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  • 2021ClampPhD

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What outcome goals do young people aged 16 to 20 years who self-harm have for therapy and what in therapy helped or hindered them in achieving these goals

Research output: ThesisDoctoral Thesis

Publication date2022
Number of pages305
Awarding Institution
  • Lancaster University
<mark>Original language</mark>English


Investigations reveal that instances of self-harm by young people are rising and are an increasing challenge for healthcare and mental health services (Morgan et al., 2017; McManus et al., 2019; Barker, 2020). Young people’s negative experiences of accessing help and support when they self-harm have been a contributing factor to them not seeking help in future episodes (Wadman et al., 2018; Jones et al., 2019)

This thesis illustrates a systematic review which is concerned with young people’s barriers to help seeking, what outcomes they wanted for therapy, and whether they experienced therapy as helpful or unhelpful. It also presents an empirical study which explored the experience of therapy for 10 young people who had a history of self-harm with an IAPT service in the East of England.

For the systematic review, a systematic search for relevant literature produced since 1978 was conducted across six databases. A total of 8768 records were sourced from six databases. After scrutiny for duplicate records, assessment for suitability, and full-text eligibility screening, 142 papers were included for synthesis. Following synthesis and quality appraisal, it was observed that literature fell into two overarching themes: young people, self-harm and help seeking, and young people’s experiences of therapy. It was also noted that studies have been published into the epidemiology and prevalence of self-harm and also for the efficacy of therapy from the perspective of the client. However, no studies have combined the two in one exploration of therapy with young people who self-harm.

The empirical study focuses on analysis of 10 qualitative semi-structured interviews. Interviews were audio recorded, transcribed, coded, and analysed using reflective thematic analysis from a social constructive viewpoint, underpinned by a person-centred and social constructionist theoretical perspective. The reflective thematic analysis identified four themes: Hope of feeling more in control, Therapy changed the way I see things, Therapist enabled a positive therapeutic space, and There are consequences to admitting to self-harming. The findings suggest that having or regaining a sense of control, beyond the common desire, is a goal for therapy of young people who self-harm. The findings suggest the reasons for participants feeling they did not achieve their goals for therapy included poor therapeutic alliance, resistance to change and idiosyncrasies of service provision in rural locations.