Lisa Ferentz, LCSW-C, is the president and founder of the Institute for Advanced Psychotherapy Training and Education, which provides continuing education to mental health professionals. She was named "Social Worker of the Year" by the Maryland Society for Clinical Social Work in 2009 and has been in solo private practice specializing in trauma for 30 years. She is the author of Letting Go of Self-Destructive Behaviors and Treating Self-Destructive Behaviors in Trauma Survivors.
What is the biggest challenge facing practitioners who are working with clients who want or need to make a lifestyle change?
In the case of self-destructive behaviors, there is the challenge of practitioners' counter-transferential responses including anxiety, fear, confusion, and anger that can create power struggles with clients by forcing them to sign standard safety contracts, pushing them too quickly to give up the behaviors that have become "coping strategies," and threatening to fire them when they relapse. The challenge for clients is they have such limited tools in their tool box regarding ways to self-soothe, manage overwhelming thoughts, feelings and memories, or communicate their pain narratives so others can bear witness. Therefore, it is difficult for them to even consider giving up their destructive behaviors until practitioners can offer them genuinely useful and effective replacements that accomplish what self-destructive acts do in the short-term for clients.
Why is it important to take time to work on self-improvement issues?
I believe there is nothing more important than the way clients talk to themselves about themselves. This internal monologue impacts their emotional states, the extent to which they operate from accurate or shaming thoughts, the myriad behavioral choices they make and the risks they take, their capacity to sustain healthy intimate relationships, their ability to be self-protective, and their ability to parent their children in loving ways. For me, working on self-improvement means strengthening clients' capacities to access their own inner wisdom, and to look at themselves and their experiences with compassion. When they do this, the other avenues of self-improvement including maintaining a healthy lifestyle and letting go of self-destructive behaviors can fall into place.
What is the most important thing practitioners treating clients trying to make changes should know?
The truth is, as practitioners we can't fix or change other people. We can educate and guide them, encourage and inspire them, but at the end of the day, people change when they are ready to and believe that they have the inner and external resources that are needed to make and sustain those changes. It's important to know that authentic change doesn't happen when clients feel pressured or when they are doing it out of a sense guilt or obligation to the therapist or other loved ones. So, I believe every baby step has to be assessed to make sure that those choices are genuinely coming from the client, resonate for him or her, and are motivated by self-compassion and the belief that they deserve to live happier, healthier lives.
What is the most prevalent misconception about self-improvement and making lifestyle changes?
I think there are several misconceptions. First, there is the idea that guilt or humiliation can work as motivators for change. I think this is absolutely false. If you are ashamed of yourself, it will resonate to keep hurting yourself, not make healthy lifestyle changes. Second, I think practitioners can get very focused on what their clients will GAIN when they work on self-improvement. I think it's just as important to allow clients to articulate their fears about what they will LOSE when they give up their dysfunctional behaviors and coping strategies. Trauma survivors,in particular, are frightened of change- even when it leads to something "better." Sometimes there is secondary gain associated with dysfunctional behaviors: less is expected of them, others step in and take care of them, it garners attention and concern from others, etc. So we shouldn't be so quick to assume that self-improvement will automatically lead to happiness. It's normal to get initial push-back from clients and that has to processed in compassionate ways.
Is there anything in particular that you’d like to highlight about the topic or your book?
Since I believe the desire for self-improvement and a move towards positive lifestyle changes can only grow out of a genuine feeling of self-compassion and empathy, my book helps clients "make sense" out of their destructive acts in a way that never shames or pathologies them. I think this is a very important first step. All of the exercises in the book are designed to help clients gain insight and self-awareness in gentle, non-judgmental ways. As clients begin to see their destructive behaviors through this compassionate lens, it moves them in the direction of wanting to make healthy lifestyle changes because they believe they genuinely deserve that. The book also allows clients to grieve the loss of old behaviors that, in their minds, served them well for a long period of time. And most importantly, it provides clients with concrete ways to replace dysfunctional behaviors with ones that still allow them to communicate their pain to others, short-circuit overwhelming thoughts and feelings and self-soothe in ways that are genuinely healthy and safe.