As a therapist who treats people who engage in self-destructive behaviors, I am often asked, “Why would someone deliberately hurt themselves?” and “How could it possibly make sense when they say they hurt themselves to feel better?”
Eating disorders, addictions, and acts of self-mutilation can be incredibly difficult to understand, and this lack of understanding only adds to the secrecy and sense of shame felt by those self-harm.
I believe one way to make sense out of the chronic, repetitive nature of bingeing, purging, abusing substances, engaging in unsafe sex or cutting the body is to recognize that when you hate yourself it resonates to hurt yourself. Self-loathing can be the tragic byproduct of trauma, abuse or neglect. Many survivors blame themselves for their trauma, unfairly believing they somehow provoked it or could have stopped it from happening. Survivors often see themselves as “damaged” or “bad” and so, in their minds, it makes sense to ignore their physical and emotional wellbeing. For these people, self-harm becomes a form of self-punishment, and a poignant statement about a lack of self-worth and an inability to engage in self-care.
Although there is a high correlation between self-harm and a history of trauma, many people hurt themselves because they have other kinds of unprocessed painful experiences including: the overwhelming challenges of adolescence; unresolved grief; economic stress; family discord; feeling stuck in a toxic workplace; stress from an unhappy relationship; or the challenges of a medical diagnosis. In all cases, I believe males and females turn to self-destructive behavior because they need ways to self-soothe or self-medicate; they want connection and caring attention from loved ones, they want the world to see their invisible psychic and emotional wounds, and they want to re-claim a sense of control over their lives and their bodies. Simply put, they want the pain to stop and they want to feel better.
And yes, in the short-term, self-destructive acts do relieve negative thoughts and feelings! People feel better because, when the body is physically compromised, threatened or hurt, the brain releases endorphins — naturally occurring opiates — that can bring a rush of euphoria and a temporary numbing of pain. Of course after the initial positive payoff, there are always negative outcomes such as guilt, shame, feelings of helplessness, the fear that loved ones or therapists will disapprove, and the hopeless sense that they’ll never be able to stop.
Since those negative outcomes create a state of emotional vulnerability, I believe effective treatment must focus, in part, on reducing the profound sense of shame that can actually fuel self-harm. In my work, I take the pathology out of the behavior, never treating it as mental illness but rather seeing it as a creative attempt to communicate one’s pain, to cope, and self-soothe. When someone abuses food, drugs, or alcohol, or engages in self-inflicted violence, they’re saying they don’t have any healthy tools to help manage their painful experiences. They need to learn other ways to short-circuit overwhelming thoughts and feelings, share their pain narratives with sensitive and caring witnesses, and need new ways to comfort themselves. Until they learn new strategies, it’s unreasonable to expect that they’ll give up their self-destructive acts!
As we work with the issue of shame in therapy, one of the best antidotes is self-compassion, and it’s something that needs to be continuously woven into treatment. Self-compassion allows us to see trauma and pain as well as destructive coping strategies through a different lens. It’s the realization that bad things happened to you, but you’re not bad. It allows for a genuine understanding that a victim never asks to be harmed and the only one who is responsible for the abuse is the abuser. It creates the opportunity to validate the fear, anxiety, sadness and anger that can accompany any life stressor without minimizing those feelings or implying they shouldn’t be felt. It frees us up to talk openly about our pain and allows us to be comforted by others. It even allows us to re-frame destructive behaviors as protective attempts to self-soothe, and then invites an exploration of healthier, safer ways to do just that, without the byproduct of guilt or shame. When we can access empathy and compassion, it no longer resonates to hurt the body, and this can often be a critical first step in the healing journey.
Lisa Ferentz is an LCSW-C, a Diplomat of the American Psychotherapy Association, and has been in private practice for 30 years, specializing in adolescent and adult survivors of trauma, abuse and neglect. She has been an Adjunct Faculty member at several universities, and is Founder and President of The Institute for Advanced Psychotherapy Training and Education, Inc. Ferentz is also the author of Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing and Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician’s Guide, now in its second edition. For more information, visit www.lisaferentz.com.
Identity Magazine is all about empowering women to get all A’s in the game of life – Accept. Appreciate. Achieve.™ Every contributor and expert answer the Identity 5 questions in keeping with our theme. As a team, we hope to inspire and motivate ourselves and inspire you to get all A’s.
What have you accepted within your life, physically and/or mentally? What are you still working on accepting?
As a therapist working with clients who engage in self-destructive behaviors, I have come to accept that I don’t have the power to make someone change or give up a behavior they’re not ready to let go of. My job is to educate, offer support, guidance and comfort, and be an authentic cheerleader and witness to their process. Their journey is their own and the choices and successes have to come from them. And there are certainly still times when I have to work hard on accepting and embracing that reality!
What have you learn to appreciate about yourself and/or within your life, physically and mentally? What are you still working on to appreciate?
I am so grateful for the countless ways in which my family, husband, children, friends, and colleagues nurture and support me, and encourage me to be true to my passions and my life’s work. Their belief in me means everything, and allows me to pay it forward in my work with my clients. What I am still working on appreciating about myself is that I get physically tired, given everything I do, and need to make sure that I give myself enough rest.
What is one of your most rewarding achievements in life? What makes YOU most proud? What goals and dreams do you still have?
I believe I am a wonderful mother to my three sons and, as I watch them evolve into such loving and caring adult men who communicate well, aren’t afraid to show their feelings, and are so kind to others, that feels like a great personal achievement. I am very proud of the work I do as a clinician. I am proud of the fact that at 55 years old I can still perform on stage and dance like a teenager! I am so proud of my husband and the countless ways he has helped others in his role as a Family Physician. I love what I do, so my goals include being able to keep doing it all! I also want to continue traveling, write more books, act in more shows and continue to provide consultation and mentoring to younger mental health professionals.
We all have imperfections, so we think. The truth—we are all perfectly imperfect. What are your not-so-perfect ways? What imperfections and quirks create who you are—your Identity?
Although I go out of my way to express my gratitude to loved ones, I am terrible at “thank you” cards, have at least 5 bottles of shampoo open at the same time, don’t always balance my checkbook, and have pretty messy closets!
“I Love My…” is an outlet for you to express and appreciate all the positive traits that make you…well… YOU! Sharing what you love about yourself will make you smile, feel empowered, and uplift your spirit and soul. (we assure you!)
Identity challenges you to complete the phrase “I Love My…?
I love my ability to be compassionate, genuinely nurturing and kind, and to feel grateful, everyday, for the countless blessings in my life!