By: Joyce Willis, MC, LPC
The Model of the Developmental Immaturity was developed by Pia Mellody. In the 1970s, Pia was working at The Meadows, a trauma and addiction Inpatient Treatment Facility. Pia found that she was encountering an increasing number of patients who identified less than nurturing, abusive family systems in their childhood - leading to adulthood behaviors of codependency. The codependency patterns translated into addictions, mood disorders and physical illness. Pia's continued work with patients led to the conclusion that people with codependence wind up in despair and actually die from the effects of codependence. Thus, the model was "born" to help patients understand the Family of Origin issues that brought them to the symptoms of their addictions, mood disorders and relationship struggles.
|NATURE OF THE CHILD||CORE ISSUES||SECONDARY SYMPTOMS||RELATIONAL PROBLEMS|
The Model of Developmental Immaturity is incorporated into every facet of treatment at The Meadows; from the week-long workshops to the intensive inpatient program. At each level, patients receive education on The Model and learn how to identify the childhood roots of their adult behaviors. Therapists at The Meadows lead patients through understanding how their core issues, secondary symptoms and relational problems were set up in childhood, leading to codependence in adulthood. The biggest understanding that we want patients to leave treatment with is the belief in the Nature of the Child - which is the Nature of the Functional Adult; that we are inherently valuable and perfectly imperfect. We will further explore The Model in stages, beginning with understanding the primary symptoms of codependency and understanding The Nature of the Child.
The Model of Developmental Immaturity is a model that has to do with codependency. Codependency is defined as a disorder of immaturity caused by relational problems. Understanding codependency is imperative to understanding The Model. There are five primary symptoms of codependency. These are:
1. We have trouble esteeming ourselves from the idea of inherent worth.
2. We have trouble protecting and nurturing ourselves.
3. We have trouble being real.
4. We have trouble attending to our needs and wants.
5. We have trouble living life with an attitude of moderation in all things.
The Model of Developmental Immaturity Issues is a model used at The Meadows to treat the effects of childhood trauma and issues of developmental immaturity. Childhood trauma and developmental immaturity can lead to addiction issues, mood disorders and physical issues.
To further understand the model, we will examine each column. The first column is the Nature of the Child. The Nature of the Child is the Precious Child Ego State. Our precious child is the reality of who we are:
As children, we get relationally traumatized by enmeshment, neglect or abandonment in the “Nature of the Child” areas. Let's explore each of these terms:
Any behavior exacted upon us as children that was less than nurturing is defined as trauma in this model. Childhood trauma causes immaturity in the Core Issues (Column II of the model).
We will examine the Core Issues in Part II of "Breaking Down the Model."
Joyce Willis is a Licensed Professional Counselor and is currently a therapist at The Meadows. She earned her Bachelor of Education degree from the University of Akron. After teaching for several years, Joyce earned a Master's degree in counseling from the University of Phoenix. She has been in the counseling profession since 1996 and in that time has worked extensively in the addictions field. Her specialties include treatment for addictions, bereavement, trauma, depression and anxiety. Joyce has a special interest in mindfulness and helping people connect their emotional, spiritual, mindful and physiological selves with compassion and respect
The Meadows Proudly Participates in UKESAD 2011 - London, England
What a tremendous experience we had in London! The Meadows Senior Staff spent the week of May 16th at the 8th Annual UK/EUROPEAN SYMPOSIUM ON ADDICTIVE DISORDERS - better known as the UKESAD 2011 Conference. The conference brought together some of the top minds in the world of addiction treatment and provided an opportunity to network and exchange national and international knowledge with more than 500 attendees.
On Friday, May 20, 2011 Meadows Senior Fellows; Pia Mellody, RN and Shelley Uram, MD co-presented the Plenary Session. The presentation titled "FACING CODEPENDENCE: WHAT IT IS, WHERE IT COMES FROM AND HOW IT SABOTAGES OUR LIVES" addressed the effects of childhood boundary violations on adult behaviors, including codependent adults lacking skills to mature or enjoy healthy relationships - personal or professional. Dr. Uram discussed the effects of Childhood Trauma on the Brain and further how those early traumas are stored to negatively affect our developmental maturity leading to co-dependent behaviors and addictions.
In addition to our Senior Fellows, our CEO, Jim Dredge, was on hand to meet and greet attendees throughout the conference. People lined up to a book signing by Pia Mellody of her best selling work. Dr. Shelley Uram hosted an Alumni Lecture titled: Understanding Trauma and the Brain, which attracted a standing only crowd! Another very popular event was The Meadows Raffle; to which a lucky winner - Alistar Richardson of London - received an I Pad Generation 2 with 32G.
There were some newsworthy issues addressed, including a review of the "Payment by Results" plan proposed by the British Government. This plan would overhaul the reimbursement to alcohol and drug programs by basing reimbursement on treatment effectiveness. This is an issue the U.S. is also debating right now so the U.K outcomes will be interesting to watch.
The experience we had at UKESAD was stimulating and thought provoking. We are already looking forward to next years’ conference.
The Meadows is pleased to present its ongoing series of videos on addiction and trauma; the series features some of the most influential figures in the mental health field, including Maureen Canning, John Bradshaw, and Dr. Jerry Boriskin, among others.
In the second video of her series, Maureen Canning, MA, LMFT, clinical consultant and senior fellow at The Meadows, discusses the nature of sexual addiction and trauma in women.
"Sexual addiction, unlike other addictions, is based in shame," she explains. "Sex addicts have a sense of self that is very diminished. They feel worthless at the core of who they are. The feel as if they don't deserve love."
She goes on to explain that most sexual addictions are rooted in childhood trauma - and that trauma causes disruptions in psychosexual development.
"When the child grows up, they want to undo that original trauma, and so they start to act out," Ms. Canning says. "And when they act out, they re-create the original behavior."
In addition to her role as senior fellow at The Meadows, Ms. Canning is a clinical consultant at Dakota, an extended-care facility dedicated exclusively to the treatment of sexual addiction and trauma. Her extensive clinical experience includes individual, couples, and family counseling; workshops; lectures; educational trainings; and interventions. She is the author of Lust, Anger, Love: Understanding Sexual Addiction and The Road to Healthy Intimacy.
In other videos in the series, Ms. Canning discusses such topics as the nature of healthy sexuality, how sexual addiction can kill, and what partners of sex addicts need to know. View the entire series of The Meadows' videos at www.youtube.com/themeadowswickenburg. For more information about The Meadows' innovative treatment program for addictions and trauma, see www.themeadows.org or call The Meadows at 888-888-8888.
Note: This article was originally published in the Summer 2005 issue of The Meadows‘ alumni magazine, MeadowLark.
Dissolving Fear and Nurturing Joy: the Personal Story of a Recovering Agoraphobic with Panic Disorder
By Charles Atkinson, MA, MSW, LCSW
Hello, my name is Charles Atkinson. I am a 55- year-old recovering agoraphobic with panic disorder. The term "agoraphobia" derives from the Greek language. The interpretation of "agora" is marketplace, and a "phobos" is defined as flight. Hence, agoraphobia literally means "flight from the marketplace." Further examination of the word agora reveals it was not only a place of intense commerce where goods were sold and bartered, but also the social hub of town for the exchange of exciting new ideas and concepts. Consequently, an agoraphobic could not venture into the marketplace for fear of overstimulation in unpredictable and chaotic surroundings. Therefore, at an unconscious level, the marketplace represented to the agoraphobic a mirror image of his childhood environment.
Today, the definition of agoraphobia has been refined to include an avoidance of a specific place or situation in which one feels trapped and may experience embarrassment. The terms "panic attack" and "anxiety attack" can be applied interchangeably. Panic attacks occur when the sympathetic nervous system goes into overdrive and generates a cognitive distortion of second-order fear, or "fear of fear." This emotion of fear is felt on both the conscious (physical) and unconscious (emotional) levels. The results are panic attacks that feel as if the sufferer is going to lose control, go crazy or die.
It is not fully understood if agoraphobia with panic disorder has its fundamental inception in biology or is a learned behavior. I believe this disorder has its roots in both theoretical paradigms. However, additional schools of thought can be applied.
Dr. Shelley Uram, a Harvard-trained psychiatrist at The Meadows, helps articulate a layperson's perspective of how the neuropsychiatry model of the mind and body adapts to stress and trauma. She explains that our amygdala is located in the limbic system of the brain. The limbic system is located in the midbrain, where our emotions originate. Constant stresses, such as childhood traumas, rattle and sensitize our amygdala, which is also referred to as the "smoke detector," a moniker indicative of its function. It does not gradually activate the sympathetic nervous system for the fight or flight response. It spontaneously stimulates the adrenal glands to flood the body with adrenaline. This results in a state of arousal for the body and mind. If the brain continually perceives the message of an external threat, whether real or imagined, it will create an internal state of perpetual hypervigilance and angst. It is analogous to revving your car's engine to the highest RPMs while in park.
Pia Mellody's longtime work in the area of trauma and addictions has resulted in a behavioral model called "Developmental Immaturity." This model addresses the problems of being relational and achieving intimacy. To gain a better understanding of Pia's model, imagine a tree.
The roots of the tree are the childhood traumas, including physical, sexual and emotional abuse. The trunk of the tree allows the core issues of immaturity to fester and impede personal growth. These core issues include problems with self-esteem, boundaries, reality, dependency and containment. The branch of the tree denotes the secondary symptoms of unmanageability. This is the stage when addictions, depression, fear and panic disorders appear. The leaves of the tree represent the final outcome of all of the dysfunctional stages and an inability to establish and maintain healthy intimate relationships.
My first panic attack occurred at age 27, six weeks after I was married. It as if I were losing control, going crazy and having an emotional breakdown. A visit to the emergency room ensued. The hospital medical staff said I was having an anxiety attack, gave me a tranquilizer and sent me home. Not only did I feel emotionally trapped and ill-equipped to engage in an intimate relationship, but the sense of overwhelming fear and impending doom was ever-present. I tentatively speculated that marriage was the problem. It was too incomprehensible to think that the problem was endogenous to me. So began my journey through life, filled with hidden shame, fear and depression spanning the next three decades.
After two years of visiting a myriad of psychotherapists and experimenting with numerous psychotropic drugs, I was still battling depression, fear and anxiety. Fortunately, at 29, I found a psychologist who diagnosed my condition as agoraphobia with panic disorder. He explained that my disorder stemmed not from my perception of marriage, but from the cognitive distortions and childhood trauma embedded in my psyche due to physical abuse. Recalling the physical abuse experience was so powerful that it felt as if my heart and soul were being suffocated. I could not address my childhood abuse issues.
However, as I developed more psychological ego strength and better coping skills, I gradually reflected back to my childhood. I was physically battered multiple times between the ages of 5 and 13. I tried unsuccessfully to stave off my father’s abuse with my feeble attempts to express anger. My retaliation was met with scorn, disdain and an escalation of violence. This violence would trigger my body to mobilize and prepare my internal milieu for the most primitive response: survival.
Today, my father would be labeled a "rage-aholic." His impulsivity and inability to contain his rage were equivalent to a ticking time bomb, ready to explode at any time, for no reason. Since I was the oldest male child in the family, I was the focal point of his outbursts. This dysfunctional
behavior perpetuated the male rite of passage in our family. The sins of the father were being passed to the next generation as an acceptable form of discipline.
After decades of therapy, I found that the model that helped me grasp and understand my problems most clearly was Pia Mellody's. Her approach illustrated that my father had an extreme failure in maintaining his boundaries, contributing to my feelings of being exceedingly vulnerable and without boundaries. His constant verbal and physical abuse was an edict to our family; he was the boss. If he was in the perennial position of one-up, we were always one-down. Being one-down all the time obviously had a negative impact on my self-esteem. Also, he emphatically and without question demanded obedience, putting himself in a position of omnipotence. This eventually distorted my reality, dislodging me from the spiritual path to my higher power. My father was continually on the verge of being out of control. His lack of control influenced my behavior, as I always tried to be in control and perfect.
As a survival technique, especially during the physical battering, I dissociated my emotions from my body. If I felt any feelings, I cognitively appraised them as anxious feelings. This psychological tactic of turning my anger at my father into anxiety within myself allowed me to function in a chaotic and unpredictable home.
Consequently, after decades of dissociating from my feelings, convoluting and twisting my emotions, I was unable to identify and appropriately express emotions. Therefore, every time I had a feeling, I assessed it as anxiety - and only anxiety. This increasing accumulation of stress and inappropriate processing of emotions provided a fertile environment for the onset of panic attacks. Pia Mellody would call this psychological process "carried feelings" or "carried shame." More pointedly, during my father's rage attacks, I felt shame, and he was shameless. As a vulnerable child, I symbolically swallowed all of his emotional frailties and inadequacies. The psychological process of feeling my shame, fear and anger, plus my father's feelings, was too overwhelming. A panic attack was the result of the carried fear and shame.
Healing the sins of the father is a Herculean effort. Many therapists employ traditional talk psychotherapies, which are extremely helpful. However, traditional talk therapies primarily engage the higher cortical portions of the brain. Some research indicates that childhood trauma seems to be locked in the more primitive limbic system. One of the most effective ways to access the limbic system of the brain is through modalities that stimulate the midbrain, or our seat of emotions. An example of this modality is guided imagery used to re-experience the childhood trauma as an adult. Pia Mellody uses this technique and others that bridge both portions of the brain, the frontal cortex (thinking) and the limbic system (feeling).
In closing, the abatement of the carried feelings is not the end; it is the beginning of one's spiritual path. Ironically, recovery is not only achieved with the dissolution of fear, but with the nurturing of joy.
Note: This article is excerpted from the recent book by Peter A. Levine and Maggie Kline: Trauma Through a Child's Eyes: Awakening the Ordinary Miracle of Healing (North Atlantic Books, 2007). The article originally appeared in the Spring 2007 edition of Cutting Edge, the online newsletter of The Meadows.
Preventing and Healing the Sacred Wound of Sexual Molestation
By Peter A. Levine & Maggie Kline
Unless you have personally experienced the deep wound of childhood sexual trauma, it may be difficult to imagine how complex, confusing, and varied the long-term effects can be. This is especially true when the molestation was perpetrated by someone the child trusted, or even loved. When a child's innocence is stolen, it affects his or her self-worth, personality development, socialization, achievement and, later, intimacy in adolescent and adult relationships. In addition, these children are prone to somatic symptoms - such as physical rigidity, awkwardness, or excessive weight gain/loss - born of a conscious or unconscious attempt to "lock out" others and not be in one's own body. Also common are tendencies to live in a fantasy world, to have problems with attention (spacing out and daydreaming) and to dissociate in order to compartmentalize the awful experiences.
Sexual trauma varies widely, from overt sexual assault to covert desires that frighten and confuse a child by invading his or her delicate boundaries with unbounded adult sexual energies. When parents have experienced unresolved sexual violations themselves, or were lacked models for healthy adult sexuality in their families of origin, they may have difficulties protecting children without conveying a sense of fear and rigidity around issues of touch, affection, boundaries, and sensuality. Or conversely, parents might avoid offering either discussion or protection due to their own lack of experience in sensing, within themselves, the difference between potentially safe and dangerous situations and people.
Are Some Children More Vulnerable Than Others?
The majority of parents, communities, and school programs warn children to avoid "dangerous strangers." Sadly, strangers are seldom the problem. Other myths persist as well, such as the beliefs that only girls are vulnerable and that most assaults happen at or after puberty. Although statistics vary, the numbers of preschoolers and school-age children reporting sexual assault are astonishing. Approximately 10 percent of sexual violations happen to children younger than 5 years old , more children between 8 and 12 report molestation than do teenagers, and 30 to 46 percent of all children are sexually violated in some way before they reach the age of 18.
Sexual trauma is pervasive - it prevails no matter one's culture, socio-economic status, or religion. It is not uncommon even within the "perfect" family.
In other words, all children are vulnerable, and most sex offenders are "nice" people whom you already know! If you have been putting off talking with your children about sexual molestation until they are older, or because you are uncomfortable with the topic, we hope that what you learn here will bolster your confidence to begin these discussions sooner rather than later.
The Twin Dilemmas of Secrecy and Shame
The sexual molestation of children is further complicated by the added shroud of secrecy. Since 85 to 90 percent of sexual violations and inappropriate "boundary crossings" are committed by someone the victim knows and trusts, the symptoms are layered with the complexity of betrayal. Even if not admonished (or threatened) to keep the assault secret, children often do not tell due to embarrassment, shame, and guilt. In their naivete', they mistakenly assume that they themselves are "bad." They carry the shame that belongs to the molester.
In addition, children fear punishment and reprisal. They frequently anguish over "betraying" someone who is part of their family or social circle, and they fantasize about what might happen to the perpetrator. This is especially true if he or she is a family member on whom they depend. If not a family member, the violator is usually someone well-known. Neighbors, older children, babysitters, a parent's boyfriend, and other friends of the family or step-family are frequently the offenders. Or it may be someone who has prestige and social status or who serves as a mentor, such as a religious leader, teacher, or athletic coach. How can children know - unless you teach them - that they are not to blame when the perpetrator is not only someone known, but someone revered? Parents can pave the way to safety by teaching their children to trust and act on their own instincts, rather than submitting to an older child or adult who is using status for his or her own gratification.
What is Sexual Violation?
If sexual violation doesn't typically involve a "dirty old man" using candy to lure a child into his car, what is it? Simply put, it is any instance of anyone taking advantage of a position of trust, age, or status to lead a child into a situation of real or perceived powerlessness around issues of sex and humiliation. In other words, when children must passively submit to the will of another, rather than having the choice to defend themselves or tell someone - whether or not they are "forced" - it constitutes sexual violation or assault.
This can range from being shown pornography by a teenage babysitter, to an insensitive medical examination of a child's private parts, to being forced to have sexual intercourse with a parent or other adult. While actual rape by a parent or step-parent is less common, exposure to pornographic material or being asked to strip, look at, or handle exposed genitals, as well as rough handling during medical procedures, are far too common.
Steps Caregivers Can Take (and that adult survivors can learn) to Decrease Children's Susceptibility
Model Healthy Boundaries: No one gets to touch, handle, or look at me in a way that feels uncomfortable.
Help Children Develop Good Sensory Awareness: Teach children to trust the felt sense of "uh-oh" they may feel as dread in the gut or rapid heartbeat, which lets them know something is wrong and they need to leave and get help.
Teach Children What Sexual Violation Is, Who Might Approach Them, and How to Avoid Being Lured: Teach children how to use their "sense detectors" as an early warning sign.
Offer Opportunities for Children to Practice their Right to Say "No."
Teach Children What to Say and Do: Also, let them know that they should always tell you what has happened so that you can keep them safe and help them deal with their feelings.
In summary, let's look further at boundary development:
Model Healthy Boundaries
There is a delightful children's picture book by James Marshall about two hippopotami who are good friends. One's name is George, the other Martha. They visit and play together and have dinner at each other's houses. One day Martha is soaking in her bathtub and is shocked to see George peeking through the window, looking right at her! George was surprised at her outrage, and his feelings got hurt. He thought that this meant Martha didn't like him anymore. Martha reassured George that she was very fond of him. She explained, in a kind manner, "Just because we are good friends, George, doesn't mean that I don't need privacy when I'm in the bathroom!" George understood.
This little George and Martha story models setting boundaries, communicating them clearly, and honoring the boundaries of others. Parents need to show good boundaries themselves, respect children's need for privacy (especially between the ages of five to seven), and support them when they are in unappealing situations and are defenseless to help themselves. This begins in infancy. The following illustration will help you understand how to offer this protection:
Little baby Arthur fussed and arched his back each time Auntie Jane tried to hold him. His mother, not wanting to offend her sister, said, "Now, now, Arthur, it's OK, this is your Auntie Jane. She's not going to hurt you!"
Ask yourself what message this sends to Arthur. He is already learning that his feelings aren't important, and that adult needs take precedence over a dependent's needs. Babies show us their feelings by vocal protests and body language. They are exquisitely attuned to the vocalizations and facial expressions of their parents. Their brain circuits are being formed by these very interactions that deal with respect for feelings and boundaries around touch.
For whatever reasons, Arthur did not feel safe or comfortable in Aunt Jane's arms. Had his "right of refusal" been respected, he would have learned that his feelings do make a difference, that he does have choices, and that there are adults (in this case his mother) who will protect him from other adults whose touch he does not want. A few tactful words to Jane, such as, "Maybe later, Jane - Arthur's not ready for you to hold him yet," would leave an imprint impacting the baby's newly developing sense of self. And if his mother's appropriate protection continues, Arthur's brain is more likely to forge pathways that promote self-protective responses that may safeguard him from an intrusion and assault later in his life. Although not in his conscious awareness, these unconscious body boundaries formed in the tender years of infancy will serve him well.
Trauma is a breach of energetic and personal boundaries. Sexual trauma, however, is a sacred wound - an intrusion into our deepest, most delicate and private parts. Children, therefore, need to be protected by honoring their rights to personal space, privacy, and control of their own bodies. As different situations develop at various ages and stages, children need to know that they do not have to subject themselves to "sloppy kisses," lap sitting, and other forms of unwanted attention to please the adults in their lives.
Other Areas in Which Children Need Respect and the Protection of Boundaries
Children instinctively imitate their parents. Adults can capitalize on this favorable attribute when it comes to toileting behavior. A lot of power struggles and unpleasantness for toddlers and parents can be avoided altogether. By respecting your child's timetable, you will encourage her to joyfully model mom's behavior and toilet "train" herself. Take the "train" out of toileting, and your little boy will proudly do it like "Daddy does," at his own pace.
Prevent unnecessary trauma in this major developmental area by following your child's lead rather than by listening to the "experts" who believe in timetables. Forcing a child who is not ready to use the toilet disrespects his right to control his own bodily functions and sets a lifelong pattern of expecting to be dominated by someone else. By encouraging rather than pushing, you will be assisting your child to develop healthy self-regulatory habits and a natural curiosity about his or her own body. In some cases, you may even help to prevent eating disorders, digestive problems, constipation, and related difficulties. And, as a side effect, you'll produce happy, spontaneous children.