Treating Self-Destructive Behaviors in Trauma Survivors
A Clinician’s Guide
By Lisa Ferentz
Routledge – 2012 – 264 pages
Routledge – 2012 – 264 pages
This is a book for clinicians who specialize in helping trauma survivors and, through the course of treatment, find themselves unexpectedly confronted with client disclosures of self-destructive behaviors, including self-mutilation and other manifestations of deliberately "hurting the body" such as bingeing, purging, starving, substance abuse and other addictive behaviors.
Arguing that standard safety contracts are not effective, the book introduces viable treatment alternatives, assessment tools, and new ways of understanding self-destructive behavior using a strengths-based approach that distinguishes between the "experimental" Non-Suicidal Self-Injury (NSSI) that some teenagers occasionally engage in, and the self-destructive behaviors that are repetitive and chronic. It also explores a cycle of behavior and uses case studies to show clinicians how to personalize the cycle with clients and form a template for treatment. In its final sections the book focuses on counter-transferential responses and the different ways in which therapists can work with self-destructive behaviors and avoid vicarious traumatization by adopting tools and strategies for self-care.
"Through her workshops, Lisa Ferentz has already become an important voice in the movement to depathologize self-destructive behaviors. I am thrilled that she has put her empowering message into book form because it will now reach the much larger audience that it deserves. The unfortunate state of the art is for therapists to pit clients against the parts of them that self-harm. Treating Self-Destructive Behaviors in Trauma Survivors is a much-needed antidote to that unproductive practice and provides clear guidelines for a new understanding of and effective approach to these dangerous behaviors, which typically scare therapists and contribute to their burnout." - Richard C. Schwartz, author of Internal Family Systems Therapy and developer of the IFS model
"This is a wonderful book! Lisa Ferentz is a steady, regulated, and informed presence, and she offers concrete, creative, and constructive ways to support therapists. Her approach provides helping professionals with compassionate and effective ways to handle counter-transference responses and offers sound, inventive approaches to help clients discover alternative ways to self-soothe, self-regulate, and connect with other people. Her strength-based orientation empowers clients to use compassion to understand their behaviors, and, at the same time, to draw on their inherent strengths to generate new more constructive responses to the challenges of everyday living." - Nancy J. Napier, LMFT, author of Getting Through the Day: Help for Adults Hurt as Children and other books
"Lisa Ferentz’s book is a rare gift to clinicians. Her focus on how therapists can care for themselves while caring for their clients is a welcome antidote for the overworked trauma therapist. The CARESS model provides a handy sequence of steps that teaches clients to substitute new methods of affect regulation for their self-destructive habits. Reading this book is like sitting with a wise old friend over a cup of hot tea—restorative, enlightening, and honest." - Joyanna Silberg, PhD, author of The Child Survivor: Healing Developmental Trauma and Dissociation
"In addressing the challenging issue of trauma-related self-harm, Lisa Ferentz manages to integrate trauma theory and neuroscience with the latest therapeutic approaches and a wonderful clinical common sense. This is by far and away the best book written on this complex and controversial topic." - Janina Fisher, PhD, author of Psychoeducational Aids for Working With Psychological Trauma
Part I: It Makes Sense Given where They’ve Come from. Towards a New Understanding of Self-destructive Behaviors. Working with Trauma Survivors: The Strengths-Based Approach. The Role of Attachment. The Inherent Struggles of Adolescence. The Meta-communication of Eating Disorders, Addictions, and Self-mutilation. Part II: Understanding and Working with Self-Destructive Behaviors. The Cycle of Self-Harm. The Triggering Event and the Loop of Negativity. Unbearable Anxiety and the Frozen Loop. Self-Injury, Positive Outcomes, Negative Outcomes, and Emotional Vulnerability. Treatment: Identifying Intervention Sites and Working with the Triggering Event. Working with the Cycle: The Loop of Negativity. Working with the Cycle: Unbearable Anxiety and the Frozen Loop. Working with the Cycle: Self-Injury and CARESS. Working with the Cycle: Positive Outcomes, Negative Outcomes, and Emotional Vulnerability. Part III: Helping Others While Taking Care of Ourselves. Focusing on Us. Creating a Sense of Internal and External Safety. Assessing Your Agenda. Being Clear About Your Control Issues. Holding Appropriate Boundaries. Understanding Your Triggers. Acknowledging Your Vulnerabilities. Pacing the Sessions. Debriefing After Difficult Sessions. Understanding the Correlation Between Family-of-origin and Workplace Dynamics. Striving for Balance in Your Life. Giving Yourself Permission to Get Supervision or Refer Out. Practicing What You Preach. Strengthening Your Work.