“Thou hast but enraged, not insulted me, sir; but for that I ask thee not to beware of Starbuck; thou wouldst but laugh; but let Ahab beware of Ahab; beware of thyself, old man.” —Herman Melville, >Moby-Dick; or, The Whale
Anna sat across from me, her eyes downcast. A middle-aged woman with a family, she had come to the Emergency Department the day before. Life had become too much for her to bear and the gun propped in the back of her closet had begun to look like the best solution.
Telling me her story, she knit her hands together, and added in a quiet voice, “Sometimes, I cut myself. But just on my hands, in the creases. You can’t tell then. When they heal you can’t see the scars.”
Such self-destructive behaviors are difficult to understand and manage, both as the person suffering and as the clinician. These behaviors come in many colors — cutting, burning, drugs and alcohol, restricting food or binging — yet all can paint a picture of personal pain and tragedy.
Every day as a psychiatry resident I sit across the table from those who suffer greatly at their own hands — often after suffering at the hands of others. For Anna, instead of providing support and comfort, her parents offered up a revolving montage of physical and emotional abuse.
Intertwining and teasing apart the past, present, and future plays an important role in understanding — and, ideally, in stopping — these self-harming behaviors. In Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing, Lisa Ferentz helps both clients and therapists explore, understand, and grapple with these behaviors.
Ferentz draws on her thirty years as a therapist who specializes in survivors of trauma, abuse, and neglect. She writes: “I’ve learned that the healing journey often begins with two main qualities: courage and curiosity.”
This compassion and empathy resonates throughout the book. Ferentz focuses on linking today’s behavior to what has happened in the past, giving the reader the opportunity to explore the “logic” behind behaviors that can seem irrational. She encourages the reader to make art depicting their stressors, journal about self-blame, and reconsider how they describe painful life experiences. She looks at how we connect with others and manage our emotions, both currently and throughout our lives.
Ferentz also delves into what these behaviors “really mean.” As she notes, “One of the ways you can be curious about your story is to be open to the idea that how and where you hurt yourself is not accidental, coincidental, or meaningless. You are using your body as a ‘canvas,’ showing the pain you cannot talk about.”
The book then offers explanations for what different self-harming behaviors can mean, and provides space and prompts for readers to consider their own personal meaning.
After exploring the origins of these behaviors, Ferentz looks at the self-perpetuating cycles that keep them going. She offers the reader exercises to tease apart what sets the cycles in motion, including negative thoughts and feelings, intense anxiety, and dissociation.
The final section of the book deals with how to move beyond these behaviors. Ferentz walks the reader through reframing negative thoughts and managing negative feelings. Through writing exercises and artwork, she encourages readers to better understand their feelings and the situations that elicit them.
Throughout the book, Ferentz gives brief examples from clients. These illustrate the process of grappling with self-harming behaviors and let readers feel less alone in their struggles.
This is an affirming book. When so much of self-harming behavior is cloaked in shame and can stem from a feeling of powerlessness, Ferentz offers wisdom.“[Y]ou have power and you have choice,” she writes. “You can choose to communicate and self-soothe in ways that are destructive or in ways that are truly effective and healing. This is yours to choose and it will always be your choice.”
For therapists, the book offers a rich selection of exercises to use with clients. And for those suffering from self-destructive behaviors themselves, Ferentz can help you develop a better understanding of patterns and move you toward recovery.
Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing
Routledge, September 2014
Paperback, 288 pages