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Talking about trauma for services


“I have attended one of your workshops for Health Professionals and found it to be one of the most enlightening and useful trainings I have attended. In particular, I really got an understanding of how to best deal with people in crisis related to past trauma.”


“The workshop was outstanding - could be used for all practitioners no matter what their discipline. I would hope that you would promote it among psychologists - particularly because the focus was on "abuse" without putting the various types of abuse into boxes.”


“I recommend Blue Knot Foundation's trauma training to every professional, worker of all setting, survivor, and carer. The better trained the earlier the diagnosis and a better chance for survivor recovery.”


“I would highly recommend Blue Knot Foundation training. The information and research is impressive and relevant; the facilitator knew her stuff, was engaging and provided relevant examples.”


Working with self harming and suicidal clients

Many survivors of childhood trauma and abuse injure their bodies in direct and indirect ways. In addition to cutting, burning, hitting, etc. self-harming behaviours include alcohol and drug addictions. Alcohol and drug addiction often go hand in hand with unsafe behaviours (drink driving, unsafe sex, dangerous drug deals, etc). The tendency to repeat patterns of trauma in violent relationships can be considered another form of self-harm. All of these behaviours possibly represent the survivor's attempts to manage or eradicate feelings, prevent memories, or re-enact some aspects of the abusive experiences (Saakvitne et al., 2000).

Safety when working with self-harming clients

With survivor clients, some of the hardest challenges of working in a model of empowerment emerge around issues of self-harm. 'Empowering clients' is especially hard when they are in hospital, in great distress, asking us to protect them, or suicidal (Saakvitne et al., 2000). Self-injurious behaviours make many of us want to take control and move to action.

Traditional models of working with adult survivors of childhood trauma and abuse often emphasise control of unusual or dangerous behaviours that are deemed as 'dangerous to self or others' or 'out of control'. When control takes precedence over collaboration, treatment systems may use and overuse restraints (physical or chemical), locked doors, contracts, denial or privileges, and withdrawal of treatment. These programs unwittingly substitute control for change (Saakvitne et al., 2000) and are often not trauma informed.

Many of our current practices around restraint, involuntary medication, and emergency room procedures create re-traumatising conditions (Saakvitne et al., 2000). Often such re-traumatisation could be reduced or avoided by consulting and working with the client as much as possible. Clients need to be included in the development of crisis response plans, with clear communication around your responsibilities and limits, seeking their help to develop the best possible plan to provide helpful responses when they are in crisis. When a discussion about safety occurs in the context of a relationship, the discussion is less about rules and more about collaboration and cooperation (Saakvitne et al., 2000).

Strategies for working with self harming clients

The first step is to distinguish between self-harming and suicidal behaviour by paying attention to the client's underlying motivation. When working with self-harming behaviour it is important to remember that this behaviour serves a purpose. In collaboration with the client, try to identify what problem self-harm solves for the client. For example, from the client's perspective:

  • To make me feel real (counteracts dissociation)
  • To punish me (temporarily lessens guilt or shame)
  • To stop me from feeling (when strong feelings are too dangerous)
  • To mark the body (to show externally the internal scars)
  • To let something bad out (symbolic way to try to get rid of shame, pain, etc.)
  • To remember
  • To keep from hurting someone else (to control my behaviour and my anger)
  • To communicate (to let someone know how bad the pain is)
  • To express anger indirectly (to punish someone without getting them angry at me)
  • To reclaim control of the body (this time I'm in charge)

The more the client and therapist understand the function of the behaviour, the more effective the intervention can be (Saakvitne et al., 2000). By identifying the underlying purpose, strategies to address the specific function of self-harm can be identified. For example:

  • Need to mark body - draw on your body with a red marker
  • Need to feel pain - hold ice against your body
  • Need to feel in control - try breathing exercises

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Health Direct


Head to Health


“Blue Knot Foundation has a key role to play in the building of community capacity in care provision to those who have experienced childhood abuse and trauma in any environment.”

NIALL MULLIGAN Manager, Lifeline Northern Rivers

“I think Blue Knot Foundation is a fantastic support organisation for people who have experienced childhood trauma/abuse, for their families/close friends and for professionals who would like to learn how to more effectively work with these people.”

Psychologist Melbourne

“It's such a beautiful thing that you are doing. Helping people to get through this.”


“It was only last September when I discovered the Blue Knot Foundation website and I will never forget the feeling of support and empathy that I received when I finally made the first phone call to Blue Knot Helpline, which was also the first time I had ever spoken about my abuse.”


"At last there is some sound education and empathetic support for individuals and partners impacted by such gross boundary violations.”


Contact Us

Phone: 02 8920 3611
PO Box 597 Milsons Point NSW 1565
Hours: Mon-Fri, 9am-5pm AEST

Blue Knot Helpline
Phone: 1300 657 380
Hours: Mon-Sun, 9am-5pm AEST

For media comment, please contact:
Dr Cathy Kezelman
+61 425 812 197
+61 2 8920 3611

For media enquiries, please contact: 
Jackie Hanafie
+61 3 9005 7353
+61 412 652 439


The information and resources on this site are provided for general education and as information and/or a guide only. They do not replace, and should not be used as a substitute for, counselling, therapy or other services, and should at no time be regarded or treated as professional advice of any kind. Personal needs and circumstances should always be carefully and thoroughly considered to determine the optimal approach in each individual case.