This can be best described as hurting oneself on purpose, but without a desire to kill oneself. The usual way this is done is by cutting oneself with sharp objects, burning oneself, hitting or bruising oneself, biting oneself, pulling out one's hair, and more rarely, breaking one's bones. It is a method of coping with extreme emotional distress. It can sometimes be a 'side effect' of Dissociative Disorders - one part that finds release in self-harm or perhaps different parts wanting to stop the therapy process for whatever reason.

Self-harm is associated with different things and it is useful for clients to secure some information about the self-harm subject. However, be aware that there is no one answer, 'This is how people who self-harm feel', there are many variables. The information should contain general statements such as, 'Some people who self-harm find it is ...' The items below are fairly typical, but not an exhaustive list.

First - a way of releasing anger. These people feel they cannot release anger to anyone (especially parents) and so they release it on the only person they have permission to hurt - themselves. The Trauma Resolution Experience (TRE) used in PICT will be very useful for people to realise they do have permission to be angry with their parents and also gives them a specific vehicle to do so. Some may also need to do further anger work using PICT's usual anger tools.

Second - a way to demonstrate the level of emotional pain they are experiencing. These people generally feel they are not important, not listened to, not believed and self-harm is one way to say to others, 'See how much pain I am in! Help me!'

Third - a way of releasing pain. These people are so removed from their feelings that the only way they can release pain is to self-harm. It is like they are showing their own self (as opposed to others) the depth of their pain. Self-harm can also be a useful distraction from the sometimes even greater emotional pain.

Fourth - a way of feeling they have some power in their life. It is similar to what can happen in the Eating Disorder arena, a condition that reflects an overall sense of powerlessness, leaving the person unconsciously taking power over the only thing they have left - their body.

Fifth - a way to punish one's self. Many people who have experienced childhood abuse feel that whatever happened is their own fault or that they made it happen in some way. That level of guilt can lead to self punishment - self-harm is one way people do that.

As a behaviour, self-harm can also become almost addictive, no matter what the underlying root cause or reason for use.

PICT therapists create a useful dialogue and help create a working relationship between therapist and client, rather than therapist holding all the cards or client holding all the cards. The main resolution technique, the TRE, is used to address self-harm issues. The client's unconscious mind is utilised to go back to a time when the FEELINGS that run the behaviour started, NOT when the behaviour started. Then the resolution work begins.