Lisa Ferentz, MSW, LCSW-C, DAPA is a nationally recognized expert on treating self-destructive behavior (a full list of her accolades and achievements are below). However, when you meet her, what is the most striking is how warm and affirming she is. This really comes through in her books, and her latest one, Letting Go of Self-Destructive Behaviors is coming out this week. Read on to learn more about how her work with clients who have self-destructive behaviors and what she wishes all clinicians knew about this population.
How did you become interested in focusing on self-destructive behaviors?
I‘ve been a trauma specialist for 30 years and when you work with people who have been emotionally, physically, sexually, verbally or psychologically neglected, abused or traumatized, it is inevitable that you will also be working with a wide range of self-destructive behaviors. Over the years, I have learned from my clients that self-destructive acts are a way to cope, numb, self-soothe, re-enact pain, ask for help, or attempt to re-claim a sense of power and control over one’s body. It makes sense to me that when people don’t have words for their experiences, or have grown up learning that their voices are unimportant, or they never got healthy modeling for self-soothing, their repertoire for coping or healing is so limited. In addition, the mental health field has tended to pathologize self-destructive acts and the people who engage in them. I felt an ethical and clinical responsibility to learn as much as I could about these behaviors and to find creative, non-shaming ways to help clients work with them.
I’m intrigued by your idea of putting self-injurious behaviors and eating disorders and addictions into a big category of “self-destructive behaviors.” Despite the fact that there is research that endorses this theory (Hollander, Briere and Jordan, Najavits), it seems that I still hear them discussed separately. How did you come to accept this view and how would you explain it to someone who feels they should be treated as separate conditions?
Part of what got me thinking about this idea of putting the different behaviors under the larger umbrella of “self-destructive acts” was the fact that so many of my clients had histories of bouncing back and forth between those behaviors at various times. It made me curious about the commonalities between the behaviors rather than the differences. And what started to emerge were the recurring themes of secrecy, and shame, along with a desperate attempt to communicate a pain narrative, short circuit painful feelings, thoughts and memories, a need to feel “in control,” a cry for help, etc. All of these behaviors are about hurting, punishing, controlling, numbing, or shaming the body. They evoke anxiety, confusion and fear in loved ones. I also found that when I could bring the same strengths-based, de-pathologized, and creative treatment approach to all of these behaviors, the work unfolded more quickly! Addressing one behavior began to impact the others.
One thing that resonates throughout your book is the importance of respecting the survivor and the fact that any and all behaviors are a way of meeting needs. I think it’s inevitable that many survivors with disordered eating or addition or self-injurious acts will wind up in non-specialists offices. What is one thing you wish ALL clinicians know about this population?
Again, the idea that these are not “mentally ill” or weak people is so important. These clients are resilient and are actually looking for ways to feel better- which is a sign of good mental health! When clinicians who work with these issues are willing to see these “symptoms” as creative, inevitable by-products of trauma and pain I think it would impact their counter-transferential responses as well. It’s easy for clinicians to become very frustrated with these clients. They don’t easily give up their self-destructive acts and power struggles/standard safety contracts don’t work well. Thinking about them as “borderline,” etc. often evokes anger, fear or frustration on the part of the clinician. If instead, they are viewed as creative survivors, clinicians can hold feelings of empathy and compassion- which dramatically helps the therapeutic relationship and moves clients forward in their healing.
Can you tell me how CARESS was developed? Is there any research currently being done on its efficacy?
I created CARESS over 15 years ago, when I had to face the reality that the standard safety contracts I was using weren’t working, created power struggles, and oftentimes inadvertently encouraged my clients to increase their self-destructive acts- just to show me who was really in charge! When I stepped back and processed what my clients were trying to accomplish through their self-destructive acts, three major intentions became clear to me. This included trying to communicate some kind of a pain narrative, attempting to short circuit overwhelming thoughts and feelings, and looking for ways to self-soothe and calm themselves. I realized that if I was going to ask clients to give up their unhealthy behaviors, I had to give them alternative ways to accomplish what their eating disorders, addictions, or acts of self-mutliation were doing for them. I am happy to report that my friend and colleague, Maria Hadjiyane is currently researching the efficacy of CARESS as a part of her PhD dissertation. CARESS has also been implemented in a number of residential treatment programs, as well as countless therapists’ offices and the feedback I always get is how helpful the strategy is for clients.
Tell me about your new book!
I am so excited about the new workbook, “Letting Go of Self-Destructive Behaviors A Workbook of Hope and Healing!.” The first book was really geared towards mental health professionals, helping them to better understand this population and treat them more effectively while taking better care of themselves in the process. The workbook is a companion piece to the second edition of the first book, “Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician’s Guide.” The workbook is written for laypeople who struggle with these behaviors. The hope is that they are working with a therapist and processing the wide variety of exercises in the book, which gives them a witness to both their pain and their healing. But I also recognized that many people who engage in these behaviors are not in therapy and I wanted to offer them the psycho-education to gain insight, and the treatment tools to self-soothe and express their narratives in safer, healthier ways. The workbook has the same strengths-based, non-shaming tone, encouraging people to access their inner wisdom as well as self-compassion. There are journaling exercise, art prompts, guided imagery and visualization strategies, behavioral exercises, breath work and movement techniques. My thinking is, these are already inherently creative people and the workbook taps into that! The second edition of the first book has new material on helping clients with self-compassion and cross references the workbook exercises so clinicians can see what is applicable as they work with their clients.
Lisa has a B.A. in Theatre, is an LCSW-C and is a Diplomate of the American Psychotherapy Association. She has been in private practice for 30 years, specializing in adolescent and adult survivors of trauma, abuse and neglect. She uses many creative modalities in her work to address issues of affect regulation, co-dependency, addictions, eating disorders and self-destructive behaviors, depression, anxiety, professional burn-out and self-care. Lisa presents workshops, lectures and keynote addresses nationally and internationally. She is a clinical consultant to private practitioners, domestic violence programs, and mental health agencies. She has been an Adjunct Faculty member at several Universities, and is the Founder and President of “The Institute for Advanced Psychotherapy Training and Education,” an organization that has provided continuing education classes and Certificates in Advanced Trauma Treatment to mental health professionals for the past 7 years. In 2009 she was voted the “Social Worker of Year” by the Maryland Society for Clinical Social Work. Lisa has written several articles on self-destructive behaviors as well as two books entitled, “Treating Self-Destructive Behaviors in Traumatized Clients: A Clinician’s Guide” (now in its second edition) and “Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing.” Lisa was also the host of a weekly, live, National Internet-based radio talk show called “Inspired Journeys: Overcoming Adversity and Thriving.” In her spare time, she acts, directs and choreographs for community theatre productions.
A New Look at Self-Destructive Behaviors: Interview with Lisa Ferentz