Psychological intervention for self-harm: A qualitative review of individual experiences of psychotherapy and a brief case series examination of a cognitive analytic therapy-informed intervention for young people

Abstract

This thesis investigated the qualitative experiences of psychotherapy for those who self-harm and the feasibility of a brief, cognitive analytic therapy (CAT) informed intervention for young people who engage in non-suicidal self-injury (NSSI). This is presented across three papers: 1) a systematic review and meta-ethnography of the literature; 2) an empirical study evaluating the intervention; 3) a critical appraisal of the research process. Paper one was a systematic review and meta-ethnography which explored peoples' qualitative experiences of psychotherapy for self-harm. Four overarching themes were elicited from the synthesis: foundations for change, the therapeutic relationship as a vehicle for change, development through therapeutic processes, and therapy as life changing. A line of argument synthesis was developed and a conceptual framework around recognising the person behind the self-harm was produced. The main findings illustrated the importance of building a trusting therapeutic relationship which led to empowerment and positive change across the unique domains of an individual's life. Clinical implications include improved understanding of the importance of collaboration and individual tolerance and the recommendation that future research incorporates those from diverse backgrounds. Paper two investigated the feasibility and acceptability of Cognitive Analytic Therapy for the Containment of Self-Harm in Young People (CATCH-Y); a CAT-informed intervention with a population of young people who had engaged in NSSI. Thirteen participants were recruited from local Child and Adolescent Mental Health Services (CAMHS) for the five-week intervention. There were high rates of referrals and study retention and overall, the intervention was deemed largely acceptable by participants. Secondary outcomes showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although the overall results were mixed and should be interpreted with caution. The results show that future research into the CATCH-Y intervention is warranted with preliminary support found for high levels of engagement and positive change. The critical appraisal (Paper 3) provides a reflective evaluation of both the systematic review and empirical project. Aspects of the design, implementation and analysis of the papers are reviewed and personal reflections of the researcher's experiences are presented.

Date of Award	31 Dec 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Peter Taylor (Supervisor)