The Meadows Blog

Wednesday, 04 July 2012 20:00

Dr. Shelley Uram on Little Traumas

Dr. Shelley Uram on Little Traumas

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from the nature of the authentic self to the benefits of Somatic Experiencing.

In the installment titled "Little Traumas," Dr. Uram, a psychologist and senior fellow at The Meadows, discusses the small traumas that people experience throughout life. While these "covert traumas" aren't visible from the outside, they get locked in the brain and, whether accurate or not, stay lodged in its trauma areas.

"And even if you learn better 10 years later," Dr. Uram states, "they're still there, and they're still going to get triggered."

In other videos in this series, Dr. Uram shares her expertise on trauma triggers, addiction, and the effects of emotional trauma on brain development.

Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain’s survival wiring — and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.

The Meadows’ video series includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg.  To learn more about The Meadows’ innovative treatment program for trauma, addiction, and other disorders, visit www.themeadows.com or call 800-244-4949.

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Over the years, I've had several persons who wanted my counseling, whom I found ravished with shame that manifested in an unusual kind of grandiosity. I connected with them because I have it in a different way myself. Over the years, I came to recognize what I call "reverse grandiosity." Sometimes after I had been working the 12 step program (at least five years), I noticed that details of my story had changed. Instead of sneaking out of Catholic seminary (where I was studying for the Catholic priesthood) and walking ten (sometimes 15, once even 20) miles to buy my drug of choice, I was really only walking three blocks! Ten to 15 miles make the story sound more dramatic and made my addiction worse that I really was. I wanted to make it sound worse. In fact I wanted to be the "best worst" in the program. Being the "best worst" was my "reverse grandiosity." I was the Star, Hero child in my dysfunctional family (capitalized because of the family systems need to have its shame diminished).

The clients whom I recognized with "reverse grandiosity" were somewhat different. They were people who claimed that their problems were so complex and unusual that no one had been able to help them. One man expressed it as clearly as possible. He said, "I';m just here to have someone to talk to, my problem is too unique to be alleviated by therapy." In other words, I'm special that I'm beyond what any humanly designed system of therapy can do. I let him rattle on and offered a follow-up visit. When he returned, I told him that after reflecting on his last visit, I found him pretty boring and quite ordinary. He became enraged when I called him ordinary. He started quickly enumerating every possible abuse that he had endured.

When he ran out of steam, I told him "you take pride in your abuse; you've made it sacred and in so doing make yourself superior to everyone else." These truths stung and my client kept coming back. I relentlessly called him ordinary, and one day he broke down crying. He told me how scared and small he felt. He said he realized that his idealization and attachment to his abuse made him feel like he was somebody superior. I took him to a 12 step meeting where he was introduced to the concept of anonymity. He soon realized that there were people of every sort in the group - men, women, rich, poor, middle class, lawyers, university professors, artists, laborers, mothers raising children, even a priest and two ministers. All had the same addiction and while their stories differed in details and they had different IQs, their common problem was the same - they had to stop using the drug they were addicted to that had caused their lives to become unmanageable. We were all simply ordinary human beings ravaged by drug addiction.

Anonymity is the great spiritual gift of the 12 step program. A Tibetan monk, Tara Tulku Rinpoche once said "the intensity of our sorrow will vary in direct proportion to the intensity of our feeling that "I am important.""

The practice of anonymity is the practice of being nobody special and that is the essence of humility. After 46 years of being free from my addiction, I can testify to the fact that those who know they are nobody special are busy doing the work that all ordinary humans are called to do in order to flourish. Gandhi constantly attested to being an average, ordinary person. When Erik Erikson wrote Gandhi's Truth (an autobiographical account) he found that Gandhi's wife and children attested to his flaws and his demanding profections of perfection on them.

Anonymity asks us to give up the idea and energy of trying to be special and different (so that we can be set apart from our fellow humans). Accepting being nobody special freed me from having to live up to demanding images. It freed me to do something I didn't have to work at, just being myself. Think of what you could let go of and the energy you would have if you stop trying to be somebody special, separate from the rest of us. Take on the amazing spiritual gift of anonymity and allow yourself to relish in the freedom of being ordinary.

Mr. Bradshaw has enjoyed a long association with The Meadows as a Senior Fellow, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. His New York Times best-selling books include Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

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Often, during the first week of treatment at The Meadows, people will skeptically inquire, "Do experiences in childhood really continue to affect my life as an adult?" While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and well-being. However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD's, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts. Of course, this resonates completely with our clinical experience and treatment model at The Meadows. However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood. In fact, results such as these have led some people to elevate childhood maltreatment to the level of a "public health threat". Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment). Over fifty years ago, John Bowlby (the "father" of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

One way that attachment security may contribute to positive health outcomes is by fostering an open, flexible, and optimistic approach to life's diverse and often unpredictable challenges. The development of such a resilient approach to life may come about as repeated experiences in secure attachment relationships organize and optimize emotion-regulation strategies and cognitive representations of self and others (i.e., internal working models). Consistent with this view, attachment insecurity has been associated with rigid, maladaptive responses to environmental demands and difficulties in appropriately understanding, expressing, and regulating emotions.

As a central feature of attachment theory and resiliency, the regulation of emotion may be an important variable linking childhood adversity to the various mental, emotional, physical, and social problems described in the ACE study. To address this clinically relevant question, my mentor and esteemed colleague, Phil Shaver, and I conducted a research study2 that has been accepted for publication in the journal of Individual Differences Research. In this study, 388 young adults completed questionnaires regarding adult attachment style (e.g., secure, avoidant, anxious), emotion regulation tendencies (e.g., emotional suppression, cognitive rumination, negative affect, emotional clarity, mood repair), and resiliency (i.e., an open, flexible, and adaptive approach to life).

Consistent with our hypotheses, the results indicated that, compared to attachment security, the two dimensions of attachment insecurity (i.e., anxiety and avoidance) were associated with lower levels of emotion regulation and resiliency. Interestingly, attachment-related anxiety and avoidance were connected to these outcomes through distinct cognitive-emotional pathways. For example, people scoring high in attachment-related anxiety reported a greater tendency to ruminate on negative thoughts and experience negative emotions, while people scoring high in attachment-related avoidance frequently relied on suppression of emotion and reported problems in clearly understanding their emotional states.

These results are very congruent with general theories on attachment and with my clinical experience at The Meadows. Attachment-related anxiety (similar to Love Addiction in The Meadows model) is characterized by hyperactivation of the attachment system, involving energetic and insistent attempts to attain proximity, support, and love. Generally, these individuals are hypervigilant to possible relationship threats (i.e., rejection or separation) and respond to such threats with intense mental rumination and high levels of negative emotion (e.g., anxiety, fear, shame, or anger). On the other hand, attachment-related avoidance (similar to Love Avoidance) involves deactivation of the attachment system, inhibition of the quest for support, and a commitment to deal with threats alone. These individuals divert attention away from possible relationship threats and tend to suppress their emotions, which contributes to a lack of understanding about the nature of their emotional states.

In contrast, repeated experiences with sensitive and responsive attachment figures increase a person's general sense of safety and security and foster optimistic beliefs about others' trustworthiness and one's own ability to effectively manage distress. Security-based strategies integrate cognitive and affective processes so that emotions can be openly acknowledged and clearly understood, while at the same time, metabolized and expressed without one's becoming excessively distressed or disorganized. In summary, the results of our study suggest that secure attachment relationships optimally organize emotion regulation capacities in a manner that enhances flexible adaptation to life's demands. This relationally acquired resiliency may be underdeveloped in people who have experienced childhood adversity and may contribute to diminished health and wellness.

Fortunately, recent evidence suggests there is considerable plasticity in the neurobiological systems underpinning social-emotional processes, which means there can be meaningful changes in emotion regulation and intimate relationships. Therefore, people who have experienced childhood adversity and relational trauma are not destined to experience the negative outcomes described in the ACE study. In fact, many professionals think of the alliance between therapist and patient as a type of attachment relationship where the capacity for emotion regulation, intimacy, and resiliency can be cultivated in an environment of safety and security. Treatment is available and there is hope for recovery.

1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks, JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 1998;14:245-258.

2. Caldwell JG, Shaver PR. Exploring the Cognitive-Emotional Pathways Between Adult Attachment and Ego-Resiliency. Individual Differences Research, 2012 (Manuscript accepted for publication; available upon request).

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Parents of young addicts suffer the aftershocks of trauma long after the addict has entered REHAB and begun recovery. The Family Member PTSD Scale © Note1 which assesses family members of drug addicts for SHOCK, ISOLATION, VICTIMIZATION, SHAME, OVER-RESPONSIBILITY, LACK OF HOPE, and GRIEF, as well as for other symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex Post-Traumatic Stress Disorder (C-PTSD), is the first tool to use when starting to work with families of addicts. The scale was designed to determine the degree of trauma and the residual effects that trauma has had on parents and siblings. There are stages of unresolved trauma which must be known before beginning family reconciliation.

Examples of some of the typical SHOCK questions on the scale that parents of addicts endorse include: "I am numb from dealing with the crisis of addiction" or "I am shut down emotionally and do not respond like I used to" or "I have flashbacks of incidents that happened in our family when we were dealing with active addiction" or "When the phone rings late at night, I sometimes still experience startle, fear and vivid memories."

Most families have some form of PTSD. A parent who found their child collapsed in the bed or bath nearly dead from an overdose, who experienced a surge of adrenalin to handle the emergency, and never processed the crisis, is frequently haunted by vivid recollection, and nightmares. The nightmares can last for years. For many parents, the long battle with trying to save their teenager's life has resulted in C-PTSD. C-PTSD was first described in 1992 by Judith Herman in her book Trauma & Recovery. It is a psychological injury that results from protracted exposure to prolonged interpersonal trauma with "loss of feeling in control", "disempowerment", or "feeling trapped," which parents suffer knowing they are responsible for underage children in grave danger. The key difference between PTSD and C-PTSD is the concept of "protracted exposure."

All previous family models for working with addiction have approached the family system from the point of view as if addiction began with adults and was passed down generationally. Today we are seeing a very high percentage of first-generation addicts, and the devastation to relatively normal parents when their children turn to drugs is incomprehensible. We have begun to work with families using a different model from the traditional model of family systems theorists of 20 years ago. Once the addict is admitted to REHAB, an immediate assessment for Post Traumatic Stress (PTS) of parents and siblings of these young addicts is begun. Some form of relief from the PTS symptoms is the most immediate need of family members. For some parents, the admonition to just "start working on your own issues" feels like a slap in the face. When the very first advice parents get from treatment center staff are things like "look at your enabling" or "look at your codependency" or "go find an ALANON group and work on your own stuff", some are offended and further traumatized by the lack of empathy for their current state of SHOCK.

"The most painful thing that we see parents dealing with," says April Lain, M.Ed, L.L.S.A.C, who has facilitated over 360 family workshop sessions integrating young adults back into their family of origin, "is the confusion of being told to disengage and leave the addict on their own - the concept of ALANON of "detach with love" is healthy but can be confusing. Parents are sometimes even made to feel guilty for continuing to seek help for their adult children who are caught in the grip of addiction, when intervention is required." She goes on to say, "I tell these parents not to feel guilty for seeking help. If you saw a stranger standing out on the ledge of a 14-story building about to jump off, wouldn't you at least call 911 and try to save their life? If you would do that for a stranger, why not for your own son or daughter who is standing on the proverbial window ledge and their life is in great danger from drug and alcohol use?" For parents who are in the trenches strategizing interventions, they are still on the battle ground. The adrenalin is still pumping. Lives are at stake.
The PTSD/C-PTSD approach to dealing with families is cutting-edge and compassionate. Without fail, along the way, the family members have suffered severe abuse from the addict. Abuse comes in several forms: Overt, Covert, Stealth, Structured, and Impulsive.

Overt abuse is clear-cut and easily recognizable and easy to describe. Cursing, name-calling, fighting, and verbal threats are overt and obvious. If your beloved son or daughter is standing in your kitchen threatening you with a knife, it is obviously abuse and is easily describable to others. If your teenager is throwing things or kicking holes in doors, you have evident visible damage. If you have bruises, broken lamps and you've started to put locks on your bedroom door out of fear, you are dealing with overt, tangible abuse.

On the other hand, covert abuse by an addict revolves around the addict's need to assert and maintain control over his/her parents or brothers and sisters. Covert abuse may not be visible to others such as to the non-custodial parent in divorced families, or with grandparents or schools and even police or coaches who continue to see the addict as charming. These "outsiders" will say, "Oh, you are making a big deal out of nothing." Or, "They will grow out of it, quit nagging them." Covert abuse is emotional and manipulative. It takes advantage of trust and costs parents their self esteem and confidence. Covert abuse is made all the more painful because others do not see the emotional damage - they only see a seemingly "crazy person" who is dealing with the aftermath of addiction.

Stealth abuse such as gaslighting is a form of abuse where the truth gets denied so often and so convincingly that the parent starts to believe they are going crazy. It is the deliberate use of false information to make others doubt his or her own reality, doubt their own memory, and not trust their own perceptions. (The term gaslighting comes from a 1944 film called "Gaslight" starring Ingrid Bergman. Her charming new husband deliberately attempts to drive her crazy, i.e., gaslighting.) Many parents report a feeling "like I was losing my mind".

Sometimes addicts manifest what is known as a patterned (or structured) abuse. That is someone who abuses everyone around them, not just parents but other children, friends, authority figures. The abuse is predictable- everyone gets a fair share. Other addicts are more unpredictable and impulsive with their abuse - they are nice at times and then they strike "out of the blue" in a flurry of chaos. One never knows when the rage fit will hit.

Bessel van der Kolk, in his "Assessing and Treatment of Complex PTSD" identified depression, lack of self worth, problems with intimacy, inability to experience pleasure, satisfaction, or to have fun, as symptoms of C-PTSD. There are no reliable statistics of the number of marriages that do not survive dealing with a child addict, but it appears it could be as high as 20 percent. It is complicated because other factors might have impacted the marriages. The emotional toll is very high on the family.

Drugs and alcohol have taken a foothold on our younger generations on an epidemic scale. Validating the stress that the families have endured is the first step for starting to work with the family. Helping the family to recognize the PTSD characteristics of their reactions, helping them to heal and finally, helping the addict to feel and show empathy for how the trauma has impacted those who love them- that is the work of a REHAB Family Counselor.

Bonnie A. DenDooven
dendooven7@gatehouseacademy.com

Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").

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My therapist told me most sex addicts have multiple addictions. Is that true?

I have never met a sex addict addicted only to sex. Typically, three to six addictions interact with one another. Most individuals who come into treatment don't realize this. Often they are in denial about the scope of their destructive behaviors, minimizing and rationalizing their patterns. Often they construct and normalize complex lives, allowing one addiction to flow seamlessly into the other.

Professionals who work 80 or 90 hours a week may feel they have earned a weekend of binge drinking and sex. They tell themselves they are not workaholics, because they can take time off to "relax." Similarly, some individuals who work excessive hours take vacations only to pack every minute with activities: scuba diving all day; a volleyball tournament before dinner; an expensive meal; and clubbing with alcohol, drugs, and sex until 3 a.m. - only to start the cycle over the next morning."I don't have a work addiction. I can relax and take time off," they tell themselves. What they don't realize is that they are addicted to intensity. They look for the high or emotional escape that allows them to avoid uncomfortable feelings.

All addicts are "shame-based," meaning they were given negative messages about themselves. A child can experience abuse that is overt (recognizable abuse that can be verbal, physical, or sexual) or covert (in which the child is not typically aware of the subconscious messages). Covert abuse is typically couched in the expectations that parents have for their children. "If I am a good athlete, my parents will be proud." "If I am homecoming queen, I will be popular."

These children believe they must perform in order to have value. Such intensely goal-oriented thinking teaches - and ultimately allows the children to avoid - feelings of shame. This is when patterns of addiction begin.

This need for external gratification sets up the children to have low internal esteem. They feel they are not enough; they are worthless and unlovable... unless they produce. Winning trophies and awards will bring attention and a sense of value. Before they are aware of it, these people establish patterns that allow emotional escape.

After cheating on his wife, the sex addict feels no guilt or remorse about his betrayals, but stops at the local pizza parlor and eats a whole pie. Still numb, he spends several hours gaming on the computer - yet another way to avoid the emotions that lie below the surface.  His patterns satiate his pain and shame.

Food addicts may gain weight so they don't have to be sexual. "I don't need sex," they tell themselves. "I am strong and independent."

The after-work drink with coworkers may turn into a one-night stand. "I wouldn't have done it if I hadn't been drunk."

In treatment, individuals look at the interactive patterns in their lives, the seamless processes they unconsciously devise in order to survive painful feelings. The healing process often overwhelms the individual, because the addict often believes his or her own lies: "I don't really have problem with..." In reality, they have spent a lifetime jumping from one addictive behavior to the next on a roller coaster; the costly consequences can impact their livelihood, relationships, health, and finances - and can even bring death.

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