For many reasons, this is a welcome addition to the literature on the management of self-injurious behaviours (SIB). Most compellingly, it delivers what it says on the book cover: it is a practical guide. The voice of a wise and experienced clinician is apparent throughout, and this will be particularly reassuring to, and welcomed by, practitioners who are relatively inexperienced in working with self-injury. Perhaps more seasoned clinicians, who have developed their own views and approaches, might not engage so well but they will very likely still learn much from this text.

Walsh's writing is particularly fluent and he has made a sometimes repellent subject engaging and readable, while never appearing voyeuristic or sensational. He manages never to present information in such a shocking way as to alienate the reader and seems sensitive to his audience's capacity to tolerate horror and respectful of the patients whom he discusses.

The text is in three parts, the first part covering “Definition and concepts”. These chapters are clear, well organized, well informed and broad based. Walsh's clinical wisdom is evident and he thoroughly explores clinical considerations before summarizing “top tips”, thus encouraging readers to consider the complexities and subtleties of SIB and to think through for themselves important issues before taking a particular course of action. He recognizes and describes both impulsive and compulsive behaviours, illustrating them well with vignettes – these clinical illustrations are a real asset to the text, bringing it alive and skilfully linking theory with clinical reality. However, when I reflected on my own practice I felt that there were a few significant omissions. For example, I would have appreciated more emphasis being given to understanding (and helping) the ambivalent patients: those who knowingly risk killing themselves and who are prepared to play “Russian roulette” when they self-injure and those driven by a powerful visceral “felt sense” rather than by thoughts or images. I also felt that more attention could be given to the role of traumatic images, substance misuse and dissociation. These all play a significant part in the pattern of self-injury shown by my patients, yet were addressed quite lightly. I felt the dissociation, in particular, was neglected.

The second section, “Assessment and treatment” is a comprehensive section which includes a range of approaches from behavioural through cognitive to pharmacological and which covers a range of presenting problems including PTSD. The treatment approach that is advocated is predominantly behavioural. As a CBT practitioner I felt that the cognitive aspects could have been discussed in more depth, for example considering the core beliefs and schemata that drive self-injury and ways in which these might be addressed.

Walsh promotes a “biopsychosocial model” for self-injury which is well considered and which recognises the role of systemic factors as well as the psychology and biology of the individual. He is particularly mindful of systemic conceptualizations and approaches and considers the impact on caregivers and addresses the role of the family. This extensive view of factors pertinent to self-injury is a very helpful reminder to the clinician to be thorough in assessment and to properly consider the scope for interventions.

The third section, “Specialized topics”, comprises three topics. “Contagion and self-injury” addresses the significant phenomenon of the spread of self-injurious behaviours within groups. This is followed by a chapter describing a protocol for managing self-injury in schools (or other institutions). The protocol is well thought through and potentially very useful, although no evaluation of the programme is cited despite its being described as having “been used successfully”. This is a great shame as it renders the rather labour-intensive approach less attractive. The final topic is major self-injury, or self-mutilation. Again Walsh provides a practical and sensitive guide to assessment and treatment which is predominantly based on clinical experience and which considers wider impact on therapists and carers.

This text will be invaluable for any practitioner who works with patients who self-injure: the novice will be informed of key issues to guide his practice and the more experienced practitioner is sure to learn from the wealth of experience and knowledge that Walsh shares. I am glad to have read it and would confidently recommend it to others.