‘They don't understand…you cut yourself in order to live.’ Interpretative repertoires jointly constructing interactions between adult women who self-harm and professional caregivers.

Abstract

The aim of the study was to illuminate interpretative repertoires that jointly construct the interaction between adult women who self-harm and professional caregivers in psychiatric inpatient care. Participant observations and informal interviews were conducted among six women who self-harm and their professional caregivers in two psychiatric inpatient wards, and analysed using the concept of interpretative repertoires from the discipline of discursive psychology. The analysis revealed four interpretative repertoires that jointly constructed the interaction. The professional caregivers used a “fostering repertoire” and a “supportive repertoire” and the women who self-harmed used a “victim repertoire” and an “expert repertoire.” The women and the caregivers were positioned and positioned themselves and people around them within and among these interpretative repertoires to make sense of their experiences of the interaction. It was necessary to consider each woman's own life chances and knowledge about herself and her needs. The participants made it clear that it was essential for them to be met with respect as individuals. Professional caregivers need to work in partnership with individuals who self-harm—experts by profession collaborating with experts by experience. Caregivers need to look beyond behavioural symptoms and recognise each individual's possibilities for agency.

Features of Everyday Life in Psychiatric Inpatient Care for Self-harming: An Observational Study of Six Women

“…Inpatients expect an environment to recover in, with support and help, including relationships, access to information, enhanced communication, a place of safety and personal space, activities, medication and a chance to be involved in treatment planning (Lindgren,Öster,Åström, & Graneheim, 2011;Lindgren, Wilstrand, Gilje, & Olofsson, 2004;Walsh & Boyle, 2009). Nursing staff report dissatisfaction with their work milieu and with their knowledge of best inpatient care practice for people with mental ill-health (Seed, Torkelson, & Alnatour, 2010;Wilstrand et al, 2007).…”

Harm‐reduction approaches for self‐cutting in inpatient mental health settings: Development and preliminary validation of the Attitudes to Self‐cutting Management (ASc‐Me) Scale

“…For example, such approaches can involve practices including providing advice on wound‐hygiene, or supplying sterile cutting blades, activities which have no direct corollaries in terms of the management of, say, aggression. Nevertheless, there has been a growing interest in harm‐minimization approaches for self‐injury, and such techniques have been advocated by some who suggest that a more baldly preventative approach can be distressing, stigmatizing and detrimental to the therapeutic relationship with professionals, and can contribute to behavioural escalation (Duperouzel & Fish, ; Holley, Horton, Cartmail, & Bradley, ; Lindgren, Öster, Åström, & Graneheim, ; Pembroke, ; Shaw, ). Much debate around the use of harm‐minimization approaches has been rooted in non‐empirical discussions of ethics and legalities, much of whose tone suggests a stark binary choice between adopting or proscribing such techniques (e.g., Edwards & Hewitt, ; Gutridge, ; Sullivan, ).…”

Meanings of caring for people who self‐harm as disclosed in narratives of dialectical behaviour therapy professionals

“…Observing the interactions between women who self‐harmed and professional caregivers, Lindgren et al . () found that the caregivers usually took on either a fostering or a supportive role, and the women who self‐harmed mainly took on the roles of victims or experts. When caregivers were supportive and acknowledged the women as experts, listened to them, and believed in their expertise based on experience, the women were more satisfied with their care.…”

“…, Lindgren et al . ) because people who self‐harm experience the behaviour as their only possible way to survive (Lindgren et al . , Brown & Kimball ).…”

“…) because people who self‐harm experience the behaviour as their only possible way to survive (Lindgren et al . , Brown & Kimball ). Some people who self‐harm experience the function of self‐harm as a way to take control over life and describe that the self‐harming act is misunderstood and often mixed with suicide attempts by professionals (Brown & Kimball ).…”