Developing and maintaining the therapeutic alliance with self-injuring patients

In this article, the authors outline methods of strengthening the therapist–patient bond with individuals who self-injure. Self-injuring patients present with a host of challenges that differ from other patient populations and therefore certain approaches may be more effective than others. Among the strategies described are validation, checking in, working collaboratively toward goals, providing support, and repairing a ruptured alliance. Potential pitfalls (e.g., reinforcing maladaptive behavior, negative judging, and the fundamental attribution error) to which psychotherapists often fall prey are discussed as well. Self-injury is explained as functional rather than manipulative behavior and detailed clinical guidelines and examples are provided to better illustrate approaches that will improve the therapeutic alliance. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1069–1079, 2007.