The idea that [clients with self-destructive behaviors] 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.
Lisa Ferentz.  Read the rest of the post on After Trauma
Part of what got me thinking about this idea of putting [eating disorders, self-harm and addictions] 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.

Lisa Ferentz

full After Trauma post here

Ghana update

Hello beloved followers,
I’ve been in Ghana about 6 weeks now. I decided pretty quickly that I wanted to work with the Ghanaian, rather than ex-pat, community because of my background in serious mental illness and complex trauma, and interest in learning about all things mental health here. 

I work part time at the Accra Psychiatric Hospital. I am starting in the Social Welfare unit, which is responsible for discharge planning, case management and some life skills coaching in the community. Dr. Osei, the clinical director, and I agree this is the best place for me to learn about the system and culture of mental health here.
My other part-time position is at the New Horizons Special School, a well-run and well-supplied non-profit for students with developmental disabilities, mostly cerebral palsy, autism and various intellectual disabilities. I provide trauma therapy to a few older teens and young adults. I will have more to write about what it’s like to assess and treat that in a cross-cultural context, but that’s another post.

I have been reading A LOT on cross-cultural psychology and psychological anthropology (if you think those sound like they overlap, you would be correct). I will start slow and get good clinical supervision with a Ghanaian who has worked with the latter population and is currently getting her PhD in psychology in the U.S.

Replacing Self-Destructive Behaviors

Step 2: Completing a self-destructive act such as cutting or bingeing/purging results in a release of endorphins, which helps regulate the individual and incentivizes him/her/ze to do the act again because it feels good. So it makes sense that a replacement would include an alternative way to release those endorphins. The two most effective ways to do this are physical exercise or laughter. So starting jumping around or watch a video/read a blog that’s guaranteed to make you laugh.

from Got Self-Destructive Behaviors? Try This Instead

We begin to find and become ourselves when we notice how we are already found, already truly, entirely, wildly, messily, marvelously who we were born to be. The only problem is that there is also so much other stuff, typically fixations with how people perceive us, how to get more of the things that we think will make us happy, and with keeping our weight down. So the real issue is how do we gently stop being who we aren’t? How do we relieve ourselves of the false fronts of people-pleasing and affectation, the obsessive need for power and security, the backpack of old pain, and the psychic Spanx that keeps us smaller and contained?

Here’s how I became myself: mess, failure, mistakes, disappointments, and extensive reading; limbo, indecision, setbacks, addiction, public embarrassment, and endless conversations with my best women friends; the loss of people without whom I could not live, the loss of pets that left me reeling, dizzying betrayals but much greater loyalty, and overall, choosing as my motto William Blake’s line that we are here to learn to endure the beams of love.

What to do when you’re tempted to give advice:
Listen
Listen to that person’s story. Listen with your eyes, as well—how do they appear? 
Be transparent when you don’t know what to say
We want to feel useful. We want to make it better. We don’t want someone we are sitting with to hurt anymore. And even though you probably know, here it is again: it’s okay that you can’t make it better. It’s okay to just say “I’m so sorry. I don’t know what to say.” Totally better than giving unwanted advice.
Ask what they want
Sometimes I feel like I have information that could be helpful, but I almost always ask, “Do you want me to listen or do you want advice?” Personally, I’ve noticed that many of my therapist friends do the same thing—we’re used to juggling the friend hat and therapist hat—and I love it. I have never been annoyed by that question—and it’s probably no coincidence that when asked, I often choose advice! You see, we are often ready to receive wisdom from someone who makes us feel seen and heard and respected.

What to do when you’re tempted to give advice:

Listen

Listen to that person’s story. Listen with your eyes, as well—how do they appear? 

Be transparent when you don’t know what to say

We want to feel useful. We want to make it better. We don’t want someone we are sitting with to hurt anymore. And even though you probably know, here it is again: it’s okay that you can’t make it better. It’s okay to just say “I’m so sorry. I don’t know what to say.” Totally better than giving unwanted advice.

Ask what they want

Sometimes I feel like I have information that could be helpful, but I almost always ask, “Do you want me to listen or do you want advice?” Personally, I’ve noticed that many of my therapist friends do the same thing—we’re used to juggling the friend hat and therapist hat—and I love it. I have never been annoyed by that question—and it’s probably no coincidence that when asked, I often choose advice! You see, we are often ready to receive wisdom from someone who makes us feel seen and heard and respected.