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Matters of Mind 005: Jack Nathan talks to us about self-harm

Jack Nathan, Consultant Psychotherapist at South London and Maudsley NHS Trust, spoke to us about how working to understand and support patients who self-harm has been a lifelong learning curve.


As the Trust’s advisor for psychotherapy and the architect of its Self Harm Outpatient Service, Jack has worked with countless patients experiencing self-destructive behaviours and developed supportive therapy techniques to help them lead a more productive life.
Drawn to the profession through personal experience, Jack’s countless conversations with patients have nurtured in him a profound appreciation for the intricate complexities of human life.
His mission? To help people pick their way through the day-to-day and adjust to more productive ways of living. He says,

Part of becoming a therapist is always continuing your own therapy and continuing to learn things about yourself

“So for me it is a fantastic honour, a privilege and a pleasure that I’m allowed to know things about people’s lives and where possible to try to help them.”
Jack typically works with people who have self-harmed as a result of abusive experiences – in their working lives, in their personal relationships and often connected to feelings of abandonment and neglect.
He characterises the act of self-harm as an essentially positive action, where the individual has made a choice to reject the drastic alternative of suicide.
From this point onward, progress can be made in helping the patient understand the destructive nature of these actions and develop different mechanisms for coping with their distress.
“One of the things that becomes very clear is that the pattern keeps on repeating itself, so part of the work is trying to help them think about those destructive patterns and how they can be kinder to themselves,” Jack explains.
“People who are doing those kinds of destructive behaviours are usually people who have ruminated a lot about their lives. Therefore, there is a sense in which they have a capacity to think.”

What becomes clear is that their thinking can become very destructive. But what it also highlights is that they have a huge capacity to develop and grow.

He believes that one of the key elements in developing a productive relationship with the patient is to create an environment in which they are genuinely listened to and understood.
This relies on the therapist avoiding condemnatory or dismissive language – even when it comes to acts of self-harm themselves.
“The therapy starts with being able to join in and enter into the patient’s experience, to really get to know what it is that is going on for them,” he says.

For example, you’re not condemning anyone for self-harming. For them it’s their safety valve. It’s how they carry on living – for them it’s not a way of death, it’s a way of life.

“If you’re going to work with self-harming patients of any sort then you need to be able to understand the patient’s experience, because one of the first things they need to have a sense of is that you’re attuning to what’s going on for them.”
Therapy continues to be more a vocation than a job for Jack, who also runs a private practice alongside his work at SLaM.
Delving into the lives of others – as uncomfortable at times as it can be – remains a genuine pleasure but a responsibility he fully respects.
“I love listening to people,” says Jack. “The stories they tell are so deep and profound, and it’s very much about human life – in its worst as well as its best form.”
“I’m really motivated to lever a patient away from a more destructive form of life to something that’s more creative.”
Listen to the full interview with Jack Nathan:

Stream and download the full Matters of Mind: Series 1 podcast.

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Posted on: 5th April 2018

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