In my third year of medical school, I was mentored by a brilliant surgeon who routinely pontificated about the virtues of his profession, with clear intent to dissuade me from entering psychiatry. On one such occasion, he disrupted my tense and halting approach at a long abdominal incision with the question: "Do you know what makes a surgeon great?" I looked up from the patient's pale, still body - scalpel still poised. "It's not the suturing; you can teach any monkey how to sew." (That didn't boost my fledgling surgical confidence.) He went on to say, "When you open someone up, it rarely looks like the textbook. It's messy, unpredictable. Great surgeons effectively respond to each new situation as it arises... they adapt."
Although this gifted surgeon didn't dissuade me from the practice of psychiatry, I was persuaded to believe that effective treatment of the body and the mind requires an ability to adapt to each new situation as it arises. Most people enter The Meadows with some idea of their underlying problems and what they want to accomplish in treatment. However, as people give themselves to the recovery process, often the mental and emotional landscape changes in unpredictable ways, presenting new challenges and new opportunities for healing and growth. The following case history highlights the dynamic unfolding of one patient's experience at The Meadows and some of the treatment modalities that were adaptively employed on the patient's behalf.
Susan, as I will call her, was a 32 year-old, single, female from Denver, Colorado who was referred to The Meadows by her outpatient therapist. She initially reported symptoms of anxiety and depression that had contributed to significant problems in her close relationships and work performance as a financial consultant. She identified pervasive feelings of uneasiness and tension, with debilitating spikes of episodic panic and fear. Also, she noticed that her self-confidence was very low and that she was uncharacteristically tearful, emotional, and sad. After discussing her condition at length with her psychiatrist at The Meadows, they both agreed to explore the symptoms further before deciding if a medication was necessary.
Forming relationships of trust with peers and providers allowed Susan to acknowledge that her symptoms of depression and anxiety were partially related to worsening addictive behaviors with alcohol, food, and sex. She admitted to a life-long struggle with binge eating, excessive dieting, and shame about her body. She also shared that, after ending a ten-year, co-dependent romantic relationship in the months prior to admission, she immediately turned to compulsive sexual encounters via phone, internet, and night clubs. With the help of her outpatient therapist, she was able to reduce her sexual acting-out, but she then turned to excessive and reckless use of alcohol. Her life had become unmanageable.
In response to this additional information, Susan was reevaluated by the medical doctor to monitor and treat any symptoms of alcohol withdrawal. She spoke with the dietician so that the treatment team could better understand the nature of her disordered eating patterns and could help her establish an eating and wellness plan. In collaboration with her primary therapist, Susan set clear limits on her use of communication devices and her interactions with fellow peers, so that she could effectively address her compulsive tendency to rely on unhealthy relationships. Susan was also encouraged to attend 12-step meetings and to make use of important mind-body activities, such as yoga, tai chi, and meditation.
Although Susan had acknowledged a history of sexual trauma during the intake process, she was unsure of its significance in her life. Starting in the second week of treatment, she participated in a unique five-day experiential form of therapy that specifically addresses childhood trauma and early family relations. For the first time in her life, she began to see how her mother's tragic death at six-years-old led to years of depression and social-withdrawal on the part of her father. She was able to see herself as a scared and lonely child who tried not to worry her already distraught father, even when she was molested by the babysitter at nine-years-old. She discovered that during those lonely years, food was a trusted ally, but by the time she reached her teen-age years, food had become the enemy and she was at war with her own body.
As Susan's second week of treatment came to an end, years of shame, anger, and self-hatred gave way to profound sadness and grief. Long-held defenses began to relax, and as a result, she touched into another source of pain and sorrow connected to a date-rape in her early twenties that resulted in miscarriage. With guidance from peers and providers, she realized that this additional trauma and loss had contributed to soaring alcohol use and plummeting self-worth. In response to Susan's evolving treatment needs, she was offered several visits with an individual therapist trained in Somatic Experiencing to specifically address her adult trauma-related symptoms. Also, her focused work in 12-step recovery during the third week became more meaningful as she explored further the links between her past trauma and her addictive behaviors.
As a result of many lectures and hands-on practice regarding interpersonal communication and boundaries, Susan felt prepared to engage in family therapy with her father and two sisters during the fourth week of treatment. Relying on the inner-child work from her second week, she was able to talk openly with her family about the bewilderment and loneliness she felt after her mother's death. For the first time in her life, she shared the deep emotional pain associated with her experiences of sexual trauma, her ten-year, unhealthy relationship, and her addictive behaviors. Susan's family members responded with concern, but also with an outpouring of love and acceptance. Together, she and her family received information and practical tools to move forward in a way that could support Susan's recovery and a healthier family system.
As Susan entered her fifth week of treatment, she was invited to participate in a special grief workshop to specifically address lingering feelings of loss and pain regarding her mother's death and her miscarriage. Also, after weekly meetings with her psychiatrist about her particular condition and possible treatment options, she decided to start a medication for symptoms of depression. Several discussions with her providers, discharge coordinators, family, and outpatient therapist resulted in an aftercare plan that fit her therapeutic needs. Susan finished her treatment with a new lease on life - ready to face old challenges and embrace new opportunities.
Of course, there are additional elements of The Meadows' treatment program that are not discussed here and not everyone's experience is like Susan's... but that is the whole point; the human psyche rarely conforms to overly-simplistic, textbook universals and treatment often unfolds in unpredictable and complex ways. As my mentor suggested, this requires that treatment professionals recognize and adaptively respond to situations as they arise. This means that providers must have the appropriate training and therapeutic techniques to effectively respond to the dynamically changing landscape of each person's recovery process. The Meadows has a proven track-record of providing this kind of treatment.