An equal struggle (psychodynamic assessment following repeated episodes of deliberate self harm)

Psychodynamic psychotherapy is a complex method of enabling a person to engage with life difficulties. This narrative paper investigates the value of psychodynamic psychotherapy within the framework of the 'Health of the Nation' document (Department of Health 1992). The paper explores an encounter with a young gay man who was admitted to the medical unit following an episode of deliberate self harm, in response to profound and thematic relationship difficulties. The writer (a liaison mental health nurse, working in a general hospital setting) examines the complexities of the transference, countertransference relationship. A case is made for the facilitation of choice as a primary goal of therapy. It is suggested that the inauguration of transference resolution is determined through an equitable relationship, in which therapist and client are engaged equally in the struggle toward understanding. The paper concludes with the suggestion that psychotherapy is an appropriate and effective method for dealing with relational conflict. However, personal, temporal and social resources may not provide the client with what is, in Kleinian terms, a necessary holding environment. The assessment process nevertheless can provide important learning and enable significant changes to be made in supportive networks.