Self-harm by omission: A question of skin containment

Abstract

This paper explores the phenomenon of ‘self-harm by omission’ and its relationship to other kinds of self-harming behaviour and to disturbances of psychic skin functioning (Bick, 1968). Process material from work with a patient ‘Kate’ is introduced to illustrate and clarify the matters under consideration. The conceptual framework provided by psychic skin theory is described, with particular reference to the defences of ‘toughening’ and ‘porosity’ and their relevance to understanding different kinds of self-harm. Arising from this work, suggestions are advanced with regard to further development and an extended range of application of a ‘skin containment’ conceptual framework.

Keywords:

• self-harm
• psychic skin
• counter-transference
• Klein
• Bick
• Winnicott