It has been well established that self-harm is a key healthcare issue facing young people (Health and Social Information Centre, 2015). Consequently, many self-harmers preferentially seek support from friends (Evans, Hawton, & Rodham, 2005). Despite their unique position, friends’ experiences have been marginalised. Historically, friends have only been considered when they feature in the lives of the person who self-harms, when they are identified as “gate-keepers” to self-harming young people (Klingman & Hochdorf, 1993, p. 123), or when they themselves go on to self-harm (e.g. Hawton, Rodham, Evans, & Weatherall, 2002). Bearing in mind the friends’ unique, yet highly vulnerable status, there is a notable lack of research exploring how friends come to understand their experiences, and the subsequent impact this has on their friendships with the self-harmer. Through this qualitatively approached thesis I aimed to explore how the impact of self-harm on friendship is understood. Data was collected through a series of interviews and focus groups with friends of self-harmers, and those who supported them. Using a qualitative methodology, I conducted three studies. In Study One, I explored how counsellors made sense of the impact of self-harm on friendship. Studies Two and Three focussed on how friends, whilst maintaining a friendship with a self-harmer, came to understand themselves, their friendship with the self-harmer, and their relationships with others. The results indicated that friends struggled to integrate self-harm into their friendships and their understanding of themselves, took on excessive responsibility for the self-harmer, and felt constrained by secret-keeping. Additionally, as the friends in Study Three felt that information available to them was either absent, or lacking, I developed a prototype support tool tailored specifically to the needs of the friends.

Background: Self-injury is a serious behaviour undertaken by those in distress. Attitudes to self-injury both with and without intent to end life is often studied in terms of professionals working in Accident and Emergency (A&E), with little attention paid to other professionals or non-professionals. There are several potential aspects to one's stigmatising attitudes, such as willingness to help individuals, perceived causes for behaviour, optimism for prognosis and general empathy experienced. Moreover, some research suggests stigmatising attitudes may be different depending on the severity of the self-injury, including the presence or absence of suicidal intent. The aim of this study was to investigate the impact on these factors of the form of self-injury and professional background. Methods: Using an online survey methodology 436 respondents completed the survey. The attitudes of Mental Health Professionals, Primary Care Professionals and those not working in either of these settings ('Non-Professionals') were compared to explore their attitudes towards self-injury. Participants were randomly shown a vignette depicting either self-injury with or without intent to end life and reported their overall empathy, willingness to help, attributions for the behaviour and optimism for prognosis. Results: On all measures Non-Professionals reported more negative attitudes than either healthcare professional group, who had similar attitudes towards self-injury. Both professional groups differed in their attitudes towards self-injury with and without suicidal intent on all measures expect for optimism for prognosis. Across all professional groups a difference was seen between the optimism for personal and others' intervention. Conclusions: The study outlined the current attitudes of different healthcare professionals and the general public towards self-injury both with and without intent to end life. Differences in attitudes were seen, showing the potential to improve the stigmatising attitudes experienced by those who self-injure; methods were suggested by which to do this. Further research is needed in order to assess the clinical effectiveness of attempts to improve stigmatising attitudes.

This thesis is based on an Australian Research Council funded research grant. Fifty-one qualitative interviews were conducted with human service workers to gain an understanding of their interpretations of their clients’ ‘drug problems’ and of their own role, the service system and wider policies. Although harm minimisation has been Australia’s official drug policy since 1985, little is known about how harm minimisation is ‘enacted’ in the helping culture. To date human service workers have not been recognised in their constitutive role in harm minimisation discourse. Whilst a significant part of drug policy interventions are delivered via human services, the helping subject has not come under scrutiny. The drug using subject remains ill-conceived as a result of neglecting its partnering others or indeed its overlapping with other subject positions. Moving beyond recognising workers only in terms of staff opinions and attitudes, a relational and multi-level approach is adopted to introduce more complexity into the debate. After a brief historic discussion of the creation of the ‘human service worker’ and the ‘drug user’ (as client) and methodological considerations about discourse analysis, the thesis proceeds with the introduction of a conceptual framework consisting of four levels: the individual, relational, institutional and cultural political economic level. These levels are used to examine the existing literature on ‘drug problem factories’ and for the analysis of the data. By focusing on these levels the critical analysis of the interview material shows that ‘harm’ and ‘minimising’ are themselves contested categories and that different harms and different harm producing and minimising practices can be identified some of which have come into discourse, others are excluded or entirely absent. The human service workers struggle to make sense of their own role and to define how drug users are being ‘helped’ and could or should be helped. Their understanding of harm minimisation discourse aligns with, supports and/or resists other discourses such as (neo)liberalism, neoconservatism, prohibition and economic rationalism. The workers are portrayed as having substituted increasing complexity for initial simplicity in the course of working with ‘drug users’. In summary, this thesis offers a poststructuralist analysis of how harm minimisation is constituted, negotiated and undermined from the perspective of human service workers and shows how the service systems’ helping cultures enrol human service workers in harm producing and harm minimising practices. Harm minimisation consists of discursive and non-discursive elements and is a product of deliberate social forces as well as messy contingencies and unintended consequences.

Syftet med studien var att undersöka hur personer med ett injektionsmissbruk, som medverkade i sprututbytesverksamhet i Sverige, upplevde att deras livskvalitet blivit annorlunda. Vidare undersöktes också vilka insatser de blivit erbjudna och om de upplevde att de hade ett minskat riskbeteende. Frågeställningarna som användes i studien för att undersöka detta var:  Vilka insatser inom sprututbytesverksamheten erbjuds personer med injektionsmissbruk att ta del av?  Hur använder sig personer som medverkar i sprututbytesverksamhet av den kunskap de erhåller om hur de ska minska sitt riskbeteende?  Hur upplever personerna som deltar i sprututbytesverksamheten att deras livskvalitet blivit annorlunda? För att kunna svara på frågeställningarna användes en enkät som skickades till sprututbytesverksamheter i Sverige. De centrala begrepp som går att återfinna i studien är harm reduction och livskvalitet och dessa begrepp är väsentliga när det gäller konstruktionen av enkäten i relation till syfte och frågeställningar. Slutligen inkom 15 stycken enkäter av de 60 stycken som hade skickats ut, vilket gjorde att resultatet som kom fram inte gick att generalisera. Enkäterna behandlades i datorprogrammet SPSS för att kunna ge en tydlig bild av hur respondenterna svarat. Det som framkom i resultatet var att respondenterna främst använde sig av insatser som byte av sprutor, vaccinationer och att testa sig för sjukdomar. Smittskydd och smittspridning var de områden där respondenterna uppgav att de erbjöds mest information, vilket också var de områden de ansåg sig ha bäst kunskap om. Det framkom även att respondenterna ansåg att deras livskvalitet hade blivit bättre sedan de började i sprututbytesverksamheten. Insatser som syftade till att personerna som deltog skulle avsluta sitt narkotikamissbruk var inte något som det angavs att det erbjöds speciellt mycket av. Slutsatsen som drogs av studien var att de insatser som erbjöds på sprututbytesverksamheten i första hand syftade till att minska riskbeteende och smittspridning av HIV

Syfte: Syftet med studien var att beskriva hur ungdomar med självskadebeteende upplever bemötandet från vårdpersonalen. Metod: Studien genomfördes som en litteraturöversikt där sju kvalitativa vetenskapliga artiklar samt en kvantitativ vetenskaplig artikel användes. Datainsamlingen gjordes i databaserna PubMed, Psyc INFO och CINAHL Resultat: Resultatet av denna studie visade på att de flesta av ungdomarna med självskadebeteende inte sökte vård då de antingen var rädda för att förvärra sina problem eller för att de inte visste vart de skulle vända sig. De valde att i första hand söka hjälp hos sina vänner. Resultatet visade på tre kategorier. Dessa var: rädsla för vården, negativa upplevelser av bemötandet och positiva upplevelser av bemötandet. I resultatet framkom att av de som sökte hjälp inom sjukvården kände sig många missnöjda. Dessa ungdomar upplevde att det största problemet under vårdtiden var negativa attityder och dåligt bemötande från personalen. De ungdomar som tagit överdoser var övervägande positiva till det bemötande och den vård de fått till skillnad från de som inte tagit överdoser. Slutsats: Studien visade att ungdomar inte söker hjälp av sjukvården för sitt självskadebeteende då de är rädda för att deras problem ska förvärras eller att de inte ska bli förstådda eller tagna på allvar. De som ändå söker hjälp upplever att de får en annan hjälp än den de önskar.

The purpose is to illustrate the phenomenon of self-harm from a social psychological and sociological perspective. The purpose is furthermore to examine the role social relationships play in the individuals´ self- imagine and what role does identification play for anyone who harm themselves? We want to examine in what way social relationships are important and how they function for individuals who harm themselves, both once they have started to harm themselves, and if the relationships in any part caused the cutting to begin with. Questions: How do individuals shape their identity based on self- harm? Which self-image do individuals have who self-harm? Is there anything in the person's previous social relationships that have caused them to begin to hurt themselves? Method: In this paper we have analyzed five autobiographies. We have used open coding from grounded theory as analytical method and subject positions based on discourse analysis. Theory: We have used the Cooley concepts looking glass self, Foucault's theory of power, Giddens' concept of ontological security and existential anxiety. Results and Analysis: We found six different categories that we thought were central. These were negative self-image, guilt, lack of family support, negative experiences of others' views, the protective identity as self- harmer and insecure social relationships in school. Conclusion: The self-harming is a very complex behavior. In this paper we have found that social relationship has a major influence on if a person begins to develop self-harm. The negative social impact on social relations in childhood plays a particularly important role and affects the individual's identity and self-image. Identity was both linked to the development of a negative self-image and difficulty to stop harm themselves when upset, it was the thing they identified with and which gave them security.

Background: Self- harm among children is a growing problem in Sweden. The behavior means that persons deliberately hurt themselves. It´s not only the child who suffer from this behavior, it also affect the parents and siblings. It’s important that the nurse can give parents the support and information that they need. Research is limited when it comes to parents’ experience of having a child who deliberately harm her-/himself. Aim: The aim of this study was to illuminate parents’ experiences of living with a child with deliberate self-harm. Method: A literature-based study based on analysis of ten qualitative articles was performed. Results: The result are presented in three categories; "Feeling responsible", "Desire to be a better parent", "Feeling invisible and extradited" Conclusion: Nurses need more knowledge about self-harm and how parents perceive their situation. Parents need more support and information from the nurse.

Introduction: Deliberate self-harm is being increasingly recognised as a behaviour with significant clinical importance. Yet, there remains uncertainty regarding which forms of psychological therapy are most effective for its treatment. Schema Therapy is an integrative psychotherapy blending elements of cognitive behaviour therapy, object relations and gestalt therapy into a unified approach for the treatment of individuals with complex and chronic psychological conditions. The current thesis aimed to provide a better understanding of the Schema Therapy model and its association with deliberate self-harm. Systematic Review: Despite the increasing evidence base for the efficacy of Schema Therapy, less is known about the evidence for its theoretical underpinnings. To address this gap in the literature a systematic review was undertaken to explore the following question: How empirically supported is the theoretical underpinning of Schema Therapy? In a systematic search of the literature conducted until 01 June 2012, studies based on cross-sectional, longitudinal, intervention, meditational and experimental designs were considered. These studies underwent detailed quality analysis culminating in 19 articles being included in the current review. Overall these studies indicate that many of the key theoretical assumptions in Schema Therapy are supported by the literature. Empirical Study: Schema Therapy has recently been expanded to include the ‘schema mode’ concept, with a number of researchers highlighting an association between particular schema modes and a number of chronic psychological conditions. Although the schema mode model allows a method for understanding moment-to-moment emotional states it has not previously been explored in relation to deliberate self-harm. The current project aimed to explore the relationship between these variables and their association with early experiences of parental bonding and current levels of perceived stress. 70 psychiatric outpatients with a history of deliberate self-harm completed a number of measures including the Deliberate Self-Harm Inventory, Schema Mode Inventory, Parental Bonding Instrument and Perceived Stress Scale. Results revealed significant associations between deliberate self-harm, maladaptive schema modes, perceived stress and patterns of parental care. Maladaptive schema modes significantly mediated the relationship between parental care and deliberate self-harm. The Punitive Parent and Angry Child modes were significant mediators in this relationship. Conclusion: Results from the systematic review support the notion that Schema Therapy has a good theoretical underpinning. The empirical study also supports Schema Therapy by highlighting the meditational role of maladaptive schema modes in the relationship between low parental care in childhood and deliberate self-harm in adulthood. These findings provide further support for the Schema Therapy model and suggest that individuals with deliberate self-harm may benefit from this treatment.

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Thesis (M.A.)--Bowling Green State University, 2009. / Document formatted into pages; contains vii, 71 p. Includes bibliographical references.