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When counselling is not enough

Updated: May 8


Some experiences are so profound they have the power to shift perception in a moment. Our clients are so often our teachers.

Over 20 years ago, as a Rogerian counsellor, I came to understand the reasons for self harm at a much deeper level when I met Sam in a Category A prison.

All these years later, I still think of him and wish I had been able to offer more than my empathy, openness and non judgment. I wish I could have given him an explanation for his suffering and a plan to help release him from his pain. The encounter with Sam was, for me, the moment I knew I would have to seek out more training. It was also the moment I realised the core conditions were necessary… but simply not sufficient. 

Sam’s story

Sam had been living rough for several years, pitching a tent in local woodland or sleeping in shop doorways from time to time.

His adult life had been tough; so had his childhood. I can see his face quite clearly, even now, grinning at me across the Formica table that separated us.Sam didn't have many teeth left. They fell out, or were punched out, over a lifetime of struggle. Like many of the men I encountered while working in this place, Sam was a victim. He had a traumatic story that went back to when he was a small boy.

Neglected and abandoned by his mother, abused by his father, Sam had opted to leave home as early as possible and took to the streets. A life of petty crime followed.But my heart really went out to him when he rolled up his sleeve to show me the many cuts that criss-crossed his arms. Mostly they were healed with raised, bluish, keloid scars. Worryingly though, some marks looked fresher, brighter, redder than the others.

'Do you want to say something about this Sam?' I asked.I listened attentively as he tried to describe some of his childhood experiences and the purpose the cutting had served for him then. The words came hard but he struggled on.

The telling of his story, and knowing it had been heard, felt important in the moment.

The experience, for me, by the end of the session, was so intense that, when he left the cubicle and I was waiting for the patrolling officer to come and open up the door for me, I hurriedly wrote down all the thoughts and feelings which came in that moment.

 Those words I would later construct into a piece of poetry to try to capture, as best I could, the essence of what Sam had tried so hard to convey. Now I work from a coach-counsellor integrated model, I would have been able to offer my client so much more. Looking at his self harm through a 'SAFE SPACE' lens could have been a very helpful starting point.Self harm and SAFE SPACE

The SAFE SPACE 'recipe' for emotional well-being is an easy way to remember our key human needs for Security, Attention, Fun, family and friendship, Emotional intimacy, Status, Privacy, Achievement, Control and Engagement. When these universal needs are being met, human beings feel life is worth living. We feel positive, motivated and engaged with a world which has meaning and purpose for us.As well as our innate needs we also have a kind of internal emotional SATNAV which is always trying to prompt us to get those needs met. Some emotions can feel uncomfortable so, along the way, we might develop complex mechanisms for emotional management (affect regulation). 

We try to maintain a sense of homeostasis by keeping emotions within a comfortable range. If unable to regulate internally, drink, drugs or certain behaviours can become the external props and crutches we use to get through.

For children, so much of their life is outside their control. As they try to construct their personal identity, pressure, stress and strain can materialise in behaviours which might begin as a coping mechanism but can soon develop into a pattern; a conditioned response or an addiction.

At first, cutting or self harm can give an illusion of Control just as with other needs:

  • As a way of avoiding uncomfortable emotion and staying Safe

  • As a way of communicating distress and drawing Attention

  • As a covert act in Private

And, for children who get caught up in a 'peer culture' of self harm, the act itself can become a bonding experience and tick other emotional needs boxes such as Achievement, Emotional intimacy, Friendship and Status.

Professional evolution

When I met Sam all those years ago, I offered him everything I had in my professional toolbox at that time and, to my former' self I would say 'You did what you could with what you had...but it was not enough.'  My evolution to therapeutic coach has seen the acquisition of many more skills and tools along the way; much of which I now know could have been so helpful to Sam, such as: 

  • Normalisation of the mechanism of his distress with psycho education

  • Resolution of his childhood trauma with an imaginal exposure technique such as Rewind

  • Behavioural pattern breaking with The STOP System

  • Identifying and resolving cognitive distortions

  • Establishing helpful new behaviours through positive mental rehearsal

  • Restoration of hope and motivation with metaphor and therapeutic story

  • Super-future pacing

  • Holistic life coaching

Yes, there is so much more I could do now but, back then, with enormous good will and good intentions, I listened respectfully as Sam told his story and wrote for him a poem that he would never see.                                                                                                  

For Sam*

For all the crap, for all the hurt

I cut.

For all the tears, rejection, fears

I cut.

For the man who was no father to me

For the mother who I lost

For all the doors slammed in my face

I cut 

The pressure builds.

Internal screams

A thousand voices rise

Orgasmic rush explodes in pain

The razor is my only friend


See my blood? I’m drenched in blame

Can you feel the toxic shame?

Consign it to an unmarked grave

Conceal it if you must 

They call me weak.

Yet I am strong

They see victim.

I survive

The look of pity in your eyes

Betrays the truth, deflects the guilt 

I am you and you are me 

The screaming of your inner child

Connects us in a bond of pain

Where do I stop and you begin? 

Coagulation seals the vein  


 * Anonymised

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