Psychology and Psychotherapy: Theory, Research and Practice

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Volume 90 Issue 3 (September 2017), Pages 245-509

Hospital staff experiences of their relationships with adults who self‐harm: A meta‐synthesis (pages 480-501)


This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self‐harm.


Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta‐synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes.


Three main themes derived from the data. ‘The impact of the system’ influenced the extent to which staff were ‘Fearing the harm from self‐harm’, or were ‘Working alongside the whole person’. A fear‐based relationship occurred across mental health and physical health settings despite differences in training; however, ‘Working alongside the whole person’ primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process.


Staff experiences of their relationship with people who self‐harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self‐awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills.

Practitioner points

  • Working with people who self‐harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients.
  • Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self‐harm.
  • Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.

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