory. Difficulties in establishing an accurate epidemiology of self‐harm are considered. Some common responses to incidents of selfharm are then explored, with particular reference to countertransference issues and the lack of containment (Bion 1962) available to practitioners in some professions. A brief overview of theoretical perspectives on self‐harm is followed by a more detailed account of the contributions of Welldon (1988), Bion (1962, 1967) and Winnicott (1949, 1962, 1967). The author describes and discusses her work with clients who harm themselves, drawing primarily upon the concepts of‘projective identification’ (Klein 1946),‘containment’ (Bion 1962) and‘psychosomatic indwelling’ (Winnicott 1967).

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This paper outlines the development of a broad descriptive account of self-harming phenomena. The author suggests that self-harm is not, as is sometimes assumed, a phenomenon that can be readily identi ed and circumscribed. She introduces a 'continuum' model of self-harm, encompassing behaviour ranging from 'good enough' (Winnicott 1960) self-care at one end of the scale to severe self-harm at the other. She draws attention to the frequently encountered but little discussed phenomenon of self-harm by omission, and identi es a class of behaviours referred to as 'cashas' -culturally accepted self-harming acts/activities.Qualitative research, taking the form of conference workshop and supervision group discussion of clinical material, is presented. Selfharm is revealed as a diverse phenomenon, one that takes a multitude of forms, each of which may be enacted at various levels of severity. 'Hidden' manifestations of self-harm are discussed as well as the 'high visibility' manifestations that are the central focus in much of the literature.The tendency towards stereotyping in relation to self-harm is examined. The author questions the wisdom of attempting to arrive at any generalized account of the cause, function or meaning of self-harming behaviour. In recognition of the complexity of situation, she suggests that 'there is no single explanation for self-harm, no single meaning or communication conveyed by self-harm and no single psychological disorder or personality pro le associated with self-harm'.

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