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This thesis finds that specific design interventions in the spaces providing therapy can improve therapeutic outcomes for those who self harm. Therapeutic interventions for this service user group typically involve various forms of talking therapy, and/or medications. However these service users are amongst the most clinically challenging to treat. The physical environments in which therapy takes place have not been thoroughly examined for their contribution to therapeutic outcomes. Despite a large body of literature affirming the links between good design practice and mental wellbeing, there is a paucity of research addressing specific environmental needs of service users who self harm. Further, existing design guidance is often generic in nature, describing broad principles to be achieved through design, but offering little tangible advice for the designer to integrate these principles into a realised built environment. The research involved an exploratory qualitative design that utilised a triangulated strategy; the method of data collection included three data collection methods: systematic literature review, multi-stakeholder interviews and case study observation. Key findings from the scoping review included the paucity of design guidance for therapeutic environments and counselling workspaces specifically, and that there is no published research examining the design of therapeutic spaces for individuals who self harm, specifically. Key findings from the semi-structured multi-stakeholder interviews included a deeper understanding of the perceptions of spatiality of individuals who self harm, aspects of therapeutic environments that are supportive or unsupportive and in what ways this occurs, and potential design strategies to assist therapeutic activities and psychological engagement. Analysing built therapeutic environments found that there is a limited inclusion or implementation of design recommendations uncovered in this research in existing built spaces.

Self harm is a plague, wreaking ugliness across the face of society, a scar deforming what was pristine, swiftly spreading to become a gaping open wound. The therapy techniques and facilities aiming to treat such self harm conditions were discovered to be ineffective; the plague is gaining momentum. This research proposes an alternative, an architecture as therapy, as a case study with the programme of a bath house to explore how architecture might operate therapeutically with respect to women with self harm conditions. This architecture is not a housing of therapy but rather a tool of therapy, an architecturalisation of psychoanalysis and cognitive behavioural therapy. The architecture as therapy inspires the shifting of paradigms, blurs and shatters boundaries and preconceived notions to further individual thought, reconciliation with the post harm body, and the development of new awareness and identity. Through a process of provocation, engagement and release the architecture as therapy addresses such notions as the inability to communicate through conventional means, and ill-developed identity and sexuality which hinder these individuals. Architecture’s potential to offer therapy is further cemented through its links with communication; it possesses a potential to generate new languages of performativity and of the body through the design of its spaces and elements. The inhabitant’s journey encompasses manipulations of ugliness and beauty, the senses and performativity within an architectural environment to elicit a therapy. Each of these notions is tested across case studies and within the architecture as therapy itself, elicited in a manner specific to these particular individuals. The architecture as therapy can be viewed as a conceptual piece; the purpose of the work is to challenge, to deconstruct preconceived notions of therapy processes and healthcare facilities. Aligning with psychoanalysis, the architecture is a conceptual vehicle with the purpose of pu