A systematic review and meta‐ethnography to explore people's experiences of psychotherapy for self‐harm

Abstract

Background: Self-harm is a major public health concern. Lifetime prevalence is high, and rates of self-harm are rising; however, available interventions do not benefit everyone, and engagement with therapy can be low. Qualitative accounts allow for a greater understanding of what is helpful to individuals. This study aimed to synthesize the experiences of interventions for self-harm, from participants who have participated in these themselves. Methods: Participants had self-harmed at least once and undergone an individual psychotherapeutic intervention for self-harm. Papers not written or translated to the English language were excluded. Four databases (Medline, CINAHL, Web of Science and PsycINFO) were systematically searched and each paper was assessed using the CASP quality appraisal tool. A meta-ethnographic approach to the synthesis was taken. Results: Ten studies encompassing 104 participants were included. Four overarching themes were developed and the importance of recognizing the person beyond the self-harm emerged through a line of argument synthesis. Building a trusted, therapeutic relationship founded on patience and without judgement was essential for the perceived success of therapy, which was unique to each person and often went beyond reducing self-harming behaviours. Limitations: Papers included in the study showed a lack of diversity with regard to ethnicity and gender. Conclusions: The findings illustrate the importance of the therapeutic alliance when working with self-harm. Clinical implications of this paper include the importance of

The Relational Approach to Treating Self-Harm (RELATE): Study protocol for a Feasibility Randomised Controlled Trial Study of Cognitive Analytic Therapy for Adults who Self-Harm versus Treatment at Usual

“…CAT can help both the therapist and patient to understand the way roles and patterns are being enacted in the therapeutic relationship, and thus repair the alliance ruptures that are a common feature. A recent meta-synthesis suggests that a focus on the therapeutic relationship is key for therapy for selfharm, supporting the use of relational approaches like CAT (40). A propensity score matched case-controlled study found 8-session CAT within NHS 'talking therapies' settings had comparable e cacy to CBT for depression and anxiety, but with a lower rate of attrition (41), which is consistent with other research (26) and highlights the acceptability of the approach.…”

A Brief Cognitive Analytic Therapy–Informed Approach for Young People That Have Self‐Injured (CATCH‐Y): A Case Series

“…A strength of this work is the inclusion of a measure of personal recovery as one of the outcomes. Unique to each individual, successful therapeutic outcomes have been found to be perceived as meaningful change within relationships with the self and others, as well as an improvement in ability to regulate one's emotions (Haw et al 2023). Qualitative investigation has consistently found that a reduction in self-harm repetition is not the main priority for many who have undergone interventions for self-harm (Owens et al 2020); however, successful outcomes in clinical trials are still typically quantified by reductions in self-harm (Witt et al 2021).…”

“…Unique to each individual, successful therapeutic outcomes have been found to be perceived as meaningful change within relationships with the self and others, as well as an improvement in ability to regulate one's emotions (Haw et al. 2023). Qualitative investigation has consistently found that a reduction in self‐harm repetition is not the main priority for many who have undergone interventions for self‐harm (Owens et al.…”

The Relational Approach to Treating Self-Harm (RELATE): study protocol for a feasibility randomised controlled trial study of cognitive analytic therapy for adults who self-harm versus treatment at usual

“…CAT can help both the therapist and patient to understand the way roles and patterns are being enacted in the therapeutic relationship, and thus repair the alliance ruptures that are a common feature. A recent meta-synthesis suggests that a focus on the therapeutic relationship is key in therapy for self-harm, supporting the use of relational approaches like CAT [ 42 ]. A propensity score-matched case-controlled study found that 8-session CAT within NHS ‘talking therapies’ settings was associated with comparable change to CBT for depression and anxiety, but with a lower rate of attrition [ 43 ], which is consistent with other research [ 28 ] and highlights the acceptability of the approach.…”