Snakes and Ladders: The Ups and Downs of a Self-harming Lifestyle— Diane Clare

This paper describes work with Jay, a woman who, after experiencing abuse as a child, engaged in acts of extreme self-harm in later life. The work involved a range of health care staff acting as a reflecting team, using outsider-witness practices of narrative therapy. To ensure that this apparently high number of resources used could be justified within the context of budget-conscious health services, the author developed the idea of clearly calculating and reporting on the ‘economix’ of the approach. The article also outlines the practice of ‘bookmarking’ with clients, which became a pivotal practice. The paper concludes with a poignant and reflective postscript given the tragic event of Jay’s death at her own hand.