By: Daryush Parvinbenam M.A., M.Ed., LPCC-S, LICDC Etiology: "There could be many reasons for the intensification of clients' symptoms, relationship issues are only one of them. This is the focus of this presentation.

1. Walking successfully through mine
fields: Effective approaches to
helping clients who hurt themselves
and sabotage counseling
Daryush Parvinbenam M.A., M.Ed.,
LPCC-S, LICDC

2. Etiology
There could be many reasons for the
intensification of clients’ symptoms,
relationship issues are only one of them.
This is the focus of this presentation.

3. Etiology
 Clients with a history of self injury and self sabotaging
patterns tend to leave both counselors and themselves
feeling frustrated and helpless.
 Many of these self destructive patterns are rooted in
early and chronic relational traumas that are acted out in
all areas of life.
 They tend to be diagnosed with multiple axis I and axis II
diagnoses, such as borderline personality disorder,
depression, bipolare disorder, and different anxiety
disorders.

4. Etiology
 Van der Kolk and his colleagues (1996) suggest
trauma re-enactment is mostly related to
affective (limbic) and the right hemisphere region
of the brain.
 Research literature supports the notion that
working with process in counseling with such
clients is more important than theory and
technique: Dawson (1993); and Miller (1997).

5. Etiology
 These clients often report history of early
and chronic relational traumas. Trauma
occurs in an environment characterized by
power differentials.
 The counseling relationship (with its
inherent power differential) often triggers
power reenactment dynamics for these
clients.

6. Core issues
 Dawson (1993) suggests chronic patterns
of abuse/neglect experiences must have
imposed an enduring sense of lack of
control, incompetence, and power in the
clients’ psyches. These issues tend to play
a significant role in these clients’ lives, and
how they engage in different relationships
and counseling.

7. Core issues
 For these clients, control, power, and
competence must be maintained in order
to prevent future traumas or re-
experiencing past traumatic emotional
memories.

8. Core issues
 Therefore the relational CURRENCIES
that have to be negotiated between
counselor and client are issues of:
 Power
 Control
 Competence

9. Assumptions of relationship
negotiation
 There is always an inherent power
differential between client and counselor
within the counseling relationship.
 The intensification of client symptoms may
be the result of interpersonal power
dynamics between the client and
counselor.

10. Assumptions of relationship
negotiation
 When the currency and dynamics of the client-
counselor relationship change, there is a
significant change in the clients’ behavior and
presentation.
 The client may feel/experience a sense of
power, worth, control and competence within
his/her hopeless state by demonstrating the
counselor is even less competent and powerful.

11. Assumptions of relationship
negotiation
 In this relational dynamic that is driven by a
power differential, the more pathological the
client “gets”, the more incompetent, and
powerless, the counselor feels.
 Clients self-destructive and pathological
strategies (cutting, substance abuse, suicidal
gestures, etc) SHOULD BE investigated as
attempts to have power in the counseling or
other relationships.

12. Practical strategies with
traumatized clients
When the client’s self destructive behavior
intensifies, consider:
1- Safety issues
2- Impact of counseling relationship as a
contributing factor

13. Practical strategies with
traumatized clients
 Make sure you have clear, specific, spelled-out
agreements and contracts.
 Promptly deal with all broken agreements, and
act on the consequence of the behavior.
 Maintain clear, firm, and reasonable limits
(expect them to be tested at least once).
 Be willing to be wrong and no to know all the
answers.

14. Practical strategies with
traumatized clients
 Be willing to let go of attachments to the
outcome.
 Do not rescue and do not prove how
helpful/good you are.
 Be supportive, empathic, and honest.
 Express concern, caring, and the desire to work
with the person, but not pity, or agreement with
issues.

15. Practical strategies with
traumatized clients
 Limit or avoid exceptions to the established rules
and procedures.
 Limit direct criticism. Traumatized clients have
limited adaptability and tolerance to criticism.
 Ask for consultation and supervision, especially
when feeling inept, incompetent or crazy.

16. References and Bibliography
 Dawsen, D. & MacMillan, H. (1993). Relationship Management of the Borderline patient. New
York: Brurmel/Mazel.
 Famularo, R., Kinscherff, R., Fenton, T. (1991). Posttraumatic stress disorder among children
clinically diagnosed as borderline personality disorder. Journal of Nervous and Mental Disease,
179, 428-431.
 Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD. New York:
Guilford Press.
 Linehan, M. (1993). Cognitive-behavioral treatment for borderline personality disorder: New York:
Guilford Press.
 Miller, J. B., Stiver, I.P. (1997). The healing connection: How women form relationships in therapy
and in life. Boston: Beacon Press.
 Van der Kolk, B. A., McFarlane, A.C., & Weisaeth, L. (1996). Traumatic stress: The effects of
overwhelming experiences on mind, body, and society. New York: Guilford Press.