Countertransference and self-injury: a cognitive behavioural cycle


  • Gillian C. Rayner MA PGCE RGN RMN DipCBT,

  • Shelly L. Allen MSc PGCE RMN,

  • Martin Johnson MSc PhD RN

Gillian C. Rayner,
Department of Nursing,
Salford University,
Frederick Road,
Manchester M5 4WT,


Aim.  This paper discusses the emotional, cognitive and behavioural effects of self-injury on nurses as helpers, and shows the usefulness of a cycle that can affect care provision for this group of people.

Background.  People self-injure for many different reasons, such as feeling angry, sad, guilty or frightened and these emotions are often linked to feeling helpless, powerless or out of control. Self-injury has often been reported as a coping strategy to gain control. Psychoanalytic and cognitive behavioural concepts have been used to understand why people self-injure and also inform intervention strategies. Unfortunately, negative emotional responses in professionals may interfere with the effectiveness of any therapeutic relationship.

Discussion.  Negative emotional responses from nurses can affect the way they think about and behave towards clients who self-injure. During clinical supervision or education, nurses’ thoughts can be challenged to become less negative, so that their resulting behaviour can also become less punitive. Non-punitive or more positive behaviour can in turn challenge some of the negative self-beliefs of clients.

Conclusions.  Knowledge about countertransference when working with people who self-injure may reduce nurses’ negative thoughts and behaviours, which may result in improved client care.