HARM Mapping is a very simple tool with two key uses.

First it is a rapid way for mapping key life areas and provide some guidance around the degree of impact, and therefore their possible reaction, any change is likely to have on an individual, whether it is in organisations, family settings or clinical services. The more core areas that the change will impact, the stronger their reaction is likely to be.

Second, it can be used to help engage clients in clinical settings, especially those who are mandated or coerced into treatment are therefore reluctant to talk about the issue or reason for referral (e.g. substance use, addiction, agression, eating disorders etc). So instead, we look for the shadow of the issue on their lives and bring the issue into the conversation that way.

​The four HARM areas are:
1) Health - as well as physical health including sleep and fitness, impacts can be upon the person's emotional and psychological well-being.
2) Activities - the meaningful activities for that person, which may be their work, home duties, hobbies, community groups, and more.
3) Relations - these are relationships with the significant people in the person's life, whether it is family, friends, work colleagues or more.
4) Material Security - a person's home and their financial security are often seen as the foundations of a person's life.

HARM Mapping can be used within a Motivational Interviewing framework and follows these four simple steps.

1. Start the conversation in what is likely to be the least impacted domain (e.g. for a gambler, don’t start in the material security domain, rather perhaps the health domain).
2. In the domain deepen your enquiry about that area, and ask what their values and goals are around that area, and why they hold those values and goals. In this first domain, there are unlikely to be impacts of the problem behaviour so it is a relatively safe area for them to open up and is less need to be defensive and protect their vulnerability.
3. Then work through each domain in turn, repeating this process ending up with the most impacted domain. Again, ask not just about the domain, but what are their values and their goals for that domain. It can be helpful to ask whether this domain is where they wanted to it be by this life stage. Sometimes it is helpful to ask them if they would be happy if their children’s domains were this way when they reached the client’s age. Try to keep this natural and avoid challenging or any agenda other than to understand them, so adopt questions and a way of responding as though you an interviewer or researcher, not someone trying to help or change them.
4. If, and only if, the client is opening up and beginning to trust you, ask them when you discover impacted areas within the domains what they feel may be holding them back from achieving these goals, or staying within their values. Explore their answers and go back to asking “is there anything else” as there are rarely just one thing holding us back in an area. However, don’t ask them explicitly about it, e.g. “do you think your smoking is affecting your health?” and hold back your desire to fix them, what Miller and Rollnick (2012) calls our “righting reflex”. Remember that the client will very likely reflect on this discrepancy after the session and so the motivation to change can, and often does, germinate after the session has ended when they feel safe enough to let their guard down.

How to do it...

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