The Meadows Blog

The Meadows' is a sponsor of the 24th Annual International Trauma Conference on May 29 - June 1, 2013, at the Seaport World Trade Center in Boston, Massachusetts. The conference director, Bessel A. van der Kolk, M.D., is a Senior Fellow at The Meadows and the Founder and Medical Director of the Trauma Center at Justice Resource Institute.

The focus of this year's conference is "Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions." The conference goal is to present current research findings on how people's brains, minds, and bodies respond to traumatic experiences; how they regulate emotional and behavioral responses; and the role of relationships in protecting and restoring safety and regulation.

Keynote conference presenters include, Alan Sroufe, PhD, Patricia Crittenden, PhD., Karlen Lyons-Ruth, PhD, Ed Tronick, PhD., Alexander McFarlane, MD, and Ralph Savarese, PhD. In addition, Meadows' Senior Fellow, Dr. Shelley Uram, and Dr. Jon Caldwell, The Meadows' Psychiatrist, will be presenting "A Neurobiological Perspective on Trauma and Attachment and the Role of Mindfulness in the Healing Process."

"The 24th Annual International Trauma Conference will once again feature the leading edge neuroscientists and treatment developers to bring you the latest research on how trauma affects mental and brain functioning, as well as how effective treatment can reverse the profound effects of trauma on mind, brain, body and soul," said Bessel A. van der Kolk.

For information regarding the conference, please contact The Meadows at 800.240.5522 or info@themeadows.com.  To register visit http://www.themeadows.com/events/detail/international-trauma-conference/.  Attendees can earn up to 27 Continuing Education Credits.

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

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

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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.

Model of Immaturity

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

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.

Dishonesty

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.

Intensity Issues

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:

  • Having a sense of self-worth based on the concept of inherent worth.  This means believing you are of equal value to others in your strengths and in your weaknesses. Being in recovery means esteeming yourself from within and realizing your humanity.

  • Setting and maintaining functional boundaries.  This means allowing yourself to be vulnerable, yet not too vulnerable. Being in recovery allows you to be intimate and vulnerable, with protection.

  • Trusting yourself by owning your own reality and being true to yourself. This incorporates expressing yourself in a diplomatic manner. Being in recovery means being able to be real and accountable for your imperfections and being willing to look for a higher power for help with imperfections.

  • Taking care of yourself and attending to your needs and wants, while being able to ask for help when needed. This involves being able to hear "no" to a request for help without taking it personally. This, also, involves being able to say "no" to a request for help when this request will enable the other person or when you think complying to the request will lead to resentment. Being in recovery means being responsible for your own self-care and being interdependent.

  • Having the ability to contain yourself, with functional spontaneity and having an attitude of moderation in all areas of life. Being in recovery means being able to experience your life moderately and maintaining a sense of functional spontaneity.

Finally, let's take a look at things you can do to support your recovery. These are suggestions for you to consider:

  • Attend Twelve Step Meetings - This allows you the opportunity to be with people who are talking about their illness and how it operates in their own lives. Twelve Step meetings are an opportunity to talk about all experiences; negative and positive that you are having throughout recovery. Twelve Step meetings can help you focus on your own progress and improvement and allow you to give hope to others.

  • Do a Written Step One – This helps you see the disease in action in your own life. When you can be honest about the unmanageability in your life, you can stop sabotaging your life. Writing helps you to see the patterns of codependency and addiction in your life. Pia Mellody's book, Breaking Free: A Recovery Workbook for Facing Codependence is a great resource in how to write out all the steps.

  • Get a sponsor - Choosing a sponsor who has time in recovery and who demonstrates functional adult behavior will help keep you on the path of recovery. Choose someone who is honest and willing to be confrontational in a nurturing manner.

  • If needed, consider the option of seeking out more intensive therapy, such as an intensive outpatient program or inpatient treatment.

  • Keep confronting the core issues and growing - We cannot be functional in the core issues all the time. This is humanly impossible. We can continue to work on our self-esteem, boundaries, own our reality, meet our needs and wants and operate in moderation.

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.

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As I try to understand the effects of psychological trauma, often it's the body that tells the story. This was certainly the case with Jennifer (as I will call her). During our first meeting, she entered my office with a veneer of aloofness, but her eyes told a different story; they were darting about, quickly scanning me and my office for any signs of threat. She sat lightly and uprightly on her chair, legs ready to spring into action. Her breathing was shallow and quick, and was probably matched by her racing heart. Her eyes hungrily snatched-up any movement inside and outside my office - always on the prowl for signs of danger. Hers was the body of someone who didn't know safety and probably hadn't known safety for a long time.

During our second meeting, Jennifer and I talked about what it was like for her to always feel as though she was on "red-alert". We talked about her constant scanning of the environment and what that felt like in her body. She described a wad of tightness in her belly that was almost always there - a persistent bodily reminder that she must never let her guard down. Her body was constantly ready to attack or to escape.

I asked Jennifer if she could imagine a scenario where her body could experience even a small degree of safety, so that the wad of tightness in her belly could begin to relax. She described a situation where she was alone in her car driving across the desert. In her mind she could see herself driving fast enough that none of the usual threats could catch up to her - she was untouchable and safe. The car's top was down and the warm desert breeze was blowing her sticky worries and fears from her mind.

Next, I invited her to hold that scene of safety in her mind while also noticing the sensations in her body. As her attention shifted slightly inward, she recognized that the wad of tightness in her belly had loosened somewhat and that she was feeling lighter inside, more spacious and free. The corners of her mouth turned upward ever so slightly and little sprigs of wrinkles formed around her now-moist eyes. In that moment, she literally embodied safety and security.

After about ten seconds however, her facial expression lost some of its buoyancy and she opened her eyes abruptly.  She explained to me that the feelings of spaciousness and freedom lasted only for a moment and then she felt herself floating away, unable to hold onto the mental image of safety or the pleasant somatic experience.  While the sensations of spaciousness and freedom in her body brought temporary relief, they were quickly followed by trepidation and fear. After all, she wasn't used to letting down her guard... it was a very vulnerable feeling for her.

In that moment, Jennifer, like many others I have worked with, felt discouraged and disheartened. She was able to taste freedom, but it quickly slipped away. She wondered if she would ever be able to maintain the feeling of safety within herself and if she could be free from the nagging need to remain on red-alert at all times.

In situations like these, I am quick to point out that, in the beginning stages of trauma recovery, establishing a sense of safety within the body takes a great deal of patience. Initially, there are small islands of safety - little oases of security in an ocean of seemingly treacherous water. However, once an island of safety has been established, even if it is present for only a moment, then the possibility of creating more islands of safety increases greatly.

In fact, from the perspective of brain science, we know that "when neurons fire together, they wire together". So, when someone interrupts their usual pattern of fearful hypervigilance to cultivate an experience of safety in the body - the brain pathways that facilitate those sensations and feelings of safety are activated! Once those brain circuits are activated, they become easier to activate the next time and can be activated more frequently. The brain is literally able to restructure its connections to support these islands of safety.

With ongoing and consistent therapeutic work, more and more islands of safety begin to appear and the islands increase in size. Pretty soon, the distance of treacherous water between islands diminishes, allowing the person in recovery to "island hop", as it were. As recovery progresses further, the ocean waters slowly recede and the once-isolated islands of safety begin to coalesce into chunks of land and eventually into large landmasses.

This was Jennifer's experience at The Meadows. Together, we were able to establish more islands of safety and she discovered many other islands through various therapeutic activities at The Meadows. Like many others I've worked with in the past, she wasn't always aware of the emerging islands or the coalescing landmasses within herself; but her body told that story too. From my perspective, she finished treatment with a brain that had already begun reorganizing itself to have greater capacity for feeling safe and a body that was clearly experiencing more spaciousness and freedom.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell's clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

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By: Joyce Willis, MC, LPC

Up to this point, we have 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. We have identified the Five Core Issues: Self-Esteem, Boundaries, Reality, Dependency and Moderation. We discussed how living in extremes in the Core Issues leads to immaturity issues. We will now explore the Secondary Symptoms resulting from living in the extremes in the Core Issues. This is where The Model of Developmental Immaturity gets interesting. Columns I (The Nature of the Child) and II (The Core Issues) are tracked straight across. Once we enter Column III (Secondary Symptoms), the chart can spider-web and does not necessarily continue tracking straight across. For instance, with self-esteem issues, we can travel down to addiction issues and mood disorders or we can experience spirituality issues or any of the other Secondary Symptoms. This is the case with all The Core Issues. Being in the extreme in any Core Issue can lead to any or all of the Secondary Symptoms. The Secondary Symptoms describe the unmanageability in our life due to trauma and immaturity. We will explore each of the Secondary Symptoms.

Negative Control Issues

Negative control issues have to do with being controlling of other people. This comes from a lack of respect for the right of other people to be who they are. Negative control issues can lead us to use manipulation and sarcasm to control other people. Negative control happens when we believe we have the right to determine what another person looks like, thinks, feels and does or does not do. On the other hand, negative control can be allowing someone else to control us. Allowing someone else to control how we look, think, feel and act is a part of negative control. How does negative control affect The Core Issues? Negative control can lead to:

  • Self-esteem – If we are struggling with esteeming ourselves and someone has an opinion about us that we do not like, we will try to control what they think in order to feel good about ourselves. This may take the form of arguing, sarcasm, or rationalizing.
  • Boundaries – If we are struggling with functional boundaries, we have difficulty separating our own reality from someone else’s reality about us. If our external boundary is dysfunctional, we often give ourselves permission to do what we want do, when we want to. We give ourselves permission to touch or keep our distance without considering the comfort level of others. Our boundaries can also be impaired by not setting boundaries with how close people get to us and not stopping people from touching us. Negative control occurs in boundaries when we either determine what we can do with someone physically without permission or we give too much permission, when it is not in our best interest.
  • Reality – If we struggle with knowing who we are, we try to control what others think to fulfill someone else’s expectations. We often do this without being aware we are doing this. We try to convince others of who we are, so that they believe in this “made-up” person we present ourselves as.
  • Dependency (needs and wants) – If we have trouble taking care of our needs and wants, we try to control others’ behaviors so that they take care of our needs or wants. We then can become angry when someone cannot read our minds and take care of these needs and wants.

Resentment Issues

Resentment issues have to do with being unable to let go of resentments after being victimized by another person. The “victim” stays in resentment by trying to get the offender to admit the violation, to express regret and/or to right the wrong. It is a possibility that the offender might never do any of these things. Thus, instead of focusing on protection and good self-care to overcome past violations, the victim remains a victim and continues to build resentment. Resentment can take the form of running old tapes in our head and replaying these tapes to try to get revenge. Resentment, in the most extreme form, is like taking poison and waiting for someone else to die. Trying to get revenge leads to the opposite of what we want. Continuing to hold onto resentment can lead to further isolation, increased shame, pain and anger.

How does resentment affect The Core Issues? Much like negative control, resentment can lead to:

  • Self-esteem – If we think that someone has offended us, our self-esteem lowers and we feel shame. We may feel a need to punish the person in order to redeem our value. We resort to getting even in order to restore our own self-esteem. Self-esteem is affected by the better than position, also. If we believe we are better than, we give ourselves the right to react in anger and offend the other person.
  • Boundaries – Often, with resentment, we have no boundaries, thus we offend and can be powerless to stop offending. The resentment we hold onto brings a need to get even.
  • Reality – By holding onto resentment, we are likely to misinterpret situations that happen and think we have been wronged when we have not been. This can lead to hostility and offensive behavior toward the perceived offender.

Spirituality Issues

Spirituality issues have to do with having no connection to a higher power. Having no connection to a higher power can result from having problems facing who we are or being unwilling to see others as they are. Spirituality issues include making others or our addictions our higher power or trying to be the higher power. Neither of these is about living in truth; which is the basis of spirituality.

How do spirituality issues affect The Core Issues? Spirituality issues affect two areas in The Core Issues:

  • Self-esteem – If we believe we are worthless, this may lead to not believing we are worthy to relate to a higher power. This can lead to us alienating ourselves from others and from our higher power. If we are trying to be our own higher power due to thinking we are better than, we do not need an external higher power. Either way, we harm our spiritual recovery.
  • Reality – Becoming truly spiritual requires that we admit and share our imperfections and mistakes and that we listen when others share their imperfections and mistakes. Not being able to do this robs us of a nurturing spiritual relationship with our higher power.

Addiction and Mood Disorders

Addiction problems usually manifest to medicate reality or to create intensity. Addictions stem from codependence. Any substance or process that relieves our distress can become an addiction. This includes addictions to substances, such as alcohol and drugs. This also includes addictions to behaviors/processes, such as eating disorders, gambling, and sex addiction. All these substance addictions and behavioral addictions can develop from a want to medicate unwanted reality or a way to relieve pain.

When we are so afraid of the painful reality of our childhood, this can lead to mood disorders, such as depression or anxiety. We can use the depression and anxiety to avoid the pain of dealing with the past or with our present situations. Depression or anxiety can let us continue to keep what happened in the past as non-existent, leading to denial and not moving into recovery.

In this area, it is important to discuss physical illness, as well. The stress of avoiding pain or owning our own reality can lead us to physical illnesses for which there are no true medical reasons. We can often suffer chronic symptoms that persist in our lives. Many of these symptoms may result from not expressing our feelings. Examples of physical symptoms are headaches, high blood pressure, and asthma.

How do Addiction, Mood Disorders and Physical issues affect The Core Issues? When we avoid reality through addictions, mood disorders and/or physical illnesses, we can develop:

  • Self-esteem – Addictions, mood disorders and physical illnesses can lead to us feeling less than other people. We can also use our substance abuse to be arrogant and better than and continue in addiction to avoid loneliness and shame. Whether we believe we are less than or better than, we cannot be in an honest, trustworthy relationship with others.
  • Reality - When we are stuck in addictions, mood disorders and physical illnesses, we often want to avoid feeling emotions. Thus, we medicate our feelings and become removed from our own reality of what is.

Intimacy Issues

Intimacy issues have to do with difficulty in being relational. Intimacy does not just refer to physical or sexual intimacy. Intimacy has to do with being vulnerable enough to let someone know us emotionally, spiritually and intellectually. Intimacy also has to with respectful curiosity to know someone else on an emotional, spiritual and intellectual level. Trauma can lead to difficulty being intimate and being relational.

How do intimacy issues affect The Core Issues? Intimacy issues affect every area of The Core Issues. An impaired ability to sustain functional intimacy can lead to:

  • Self-esteem – If we are in the less than position, we compare ourselves to others and come up short. Thus, we cannot truthfully share in an intimate way, because we fear others will find out how defective we are. If we are in the better than position, we often judge others. This makes it uncomfortable for someone to be around us.
  • Boundaries – Intimacy is blocked when we are in the victim or the offender role. We cannot get to know others or share who we are if we do not have a functional internal boundary.
  • Reality – If we struggle with knowing who we are, we cannot share ourselves with others. If we are looking for someone else to define who we are, then we may try to change how we think, feel and act. This can lead to dishonest and manipulative behavior that does not allow for intimacy.
  • Dependency (needs and wants) - If we are too dependent on others to meet our needs and wants, we risk becoming the child in a relationship, rather than an equal adult in the relationship. If we are stubborn about our independence and do not ask for help, intimacy is blocked because we stop sharing our needs and wants. If we deny our needs our wants completely, then we are out of touch with our own humanity and are, in essence, not operating as a real person in a way to be intimate with others.
  • Moderation/Containment– If we behave in a way that shows no containment, (angry outbursts, threatening behaviors, extreme intensity), there is no intimacy. If we share who we are in an intense and frightening manner, we are blocking true intimacy. The other side of this is shutting down our emotions and shutting others out. This leads to intimacy dying. True adult to adult intimacy is about being able to be spontaneous and fun while being responsible and respectful.

We have now explored the first 3 columns of The Model of Developmental Immaturity Issues. Childhood Trauma causes Immaturity in The Core Issues. Trauma and Immaturity drive the Secondary Symptoms leading to unmanageability in our lives. Trauma, immaturity and unmanageability create Relational Problems. We will explore Relational Problems in Part IV of Breaking Down The Model.

Resource: Mellody P. (1989). Facing Codependence. New York: HaperCollins.

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.

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A rate increase for Meadows' workshops will take effect on April 1, 2013. So now is the time to take advantage of the current prices. The new cost of our specialty workshops will be $2,925 while the Couples workshop will increase to $4,000.

The Meadows has earned a national reputation for our clinical focus on healing from trauma, codependency and process addictions. In our 36-year history, we have helped more than 20,000 individuals in our inpatient center and 25,000 workshop attendees support their hopes for a sober and fulfilling lifestyle.

The Meadows offers a variety of unique, five-day workshops available to all interested individuals. These workshops specifically address the needs of those who have just begun a recovery process or those who have been on a recovery path and may be stuck or want to deepen their experience. It can also be a source of renewal for anyone who has undergone treatment. Participants work on sensitive issues in a concentrated format allowing them to enhance their personal journey by gaining insight into dysfunctional, embroiled patterns and practicing new relational skills within a safe environment.

For more information, visit http://www.themeadows.com/workshops/.

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