The Meadows Blog

Wednesday, 20 February 2013 19:00

Breaking Down the Model: Part II - Core Issues

By: Joyce Willis, MC, LPC

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:

  • Self-Esteem
  • Boundaries
  • Reality
  • Dependency
  • Moderation/Containment.

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:

  1. I am better than.
  2. I am less than.

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:

  1. Being able to ask for help when you truly need it.
  2. Being willing to help someone when they make a reasonable request.
  3. Being able to say “No” for self-care. This keeps you from stretching yourself into resentment.

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.

Published in Blog

When Adolescence Doesn't End at the Same Time Adulthood Arrives: REHAB Treatment for Young Adults


Bonnie A. DenDooven, MC, LAC

Ad·o·les·cence is defined as a period or stage of development, preceding maturity. But what happens when chronologically your son or daughter becomes an adult and emotionally they are still locked in immature, self-destructive patterns that you thought they would out grow?

For a therapist working with young adults and their families, REHAB is a process of untangling the mystery of maturation gone wrong. Getting young adults sober from drugs and alcohol is just the tip of the iceberg. Unless the underlying issues are addressed, the young adults are precariously at risk to return to the immature habits that put them at risk to start with.

Karen Horney, pioneer psychotherapist who focused on the struggle toward self-realization, held that basic anxiety brought about by insecurities in childhood was fundamental to later "character development". (Footnote 1) In other words, some anxiety and some insecurity are needed to produce maturity, much like the baby chick in an egg needs to press against the adversity of the hard egg shell in order to emerge strong and capable from the hatching process.

In 1969, a publication changed how we treated children. The "Self-Esteem Movement" was birthed when psychologist Nathaniel Brandon published a widely received and highly acclaimed paper called "The Psychology of Self-Esteem" and argued that "feelings of self-esteem were the key to success in life". (footnote 2) A 40-year craze of self-esteem building began then. This craze changed how parents and teachers treated anxiety and insecurity in children. The "Self-Esteem Movement" encouraged parents and teachers to remove as much anxiety as possible from the lives of children. Suddenly it was NOT okay to give 1st, 2nd, and 3rd place trophies for fear that some child would feel less than others. Teachers put away red markers previously used to grade papers because it might make students "feel bad". Parents began a chorus of constant praise and admiration such as "You're so smart!", and "You're so pretty!";, and the killer, You've got so much potential". Research now shows that by age 12, children no longer believe these overworked compliments and see these compliments as an attempt by adults to manipulate them. (Footnote 3) Worse, the self-esteem movement created children who may have high self-esteem but who cannot tolerate any form of anxiety or insecurity. Without tolerating basic anxiety and insecurity they cannot produce character in themselves. Teenage use of drugs and alcohol to medicate the anxiety and insecurity is leaving us with a generation of addicts who live by the cognitive distortion, "I should never feel bad."

In the therapy room, when working with immature young adults (ages 18-29), it is easy to detect patterns. The newest research on addiction indicates that attachment disorders underscore addiction, but what does that mean? Karen Horney wrote about how the authentic self emerges. She described three classifications of how we relate to others. It is in our relationships with others where authenticity or the lack thereof shows up. To see attachment disorders in action, therapists watch how young adults: (1) Move toward people, (2) Move against people, or (3) Move away from people.

In essence, it is a simple and brilliant way to look at this thing called attachment disorder and to prepare therapeutic interventions that are effective. In the close conformity of the REHAB environment, these reactive positions of relating to others become visible, and set patterns readily emerge in the day-to-day required activities. Following are the three categories and ten patterns

Attachment style of Moving toward People:

Pattern 1: The need for affection and approval; pleasing others and being liked by them. The feelings of peer pressure are too powerful to resist and results in CODEPENDENCY and trauma bonding to unhealthy "friends" Young people can become just as addicted to "the lifestyle" of the drug world as they are to the chemicals.

Pattern 2: The need for a partner; one to love and who will solve all problems - the emphasis is that "love will solve all problems". This results in love addiction and sexual promiscuity with either an inability to disengage from abusive relationships or the inability to be without a relationship. These are the REHAB residents who strike up romantic or sexual liaisons in treatment.

Attachment style of Moving against People:

Pattern 3: The need for power; the irresistible urge to bend the rules and achieve control over others. While most people seek strength, an immature young adult may be desperate for it.

Pattern 4: The need to exploit others; to get the better of them. To manipulate, operating from the underlying belief that people are there simply to be used staff splitting and using humor to control a room (they are just an audience). People become objects and the immature adult operates without empathy.

Pattern 5: The need for social recognition; and limelight. The immature young adult manifests as desperate for recognition; they posture before staff, lie, cheat, and steal in order to be the center of attention, or become the clown and the butt of their own joking, never taken seriously. This need is an act of moving against people because it connotes beating others out for attention.

Pattern 6: The need for self respect; an exaggerated need to be valued can result in an overly inflated ego and a young person who is not in touch with their own limitations and unable to see their own character defects. This pattern forms Narcissism and self-blindness.

Pattern 7: The need for achievement; though virtually all persons wish to make achievements, some are desperate for it. Some are so driven for success, that they sacrifice relationships, health, and sometimes integrity for it. The paradox is that achievement is an elusive line that seems to move just as soon as a goal is met. The success never satisfies.
Attachment styles of Moving away from People:

Pattern 8: The need for self-sufficiency; taken to the extreme, some are independent to the point of becoming "needless and want-less". ISOLATION and LONELINESS ensue, along with an inability to live among others interdependently.

Pattern 9: The need for perfection; while many are driven to do things well, some young adults display an overriding fear of being even slightly flawed. This perfectionism causes "Fear of Shame" to become a driving force in their life, causing them to quit tasks they enjoy if they can't be the BEST.

Pattern 10: The need to contain; some find a need to restrict life to within narrow borders - to live as inconspicuous as possible. The ultimate result of an extreme of this pattern are ANOREXIA and DEPRIVATION. We find young people who have gravitated toward living alone and homeless. They find it difficult to rejoin others in the REHAB community.

In a REHAB environment, a young adult is forced to display every coping skill they have ever engineered. For many, it is the first time they are in close quarters with so many people 24-hours a day. If their tendency is to move toward and enmesh and give away their soul in order to deal with the anxiety, we see it in the friendships they form and as a failure to confront others out of fear of rejection. If the tendency is to move against others to cope, peers will react to them- against postures are offensive and conflicts with ensue.A tendency to move away from others manifests as depression, rage and laziness.

The best REHAB treatment centers are those that know how to manage, not eliminate, the anxiety and insecurity, in fact many activities are designed to increase the anxiety. Activities are planned to strategically intervene on the coping defenses above. As the defenses are exposed and the resident is taught to tolerate anxiety and feelings of inferiority, gradually the immature self begins to grow more confident and merges into a whole and complete self. This new self has character and is capable of navigating the adult world. The alternative is to stay immature, without a confident self, and to medicate with drugs and alcohol or other self-defeating behaviors.

Bonnie A. DenDooven


Bonnie A. DenDooven, MC, LAC is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work disorders. 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").

Footnote 1: Neurosis and Human Growth: The struggle toward self-realization, 1950

Footnote 2:

Published in Blog
Sunday, 07 August 2011 20:00

Good Enough

Amy Winehouse skyrocketed to the top of the music charts in her early 20's. Most well known for her song"Rehab", Amy professed her resistance to treatment. She said, "no, no, no". Amy was rebellious. She was 'very good at being bad'. Defying conventional style and standards, she fashioned herself in 50's feminine attire and tattooed herself with eyebrow raising images. She dated a 'bad boy' and brazenly colored tales of sex and drugs, while singing "You Know I'm No Good". Amy had reality issues. Obscured by distortions of self-image, she could not see her own value and worth. Amy did not know that she was "good enough".

Distortions of reality plague those affected by addiction. Living in reality is recognition of one's own worth and value. It is acceptance that the self is inherently and forgivingly prone to human frailty. The self is neither perfect or broken, it is perfectly imperfect. Those living in active addiction struggle to see the perfectly imperfect self shadowed by rebellious behavior.

However, upon pressed to recollect the self as an infant, the lenses of reality become clear. Few will debate the worth, value and perfect imperfection of a baby.

At The Meadows, we see many women and men who have become detached from their reality. They see themselves as "bad" and often live up to their distortions of reality. Having lost touch with their inherent worth and value they become very good at being bad. In truth, nothing changed about the perfectly imperfect child who grew into a rebellious adult. What shifted was merely the perception of "self". Trauma, be it physical, spiritual, sexual, emotional or intellectual, led to cognitive distortions ('lies'). The cognitive distortions led to behaviors not accurately reflective of the true self. Addiction, rage and rebellion are just vestiges of the past. They are what is leftover from the trauma. The nature of the child did not change, only what she (or he) thought of herself changed. The perfectly imperfect and "good enough" child still exists, yet simply does not believe it anymore.

Treatment is not about making bad people good. "No, No, No". It is about making good people healthy. Resolution of the core issues, including that of "reality", addresses the root causes of addiction. It restores the true self and returns the "good enough" (inner) child to the safe harbor of his/her functional adult.

Anne Brown, a primary counselor at The Meadows since 2008, has a master's degree in counseling from Johns Hopkins University; she specializes in treating sex addiction, co-sex addiction, eating disorders, co-dependency, and the underlying trauma issues of addiction. She has been working in the counseling field since 1999.

Published in Blog
Friday, 01 April 2011 20:00

Celebrity Addiction – Part 2

(This is part two of a two part blog post. If you would like to read part one please go here: Celebrity Addiction Part 1)

This raises the question: Has the media gone too far? Since television and movies became mainstream in America, teens have tried to emulate the speech, dress, and behavior of their favorite celebrities. And now, scientists have even found a correlation between celebrity worship and depression/anxiety. Does depression lead to addiction, or does addiction lead to depression? Or does it matter? The bottom line: A generation of teenagers feels entitled to become famous. For what they will become famous has become irrelevant. Teens believe that becoming famous is a cure-all for all of life's challenges. Our society is raising a generation of narcissists whose only sense of self rises around entitlement and fame. Healthy relationships will be replaced with illusory relationships that lack intimacy and real connection. Teens will continue to seek temporary relief in substance abuse and celebrity worship to ward off the pain that normal adolescence brings. This practice of "numbing" is dangerous and will result in a generation that is unable to function in the real world.

Another difficulty many adolescents face today is eating disorders. Television, Hollywood, magazines, the Internet, and the fashion industry portray slender women much more often than women with normal body types. Children and teens then develop distorted images of what a body should be. Once these idolized perceptions are accepted as truth, thought distortions may develop, which can lead adolescents to self-destructive behaviors such as eating disorders, self-injury, and excessive exercise.

How can we prevent our teens from idolizing tragic celebrity figures of fantasy and deception? How can we reduce substance abuse and eating disorders among teens? Self-esteem is a major buzzword. Low self-esteem can increase the odds that a teen will look to numb or suppress discomfort, frustration, or pain. When a child is comfortable in his own skin, he can reach inward for well-being and strength rather than relying on outside sources to dull the senses. Having an open dialogue with your teens, without judgment or criticism, allows them to feel more comfortable discussing substance abuse, peer pressure, and sex. They will feel heard and understood, which will allow them to trust you with their deepest and darkest demons. Otherwise, they may look for validation elsewhere, joining groups or gangs where drugs and alcohol are the norm.

Another solution to this growing epidemic might be getting to know our neighbors. Creating deeper bonds within our own circles might alleviate the need to search for outside validation.

There are numerous causes of addiction, such as trauma, a genetic predisposition, peer pressure, a divorce, or a significant loss in one's family. Celebrity addiction is not as dangerous as drug or alcohol addiction, but it is another way that teens avoid what is really going on in life. It can prevent or delay teens from forming identities; rather, they opt to emulate a false self based on a favorite idol. Such a teen will never develop a true core self. If your teen shows warning signs, such as isolation, eating changes, depression, excessive sleep, or new acting-out behaviors, seek professional help. It could be a sign of addiction or an eating disorder. A professional can assess if there is a serious problem.

We all want to be loved for who we are, not for who we wish we could be. Being aware of the signs of celebrity addiction is a proactive way to curb negative behaviors before permanent damage occurs.

Published in Blog

Jennifer Finlayson-Fife, PhD will be speaking at The Meadows Free Lecture on April 7, 2011, at 7:00 pm at the Winnetka Community House in Winnetka, Illinois. Dr. Fife will discuss Developing Solid Boundaries and Self Esteem: The Foundation of Healthier, Happier Relationships. The presentation will address the ways that poor self-esteem (whether it is expressed through shame or feelings of superiority) and impaired boundary systems (e.g. the inability to set limits, or the tendency to wall off emotionally) affect the dynamics of our relationships, how to recognize these unhealthy dynamics between you and significant others, and also how to improve self-esteem and develop healthier boundaries in your relationships. Dr Finlayson-Fife will give you tools to help you track what it is you are doing in your relationship, to understand it's negative impact on you and others, and to know how to correct it in order to make your interactions healthier.

Contact Jenna Pastore at 815-641-2185 for more information. No registration required. We look forward to seeing you.

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