Am I competent enough to be doing this?: A qualitative study of trainees’ experiences working with clients who self-injure

Abstract

This study examined the experiences of counsellors in training working with clients who present with non-suicidal self-injury (NSSI) as a basis for understanding how trainees react to and resolve the challenges presented by difficult counselling cases. A qualitative data analysis using consensual qualitative research [Hill, C.E., Knox, S., Thompson, B.J., Nutt Williams, E., Hess, S.A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196–205; Hill, C.E., Thompson, B.J., & Nutt Williams, E. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517–572] was conducted on 12 transcribed interviews of Master's level trainees who had recently worked with at least one client who self-injured. Three general themes were reflected by the data. Specific to NSSI the findings revealed that trainees created an intuitive model of NSSI that reflected some understanding of the phenomenon despite little or no prior exposure to it. With regard to the work involved in these challenging cases, trainees reported a number of personal struggles and tasks that they needed to resolve while trying to be helpful to these clients. These tasks included managing their emotional reactivity and resolving ethical and confidentiality issues. Engaging in these two tasks heightened their feelings of uncertainty yet also focused them to be highly intentional in their work. Whereas supervision often serves novices well when they struggle, participants reported that supervision only partly alleviated the difficulties they faced. Implications and limitations of these findings are discussed.