Double-edged: Thinking about healthcare professionals' responses to self-harm

Self-harm is common and familiar to many healthcare professionals working in mental health and emergency medicine. Encounters with patients who have self-harmed frequently elicit powerful emotional responses from professionals, which have been explored and characterised in a number of existing qualitative studies. Self-harm serves a number of different functions, ranging from conscious, intrapsychic motivations such as affect regulation, to interpersonal communicative functions which are understood within the psychoanalytic literature to be largely unconscious. This paper aims to explore the unconscious communicative functions of self-harm by characterising the common emotional responses of healthcare professionals encountering patients who have self-harmed, drawing on a narrative review of the existing literature as well as short interviews with clinical staff. Furthermore, this paper aims to understand these responses within the framework of the established unconscious interpersonal functions served by self-harm, thus bridging the divide that can often exist between the front-line exposure to the physicality of self-harm and psychodynamic understanding of the meanings underlying these experiences. The range of responses is organised firstly in terms of the primary emotional reactions, and secondly in terms of the healthcare professional's defences against these emotions, which may themselves be either intrapsychic or enacted. In conclusion, the essential importance of reflective practice in clinical work is emphasised.