Multicentre monitoring of self-harm in England has demonstrated similar overall patterns of self-harm in Oxford, Manchester and Leeds, with some differences reflecting local suicide rates. Diurnal variation in time of presentation to hospital and the need for assessment of non-admitted patients have implications for service provision.

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Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

A questionnaire survey of 95 qualified psychotherapists of various therapeutic orientations and 69 psychologists in clinical training was carried out to investigate the main influences on their clinical practice, using the Questionnaire of Influencing Factors on Clinical Practice in Psychotherapies (QuIF-CliPP). For the qualified group the most highly rated factors were current supervision, client characteristics, client feedback, psychological formulation, intuition/judgement, professional training and post-qualification training. For the trainees, those rated highest were current supervision, past supervision, client characteristics, client feedback, psychological formulation and professional training. Evidence based factors such as treatment manuals and evidence based guidelines were rated relatively low for both groups, although the cognitive behaviour therapists rated them significantly higher than the other groups. Personal therapy was rated highly by the psychodynamic, psychoanalytic, person centred and eclectic therapists but not by CB therapists. The implications of these findings for the application of evidence based practice and the need to evaluated supervision, personal therapy and training are discussed.