Note: This article was originally published in the Summer 2008 issue of MeadowLark, the alumni magazine of The Meadows.
Science and Ancient Wisdom: Treatment Here-and-Now
Before reading further, take 20 to 30 seconds to do this exercise: Let your gaze leave this article and let your eyes look around wherever, and at whatever, they want - just 20 seconds or so. (Really, try it, and then come back to reading.) People in my Somatic Experiencing® (SE) Trauma Treatment courses who try this are surprised that, in a very short time, they feel noticeably more relaxed, peaceful, and in the "here-and-now." Some say they should do this all the time!
Thanks to the forward-thinking people at The Meadows, the connection between trauma and addiction is better understood and more effectively treated. Part of this treatment at The Meadows' extended-care facilities consists of working with the trauma-resolution skills of Peter Levine’s Somatic Experiencing®. The relationship between trauma and the exercise you just tried is that, according to Bessel van der Kolk, post-traumatic stress is fundamentally a disorder in the ability to be in the here-and-now. This means that the state of- the-art in trauma therapy is no longer intense regressive or cathartic therapy. Instead, state-of-the-art therapy is the process of becoming alive to the moment.
For those I train in SE, like those at The Meadows, working in the here-and-now is a cornerstone of clinical theory and practice. When doing his dissertation decades ago, Peter Levine met Stephen Porges and explored his research. Porges' "Polyvagal Theory" (Porges, 2001) shows how one pathway of the nervous system engages freeze and another relates to social engagement. Levine discovered how to work with the transition of the nervous system through these phases (freeze and engagement), as well as the phases of fight and flight. This is SE. This article’s focus is on the engagement phase, which must be integrated into all other nervous system phases.
While Porges' emphasis is based on single linear phase transitions, in SE we work with non-linear and rapid cycling states, for instance, freeze and fight, or flight and orientation. Traumatic symptomology such as intrusion of fight, flight and freeze means that the past has become the present. Flashbacks are the classic example of such disorientation - innocuous cues can trigger an all-out response. In other words, the person temporarily experiences a state that is disconnected from the actual here-and-now environment. One of the antidotes to this traumatic recollection is orientation. I provisionally define orientation as "connecting to the environment through the senses" - in other words, coming back to our senses. This is a broader understanding of engagement than social engagement, per se. For clients whose early life experiences were marked by trauma and abuse, social engagement is actually a trigger for fight, flight and freeze. In this process of orientation, rather than being inundated with a cycle of feelings, thoughts, and sensations associated with unresolved trauma, the client's attention can be directed to the reality of the environment that is available through the senses. Typically we see decreased blood pressure and decreased heart rate, as well as the subjective experience of greater relaxation and interest. In other words, it is the difference between stopping to smell the roses and reliving getting stuck by a thorn!
With many severely disoriented clients, much of the initial therapeutic work (in addition to establishing rapport) consists of the stabilization that comes from establishing better cognitive pathways or habits of here-and-now sensory attention. In attending to the sensory experiences of the external world, physiological mechanisms for assessing safety are allowed to occur without undue influence from traumatic memory. The mechanisms of this assessment are far too important, in a survival sense, for the slow processing of linear thought or conscious effort. Porges aptly names this subconscious process of safety assessment "neuroception" (Porges, 2004). Thus, a natural orientation to the external environment via the senses facilitates the neuroception of safety.
This approach is receiving increasing scientific and popular attention (Time Magazine: Mind & Body Special Issue, January 27, 2007, pp. 55ff). Whether incorporated into CBT, DBT or meditation, the role of the observer is crucial. The process of orientation is fundamental to this cognitive activity. However, many traditions that recommend observation may not adequately reinforce with clients the importance of orientation to the outer versus the inner environment. For those with significant disorientation, it is nearly impossible to track the interior landscape without being involuntarily drawn into what SE terms the "Trauma Vortex." The involuntary and repetitive attraction to this "vortex" is the disruption of the approach-avoidance system, and it is one of the dynamics that underlies addiction and compulsive behaviors in general. Although somatically informed therapists draw from Levine's work, they often make the mistake of inviting clients' attention to the inward sensate experience, without consideration to the vital criteria that indicate whether a client can negotiate such attention without reactivating and reinforcing trauma states. For instance, one of the most common beginner's mistakes is when a therapist asks an anxious client to focus on that sensation in the body. For some clients, this can work well and provide a sense of relief and transition to a more relaxed state; for others, this can lead to further discomfort and other states of disintegration. It is vital for the therapist to immediately and accurately assess the client's capacity in order to determine the appropriate intervention. Without such assessment skill, the safer route is to begin with external orientation, which can stimulate the innate orienting response and build stability.
Once relative stability is attained, a balance of interior and exterior attention can be facilitated. Then a more neutral and practiced observation of the range of experiences can be enjoyed, as the attention can shift naturally between affective experiences, both positive and negative. (This fundamental process at the heart of SE is known as "pendulation," which I discussed briefly in the Summer 2006 edition of The Cutting Edge) This natural swing between polarities is the normal condition of the balanced nervous system. And interestingly, the resulting integration that comes from this innate oscillation is a broader and more nuanced life in the here-and-now. The experience brings awareness, presence, and a greater ability to experience life on its own terms, without undue constriction or elation. Obtained after significant work of attending, this resulting state can yield an expanse of awareness with an increasing ease of relation and a connectedness to everything that is. This state, known among meditative adepts, is simply our human mind freed of its overlay of conditioning hewn by survival networks related to approach-avoidance. Freed from the dominance of an ill-conditioned approachavoidance paradigm, one enjoys engagement with what is now, new and alive. And so, as clinicians, we can orient to the fact that we live in a time of opportunity, when mind and body are becoming reacquainted, and when science can shake hands with ancient wisdom.
Hoskinson, S. (2006) "SE's Systemic View of Functional Reward Systems." The Cutting Edge, Summer 2006. See TheMeadows.org.
Porges S. W. (2001) "The polyvagal theory: phylogenetic substrates of a social nervous system." International Journal of Psychophysiology, 42, 123-146.
Porges, S. (2004) "Neuroception: A subconscious system for detecting threats and safety." Zero to Three [Online] National Center for Infants, Toddlers and Families. No. 5, May. See zerotothree.org.
Stengel, R. (Ed.). (2007). The brain: A user's guide [Mind and body special issue]. TIME, 169 (5).
ABOUT THE AUTHOR
STEVEN HOSKINSON, MA, MAT
Under the auspices of Hoskinson Consulting in Encinitas, California, Steven Hoskinson, MA, MAT, is an international consultant and trainer for clinicians and trauma treatment providers. Steven is a Senior International Instructor for the Foundation for Human Enrichment and has done research in creativity, myth and spirituality. His perspectives include evolutionary, developmental, cognitive-behavioral and systems approaches within a mindfulness framework. Other major influences include personal mentoring with Peter Levine, PhD, more than 20 years of experience in the contemplative arts, and a decade as a practicing aikidoist. www.HoskinsonConsulting.org
John Bradshaw, MA, Fellow of The Meadows, was mentioned in a recent article in the Sudbury Star. In "Different Views on Ethics", librarian Kaija Maillloux rounds up eight books with unique perspectives on ethics. From the article:
"Reclaiming Virtue: How We can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason, by John Bradshaw, shows that each of us has what he calls an inborn moral intelligence, an inner guidance system that can lead us - if we know how to cultivate it in ourselves and others. His fascinating discussion ranges from the ancient Greek philosophers to modern explorations of emotional development, from provocative historical insights to the recent discoveries of neuroscience."
To learn more about Reclaiming Virtue, see this interview with John Bradshaw from earlier this year. For more information about Bradshaw and The Meadows, visit www.themeadows.org.
Note: This article originally appeared in the Spring/Summer 2009 edition of MeadowLark, the magazine for alumni of The Meadows.
By Judith S. Freilich, MD
I am a psychiatrist thinking about knitting - about dropped stitches, in particular. Knitters know that a dropped stitch weakens the whole cloth, disrupts the garment's integrity and leaves a hole that may not even show until there is a stretch or stress on it. Then, the fabric is likely to begin unraveling from the hole, no matter how carefully the rest is knitted.
I wonder about this in my life. In the fabric of my life, there were many dropped stitches - emotions suppressed, voices blocked, roads not taken, losses not grieved before moving on, trauma endured. Life.
My way was to keep moving forward with determination, compassion and courage. I loved, worked hard, accomplished, learned and helped others along my way. On the surface, my efforts seemed of strong cloth. As time went on, those invisible holes - the dropped stitches - began to show and unravel.
"The body is the mind's subconscious," says respected neuroscientist Candace Pert, PhD. That which our minds can't absorb is held for us in our bodies. Dropped stitches remain in our garment, a part of us. They do not just disappear.
What to do about my dropped stitches? Do I leave the past untouched and continue pressing forward? What would that mean for the whole cloth? Does it end up in the trash that way? Do I choose the difficult task of repairing my garment, so it has more integrity for the future?
When a knitter discovers a dropped stitch, she repairs it. She unknits back to it, picks up the dropped stitch and then knits forward again. Knitters call this "tinking" - &"tink" being "knit" spelled backwards.
I think I will "tink." Many of my dropped stitches are losses not fully grieved. There are trauma-made holes, too. The largest is from when my daughters died in a tragic car accident in 1985. Then, I had no ability to grieve. I might have died or gone crazy had I not become frozen and dissociated.
I did not consciously make a decision to freeze. Perhaps my soul did, in order to preserve my life. And by doing so, the memories and grief were frozen and stored in my body - until the time came to unfreeze and release them. And, yes, it left dropped stitches. I think this was preferable to having no garment at all.
There are many ways to "tink." Each begins with recognizing a hole. We can complete a grief left undone. We may reconnect with an attenuated relationship. There is repair that is spiritual in nature, such as gratitude and forgiveness in their many forms.
There is trauma work. Effective trauma release is "tinking" at its best. Sometimes it involves finding memory pictures, then developing them to bring buried treasure to light or frozen emotions to life. Sometimes, tracking body sensations is the way to find and release them. Or we might return to an old physical environment, restoring an emotional state that was left behind before it was time.
The purpose is to transform trauma. It helps to think about chemistry and alchemy. Like knitting, these are transformational processes. They turn one thing into another. If a single step in the process is missed, the whole thing won't go to completion. It just doesn't work.
Tinking is precise, too. It begins with intention - and some resistance, as undoing is unpleasant. The knitted strand is carefully pulled apart, all the way back to the hole. The yarn is neither lost nor cut. It remains an integral part of the garment. When reknitted forward, it becomes part of a stronger garment.
Knitting creates links. A bridge is a link. To pick up a dropped stitch is to build a new bridge, make a strong link where one was weak or not even there. Building a strong bridge requires first building good foundations at each end of the span.
Not long after my girls died, a friend talked to me of bridges. She said that when your child dies, the foundation of your life collapses. For a while, you must go forward, building a new foundation. At some point, you then can build a bridge back to the past. Healing happens then. Connecting past and future makes a stronger whole.
With thanks to Descartes: "I 'tink,' therefore I am."
- Judith S. Freilich, MD, is a psychiatrist at The Meadows who is board-certified in psychiatry and neurology.
Peter A. Levine, Clinical Consultant for The Meadows, was recently quoted in the Psychology Today blog Let's Connect. In a post entitled "Enjoying Your Emotions", Thomas Scheff explores the psychological aspects of grief and fear, and suggests that too often, we are told to learn to control our emotions, instead of learning to enjoy them. For instance, grief can be a painful emotion to a person who does not feel safe to grieve.
"We have 'good cries' when we are able to rapidly move in and out of the grief. Peter Levine (1997) called it pendulation. Without this movement, we either don't feel at all, repression, or feel so much that we get lost in it (a 'bad cry')."
Scheff concludes that critics of catharsis haven't considered pendulation, but ought to.
For more information on Peter Levine's works, please visit the Meadows Addiction Treatment Center website.
Note: This article originally appeared in the Spring/Summer 2009 edition of MeadowLark, the magazine for alumni of The Meadows.
The Triggering Effect
By Claudia Black, PhD, MSW
Article excerpted from newly released CD Triggers and DVD The Triggering Effect.
Triggers are specific memories, behaviors, thoughts and situations that jeopardize recovery - signals you are entering a stage that brings you closer to a relapse. The process is much like riding a roller coaster that loops over itself. Once the roller coaster car gets to a certain spot in the track, a threshold is met, there is no turning back, and it starts the downward loop.
It is very likely you have heard your husband, wife, partner, mother, father, boss, a friend, attorney or even a judge say, "What were you thinking?" The answer is: you weren't thinking.
The inability to recognize the impact of your behavior, the willingness to risk what is significant in your life, and in this case, the quick lapse into old behaviors in spite of good intentions appear to be connected to brain chemistry. Addiction hijacks the brain. The reward/pleasure center holds captive the thinking center.
The good news is that the brain has plasticity. That means, in treatment and recovery practices, you can learn skills to calm the brain's emotional responses and reactivity area. You can learn to avoid triggers that activate the emotional area, and you can learn to enhance the decision-making area so you can rationally think through decisions, rather than respond impulsively and from such a strong emotional basis. But it takes time for the brain to be rewired, and it gets rewired with the repetition of new skills and new ways of thinking; hence, we strongly urge ongoing involvement in aftercare and other support systems.
Willpower alone is not a defense against relapse. Recovery is achieved, maintained and enjoyed through a series of actions. Learn to identify your triggers and, with each, identify a plan that anticipates and de-escalates the power of the trigger. With that, your reward is another day of sobriety with endless possibilities.
Five common triggers are:
1. Romanticizing the Behaviors
Romanticizing involves a tunnel focus on the positive feelings you associate with the behavior; it involves glamorizing using behaviors and, in the moment, totally forgetting about the negative consequences.
Getting overwhelmed at times is to be expected, but it's very easy to slip into romanticizing without any insight as to how you got there. At that moment, you enter a slippery zone, touching the trigger. While romanticizing is itself a trigger, it often occurs in tandem with an external trigger such as noises, sights, sounds or even tastes. You could be watching a movie and the next thing you know it is depicting the power of alcohol, drugs and sex in a positive way, and you are romanticizing. Or you're listening to the radio and an advertisement for a drug comes on, and you think about your pain pills as the commercial goes on to tell you how much better you'll feel, and off you go. Or you're watching a ball game on TV and can almost smell the popcorn and peanuts, and you see the spectators drinking large cups of beer and everyone is smiling like it's only a good time.
Take a few moments to think about how you romanticize your addictive behavior. What do you find yourself thinking about? What is the romanticizing covering up? What are you forgetting to take into account?
Addicts have used their behaviors and substances for years to separate from their emotional states. And there is so much to feel - guilt for how your behavior has hurt others, sadness for your losses, anger with yourself, fear of what is in front of you, shame for thinking you are inadequate, not worthy. You can act out in response to every feeling imaginable.
You lessen or get rid of feelings when you own them, talk about them or, in some cases, engage in problem solving. It is when you try to divert, ignore, and numb that you get into trouble. Feelings are a part of the human condition and you can't escape them. Recovery is the ability to tolerate your feelings without the need to medicate or engage in self-destructive or self-defeating behaviors and thoughts.
Recognize the gifts that come with feelings. Feelings are cues and indicators telling you what you need. Loneliness tells you, in your humanness, you need connection; fear can offer you protection, sadness offers growth, guilt is your conscience, offering direction for amends. It is critical for you to have this insight and, more importantly, to start to take ownership of the feelings when you have them.
Coupled with the trigger of feelings is the fact that those feelings are often associated with loss. By the time you get to recovery, you have had multiple losses in your life, often related to childhood, many times due to being raised with abuse, addiction, mental illness, etc. While you may have experienced trauma within your original family, pain of loss may be from a specific situation.
You may have experienced the loss of relationship with your parents or children, the death of friends or family, abortions, or career or work opportunities missed. As an addict, you are likely to have experienced losses related to health issues. Perhaps you have Hepatitis C, HIV, or injuries due to accidents.
It is not that you are suddenly thinking about these losses, but there may be a trigger. Perhaps you are in treatment and you see other people's children come to visit, and you have three kids and you don't even know where they live. Your daughter tells you that your ex-husband has just moved in with someone else. The goal is not to dwell on your losses, to not live in the pain and anguish. This is what happens when you don't acknowledge them and what they mean, triggering you back to your using behavior. With some losses, you can only grieve and ultimately come to find some meaning from your experience; with others, in time, you can attempt to repair damaged relationships.
Resentment is also a feeling, but I think it warrants its own place as a significant trigger. Resentments are like burrs in a saddle blanket; if you do not get rid of them, they fester into an infection. Resentments are often built on assumptions, i.e., "When you don't look at me, I assume you think you are better than me." "When you don't include me in a social gathering, I am assuming you think I am not good enough to be with you and your friends." Resentments are also built on entitlement, which is a form of unrealistic expectations and impatience.
Unrealistic expectations + impatience = resentments.
Move from resentments. When assuming, check it out. Put yourself in someone else's shoes (it may allow expectations to be more realistic). Identify and own the feelings the resentment is covering (often it's a cover for feelings of inadequacy and/or fear). Be willing to live and let live.
5. Slippery people, places or situations
You need to identify specific triggers - the people, places, and situations that are high-risk. Slippery people could be your ex-lover, certain family members, or past using/party buddies. A slippery place might be a bar you used to frequent, a casino, or an area in your community where you cruised - in essence, any place that triggers a positive association about the use of your drug of choice. Slippery situations could be an emotionally charged social gathering, such as a wedding, family event, or vacation.
Medication may be a trigger for which you need to be accountable. While there are situations when medication is needed, you are at high risk to abuse. You need to be proactive in how you are going to cope with this situation, because it is likely that your brain is going to remember a good feeling, saying more is better. Again, there are situations when medications are necessary, but self-diagnosis and/or self-prescribing only create a recipe for disaster.
What are the people, places or situations that are potential triggers? What provides safety for you to not be triggered? What triggers can you avoid? While some decisions around triggers are absolute, others are not necessarily in place for the rest of your life. Know your triggers and plan accordingly. In the face of a trigger, what do you need to do? What do you need to tell yourself? To whom can you reach out for support and/or problem solving?
Today in recovery:
1. Practice staying in the present; don't sit in the past or project into the future.
2. Validate the gifts of recovery for the day - practice gratitude daily.
3. Identify, build and use a support system - you need to stay connected. History and experience have proven time and time again that recovery is not a solitary process and cannot be sustained in isolation.
4. Trust that your Higher Power is on your side.
Maureen Canning, Clinical Consultant for The Meadows, recently discussed the topic of sexual addiction with Dennis Miller at Behavioral Health Central. In the interview, Canning explains many topics, including:
To listen to or read a transcript of the interview, visit the Behavioral Health Central website. To learn more about inpatient treatment for sexual compulsivity, visit www.themeadows.org, or for information on extended care for sexual recovery, visit www.themeadowsdakota.com
Note: This article originally appeared in the Spring/Summer 2009 edition of MeadowLark, the alumni magazine of The Meadows.
Would You Marry Yourself or Someone Like You?
By Debra L. Kaplan, MA, LAC, LISAC
Many magazines today offer practical advice and "how-to" strategies to pursue the man or woman of our dreams. Let's face it: Sexy taglines and catchy subtitles make for good print copy, but they do little to help us build healthy, sound relationships. By projecting our wants, expectations or intentions onto our partners-to-be, we serve only to foreshadow the inevitable relational demise. It is as if we incorporate our obsolescence from the very start.
"How is that possible," you may ask, "when I'm doing all the right things, paying close attention to selecting my partner, and looking at what he or she has to offer the relationship?" While I admit that these words sound counterintuitive, first consider this proposition:
Would you marry yourself or someone like you? Do you like the person you are - and that which you have to offer - enough to marry yourself?
Some time ago, I put this question to a client. In his plunge toward self-pity, he began to lament the state of his personal affairs, citing one futile relationship after another. "I don&'t know what else to do," he said with exasperation. He cynically sneered, "Just when I think I've found someone 'special' and things are going 'swell,' she leaves me. How does this happen that I pick women who cheat on me, time after time?"
That's when I asked him to humor me, as I was about to ask a question that might sound strange. "Geez, no," he answered. "I wouldn't marry anyone like me!" He went on to state that he was amazed that anyone liked him at all. That response, or a variation of it, often followed when I posed the question to clients.
Courage to look at our own fallibility and dark sides goes a long way in building healthy relationships - not just in romance, but in all of our personal interactions. Knowing our dark sides involves embracing those aspects of ourselves that cause us shame or guilt. While our tendency might be to bury or dismiss the parts that we don't want to acknowledge, this undermines the positive changes and inner strength we strive toward.
Initially, our tendency might be to assess what our partners bring to the proverbial party - without assessing what we have to offer. Are we emotionally available? Do we remain open to constructive criticism and risk being known, or do we defend ourselves into isolation, staunchly committed to our self-righteous deception? Is it okay to be lonely just as long as we are not "wrong"?
These are hard yet essential questions. Only when we like ourselves will we attract the same positive energy in others. The journey to know spiritual peace and fulfillment is an inside-out endeavor.
The first step begins with defining what we want to change about ourselves - and being honest about who we are. If we are too close for honest introspection, we can start by observing others' behaviors. Those behaviors we find uncomfortable or unpleasant reflect our internal barometers. Essentially, by noting unlikable behaviors in others, we face reflections of our true selves.
Defining what we want to change takes an honest assessment of what we reject in ourselves. How often are we drawn to attractive people while believing, deep down, that we are not equally attractive? When we accept and love our own qualities, we form the strongest foundation for intimacy.
By taking that simple but profound step, we begin the enlightened journey toward inner peace and fulfillment. As propositions go, there is no better partner with whom to say "I do!"
ABOUT THE AUTHOR
DEBRA L. KAPLAN, MA, LAC, LISAC
Debra L. Kaplan is a practicing licensed therapist in Tucson, Arizona. She integrates her training with Pia Mellody into her work with CPTSD and co-occurring addictions.
Note: This article originally appeared in the Spring 2005 issue of MeadowLark, the magazine for alumni of The Meadows.
Marriage in a Changing Society
When I write about marriage, I am concerned that my views will appear negative and be viewed as relationship 'bashing.' I believe that we suffer from our own hedonism and lack of personal discipline. I am deeply saddened by the apparent attitude that what we have, as a culture, is somehow permanent and that we will always be free. However, freedom is a two-edged sword: it gives us the right to think and act as we choose and to not have overt negative consequences as long as we stay within legal bounds. It is then the individual's responsibility to behave in a way that is personally productive while maintaining the discipline to not jeopardize the society in which we choose to live.
I have been thinking about the how's and why's of marriage and I keep trying to understand what has happened in my lifetime that has caused so many changes. I want to believe that there is an answer that will allow couples to court, marry and live happily ever after. This final phrase from many fairytales may now be more of a fantasy than it ever was.
The basic biological purpose of marriage is to provide for the preservation of the species by producing survivable offspring at a rate that at least replaces those that die. Looking at world population it is apparent that we have more than met this goal. There does not seem to be an 'off' switch on the reproductive imperative. There does seem to be a temporary accelerator that increases the birthrate after major stressors like war, pestilence and famine strike.
The attitude toward maintaining an integral family with the traditional couple staying married (until death do us part) has greatly diminished. In our culture, for many, marriage is a temporary arrangement. In other cultures, staying together and producing children, still holds a strong influence. Some religions make the goal of a large family a basis for pride and status. In the third world, where child mortality is high, the original imperative still makes sense. Some cultures have adopted our attitude and now find them below the population replacement rate. Sub cultures within a country now are out-reproducing what had been the dominant group.
Is this bad? I doubt that there is intrinsic good or bad in the shift to a new dominant group. In any case, it seems to be where we are and there is little evidence we can or will make changes to preserve what some believe should be our norm. Change would require discipline and/or oppression. Most of us lack the former, and the latter is against everything for what we believe and stand. Xenophobia explains our fears. For many, our values are being challenged; and we each believe that the values we hold are correct, moral and in the best interest of all. Accepting that others have as much right to their beliefs as we do is a difficult journey.
I still believe we are capable of entering and maintaining a comfortable, stable relationship. It will not be the marriage of our fantasies. It will be a union that requires hard work, acceptance of one another, dedication to being a couple and the realization that although it takes two to make it work it only takes one to destroy it. We cannot expect much in the way of support from a society that seeks instant gratification and demands that the fantasy becomes real. The fantasy comes out of initial, often sexual attraction; the intensity of which blinds us to reality. We desperately want to believe that love conquers all and that areas of incompatibility will resolve themselves. Johnny Cash's song "Jackson" says, "We got married in a fever. . .we've been talking about Jackson ever since the fire went out." In order to have a lasting relationship we must be able to stick to a commitment long after the initial flush of excitement has waned.
The journey is not for everyone. It does not seem like there are many who are willing to discipline themselves to adhere to the promises they have made. Having had three marriages myself, I certainly cannot say, "do as I have done." There are couples that seem to make it in long-term marriages. It is sad to me that the number is small and the trend is downward. It is similar to recovery in that the opportunity is there for all, but those who succeed are among the fortunate few.
Welcome to Addiction Recovery Reality, the official blogging voice for The Meadows treatment center, a multidisorder inpatient facility based in Wickenberg, Arizona.
The purpose of this blog is to open a window into our world. The Meadows specializes in the treatment of addictions, compulsive behaviors, and anxiety and mood disorders. We also actively participate in the larger addiction community; our senior fellows are recognized worldwide as academics, authors, lecturers and trainers.
This blog will enable us to share more information about the latest trends, resources, articles, announcements, lectures, book releases and workshops. Many entires will be published by The Meadows’ professional staff, but we’re also looking to highlight some ”best of breed” materials from the outside world.
Please stay tuned for our opening posts!
Note: This article was originally published in the CuttingEdge Spring/Summer 2009 Newsletter
By Debra L. Kaplan, MA, LAC, LISAC
Not too long ago, a client who I was treating for prescription drug abuse, looked at me and said, "It's my desperate need to silence my feelings that drives me to want to use." She went on to describe what it felt like to live in her skin. "It's as if the people in my life are at the controls of this rollercoaster called my life and I'm trapped and I can't get off. I like or hate the ride based on how I feel about them at that moment; in my mind you're either with me or against me. But I can't fire them from the controls!"
Unbeknownst to this woman, she was verbalizing her underlying issue: Complex Post-Traumatic Stress Disorder (CPTSD). For the uninitiated, CPTSD is classified as a long-term traumatic stress disorder that may impact a healthy person's self-concept and adaptation. Exhibited symptoms include mood disorders (depression, manic-depression, anxiety); fear of real or imagined rejection or abandonment; and addictive, self-defeating behaviors including bulimia, anorexia, compulsive spending, sexual compulsivity, and perhaps self-injury.
In an effort to differentiate between psychosis and neurosis, the condition first was branded Borderline Personality Disorder (BPD). New research and advances in studying chronic trauma’s effects on self-concept and psychological organization have yielded a more accurate approach to characterize exhibited symptoms.
Recurring bouts of emotional instability wreak havoc on the life of an individual struggling with this issue. Along with the ups and downs of the emotional roller coaster comes confusion about one's identity. An individual with CPTSD often wrestles with a persistently unstable self-image; like in a house of mirrors, one's identity is rendered illusive and distorted.
Those who are familiar with CPTSD know all too well the chaos and havoc brought to bear upon relationships. In working with trauma complicated by emotional dysregulation, I have often likened the displays of impulsive rage to a cluster bomb. From one furious mass come multiple smaller submunitions. These emotional explosions neutralize any threat of real or imagined relational rejection, abandonment or disapproval. Loved ones who are idealized one day are devalued and rejected the next, relegated to the role of enemy - perhaps simply because an act of parting was interpreted as an act of betrayal. Some who struggle with CPTSD have co-occurring mood disorders that exacerbate internal stressors to the point of brief psychotic episodes.
Individuals with CPTSD often verbalize feeling wronged, misunderstood and empty. As is often the case, the trigger - be it internal or external - prompts attempts to self-medicate overwhelming emotions with alcohol or chemical dependence, acts of self- mutilation (cutting, burning, wrist-slashing), and even suicide attempts.
Historically speaking, the prognosis for CPTSD has been poor. Within the therapeutic community, clients who present with these symptoms have been branded unmotivated, hard to treat or, worse, noncompliant. The current belief - and one that I genuinely embrace - posits that a consistently supportive therapeutic relationship can become a healthy foundation that allows a client to begin to experience trust and safety. Much is still unknown about the post-traumatic condition, but continued advances in neurobiological, genetic, and social research have led to new treatments and psychopharmacological interventions that have proven successful in generating enduring, positive change.
The path out of the CPTSD maze begins with a gradual acknowledgement of the problem and a willingness to accept oneself. But what happens when one does not acknowledge the presence of a problem? Clearly, such denial undermines progress toward positive change. An individual's need to shield himself from unacknowledged and overwhelming feelings exists until he is psychologically ready to see himself as he really is - and not who he wants to be.
Support for an individual's attempts to break through denial is necessary for enduring progress to be made. The presence of a psychological struggle does not designate a bad or defective person. He's done nothing to deserve it, much like a child does nothing to deserve the onset of juvenile diabetes. However, the individual is now living a reality of roller coaster emotions, unstable relationships, addictions, and feelings of emptiness. The cold, harsh fact is that the self-defeating behaviors and unstable self-worth are not likely to change until the person changes.
As with all physical and emotional distresses, there comes a moment when the status quo is no longer acceptable. The chaos or unmanageability of a situation necessitates asking for help and taking action. Perhaps the adage "being brought to one's knees" applies here. An ensuing adjustment period, in which one comes to terms with a new reality, may not be immediate. However, a new perspective might arrive with a sobering blow to the denial - or with the quiet realization that life is eroding beyond one’s grasp. Self-acceptance can be attained perhaps only through small, sometimes imperceptible steps. In recovery speak, it is progress rather than perfection that guides us: "I am not a problem, but my behavior has become problematic!" I ask my clients, "Which would you prefer to be: resolutely right or resolutely happy?"
When one is living a life that, despite great efforts, no longer results in satisfying outcomes, it is time to look inward and ask the hard questions: "What am I doing that is no longer working? Harder yet, what am I prepared to do about it?"
Until that moment of introspection and committed motivation, little if any enduring change will occur. But the path out of the house of mirrors, and away from the emotional roller coaster, is the path to a new life.