My Greatest Clinical Learning Experience

Finding the "Genuine Hero" in Even Your Most Troubled Clients

Lisa Ferentz

The most effective teacher I ever had in the field of trauma therapy wasn’t a trauma specialist, or a clinical expert, or even a colleague: she was a client, a deeply complicated woman, who initially scared the hell out of me.

Marisa came to see me in the early 1990s—about 10 years into my work as a therapist—because she’d begun to have terrifying obsessive thoughts about suffocating her 4-year-old daughter with a pillow whenever she heard the little girl crying. As she explained it, something about the child’s crying triggered almost intolerable feelings of rage and helplessness. I have to get her to stop screaming! I just want her to shut up! At the same time, Marisa felt deep fear and shame about these thoughts, insisting she’d never actually lay a hand on her child. At 35, Marisa was a highly intelligent woman in a stable marriage. She had a rewarding career as a librarian and was also the mother of an 8-year-old boy, who didn’t elicit such thoughts in her.

I was Marisa’s first therapist, and we quickly established a good rapport. She consistently showed up for sessions and followed—or tried to follow—the behavioral suggestions I knew to offer: taking time-outs when she felt stressed, learning to knit as a way to relax, reading the parenting books I suggested, listening to my advice about managing a crying child. She even brought her husband into a few sessions so I could work with them as a parental team. I knew she was trying hard, but these measures didn’t seem to be working. And because I didn’t want to let her down, I kept trying too.

As therapy continued, Marisa found the courage to share even more of her difficulties. By the sixth month of therapy, I’d learned that she was self-medicating with alcohol, cutting her herself, and struggling with medical maladies that ranged from chronic gastrointestinal upset to migraines to possible fibromyalgia. I began to feel uneasy. This is a deeply troubled woman with about 10 different diagnoses, I thought. I’m in over my head.

Then, during a session early on in our second year of therapy, it happened. Right there in my office, before my eyes, Marisa morphed into a different personality. As I sat frightened in my chair, she slipped off the sofa, sat cross-legged on the floor, and began talking like a 4-year-old. “Can we play a game?” she asked, her face bright with childlike anticipation. Before I could even think of a response, she followed up with, “Or can we color?”

Holy crap! What do I do? I thought in a panic. This was the first time I’d ever seen “switching” in real life—a behavioral manifestation of what was then called multiple personality disorder and is now known as dissociative identity disorder.

That session lasted well over an hour because, as a 4-year-old, Marisa couldn’t drive herself home, and I could hardly let her leave my office in that state. I got her to walk around the room, desperately trying to reorient her to present time and space, until the adult in her had sufficiently returned to know what to do with the car keys dangling in her hand. But my sense of inadequacy haunted me. The next time we met, I said, “Listen, Marisa, I have an inkling about what’s troubling you, but it’s something I have no expertise in treating. You deserve the best possible care, and I know just the therapist who can help you. I’d like to refer you to her.”

“No,” Marisa said, sitting up in her chair, her voice uncharacteristically firm. “I’m not going anywhere else. I want you to help me. So go ahead and read everything there is to read, talk to your supervisors, find all the resources you can, but I’m not going anywhere.” And so began my crash course in trauma therapy. I felt overmatched, but Marisa had been insistent. I feared that if I didn’t stay with her, she might not continue therapy.

Taking Up the Challenge

At that point in my career, I wasn’t completely ignorant about how to treat trauma. But the approach I’d been trained in during the late 1980s was based largely on the idea that clients like Marisa carried awful experiences that needed to be excavated and fully relived before they could be healed. Little, if any, attention was paid to the inner strengths that traumatized clients might reclaim if given half a chance. With the focus on all pathology, all the time, it was no wonder therapists tended to regard clients as one-dimensional bundles of dysfunction and pain.

And I could easily have come to see Marisa this way. After all, I soon learned that she’d been sexually abused for much of her life, from age 4 until 20. Her abusers included both of her parents, her sister’s boyfriend, and an unknown number of teenage boys who’d raped her when she was in a dissociated state. But by ordering me, in effect, to get my clinical act together and become an enlightened therapist, rather than a clueless one, Marisa revealed an aspect of herself that I hadn’t seen before. Here was a presumably “highly disturbed” woman exhibiting a solid sense of determination and willpower, as well as an acute awareness of what she needed to heal. Whatever her difficulties and however terrible her past—and it had been awful, indeed—she’d been at that moment capable of extraordinary self-advocacy, making it clear that her best chance of recovery lay in staying with me, in the trusting, authentic, and safe relationship we’d already established.

The process was daunting, but I was game. I read every new book on trauma, attended every workshop I could find, and began to work with trauma experts who were on the cutting edge of the field in the early 1990s. I learned about the importance of creating a safe environment, taking the time to build a trusting relationship, assessing for and undoing cognitive distortions, and increasing external resources for support.

At a certain moment in our treatment, I had a kind of epiphany. Not only did I come to realize that Marisa was the teacher when it came to her dissociative identity disorder, but that even the symptoms of her condition represented a kind of wisdom. Everything she grappled with—the thoughts, feelings, and behaviors that were pathologized in textbooks and held up as evidence of how troubled she was—were actually creative coping strategies that had kept her alive.

However frightening Marisa’s various parts seemed at times, it began to dawn on me that they weren’t fundamentally pathological. Instead, they were members of a self-created inner family that made it possible for her to function. Some parts pushed down her deep-seated rage so she could stay attached to her abusive parents and interact socially with peers. Other parts compartmentalized her memories of abuse so she could show up in school and concentrate on math and history. I began to view even her self-destructive behaviors—alcohol abuse and cutting—as creative attempts to both communicate her pain and distract herself from it when horrific memories bubbled to the surface and threatened to overwhelm her. Her symptoms were lifesaving emergency measures. And I began to regard her with admiration, even awe, for the strength of mind and soul that allowed her to survive.

I started working with my clients differently. I understood their symptoms as both painful and traumatic and creative and lifesaving. By holding that “both/and” thinking, I could bring more hope to the work. Together, my clients and I began to become curious about their innate abilities and about other, more affirming aspects of their lives. I started to talk less and listen more, and what I heard confirmed that my clients were more than their trauma—much more. Not only were they simultaneously struggling and growing, but in many cases, their growth seemed to be the byproduct of that very struggle.

As I continued in my work as a trauma specialist, I often heard Marisa’s words in my head: “Read more, go to conferences, study with mentors so you can figure out how to help me.” And I did. I used strategies from Focusing and sensorimotor psychotherapy while also working with movement, body sensations, and breath to process Marisa’s painful memories of sexual abuse. With my encouragement, she drew images of safe places and wrote poems celebrating her 4-year-old daughter as well as her wounded 4-year-old self.

Working creatively seemed to energize many of my traumatized clients, in part because they were already creative, having invented all kinds of strategies for safety and survival. Now they were using their imaginations to move beyond their pain and even find ways to make meaning from horrific events. Marisa, for example, developed a plan to speak at local high schools to educate teens about rape. She said to me, “I’m going to do everything in my power to help spare girls the terrible trauma I experienced.”

Post-Traumatic Growth

As I continued to bear witness to similar processes with other traumatized clients, I stumbled upon a paradigm called positive psychology, developed by University of Pennsylvania psychologist Martin Seligman, that was grounded in research exploring the qualities that allowed individuals to thrive in the face of adversity. Contrary to his original clinical assumptions, Seligman discovered that not everyone responded to trauma with a pervasive sense of helplessness. For some, the byproduct of trauma was significant growth, hope, and even empowerment. This clicked for me: I was witnessing it in my own practice. Further, the research found that clinicians could nurture this kind of growth by helping clients shift into positive emotions and thoughts, and encouraging them to pursue supportive relationships.

Seven years into therapy, even as Marisa continued to navigate many ups and downs, she began to feel more compassion toward herself, her fragmented parts, and remarkably, even her abusers. “My parents were horribly abused themselves while they were growing up,” she told me. “I’m not making excuses for them. It’s just that I’m starting to understand that there are generations of victims and pain in my family. My parents were clueless. Yeah, they should’ve learned how to parent better, but they had ninth-grade educations, no money, no way to get therapy.” She sat up straighter in her chair. “I know that I’ll never let my kids suffer the way I did. The cycle of abuse and ignorance stops with me.”

In a visible shift from PTSD to post-traumatic growth, Marisa took the quilting needles she’d used for years to cut herself and began using them to make beautiful quilted bedspreads for children in homeless shelters. She was setting free the parts of her that had punished her body and channeled her pain through self-destructive behaviors.


In my 32 years of trauma work, I’ve learned to see my clients as genuine heroes—wise, brave, and creative at the same time that they’re holding intense pain and sorrow. And I’m honored to help conduct their orchestra of inner parts until they can do so on their own. I know I can’t play their instruments for them, but I can guide and inspire them, hoping that phrase by phrase, measure by measure, they can begin to create their own music.

This blog is excerpted from "Transcending Trauma" by Lisa Ferentz. The full version is available in the September/October 2016 issue, Courage in Everyday Life: An Interview with Brené Brown.

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Topic: Trauma

Tags: abuse survivors | child abuse | childhood abuse | IFS | inner parts | Lisa Ferentz | martin seligman | positive psychology | positive psychology movement | positive thinking | post traumatic stress | post traumatic stress disorder | post-traumatic stress disorder ptsd | PTSD | ptsd and depression | ptsd symptoms | ptsd treatment | treating ptsd

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1 Comment

Sunday, October 2, 2016 1:07:34 PM | posted by Pamela Clements
I would like to thank Courtney Armstrong for her article, "Hiding in Plain Sight." I have taken a strengths-based and mindfulness-based approach to life and my professional work for as long as I can remember. I noticed that Courtney used the word "nemesis" according to common vernacular, as synonymous with "enemy," something to fear. I would like to point out that an older, "heirloom" if you will, definition of nemesis is that person or thing that challenges us so greatly that we may easily perceive it to be insuperable, yet if we dig in, we find that the work we do in responding to the challenge becomes a unique opportunity for growth. This is actually the premise of the article, summarized well in Courtney's statement, "People want to get rid of fear, as though fear itself is the dreaded villain, but in fact, it's nature's way of giving us extra (italicized) strength." In keeping with the insights shared in the article, I would like to suggest that we also help our clients understand this deeper understanding of the word nemesis.