By: Joyce Willis, MC, LPC
In Part III, we discussed The Secondary symptoms that are caused by immaturity in The Core Issues. Trauma in Column I, (The Nature of the Child), leads to immaturity in The Core Issues. Trauma and immaturity leads to The Secondary Symptoms, as discussed in Part III. All three; trauma issues, immaturity and secondary symptoms lead to Relational Problems.
In this last installment of Breaking Down The Model, we will explore Relational problems that have been caused by trauma, immaturity and secondary symptoms. Relational problems can stem from any extreme in any of The Core Issues, as well as from the secondary symptoms. In other words, due to trauma, immaturity and the secondary symptoms, we can develop relational problems. Let's explore each of the relational problems.
Relational esteem can be a problem in one of two ways. We may overvalue our partner or the relationship when we believe we are less than. We may overvalue ourselves and undervalue our partner when we believe we are better than.
Enmeshment and Avoidance Issues
Enmeshment and avoidance have to do with boundary issues. When a person has no boundaries, he may try to enmesh or use the partner in some way. When a person puts up walls, he will avoid intimacy. This can lead to relationships that are either stuck in love addiction or stuck in love avoidance.
The simple truth of relational problems when it comes to dishonesty is that we are living in a lie when we believe we are better than or less than someone else. In other words, when a person cannot be real because he believes he is worthless, he will not be truthful with his partner. When a person believes he is one up or better than, he may believe he is a god and, therefore, distorts the truth of who he is.
Problems with Interdependence
Interdependence has to do with allowing yourself to self-care first before taking care of someone else. When you cannot care for yourself in a proper and functional manner, you cannot be functionally interdependent, Self-care creates the necessary energy to ask for help and give help appropriately.
When a person has no boundaries or is walled off, he is draining the relationship. This can create either chaos or a sense of deadness in the relationship. Chaos in a relationship is created when the person is out of control or not containing his spontaneity as a functional adult. Deadness in a relationship is created when the person is controlling.
Now that you have learned about The Model of Developmental Immaturity, let's consider what recovery looks like. As Pia Mellody says, "There is no recovery without Core Recovery." Characteristics of a healthy person begin to emerge as a person gets into recovery. These characteristics are:
Finally, let's take a look at things you can do to support your recovery. These are suggestions for you to consider:
Life is continuous practice in all core issues. Recovery is about getting to the center in each of the core issues, as much as humanly possible on any given day. We can live our lives with hope and happiness!
Resource: Mellody P. (1989). Facing Codependence. New York: HaperCollins.
In Part I of "Breaking Down the Model, the Nature of the Child” column was discussed. To review Part I: We discussed the history of The Model of Developmental Immaturity and how The Model is incorporated into treatment at The Meadows. We learned the definition of codependency and the five primary symptoms of codependency. Now, it is time to get into the core of the model; the Core Issues. The five core issues are:
As stated in Part I, the Core Issues are caused by childhood trauma, in the form of anything that was less than nurturing in childhood. Less than nurturing behavior comes in the form of enmeshment, neglect, abandonment or abuse. The Core Issues (Column II of the Developmental Immaturity Issues) have to do with how we operate in extremes. These extremes were set up in childhood.
Let’s compare the connection of Column I (Nature of the Child) to Column II (Core Issues) before exploring each of the Core Issues. As stated previously, core issues emerge due to less than nurturing events in childhood.
The nature of a child is to feel valuable just as he/she is. If a caregiver falsely empowers a child, the child will feel better than in Core Issue #1 (Self-Esteem). A parent (caregiver) can falsely empower a child by enmeshing with the child, telling the child that they are the hero, the best, or that they are always right. A parent can falsely empower a child by not allowing the child to take responsibility for mistakes the child has made. If a parent disempowers a child, the child will feel less than in Core Issue #1. A parent can disempower the child by neglecting the child, abandoning the child, putting the child down, calling the child names and such.
The nature of a child is to be vulnerable and to accept protection when needed. If a child is parented without boundaries or with using walls, the child will be too vulnerable or invulnerable in Core Issue #2 (Boundaries).
The nature of the child is to be imperfect and human. This is about Core Issue #3 (Reality). If a caregiver identifies a child’s humanity as “good or bad,” the child will be rebellious or perfectionist. This happens when a parent attacks or over-praises the child’s humanity, rather than looking at the child’s behavior. An example of this is a mother slapping her young daughter’s hand for spilling milk and saying, “bad girl,” instead of mom letting her daughter know that she made a mistake, like all humans do. If mom continues to parent by saying “bad girl” instead of looking at the humanity of mistakes, young daughter will grow up believing she is bad and will be rebellious as a child and into adulthood.
The nature of the child is to be dependent on other people for wants and needs that the child cannot provide for himself. This refers to Core issue #4 (Dependency). If a parent shames a child’s wants or needs, the child will be needless/wantless as an adult. If a parent is needy towards a child, the child will be anti-dependent as an adult. If a parent neglects a child’s needs or wants, the child will be too dependent as an adult.
The nature of the child is to be spontaneous and open. This has to do with Core Issue #5 (Moderation/Containment). If a parent fails to set limits on the child, the child will grow up to be in control of being out of control. If the parent focuses on the child being good and perfect, the child will grow up to be too contained and controlling of others.
Let’s examine each of the Core Issues a bit more, starting with the Core Issue of Self-Esteem. Self-Esteem is a knowing that you are valuable and have worth. Self-Esteem is about being able to say, “I have inherent worth” and believing this statement. There are two big lies we tell ourselves:
When we tell ourselves we are better than, we have been falsely empowered as a child. When we tell ourselves we are less than, we have been disempowered and undervalued as a child. Our strengths do not make us better than and our weaknesses do not make us less than. We are all valuable and precious. Recovery is about appreciating our strengths and learning from our weaknesses in the interest of being relational.
The second Core Issue is Boundaries. Boundaries have to do with protection and containment. In the extremes, we are either inadequately protected or being overprotected in any or all boundary areas; physical, sexual or internal.
Physical boundaries let you know that you have the right to determine how close another person gets to you and whether another person can touch you or your personal property. When we use containment, we are containing how close we get to another person and not touching the person or their property without permission.
Sexual boundaries let you know you have the right to determine with whom, when, where and how you are going to be sexual. When we use containment with our sexual boundary, we are respecting another person’s sexual rights.
Internal boundaries allow us to contain and protect our thinking, feelings and behavior when we are talking to or listening to others. We demonstrate use of the talking boundary by talking to someone with respect and without blaming, controlling or manipulating. We demonstrate use of the listening boundary by listening to someone with respect and curiosity.
When we protect ourselves, we keep ourselves from being victims. When we contain ourselves, we keep ourselves from being offensive. Boundaries help us mitigate our relationships. Recovery is about protecting and containing ourselves in a functional manner; not being too vulnerable and not putting up walls.
The third Core Issue is Reality. Reality has to do with self-identity. Reality asks the question: “Who Am I in this moment?” Reality issues are the hub of the wheel of the core issues. If a person struggles with reality, he/she is allergic to the self. When a child is not allowed to be himself/herself, the child will see self as bad or good. As mentioned previously, a parent defining a child as bad or good sets up rebelliousness or perfectionism. Recovery comes when we can see and accept ourselves as human in all areas of our life; our physical self, our thinking, our emotions and our behavior.
The fourth Core Issue is Dependency. Dependency has to do with self-care around our needs and wants. What is the difference between needs and wants? Needs are basic to survival. Needs keep our body, mind and soul in balance. Wants are not necessary for survival, yet they are important to our sense of abundance. Our wants bring us joy.
Being too dependent comes from not having needs and wants met as a child. The adult will have expectations that others will take care of needs and wants that he/she can take care of on their own. Being needless/wantless comes from being neglected or being shamed for having needs and wants as child. The adult will be detached from their needs or wants. Being anti-dependent comes from having a sense of our needs and wants, yet refusing to ask for them or refusing to acknowledge those needs and wants. Recovery is about being interdependent.
How can you be interdependent? There are three rules to being interdependent:
The fifth core issue is Moderation/Containment. Moderation and containment have to do with living in moderation and containing spontaneity. When a child gets shamed or traumatized around being spontaneous or a child is told they are not spontaneous enough, (a shy child being told to go out and do something), issues are set up around moderation and containment.
The “out of control” person will do what he/she is going to do when he/she wants to, thus controlling with chaos. The “controlling” person will try to control others by trying to be good and perfect. This kind of behavior shuts down relationships. Recovery is about learning to use your personal boundaries to contain yourself so that you are containing spontaneity in a functional adult manner. This leads to being relational without being abusive.
When we are at the extremes in the Core Issues, we are living in immaturity in the Core Issues. Recovery happens when we have recovery in all core issues. There is no recovery without core recovery. Recovery is about living in truth and love. We do this by coming close to the center in each of the core issues.
In Part III of Breaking Down the Model, we will explore secondary symptoms which are driven by immaturity in the Core Issues.
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.
Shelley Uram, M.D.
January 4, 2011
The Meadow's Overview of the Core Issues and how they relate to our psychological and behavioral symptoms is the most encompassing model I have worked with. This model accurately captures our nature at birth, and how the chronic psychological "bumps and bruises" through our formative years can distort our underlying nature. Ultimately, many of us develop psychological and behavioral symptoms that are directly rooted in these early psychological traumas. These symptoms can include inflexible or inadequate coping mechanisms, addictions, mood and anxiety disorders, personality disorders, etc.
Depressive conditions very commonly develop from these earlier childhood psychological traumas.
There are currently over 21 million American adults diagnosed with a depressive disorder, or almost 10% of all American adults. These numbers do not include the many, many more who have not sought professional help. This is a staggering number of people!
When someone feels the pain of depression, they want relief; the state of depression feels very uncomfortable and negative. In our country, the vast majority of people who go to a doctor for depressive symptoms are treated with antidepressant medication.
Many people feel significant relief within a few to several weeks after starting the medication. Later on, if the depression recurs, they will likely, once again receive a prescription for antidepressant medication. Eventually, many patients are instructed to remain on this medication for years to come in order to prevent a recurrence of their depression.
One of the current popular recommendations from our national and local psychiatric associations is that psychiatrists should treat patients with medication, striving towards a goal of 100% relief of symptoms. Most patients are happy with feeling so much better; however, they have not addressed the underlying issues that initially lead to the depressive state.
Why does this matter? Why should we address the underlying issues behind the depressive state if medication takes away the symptoms?
In my opinion, we are all ultimately trying to master the challenges that show up in our lives. There is a subtle "push" in all species to keep on evolving their mastery skills and ability to cope. We develop better mastery skills with our relationships, health, life stressors, etc. We all stumble and fail at times; sometimes we are flat out stymied by life circumstances. Ultimately, we want to come to some kind of terms with the challenges that show up in our lives, and feel more at peace with them.
In my opinion, many people who suffer from depression are in a "stymied" state of dealing with life challenges. Very often, it is their coping skills that are not adequately flexible or mature enough to successfully deal with the challenge. They are left feeling overwhelmed or "shutdown". In this condition, they are simply not able to master the circumstances at hand.
In my opinion, if a patient is overwhelmed by their symptoms, antidepressant medication may be helpful to alleviate some of the symptoms. The patient can then enter into a "working zone" of being able to actively participate in psychotherapy, and eventually reach a new level of mastery in dealing with their life-stressors.
I think it is wise to utilize antidepressant medication if it is an adjunct to the patient MASTERING the underlying issues.Unfortunately, the trend in our country is to replace the psychotherapy with only symptom relief through medication.
If a person's coping skills are not maturing, they are just as vulnerable to another bout of depression as they were the first time. Research has actually shown that a person is even more vulnerable to further depression episodes with each new episode of depression.
In my opinion, we psychiatrists should tailor our medication prescribing to meet their ideal needs in psychotherapy. For example, if a patient ideally needs to experience some sadness or anxiety in order to be motivated to master the underlying issue in therapy, I think it is appropriate to let them have some of their symptoms, but to a tolerable degree.
I view some depressive or anxiety symptoms as a "barometer"that tells us how we are doing inside. Instead of automatically silencing these depressive or anxiety "signals" with medication, these symptoms can frequently be utilized to motivate us to dig deeper in psychotherapy.
The Meadow's Overview of the Core Issues, is an excellent diagnostic and treatment model upon which to base psychotherapy. It is from this model that mental health professionals can analyze where a patient is psychologically "stuck", and in what therapeutic directions to move. In patients that medication would serve the purpose of alleviating certain symptoms that would stand in the patient's way of utilizing this psychotherapy, then the two treatment modalities could become a unified and useful treatment approach.
Exceptions to the above would include patients who are not interested in mastering the underlying issues and improving their coping skills. If a patient clearly wants to just have the symptoms removed, I do not see a problem utilizing only a medication approach. Other possible exceptions include patients who suffer from other disorders, such as psychosis, Bipolar I disorders, Schizoaffective disorders, etc. When patients have reached an extremely distressed state and have thoughts of harming themselves or others, then the medication route is often helpful in bringing some relief, after which the psychotherapy can play an increasingly important role.
©2011 Shelley Uram