Experiences of impulsivity, self-harm and DBT groups: a qualitative enquiry in a secure setting

Introduction This study was developed from a recognition of the lack of research exploring experiences of self-harm, impulsivity and the group component of Dialectical Behaviour Therapy for women in low secure forensic setting. Psychological understandings and models proposed do not consider self-harm within particular contexts. It is important to gain an understanding of impulsivity and self-harm, within the context in which they occur, to develop models of understanding and ensure therapies offered are adapted for the specific needs of the population. Method Using a combination of purposeful sampling and snowballing, a sample of six women, who were detained in a low secure forensic hospital, were recruited. They participated in semi-structured interviews which were transcribed and then analysed using Interpretative Phenomenological Analysis. Individual transcripts were analysed and three levels of themes were identified for each participant. Individual themes were then used to develop the group themes. Results Two sets of results are presented. The first focuses on how women make sense of their experience of self-harm and impulsivity. Three levels of themes were identified, the first level consisted of ‘I need you for safety but I fear you’, ‘I’m going round in circles and keep making the same mistakes’, ‘Living in a hostile world’, ‘A sense of losing and finding myself’. The second set of results focuses on experiences of Group Based Skills Training component of Dialectical Behaviour Therapy Two levels of themes were generated, the first level consisted of ‘Mistrust and vulnerability: denial and defences’, Making sense of GBST: Is it worth it?, Tentative changes’. Discussion The key findings of the study are linked to psychological theory, current models of understanding self-harm and previous research findings. The study adds to literature on experiences of self-harm and impulsive acts, in addition to, understanding the relationship between self-harm and impulsivity within forensic settings. It also adds to the minimal literature exploring the experiences of Group Based Skills Training for women within secure forensic settings.