Shelley Uram, MD, Senior Fellow at The Meadows, presented on January 17th Free Lecture in Scottsdale, Arizona. I was so inspired by the presentation, that I wanted to share a bit about my experience. I have one word to describe Dr. Shelley Uram's presentation at The Meadows' Free Lecture in Scottsdale last night: amazing! I am sure I am not the only attendee still inspired by the outstanding lecture on trauma, addiction, and the brain.
Dr. Uram's professional training and expertise were complemented by the nonthreatening and compassionate manner in which she delivered the information.
During the presentation, Dr. Uram discussed Pia Mellody's model of Developmental Immaturity, which is used as the main treatment model at the Meadows Treatment Centers. She presented the five core issues of codependency which include problems with boundaries, self esteem, dependency, reality, and moderation and discussed the ways in which trauma affects each of these areas. Many people have been exposed to information about these five core issues and have learned about the negative impact of trauma on development due to its incredible success in helping people heal.
Dr. Uram took this information a step further and presented the ways in which trauma effects the development and functioning of the brain. As I listened to her explain how traumatic experiences can affect the various parts of the brain, I looked around the room and saw people starting to have a greater understanding of why we do the things that we do. Dr. Uram continued in her presentation and gave us a sense of hope when she discussed how we are able to actually change the structure of our brains with bottom-up treatment approaches so that we may live happier and healthier lives. I learned a great deal from this event and anxiously await additional presentations by this knowledgeable and charismatic speaker.
Thank you, Dr. Shelley Uram!
"In desperate love, we always invent the characters of our partners, demanding they be what we need of them, and then feeling devastated when they refuse to perform the role we created in the first place." - Elizabeth Gilbert (Eat, Pray, Love)
In Facing Love Addiction, Pia Mellody outlines how childhood trauma creates relational patterns of love addiction and love avoidance in adulthood. Love addicts "invent the characters of our partners." We enter relationships from a wounded child ego state, believing that we are less-than and making up a fantasy about our partners. We make ourselves completely vulnerable, we tell ourselves that we are "bad" when our partner pulls away from us, we become needy, and we act out-of-control. We demand that our partners become what we "need." Often, we look at them to give us the love that our parents did not. As a love avoidant in relationship, we become the "character" that is expected of us. We enter relationships from a better-than position, we act invulnerable, we demand perfection, we are needless, and we attempt to seek control by creating intensity to feel alive. We get our sense of worth from taking care of someone we perceive as needy, but we resent him or her for it.
At The Meadows, patients often ask me what a "normal"relationship looks like. Of course, this is relative to the individual's experience of what is "normal." And it begs the question: What do functional adults do in relationships? What do recovering love addicts and love avoidants do? How do we date again? In order to address these important questions more completely, we are introducing a new workshop. It will help patients explore what a healthy relationship looks like by first tracing their own relationship histories and then considering what they want in potential partners.
First things first, sobriety must be established from any addiction that is present. Patients also must begin to examine their childhood traumas and identify whether they were abandoned or enmeshed in their families of origin and how this impacts their current relationships. Then we identify how they operate from a love-addiction or love-avoidant relational cycle. Often patients will tell me about how their partners have wronged them. In this process, participants begin to discover how they have re-created their own families of origin in their relationships and can understand what they bring to those relationships. Before someone can be intimate, he must begin the process of loving himself and knowing who he is. In our dating workshop, we will start by studying an individual's value system. In active addiction, people live outside of their values, so we want to remind them to reflect on their values. This way, they can begin to live in integrity and choose partners who have shared values. Next we have a patient define what is non-negotiable, negotiable, and "gee, it would be nice if..." about a future partner. For example, if you are a sober person, a non-negotiable may be drug use and "gee, it would be nice if he was 6 feet tall." Examining values and what is non-negotiable is important because love addicts are notorious for abandoning themselves to be with partners. This exercise helps them gain understanding of who they are and what they want.
The next step is to clearly define the impact that sobriety has on dating. Just like we define our sobriety when we get sober, we must have a plan when we enter the single world. This plan should include specifics, such as how many dates per week, how much phone/text contact, when physical contact is okay, how to discuss sobriety, social networking contact, etc. In essence, we are establishing boundaries. It may be helpful to have the patients set an intention for their dating experiences and future relationships. For example, they may say, "It is my intention to be myself while dating."
The goal is to be a functional adult when dating. This means entering relationships from a position of equality, with realistic expectations. We are authentic, we maintain our lives outside of the relationship, and we are mindful of our partner's walls in addition to our own. As the relationship progresses, we acknowledge our disappointments and feelings of overwhelm, and we communicate. The goals are to resolve conflict, negotiate, and repair disharmony while acknowledging our own childhood woundings that may be surfacing. We also bring our sober living skills into our relationships. The idea is that we enter relationships with self-esteem, boundaries, reality, willingness to express needs and wants, and a commitment to moderation.
Lastly let us remember love and respect. To quote Pia Mellody's book The Intimacy Factor, "Love is a continuum that ranges all the way from respect to very warm regard, the latter of which most people call "love." For many years, I mistakenly thought that if I loved someone, all I needed to do was to continually have a deep sense of warmth for him. Although that deep sense of warmth is basic, there are also other degrees of love that have to do with the condition of the relationship. As we experience the truth of another person, that person may be difficult- human. We might naturally feel fear, pain, and shame - not exactly pleasant. I had the idea that if I felt these unpleasant emotions, I was not loving the other person. And early on I actually wasn't, but as I got into recovery, I began to feel something healthy in its place. I learned to recognize another ingredient, and that was respect."
First we respect and love ourselves, then we practice respecting and loving others.
In a series of brief articles, beginning below, Pia Mellody illustrates how living The Meadows' model has brought balance to her life.
In beginning the draft of my fifth book, I find myself continuously re-examining the relationship between body, mind, and spirit. In doing so, I have become even more acutely aware of the spiritual battle that rages between the ego and the soul. This topic becomes more poignant as I watch The Meadows' treatment model continue to gain worldwide recognition as the "spiritual model for the treatment of trauma and addictions."
Treatment at The Meadows has always been all-encompassing, addressing the body, mind, and spirit. Treating the body through our Wellness Program contributes to the healing process. Treating the mind through readings, lectures, workshops, and group interactions leads to healing through a shift in cognition's role in our lives. Treating the spirit is about treating spiritual impoverishment; different forms of spiritual practice include, but are not limited to: meditation, tai chi, yoga, and following 12 Step practices. These, in effect, engage the patient in spiritual balance.
Looking at the role of ego in the spiritual battle, I see it as attached to "I," "me," and "my." Self-examination can reveal how the ego has been destructive in life processes. If the ego is too powerful, the individual cannot see how it's creating misery. Our treatment goal in this scenario is to get the patient to self-examine what he's doing via his own self-destructiveness. The ego is attached to the body and naturally seeks pleasure. Our senses lead us to addictive processes and compulsions to seek pleasure and thereby medicate ourselves. When we use substances (alcohol, drugs), processes (sex, gambling), or people (love addiction), ultimately we will experience misery, as we are self-medicating.
When we cover our soul with our ego, we lay the foundation for spiritual impoverishment. We have buried our value, power, and abundance. The soul, in this scenario, plays a pivotal role; it remembers that we - and others - have inherent worth.
As I work on the new book, I will continue to share my thoughts on the rich connections between mind, body, and spirit, as well as show how value, power, and abundance affect individuals and the greater world. In the next article, I will illustrate how to truly heal through the understanding and application of the five core issues.
Note: This article originally appeared in the Spring 2006 edition of Meadowlark, the magazine for alumni of The Meadows.
Fear of Abandonment: Some Lessons from M. Scott Peck and Pia Mellody
By Lawrence S. Freundlich
In Pia Mellody's charting of childhood developmental immaturity, one of its primary symptoms (meaning one of the inherent, essential human attributes of the child at birth) is dependency. Each human child is dependent for his survival on his primary caregivers and, as he matures, on his ability to cooperate with others so that he may get what he needs and wants in order to become a functional adult. Thus, the infant is first dependent and, then, as he matures, interdependent. However, this potential to develop the skills necessary for interdependence has a built-in obstacle, one that, like the other primary symptoms, is inherent at birth; this built-in obstacle is the child's fear of abandonment.
My recent readings in M. Scott Peck's enormously influential The Road Less Traveled (Simon and Schuster, 1978) have reminded me how much of a creative and/or a destructive force the fear of abandonment can be in the shaping of a child's psyche. Its power to harm is obvious. On the other hand, its power to become a shaping element in a child's healthy development of interdependence is less obvious, but just as elemental.
As an infant, totally dependent on his parents for the fulfillment of his needs, the child's expectation is that the world exists to satisfy his own desires. This instinctual expectation of immediate satisfaction is unreasoning, uncivilized and innocently selfish. In the first few months of an infant's life, a child does not take care of himself. He is taken care of. Not only does he lack the skills to self-care, but also he has no conception that the environment has anything else on its mind than to care for him. He demands everything, with no inkling that it might be refused or unavailable. If it is refused or unavailable, he will presume that he is being abandoned. He will view any denial of his wishes as a mortal threat, and anyone who has heard a baby scream for solace knows how nature has shaped his voice to indicate the imminence of a mortal threat - even if the threat is only a wet diaper, a desire for an ounce of milk or the need for a nap.
If very young children are to emotionally survive these reality-based inklings of abandonment, they must learn, in Peck's terminology, "delayed gratification." Peck equates delayed gratification with discipline - the discipline forced on every child when he recognizes that he is part of a social system and not "God the Baby." The challenge of delayed gratification brings the child face-to-face with the reality of being only one human being among others, competing for survival in interdependent groups.
Self-care - or the ability to recognize that you will get what you want only if you do some of the job yourself - is learned in the face of the child's elemental desire to be cared for totally: "I want what I want, and I want it now." The parental challenge is to teach the child discipline without implying abandonment. In other words, in order for a child to grow up, he has to learn that delayed gratification is not equivalent to abandonment. The child's ability to survive will depend on how well he learns to cooperate. This is when the sublimation of abandonment fear becomes the engine for healthy development. Peck says:
Most parents, even when they are otherwise relatively ignorant or callous, are instinctively sensitive to their children's fear of abandonment and will therefore, day in and day out, hundreds and thousands of times, offer their children needed reassurance: "You know Mommy and Daddy aren't going to leave you behind"; "Of course Mommy and Daddy will come back to get you"; "Mommy and Daddy aren't going to forget about you!" If these words are matched by deeds, month in and month out, year in and year out, by the time of adolescence, the child will have lost the fear of abandonment and in its stead will have a deep inner feeling that the world is a safe place in which to be, and protection will be there when it is needed. With this internal sense of the consistent safety of the world, such a child is free to delay gratification of one kind or another, secure in the knowledge that the opportunity for gratification, like home and parents, is always there, available when needed....
But many are not so fortunate. A substantial number of children actually are abandoned by their parents during childhood, by death, by desertion, by sheer negligence... Others, while not abandoned in fact, fail to receive from their parents the reassurance that they will not be abandoned. There are some parents, for instance, who, in their desire to force discipline as easily and quickly as possible, will actually use the threat of abandonment, overtly or subtly, to achieve this end. The message they give to their children is: If you don't do exactly what I want you to do, I won't love you anymore, and you can figure out for yourself what that might mean." It means, of course, abandonment and death... So it is that these children, abandoned either psychologically or in actuality, enter adulthood lacking any deep sense that the world is a safe and protective place. To the contrary, they perceive the world as dangerous and frightening, and they are not about to forsake gratification or security in the present for the promise of later gratification or security in the future, since for them the future seems dubious indeed.
Considering the shaping power of the fear of abandonment, we can see that being taught to self-care may appear to the child as the withdrawal of his parents" support. How then does one introduce the discipline of self-care without exciting the fear of abandonment? Peck says that self-care is impossible unless the child feels that he is valuable. "The statement "I am a valuable person" is essential to mental health and is a cornerstone of self-discipline [delayed gratification]." Peck and Pia Mellody are in agreement on this point of being valuable. Without a feeling of value, the child will not self-care.
For Mellody, self-esteem is the first core issue. In discussing the internal connections of the core issues, Mellody speaks of psychic balance being achieved when value, power and self-care are properly functioning. She observes that, when we believe we are valuable, we do not have to depend on the opinions of others to verify our value (our internal boundary is working). We are in touch with our inherent worth. Our actions are congruent with our belief in our own value. Then, because we value ourselves, caring for ourselves becomes an act of self-esteem. Self-care then is a function of self-esteem, because it is natural to care for someone we like. The good feeling we have about ourselves is projected out into our environment. We learn to care for ourselves because we believe we are worth caring for in a world abundant in possibilities of caring for us.
It is impossible to teach self-care to a child who is unwilling to delay gratification because he is terrified of abandonment. Self-esteem, on the other hand, makes the child confident that abandonment does not lie waiting in the shadows of delayed gratification. The abandonment-haunted child will not allow himself to be vulnerable enough to experiment with the techniques required for interdependence. If he takes a chance, he thinks he will be injured. Instead of venturesome vulnerability, he will hide himself behind various kinds of lies (adaptations) so that no one can touch him. He becomes, in Mellody's terms, "the adapted wounded child." Peck writes,
...For children to develop the capacity to delay gratification, it is necessary for them to have self-disciplined role models, a sense of self-worth, and a degree of trust in the safety of their existence.These "possessions" are ideally acquired through the self-discipline and consistent, genuine caring of their parents; they are the most precious gifts of themselves that mothers and fathers can bequeath. When these gifts have not been proffered by one's parents, it is possible to acquire them from other sources, but in that case, the process of their acquisition is invariably an uphill struggle, often of lifelong duration and often unsuccessful.
That uphill, lifelong struggle takes place in the arena of our relationships and their failed intimacy. As Mellody pointed out in her book, Love Addiction and Love Avoidance, the only proper use of the word "abandonment" is in the context of childhood. The child who is without the ability to self-care can, indeed, be abandoned - left with no resources. Adults, who have presumably learned to care for themselves, cannot be abandoned; adults have resources even when they are rejected or disappointed in relationships. Adults are responsible for their own self-care.
Note: This article was originally published in the Spring 2005 edition of MeadowLark, the magazine for The Meadows alumni.
Self-Esteem: An Inside Job
By Kingsley Gallup, MA, LISAC
The concept may be nebulous, but it's by no means inconsequential. Our very lives are a testimony to our self-esteem, the condition of which is the distinguishing difference between surviving and thriving. Consider the following questions:
Do you live by the credo, "If I can't do it perfectly, then why do it at all"?
Are you carrying the weight of the world on your shoulders?
Do you bend over backwards to please others?
Is it hard for you to forgive yourself?
Is self-care selfish?
Do you "shape shift" to fit your particular setting?
Do you go one up or one down?
Are compliments hard to handle?
When someone says "I love you" do you silently wonder, "What's wrong with them?" maybe even, "I'm not sure I want to be with the kind of person who would want me."
And so, what's the state of your self-esteem? How miserable are you making yourself? For each of us, there comes a time when we are faced with our own human frailty. It is in these moments we are confronted with the state of our self-esteem. We discover how we really think and feel about ourselves. We may find that we have simply been operating in survival mode, having mastered an array of techniques for disguising our self-loathing. The good news is to make a change we need not look far. The answers lie within.
Pia Mellody has defined self-esteem as the internal experience of one's own preciousness in the face of one's human frailty. It is a total reality experience, and it comes from embracing the concept of inherent self-worth and applying it to self.
Consider what self-esteem is not- keeping in mind that the absence of self-love can be masterfully disguised. Genuine self-esteem is not about adaptations. It is not about measurement and comparison, nor is it about "should-ing" and shaming ourselves. Self-esteem is neither other esteem (the esteem others have for us) nor reality-based esteem (esteem that comes from comparing our reality to another person's reality to determine how we measure up). Self-esteem neither goes one up nor one down. And it cannot be acquired externally.
The kicker is, external esteem seekers tend to gravitate toward those from whom acceptance and love cannot easily be found. We flee from those who want us and pursue the rejecters. Perhaps we learned external esteem seeking early on. Perhaps it was how we learned to garner worth and value. It failed us then. And it fails us today. Genuine self-esteem, on the other hand, cuts beneath externals to inherent worth and value. It is constant, rather than situational; enduring, rather than fleeting. It is a mature and unconditional love. And yes, it truly is an inside job.
Breaking the shackles of our histories and reclaiming our preciousness hinges on the internal work of shame reduction. Much like faith and fear, so too are shame and self-esteem contrasting forces: more of one, the less of the other. It's the carried shame, that toxic carryover from our histories, that cripples. Letting go of this shame is an act of self-love. It is motivated out of an awareness of the truth of who we are- inherently precious, worthy and valuable.
Building self-esteem hinges on exposing our harsh inner critic- you know, that critic who without our awareness shames us... blames us when things go wrong... and calls it simple "luck" when things go well. That inner critic is dishonest. It exaggerates our failures; it calls us names; it records all past mistakes and transgressions. Sadly, this critical voice may be so familiar we hardly notice its destructiveness.
Recovery is about coming to our own assistance. In doing so, we match our healing action steps to our unique histories, giving ourselves today what we didn't get then. If we were falsely empowered as children, says Pia Mellody, we need first and foremost to base our sense of self-esteem on the concept of inherent worth. We stop controlling, manipulating and caretaking others, focusing instead on self-care and interdependence. Self-care is not selfish. It's not a character flaw to ask for help! We learn to love ourselves in the face of our humanity - as human beings rather than doings.
If we were disempowered early on, we need also to develop self-esteem from the concept of inherent worth. We learn to use boundaries accompanied by an attitude of moderation, so as to start living in action rather than reaction. We take responsibility for our own issues of self-care.
All of this involves stepping out of our comfort zone. It entails not only thinking our way into feeling and behaving but also behaving our way into thinking and feeling. It's the "act as if" principle. We say goodbye to our adaptations – to the coping mechanisms that perhaps helped us survive less than nurturing histories. We find gratitude for our insights and in so doing, become liberated from resentment. We learn to change the one person we can change. After all, if we want something we've never had before, we've got to do something we've never done before!" (Drina Reed) In this spirit, here are some thoughts for developing self-esteem:
Do an accurate self-assessment, listing positive and negative traits. Then, clean up the negative statements by making the statements factual, not judgmental. Remember, self-esteem is based on an accurate self-assessment.
List important positive traits. Repeat them frequently with feeling.
Accept the things you cannot change. Don't confuse an unchangeable cause with an unchangeable trait.
Become a change agent, a self-helper. Attend to your wants and needs, identifying and respecting what fulfills you. Your number one responsibility is yourself.
Identify the internal critic inside you. Write about it. What messages bring you mental misery?
Use affirmations to challenge negative cognitions. Tailor them to counteract individual self-defeating cognitions. Confront the internal critic.
Eliminate shame-based self-talk. It drains and discourages. It distracts us from identifying and fulfilling our needs, abilities, interests and goals.
Watch out for victim language. People and events do not cause feelings. They simply trigger mental habits.
Adopt responsibility language. Instead of "I can't," "I should" or "I'll try," use "I can," I will" or "I choose to." As Henry Ford once said, "Whether you think you can or you think you can't, you're right."
Set achievable goals and seek out situations in which the probability of success is high, places where you will stretch, but not overwhelm.
Be proud of who you are. Don't try to be someone else. Rely on your opinion of you for that's the one that matters.
Be patient. Our self-concept reflects years of experience and self-evaluation. Seeds were planted in our subconscious long before we had a say. Debunking the internal critic is a daily practice.
Today, we have choice. We can drape ourselves in the cloak of self-love. We can let go of the old to grab onto the new, remembering that recovery isn't changing who we are but rather letting go of who we are not! (Claudia Black) We can choose no longer to accept the lies we learned about who we were, embracing instead the beauty of who we are- perhaps for the first time.
No man is rich enough to buy back his past. As such, the best redemption is recovery. We can embrace the pain of the past and burn it as fuel for our journey. We may not have had choice early on, but today we do.
This is mind, body and spirit work, the fruits of which are nothing short of freedom, authenticity and acceptance of self and others. How liberating for those of us who have long played to an audience, denying the truth of who we were to come to love ourselves - not in spite of our humanity, but because of it!
This self-esteem journey is a homecoming of sorts. It's a coming home to self- to a place we have always known and to a place that we've never known. It's both liberating and daunting, familiar and foreign. It is the essence of authenticity and the ultimate soul work. And pretty soon, our hearts become strangely warmed. We have arrived home at last.