'John" came to Karl Tooher in distress. Now in his mid-30s, he had been injuring himself since he was 12 years old.
He had faced many difficulties, including problems at work, but it was the break-up of an important relationship that caused his greatest crisis.
After that, John cut and hit himself every day, but not in a way that required hospital treatment. The cuts were superficial and did not leave scars, and he was able to cover up the bruises.
He told his therapist that self-injury was his way of coping with life. It emerged that John had a difficult and unloving childhood.
He did not learn the normal ways of coping with problems, which meant he had no way of handling stress.
Tooher started examining ways to help John cope. He encouraged John to take better care of himself and be more sensitive to his needs.
This was a concept that seemed alien to John. While he was thoughtful and would help others, John appeared rarely to think of his own needs.
Tooher also encouraged John to notice the warning signs of stress building up, so he could take action before the stress reached crisis level.
Gradually, John reduced his reliance on self-injury. He injured himself on a stop-start basis for a while, but after a year of counselling he was no longer injuring himself.
While the initial focus was on the break up of the relationship, his therapist noted that John's need to have a relationship lessened as his self-esteem grew.
Almost a year after he finished counselling, John has not started injuring himself again.