Counseling Women and Girls: The Feminist Therapy

Subject: Psychology
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Study level: PhD

The feminist therapy has been defined as that practice of therapy that is usually informed by the analysis and philosophies of political feminist grounded in a diverse study of gender psychology, social location, and power, and which leads a client and the therapist towards solutions and strategies that advances feminist transformation, resistance and social change in the everyday personal life, emotional, social relationships, and political environments (Brown 1994).

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The feminist therapy places both power and gender at the heart of the therapeutic progression. The theory rests on a need to better understand the cultural and social perspectives which seems to influence an individual’s problems, with a view to better understanding such an individual. The “psychological oppression of women”, coupled with the restrictions forced by the social political rankings that women have in essence been consigned to, seems to be the hallmark of the feminist therapy theory.

Seeing that the feminist therapy has assumed a grassroots form of development, while at the same time also responding to women’s emerging needs and challenges, perhaps this could explain its relatively brief history. Moreover, the feminism therapy is not attributed to a single founder. Its history dates back to the1960’s women movement. During this period, women joined hands to voice their discontent with the confining and limiting nature that was a characteristic of the conventional gender roles.

The 1970’s paved way for a profusion of gender-biased research, in effect facilitating a furthering of the ideas of the feminist therapy. Towards this end, the Women in Psychology Association (AWP) and the Psychological Association of Americans were established. During the 1980s, feminist therapy claimed its place as an independent entity. As a result, individual therapy became the most common and frequently practiced type of the feminist therapy theory.

At this point too, the scholarly work of Stone Centre and Miller greatly impacted in the expansion of “feminist personality theory”. This was however to undergo a dramatic change, as diversity and focus now shifted to such definite issues and problems as abusive relationships, body image, sexual abuse and incest, as well as eating disorders. The philosophies of feminist that were a guide of the therapy practice were also diversified.

With respect to SIV, the feminist therapy theory is linked to a specific set of other correlated therapies that seems to stem from the disparity understanding between the well researched psychological theories on the one hand, and the practices associated with individuals seeking counseling on the other hand.

The setting of a feminist therapy is such that both the client and the therapist are equals at work. It is the role of a therapist to demystify the feminist therapy right from the start. This is important, so that is can be demonstrated to the client that it is her duty to rescue herself from the trauma that seemed to bedevil her.

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In addition, the roles, expectations ands responsibilities of the client as well as the therapist have to be both regarded and explored on an equal basis. The therapist too is also awake to the realization that for every symptom exhibited by a client, there is a corresponding strength, and a therapist aspires to help a client utilize such strength.

The feminist therapy heavily borrows from the developmental theories, liberation psychology, and humanistic psychology. Thus, clinical psychologist tends to be extremely interested on how data inform their experiences, but are often careful that they are not bound by dispensing empirically-aided treatments. The feminist theory is a reflection on the complexity and diversity of the human experience. In essence, the feminist theory views, in retrospect, the “other” positively and centrally, as opposed to a deviant perspective.

This is especially vital when dealing with self-inflicted violence, as the victims often tend to be stigmatized, especially when SIV appears to be interpersonal, that is, the violence as seen from the point of view of the victim. The feminist therapy is also seen as arising from the “experience of other”. It is thus a reflection as it were, of the real world as people have come to know it.

The feminist therapy theorizes behavior as having arisen as interplay of both the internal as well as the external worlds. The feminist practice at both the behavioral and the non-conscious level, appears to be subverting patriarchy in respect to the body, self, the interpersonal relationships, society, work, creativity, and values. Patriarchy per se is not used here in reference to man, but rather to norms and institutions that gives privilege to those attributes that are attributed to being male, as well as those that appears to marginalize, shame, and degrade the aspect of femaleness.

It could as well be inclusive of “obvious women subjugation”, or fail to altogether. In a patriarchal society, individuals occupying dominant positions are characterized by certain power types, and this makes the practice of going “head to head” disastrous.

The feminist perspective on its part seems to go around, over, and through the issue; the feminist therapist holds a client in her/his center, in effect sipping off patriarchy away from the center.

Feminist therapy has both contextual and specific clients. From a contextual perspective, this is with regard to the broad nature of the culture that allows clients to operate, and which could as well be the particular sources of SIV. On the other hand, the specific context is with regard to that client in an office. The assumption taken here is that the feminist theory is a complete vision of a “give-and-take influence” that sits between all the parts of a client-system, family, therapist, the culture, the society at large, and the cycle continues.

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Gender appears to be both a resilient and a risk factor in view of SIV. In Western societies, the female gender is usually associated with relational distress, while the male gender is always associated with acts of violence. Variations do often occur though, as a result of cultural changes and class. In light of this, it becomes important then to assess how gender appears to inform the self-inflicted violence experience, and how clients are able to respond to such an experience, the responses of a therapist, and the existence of rules of the cultural context, with regard to gender.

Questions have often been raised as to the definition of gender, aside from “the sex of the body”. The view held by the prevailing psychological perspective of feminists is that gender is something that we usually do, as opposed to” something that we are”. Gender is a social organization pattern that gives structure to power relations. From the assumptions of constructivists; gender appears not to be inherent, but rather as a construct which merges during social encounters.

Another assumption is that behaviors are often gendered by those conventions that have been assigned to them, and not by the sex of actors. In addition, power seems to impact the behavior role of gender. For this reason, “more feminine means more powerless”. Should there be a default in gendered assumptions, with regard to behavior, this might as well cause a misdiagnosis.

As such, a behavior could be assigned to a gender by membership, as opposed to dysfunction. In people who have been traumatized, trauma effects may either be invisible or denied owing to in fact “normal” behavior that are gendered. It is important that the issue of gender be tackled critically, as this is a powerful variable for individual selves, and which is often self-objectified as a way through which an individual fails as either a man, or a woman.

A critical thinking on the part of a therapist in terms of gender perspective could also lead to them developing useful hypothesis regarding their clients. A critical gender review occupies a central position in the feministic perspective while handling trauma, as trauma usually appears to be a biopsychosocial and gendered experience. In a case whereby a therapist is handling a trauma, (in this case, SIV), it is important that she/he becomes aware of their apparent shift in powerlessness. In light of this, the adage, “to give is to have”, appears to apply here.

When a therapist chooses to cede power by way of creating a space that is eventually occupied by a client, such a therapist is in effect punctuating their power simultaneously. This is because they have a choice to either yield, of fail to, and this is an illustration of power at play.

It is often considered an inherent assumption in the feminist therapy theory that clients usually have intra and inter-personal powers, although they may not be currently able to access such capacities. The feminist therapy calls for openness, on the part of a client, so that they could be easily transformed. According to a paradigm of the feminist therapy, a therapist is an expert in the creation of ideal conditions to individual transformation and empowerment.

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On the other hand, the client is seen as an authority and expert of their individual lives, meanings, and values. Moreover, it is possible that a client may not be aware of the powers that they possess especially if they have a history of “interpersonal trauma”. In this case, the job of a therapist is not to displace this power with values and own meanings, but rather to utilize power and enable a client to both uncover and own the values that they have always possessed.

Power shifts often tend to be change markers in the process of therapy, from the perspective of a client, and in as far as the cultural context that seems to impact on a therapy session is concerned.

In a 2007 article title ‘Feminist therapy with people who self-inflict violence’, Bryan (2007) has extensively explored the issue of feminist therapy. The article tries to explore specific clients that have already fallen victim to SIV. The entire persuasion has been amassed from sensible grounds, and a wide variety of feminist therapist concepts have also been evaluated here.

The article seems to have remarkably illustrated the feminist therapy, with the therapist being portrayed as a promoter of the impacts that are associated with the safety measures of clients. Beyond this application, client empowering seems to be the prime objective. As such, the principle of egalitarian relationship is a key element of the feminist therapy.

On the one hand, the therapist is able to utilize their knowledge on psychology to the benefit of the clients, while the client on the other hand supplies the therapist with the knowledge of herself. As such, this sort of relationship is a model that challenges women to assume responsibility of ensuring that all their relationships are egalitarian.

The role of a feminist therapist is to harness the strengths of a client, as opposed to offering a remedy to their weaknesses, thus accepting and authenticating the feelings of a client. The theory of the feminist therapy is under constant review, owing to the dynamic nature of social contexts, coupled with development discourse.

Nevertheless, the well-being of a client still remains the overriding factor of the therapy. It is worth noting here that a therapist has to at all times maintain accountability. In addition, this model does not heap blame on victims.

In a feminist therapy session, the issue of context identity is always addressed. This refers to that complex understanding of an individual, which also appears to be fluid and multifaceted, on the basis of societal as well as individual factors that could either vary or be fixed, of even evolve with time.

The experience that an individual has lived through seeks to provide the inner self of an individual, be it unconsciously, or consciously. There is also a sense of the way such an individual is able to perceive themselves. One such aspect is that of an individual self, which has an emotional, biological and cognitive perspective.

Additionally, the identity level includes among others thoughts, feelings, beliefs, wishes, changeable understandings and intangible aspects. In light of this, a majority of the people that finds their way into a feminist therapy session are often forced to come into terms with this level of individuality. For example, to remedy transitions in life, to handle loss and pain, or even establish a focus into their lives. It is this latter aspect of the individual self that is of utmost relevance to the feminist therapy in light of SIV. The conventional psychotherapy of the west appears to lay much emphasis on this level of individuality.

The feminist theory makes use of the integrated effort of such contributors as Carolyn Zerbe Enns, Lurs Brown, Jean Baker Miller, and Olivia Espin. Whereas the feminist theory is alive to the realization that the cultural and social contexts have an impact on the problems of an individual, it is worth noting too that the oppression of women psychologically, appears to have an impact on their life experiments, and their overall wellbeing.

Many of the clients for this therapy are often women. Coincidentally, most feminist therapist also tend to be women too, in a sharp contrast to the other related theories that all seems to revolve around western culture and their male founders. As such, the feminist theory poses a challenge to male-inclined suppositions with respect to that which gives identity to an individual who is healthy mentally.

Some of the questions that are often posed by theorists in as far as the feminist therapy is concerned includes among others, why more women that men appears to fall victims to depression, the best way to handle the needs of the minority, and ways of dealing with the oppressed and marginalized persons in any one given society.

Thanks to the development of network groups that were established to assist women in such issues as improved shelter, crisis center, rape, reproductive and health matters, this seemed to effectively address the issues of women.

Traditionally, women were often treated based on psychotherapy approach, but this later shifted to self-help with the popularization of the feminist therapy. As of now, the feminist therapy lays more emphasis on the integration of features that seeks to better understand multicultural awareness, oppression, and multicultural competency.

In the conventional setting, the therapist normally had the upper hand in related sessions on the basis of their vast knowledge in psychology. With changes in both cultures and societies however, the feminist therapy became further specialized into such areas as incest, rape, and domestic violence. Even as we continue experiencing cultural and societal shifts, these also impacts on some of the philosophies of the feminist theory. Some of these aspects would include cultural feminists, liberal feminists, global-international feminists, and post-modern feminists.

The feminist theory seeks to create an egalitarian approach in as far as the treatment of individuals with SIV is concerned, while still paying attention to the impact of current cultural and social effects of the environment. A key element of such an understanding rests on the understanding that the development of personality has deeply been ingrained in the expectations of the society; that women are often the ones who offer care to children.

This role further seeks to illustrate how these women then develop their morality and sense of self, as well as their role of having responsibility over those that surrounds them. The theory of feminist uses this quality with regard to relationships as an approach towards strength, growth and healing.

Identifying with the identity development of women falls in the gender schema perspective theory. This includes the element of belief such as that of girls wearing makeup, whereas boys have none. The role of these behaviors is in the determination of that which is masculine, and that whish is feminine. Moreover, these behaviors tend to be unique and specific to both culture and society.

The therapist has to work together with a client to help them understand the oppressions that they may be going through. In addition, the therapy is often a shared journey between the client and the therapist. As such, the element of truth becomes an essential component of the process, with the therapist not only believing in a client, but also encouraging them to go forward in a constructive and positive manner.

The feminist trauma concept rests on the supposition that that which may be traumatizing to an individual is not just a treatment experience to either safety, or life. Instead, that which gets evoked symbolically through such an experience, as well as the way in which an individual is able to respond to the prevailing social contexts, facilitates in the differentiation of what is traumatic, and that which is not.

Trauma treatment models of feminist posit that the traumagenic culture is the one hindrance to healing. Individual change becomes difficult or impeded when environmental and societal changes fails to take place. In the feminist therapy, it is important that the effects that a continuance traumagenic outcome has on the recovery process of trauma be viewed at as a critical element of the feminist therapy.

Pitfalls for a feminist therapist usually abound when she/he tends to assume the urgency of a client, or fails to cede power and be at the same level as the client. The issue of self-inflicted violence has a direct correlation with self-harm. This matter is particularly crucial in especially a scenario whereby persons inflict injuries upon their individual bodies.

In the application of the theory of feminist therapy, the idea is to facilitate a broad-based form of speculation with regard to the issue; in as far as women are concerned. The underlying cause of such an attempt stems from the fact that we are living in societies that are patriarchal in nature.

Nevertheless, technical terms appears to amalgamate such psychological situations that women often have to go through in the every day lives. In a majority of the scenarios whereby women tend to be the main participants, the relief attaining factor seems to be the basic element attributed to this kind of attempt. In this regard, it has already been determined that the prime cause is the unbearable emotions often linked to the unreal and outrageous sensations, leading to numbness aspects.

Feminist theories together with the associated practices, lays emphasis on the culturally related context, eminent and societal factors, as well as imminent issues with regard to the political causes. These are the key issues that are usually encountered in the therapeutic counseling process. The aim here is to directly understand and encourage client participation against a framework of the world that she may be living in.

As such, the analysis appears to be under the influence of a political state that is structured along patriarchal and social inclinations. When SIV behavior that is not socially sanctioned gets intertwined with the feministic approach, a multitude of viewpoints come into play in a bid to arrive at a solution over this issue.

Laura Brown has especially been noted as the main exponent in as far as this issue is concerned. This scholar (Laura Brown) has explored a wide variety of perspectives that bears a relationship to SIV behavior that is unsanctioned. With respect to the feministic approach, women condition on a universal basis appears to be extremely pathetic. Their physical weakness attribute ensures that they constantly fall victim to nearly all the social conditions.

SIV behavior has become a common field for the assessment of the conditions responsible for their social context. In light of this, Ms. Brown arrived at a broad-based speculation, as well as SIV behavior that is unsanctioned, and which had hitherto not been tackled to a great extent.

The feminist therapy serves the purpose of according recognition to the potential of women, and also to come into terms with the position of women in view of the sufferings that have traditionally been bestowed on them. Such a speculation appears to be extremely perfect over the women’s disadvantaged position in the society in respect of a world that is dominated by males.

Usually, the discrimination that exists amongst the females is attributed to their being the weaker sex. A further differentiation occurs, on the basis of sexuality, race, age, ethnicity, religion, as well as all the other weaker categories. In terms of feminist-led therapy initiative, due recognition has been given to all the problems that are capable of bringing in specified therapy provision for the disempowerment of social context forces that are relevant. It is here then that core objectives of the therapy are recognized.

The entire recognition process, getting held over social context forces leads to a dominant empowerment of the respective clients who may be victims of SIV. In order for the feminist therapy to function, the therapist as well as the client has to be literally, on an equal footing. In principle, instances always abound whereby a therapist appears to be under pressure of being demystified.

The commencement of the feminist therapy is geared to assisting the client get hold of the empowered facility. In this regard, this acts as a clear demonstration to a client that she is her own rescuer, as opposed to relying on external forces to facilitate such a rescue. It is thus the duty of a client to bring in the dynamic responsibilities and the roles within her as a client, and this will assist a therapist get rid of her tortures and pains.

The recognition of this power places a vital role on a therapist, in her quest to assess the symptoms of a client, so that the ensuing prescription may lead to a build-up of strength within such a client.Statistics estimates that one in every four persons in the general population and between 21 and 66 percent of the clinical samples usually engage in self inflicting violence.

Evidence also suggests that self inflicting violence behaviors are usually distributed equally among men and women in samples taken from the community. Research studies conducted among students in high school revealed that such students have a 13 percent chance of having engaged in self inflicting violence at least once. A more recent research study conducted on college students further revealed that they had a 17 percent prevalence rate of having been involved in SIV at least once (Simeon & Favazza 2001).

As such, this shows that adolescents and young adults alike engage in self inflicting violence in a significant way. Self inflicting violence appears to have lately gained considerable attention not just in the clinical environments; it has extended to include popular music, current episodes on the television and movies.

SIV is a complex behavior and those individuals that self-injure themselves tend to have multiple diagnoses of mental health as well as a multitude of personal and developmental contexts that could have an impact on their behavior. As such, SIV serves a wide range of functions for a variety of people at various periods of time. Given the fact that the behavior is naturally multifarious, this hinders mental health therapists from determining the most ideal interventions to adopt.

For counselors to assist clients with a penchant for self injuring, this calls for the establishment of a vivid conceptual framework that shall aid in the establishment of effective plans of treatment and the implementation of interventions. The model of motivational interviewing usually assists in counseling session of SIV patients. This model is “a directive style of counseling’ that is centered on the client, and which help them to assess and settle ambivalence.

The link between suicide attempts and self inflicted violence could be complicated when individuals with BPD (Borderline Personality Disorder) are undergoing counseling. Moreover, between 70 and 80 percent of all clients that have been diagnosed with borderline personality disorder (BPD) have also been shown to engage in one form of self injury or another. SIV and suicide shares a complicated relationship.

SIV ought only to be viewed at as being suicidal in the event that a client has shown an indication of wanting to die. Nevertheless, it is possible for an individual to harbor suicidal thoughts as well as those of SIV and still not be considered suicidal.

According to a survey that was conducted by Gardener and Gardener (1975), between 28 and 41 percent of the patients diagnosed as self injuring also reported having suicidal ideas. Therefore, the link existing between self injuring and suicide is very thin and blurred, but is nevertheless very much in existence, while its extent and nature continues to be investigated.

Psychological trauma has also been linked to SIV, with some individuals who self-injure themselves exhibiting significant trauma history. According to Herman (1992), “complex trauma” symptom includes SIV, chronic preoccupations of suicide, persistent distrust, and isolation from the rest.

A multivariate of reasons has been proposed as to why individuals self-injure themselves. At the same time, such behaviors seem to serve various functions which also tend to evolve with experiences and time. Usually, SIV serves multiple functions simultaneously. Prinstein and Nock (2004) opines that SIV acts as an autonomic regulation (a way to attaining social reinforcement), such as the acquiring of the support of other individuals.

According to other researchers, it is also possible to self-injure oneself as a way of diminishing depersonalization, dissociation, and derealization, and also in the relieving of feelings of numbness and emptiness. Some other people have also reported that they usually acquire a sense of control of their emotions and lives through self-injury (Dallam, 1997; Simeon & Favazza, 2001).

The proposal of biological theories has been with a view to offering an explanation as to why individuals self-injure themselves. Suggestions have also been put forward that an element of genetic predisposition is responsible for this in some people, while vulnerabilities and chemical imbalances are usually attributed to others.

Additionally, there are those that undergo a near chemical change experience, and this seems to reinforce self inflicted violence (Dallam, 1997; Pies & Popli, 1995; Simeon et al., 1992). According to studies on biological functions that are a characteristic of persons who self-injure themselves, it has been suggested that a reduction in serotonergic function has a link to a rise in impulsivity, suicidality, aggression, and SIV (Kraemer et al 997; Spoont 1992). Deiter (2000) opines that family violence and sexual abuse on children are strongly associated with self-injury.

Seeing that persons subjected to these forms of violence and abuse usually experience a constant dyregulation of emotions, it may be hard for them to acquire the necessary skills for the regulation of intense experiences of emotions, and this could lead to SIV as a way of normalizing these strong emotions. Moreover, those persons that are deficient in impulse control have a higher chance of self-injury (Fong 2003).

Fong opines that SIV tend to share some two qualities with “impulse control disorders” (for example, stealing, gambling): a rise in the activity of the autonomic nervous system prior to the act, and the lack of an ability to resist urges for acting in specific behaviors or acts. Limited guidance for the establishment of an effective remedy to SIV appears to be scarce, with the evidence-aided treatment procedures and empirical research being also limited. (Klonsky & Muehlenkamp 2007; Muehlenkamp 2006).

Nevertheless, dialectical behavior therapy problem-solving therapy appears to have the most support for reducing SIV (Muehlenkamp 2006). Therapeutic approaches lay emphasis on emotion regulation, problem-solving, while behavioral analysis and functional assessment have been cited as vital elements of the treatment (Klonsky & Muehlenkamp, 2007), including solid therapeutic relationships and cognitive restructuring (Muehlenkamp 2006)


Drawing from the literature, it is apparent that self-inflicted violence involves a combination of biopsychosocial factors as they operate within culture. It has already been suggested that self-inflicted violence can be understood as more than a disorder confined to an individual and that issues relating to power, marginalization, injustice and reisistance may be important. Theorists should be interested in exploring these issues and investigating how self-inflicted violence is a text that is able to be read or interpreted.

Favazza suggests that the skin may be thought of as a sort of ‘message center’. The skin is a border between inside and out. Emotional states are often communicated via the skin such as flushing of the skin when feeling rage. Thus, self-inflicted violence is an effective way to send a message of internal pain.

The body is also the site where cultural experiences are inscribed. The body is an object which is always socially influenced, it is marked and shaped, and yet it is also experienced as unique to the individual. The body in self-inflicted violence is a kind of battleground where the person acts out a struggle with the self; a self who is unique and subjective and a self who is a social object that is not only molded but also constrained by beliefs and practices which have been embedded by society. For example when a person cuts themselves, they are the subject of their bodily experience who is expressing their internal pain and who is a social product frustrated with being treated as an object. The idea that one can both act and be acted upon is a paradox that seems to be the core struggle for those that inflict violence on themselves.

Other dialectics are apparent on experiences of self-inflicted violence such as simultaneously feeling love and hate, feeling everything and nothing, feeling overwhelmed and empty. All of these experiences produce tension and are not readily accepted or understood in conventional society. Instead, conventional discourse would have the person choose between feeling one or the other. Appreciating the existence of dialectical tension may represent a way forward on the path to treatment. Individuals who self-inflict violence can learn that it is possible to feel love and hate simultaneously. It is also possible to be both a subjective and objective self.

The experience of emotional trauma such as that resulting from physical and sexual abuse and neglect can be grossly objectifying and one must learn to live with that experience. Often, the line between being an objective self, an ‘other’ who is externally controlled, and a subjective self, a unique being who is self-regulating, is blurred.

Research Recommendations

Despite the clinical importance of self-inflicted violence, empirical research informing the treatment and prevention of this behavior has been limited. As much of the extant literature on self-inflicted violence originates from studies and theories that focus primarily on clinical populations of women, especially women diagnosed with borderline personality disorder, future research should begin to explore the etiology of this behavior among more diverse groups of individuals. In light of evidence that self-inflicted violence occurs among nonclinical populations and to a comparable extent among women and men, research on the development and maintenance of this behavior in both clinical and nonclinical samples of women and men is needed. Moreover, given that the small amount of research examining the impact of gender on the risk factors for self-inflicted violence has suggested the presence of potentially important gender differences in the risk factors for this behavior, future research would benefit from the systematic examination of the effects of gender when developing models of prevention, intervention, and treatment.

Despite growing interest in this phenomenon, no consensus has emerged for intervention (Hawton et al., 1998). Treatment for self-injury currently takes a number of different approaches and strategies. Individual counseling tends to dominate the treatment modalities, including feminist therapy, cognitive behavioral therapies, problem-solving approaches, dialectical behavior therapy, and intensive in-patient treatment. Outcome research remains limited. Most studies reported in the literature employed small samples that were extremely heterogeneous; many of the studies were conducted upon patients treated in emergency rooms or within inpatient settings. Given that the target population for self injury is adolescents, the reported research may not be generalized for application to outpatient intervention and counseling. Specific recommendations useful in community and private practice settings have been identified, however.

Implications for Practice

Self-inflicted violence can provoke intense negative reactions among care providers. Clinicians may feel angry, helpless, disgusted, betrayed and dismayed when working with individuals who engage in this behavior. Understanding the state of affect dysregulation and physiological hyperarousal, the lack of capacity for self-soothing, and the occurrence of self has significant implications for practice. At the least, this knowledge can shift clinicians away from viewing self-inflicted violence as manipulative and attention seeking. It can help clinicians understand and put into clinical perspective the turbulent, highly impulsive, and predictably unpredictable behavior of clients.

Many therapeutic interventions are characterized by deficit-based discussions of victimized individuals, generally overlooking how they display tremendous strength and courage on a daily basis. Many trauma survivors have been silenced by society unwilling to acknowledge the abuses that have lead individuals utilizing self-inflicted violence as a coping strategy.

Therapy for women with impaired ability to self-soothe must be directed at helping women develop the internal capacity to self-soothe. This capacity develops with a therapeutic relationship in which the client experiences safety, reliability, and consistent, nonjudgmental stance by the therapist.

The therapeutic work must be directed at three areas: helping to manage overwhelming emotions, developing less harmful modes of self-soothing, and dealing with the profound psychological impact of trauma through informing clients about the physiological and psychological impacts of childhood trauma.

Psychoeducation can be empowering and relieving. That which was not understandable now becomes clearer. Clients can experience themselves not as crazy but as individuals who have found ways to survive life altering events. Psychoeducation can be a powerful reinforcement of the therapeutic alliance, creating a sense of working together toward shared understanding and growth.

Clinicians must recognize for themselves and their clients that reducing violence inflicted on self will take time, and during that time the client will continue to be at risk for harming the self. Helping the client develop the belief that she is worth self-soothing is a critical step on the path to the acquisition of a capacity to self-soothe. As Chu (1992) observed, it is critical during early stages of therapy to focus on self-care emphasizing the necessity of creating an environment of personal safety before the “dismantling of protective defenses” (p.352). Many individuals who inflict violence upon themselves feel undeserving of anything positive and comforting, however small, that any pleasure must be punished. A particular goal of therapy is enabling an individual to comfort self without feeling the guilt and shame that ultimately result in self-inflicted violence.

For the survivor of past and ongoing emotional and physical trauma, the desire to engage in self-inflicted violence and the lack of capacity for self-soothing are deeply ingrained. Long-term work with those who self-inflict violence requires considerable skill and the ability to tolerate risky behavior and relapses. Clinician’s energy should focus on understanding the individual’s process and finding ways to tolerate the behavior until alternative modes of self-soothing can be established.