ABSTRACT
See if you can relate to the following clinical scenario: ere are 5 minutes to go at the end of a seemingly calm and productive therapy session with a trauma survivor. Suddenly, the client rolls up her sleeve, exposes her wrist and forearm, and reveals five deep, angry-looking scratches and a cigarette burn. Her affect is a combination of intense shame and pride. She says she spent the whole session internally debating about whether to show you what she had done the night before. She discloses that she has been hurting her body off and on for years. She is worried that you will be angry, disgusted, or afraid. She is even more terrified about the possibility of you wanting to put her in the hospital. You are trying to maintain an outwardly calm facade, yet your heart is racing, and you are unsure of how to proceed. Although you have been working competently and comfortably with trauma survivors and their issues, when faced with client disclosures of chronic self-destructive behaviors, you are on less confident ground.
