The fields of psychiatry and psychotherapy are peppered with uninformed beliefs and misjudgments. For instance, individuals can be pejoratively diagnosed as borderline or, perhaps more accurately, viewed as exhibiting symptoms of complex traumatic stress. In cases of the latter, old unresolved traumas are reenacted in the here and now and, to say the least, are difficult to clinically modulate.
Betrayal is not Borderline
Nowhere is the borderline label less fitting but more frequently appended than in the case of a betrayed spouse. The label is applied to individuals who present in therapy as "help-me-no-don't," chronically angry, scared, defensive, and reactive. Unfortunately, the label is all too frequently applied by uninformed clinicians dealing with an angry, emotional, scared, "leave me-now-no-don't" spouse who has learned of a partner's sexual indiscretions, compulsivity, or addiction. Few spouses comport themselves with grace in the face of betrayal, yet the insinuation or diagnosis of borderline disorder is all too readily affixed. And by brandishing the borderline label, the clinical community serves to reactivate the emotional wounding and reinjure the person already reeling from betrayal and violation.
It's currently debated - not-so-nicely at times - whether sex addiction is an addiction at all. Is it merely a hall pass for out-of-control behavior, or is it an addiction warranting legitimate attention? The psychiatric and psychological camps contend that it's objectionable to label a behavior as an addictive disorder without rigorous scientific support. Assessment, diagnosis, and practice based solely on anecdotal experience may not be legitimate, yet the field of psychotherapy often treats issues and behaviors with modalities and techniques that have yet to be invited to the scientific table of clinical legitimacy.
Judge Not the Name
So it makes sense that borderline personality disorder and sex addiction find their way into the same scrape. An individual who exhibits reactivity and another who exhibits out-of-control sexual behavior tend to face negative public reception, while the pain and wounding that drive the behaviors are overlooked. By brandishing a label, the professionals with whom the pain can be shared reinforce disapproval of the behavior and invalidate the pain.
The American Psychological Association determines what is included in the Diagnostic and Statistical Manual of Mental Disorders, the fifth edition of which is to be released any year now. The term "borderline personality disorder" is currently under reconsideration; it is quickly becoming a term of old to describe a cluster of symptoms driven by trauma-induced stress.
A more appropriate term is "complex traumatic stress," which speaks to abuse inflicted by an attachment figure, the loss of the authentic self due to repeated trauma and abuse, or problems in regulating emotion. Whether that description finds its way into the upcoming DSM remains to be seen. So far the jury is out, and confusion still rules. Clearly, this is not an exact science.
We must realize that an individual who struggles with a behavior by any name is an individual who suffers. As clinicians, we are at the forefront of healing and facilitating growth. Whether addictive behavior centers around sex, drugs, or rock-and-roll, it involves pain and suffering. To label the pain or question its legitimacy is to shut down an opportunity for growth and healing - for both the clinician and the client.
In an article on NewsFirst5.com in Colorado Springs, they discussed treatment for Post-Traumatic Stress Disorder (PTSD). In the article, they discussed a conference in Colorado Springs, where Dr. Bessel van der Kolk discussed his concerns regarding treatment for soldiers diagnosed with PTSD. The article reports, "Local experts say that 10 to 30 percent of military coming home from war could be diagnosed with Post-Traumatic Stress Disorder." Dr. van der Kolk discussed the need for people to "feel safe." To read more about this go to:
In the eyes of a child money is alive. Money leaps out of machines in a mysterious way and solves problems or creates others. Money jumps in the middle of parental arguments and draws its sword, threatening to separate a child from his family. Money leaves powerful messages in marriages; it "wakes" up emotions as it "writes letters" to the family in the form of bills or makes phone calls to the household in the form of bill collectors. Money-talks are frequently the most emotionally charged conversations that a child hears, and children become aware of the social implications of money as soon as they become aware of, and responsive to, others. Money becomes a god that Mother sacrifices Motherhood to obtain and Fathers forsake home life in pursuit of "making a living". Money is the visible representation that a child sees as individuals connect one to another and exchange the green stuff. A child observes the social contracts of money between people and knows that money itself is social; it creates agreements, happiness, and pain as it pulls people together or separates them forever.
Understanding our client's financial and work dilemmas requires much more skill than just offering them the telephone number for credit-consolidation companies. The behaviors themselves can be as varied as trauma repetition, mood-altering experiences, or acts of defiance, as well as many other possibilities. Debt may be for one individual an act that quiets a suppressed and unconscious fear of separation; for another it might be an angry response to feeling confined and trapped; to a third it might mean an anesthetizing behavior allowing one to "zone out".
Healing wounds made by money and work is best approached as if the behaviors themselves sat on a three-legged stool - not to be understood unless all three legs are available. For clinicians the first leg is to understand the Attachment and Trauma issues that arise out of early childhood experiences that serve to create templates for adult behaviors. The second leg is isolate the exact Temperament - answering the question that it is both nature and nurture that give us our attitudes and behaviors with money and work. The third leg is Affect - when we help our clients to understand that the phenomenon of debt creates feelings of emotional pain and fear - and sometimes it is the emotion itself that is most attractive to a traumatized individual.
The money and work disorders create a collage of dysfunctional behaviors. Clients may display a pattern of compulsive shopping, spending and/or debting; some may have progressed into hoarding or shoplifting. Other clients become obsessed with money or work, and some retreat into deprivation and under-earning. Some gamble, either in traditional ways with slot machines and gaming tables or with high risk investments and business adventures. Still others might find themselves paralyzed by the wealth they have inherited or with which they have grown up, and are now unmotivated and untrusting, alone in a threatening world. Assessment of money disorders frequently shows a correlation between adaptations such as gambling with embezzlement, shopping with shoplifting, workaholism with at-risk entrepreneurship or embezzlement, or compulsive giving with relational issues (the "Financial ALANON Factor"). Regardless of how the puzzle pieces fit together to create the unique profile, the treatment follows a predictable course.
Specific steps that need to be taken by clinicians wishing to approach and understand the emotionally-charged, compulsive work and money behaviors include:
(1) An Assessment of disordered patterns of work and money.
(2) An Evaluation of client's temperament and confirmation of underlying personality-specific innate fears.
(3) Childhood memories narrative to determine template(s).
(4) Re-scripting of cognitive distortions regarding finances and work.
(5) Vision work to establish clear goals for future behavior.
(6) A relapse prevention plan based on knowing risk and trigger issues.
Money trauma and the related adult behaviors surrounding money are the unspoken burdens of shame that often take our clients into relapse. In the past twenty years we have made great strides in healing the wounds of sex addiction and we can now talk about sex openly. The time has come for us to talk about money as well and conquer the shame that has kept this subject in silence for too long.
Bonnie A. DenDooven
Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors, 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").
On March 25, Dr. Jerry Boriskin gave a marvelous presentation titled "Complex PTSD and Co-occurring Addictive Disorders: Demystifying Demons and Developing Multidimensional Treatment Skills."
An expert in the field of Post-Traumatic Stress Disorder, PTSD, Dr. Boriskin has garnered the support of a large group of professionals who gathered on a cold Chicago day to hear him speak. Providing an intense look at the complexity of treating PTSD and co-occurring addictions, Dr. Boriskin shared a documentary on a military case subject. Visibly moved, attendees gained a new appreciation for our military personnel.
The group then employed "group thinking" to come up with clinical solutions to a particularly challenging case. The results were varied and fascinating.
The day was a tremendous learning opportunity; most remarkable was Dr. Boriskin's evident passion for his field.
If you or someone you know is struggling with the effects of PTSD, please call The Meadows today at 800-244-4949.
By Jenna Pastore, National Community Relations Representative
Bessel van der Kolk, MD, was recently mentioned is an interesting article in the Contra Costa Times. The article was a review of a conference at UCLA where Dr. van der Kolk presented. Dr. van der Kolk discussed what trauma is "doing to America's youth." The writer described this conference focusing on trauma and brain science as "fascinating." To read this article, go to: