ABSTRACT
How do you work with someone who thinks they already have a satisfactory way of managing their distress? How do you establish a therapeutic relationship with them, and together begin to explore the meaning of their actions? How do you move from surface concerns to the underlying conflicts? This chapter focuses on such aspects of the psychotherapeutic process, beginning with some thoughts on the importance of the working alliance with people who harm themselves, and including pragmatic concerns around safety, privacy and confidentiality. This is followed by a discussion on interpretation, on how to deal with silence, and on working with dreams as one way of accessing the unconscious. In the second part of the chapter the deeper concerns of the psychotherapeutic process are discussed, and some ways of thinking about the necessary shift from destructive behaviour to constructive thought.
