The Meadows Blog

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

Published in Blog

Bessel A. van der Kolk, MD

Trauma, Attachment and the Body
February 11, 2011

Universal City, California
In recent years there has been an explosion of knowledge about how experience shapes biology and the formation of the self. Within the disciplines of psychiatry and psychology, the study of trauma has probably been the most helpful in understanding the relationship between the emotional, cognitive, social, and biological forces that shape human development. Trauma research has revealed new insights about how extreme experiences can profoundly impact memory, affect regulation, biological stress modulation, and interpersonal relatedness. These findings, along with a range of new therapy approaches, have led to new and unexpected ways to help traumatized individuals. This lecture will present current research findings about post-traumatic responses at different developmental levels and in various domains, and will explore the treatment implications of these findings.

Learning Objectives
Participants will be able to:

  • Identify and discuss recent advances in the neurobiology of trauma.
  • Identify the ways in which somatic experience contains the imprints of the traumatic experience.
  • Discuss and demonstrate ways in which these imprints must be reprocessed for a successful treatment outcome.

About the Presenter
Bessel A. van der Kolk, MD, Clinical Consultant for The Meadows and Mellody House, is one of the world's foremost authorities in the area of post-traumatic stress and related phenomena. His research work has ranged from the psychobiology of trauma to traumatic memory, and from the effectiveness of EMDR to the effects of trauma on human development. He is professor of psychiatry at Boston University School of Medicine and medical director of the Trauma Center in Boston, a Community Practice Site of the National Child Traumatic Stress Network. The Trauma Center is one of the foremost training sites in the country for psychologists and psychiatrists specializing in the treatment of traumatized children and adults.

Dr. van der Kolk has published extensively on the impact of trauma on development, borderline personality and self-mutilation; cognitive development in traumatized children and adults; and the psychobiology of trauma. He's currently studying the effects of treatment on brain function, the effectiveness of EMDR, theater groups working with traumatized inner-city youth, and yoga. His most recent book is Traumatic Stress. He has taught in universities, hospitals and clinics on five continents.

Location
Hilton Los Angeles
Universal City
555 Universal Hollywood Drive
Universal City, CA 91608
818-623-1479
Self-parking at hotel is $9.

Schedule
Registration: 8:30 a.m. 9 a.m.
Lecture: 9 a.m. 12 p.m.
Lunch: 12 p.m. 1 p.m. (boxed lunch provided)
Lecture: 1 p.m. 4 p.m.

Earn 6 Continuing Education Credits

To register: http://www.themeadows.org/events/index.php?rm=event_details&param1=show&param2=144&

Bessel A. van der Kolk, MD
 

Trauma, Attachment and the Body
February 11, 2011

Universal City, California
In recent years there has been an explosion of knowledge about how experience shapes biology and the formation of the self. Within the disciplines of psychiatry and psychology, the study of trauma has probably been the most helpful in understanding the relationship between the emotional, cognitive, social, and biological forces that shape human development. Trauma research has revealed new insights about how extreme experiences can profoundly impact memory, affect regulation, biological stress modulation, and interpersonal relatedness. These findings, along with a range of new therapy approaches, have led to new and unexpected ways to help traumatized individuals. This lecture will present current research findings about post-traumatic responses at different developmental levels and in various domains, and will explore the treatment implications of these findings.

Learning Objectives
Participants will be able to:

  • Identify and discuss recent advances in the neurobiology of trauma.
  • Identify the ways in which somatic experience contains the imprints of the traumatic experience.
  • Discuss and demonstrate ways in which these imprints must be reprocessed for a successful treatment outcome.

About the Presenter
Bessel A. van der Kolk, MD, Clinical Consultant for The Meadows and Mellody House, is one of the world’s foremost authorities in the area of post-traumatic stress and related phenomena. His research work has ranged from the psychobiology of trauma to traumatic memory, and from the effectiveness of EMDR to the effects of trauma on human development. He is professor of psychiatry at Boston University School of Medicine and medical director of the Trauma Center in Boston, a Community Practice Site of the National Child Traumatic Stress Network. The Trauma Center is one of the foremost training sites in the country for psychologists and psychiatrists specializing in the treatment of traumatized children and adults.

Dr. van der Kolk has published extensively on the impact of trauma on development, borderline personality and self-mutilation; cognitive development in traumatized children and adults; and the psychobiology of trauma. He’s currently studying the effects of treatment on brain function, the effectiveness of EMDR, theater groups working with traumatized inner-city youth, and yoga. His most recent book is Traumatic Stress. He has taught in universities, hospitals and clinics on five continents.

Location
Hilton Los Angeles
Universal City
555 Universal Hollywood Drive
Universal City, CA 91608
818-623-1479
Self-parking at hotel is $9.

Schedule
Registration:  8:30 a.m. – 9 a.m.
Lecture:  9 a.m. – 12 p.m.
Lunch:  12 p.m. – 1 p.m. (boxed lunch provided)
Lecture:  1 p.m. – 4 p.m.

Earn 6 Continuing Education Credits

To register:    http://www.themeadows.org/events/index.php?rm=event_details&param1=show&param2=144&

Published in Blog
Tuesday, 28 December 2010 19:00

Equine Assisted Psychotherapy & The Meadows

Upon arriving at The Meadows, many patients are charmed by the view of equine activities at nearby ranches. They frequently ask about having Equine Assisted Psychotherapy (EAP) as part of their primary treatment program. As a direct result of these requests, EAP is among the newest offerings coming to The Meadows. The initial challenge was finding a provider who was knowledgeable about both EAP and The Meadows' unique model of treatment. Molly Cook, LCSW, LISAC, has experience as a family and primary counselor at The Meadows, as well as at other addiction treatment centers; she also has been trained in EAP by the Equine Assisted Growth and Learning Association (EAGALA). Working around horses since she was a teen, Molly has significant experience using EAP in her private practice. She now blends her EAGALA training and her experience with The Meadows' model into effective therapeutic sessions.

Equine Assisted Psychotherapy supports patients in recognizing the life patterns that create obstacles for them. By incorporating horses, EAP allows individuals to experience how those patterns play out with someone other than family or friends. Participants learn how to relate to others - and their own addictions - by interacting with horses. Horses are dynamic and living beings who have fixed roles within their herd, much like the roles in a family or group of friends. When humans are introduced to horses, they are incorporated into the horse herd and its social structure. In this joining, the horses start to recognize and reflect the unspoken emotions of humans, demonstrating exactly what human body language tells them. In this demonstration lie metaphors and lessons about the patients that can facilitate change. A healing bond encourages the recognition and change in behaviors. Because of the intimacy that can develop between humans and horses, positive results can start immediately.

For example, a recent patient was struggling with her role as a victim due to childhood traumas. By interacting with the horses, she was able to recognize her previous reality about herself and see that she was precious in her own right. Her role as a victim disempowered her; as she experienced EAP and gained more self-knowledge, her new confidence and skills enabled her to begin to see her own power. She was able to set boundaries, express her needs, share her feelings, and face her fears and anxieties - all without her previous coping mechanisms. Through interaction with horses, she gained the confidence necessary to use these new tools in her life. She gained a sense of self-trust and continues to use her newfound skills to build the self-assurance needed to face the issues of day-to-day life.

During treatment, new coping skills are taught to patients who need new ways to deal with past trauma and addictions. In EAP, these new coping skills are demonstrated, practiced, and reinforced. This experiential modality allows patients to utilize the knowledge gained at The Meadows. It then provides the opportunity to apply the tools learned in treatment to real-life situations. In addition, patients who are struggling with releasing old behaviors, ideas, patterns, and thoughts can be challenged with a new therapeutic technique that mirrors the reactions of those around the patient. The size of the horses allows patients an opportunity to overcome fear and develop confidence. While interacting with horses, patients have the ability to integrate boundary work and reinforce coping skills, such as expressing their needs or asking for help. They also develop intimacy with those around them. Patients who are resistant to letting go of old patterns or ideas can utilize EAP models to see the lack of control their old ideas bring into their lives. In treatment, patients gain information and knowledge. However, without practice, patients may not be able to make the necessary changes. EAP allows patients to enhance their new knowledge with experience that helps to solidify personal changes.

Equine Assisted Psychotherapy is an experiential, interactive, hands-on mode of therapy that can help patients see any issues that have been blocking progress in treatment. With the dynamic medium of equine assistants, patients can see which ideas work and which don't.

Anyone can participate in Equine Assisted Psychotherapy; no prior horse or riding experience is necessary. It is completely safe; no riding is involved, and all activities are done on the ground under the supervision of equine professionals.

Published in Blog
Sunday, 26 December 2010 19:00

John Bradshaw: Discusses his work

The Meadows, America's premier center for the treatment of addiction and trauma, is pleased to present an 11-part video interview with John Bradshaw, senior fellow, world-famous educator, counselor, motivational speaker, author, and leading figure in the field of mental health.

In the 10th video of his series, Mr. Bradshaw talks about his long association with The Meadows and its people.

"When I was asked to come to The Meadows, I considered it an honor," he says. "They have some of the top people in the field."

He then describes some of those people and their contributions. Peter Levine, a pioneer on the impact of trauma on the body. Pia Mellody, whose intuitive genius and personal history helped make The Meadows’ treatment model accessible to non-professionals. Bessel van der Kolk, who shaped the field of PTSD. Maureen Canning, a leading expert in sex addiction and trauma.

"It's wonderful to be part of a class act," Mr. Bradshaw adds. "We give something to people, and they get something out of it."

Mr. Bradshaw has enjoyed a long association with The Meadows, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. His New York Times best-selling books include Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

Other videos in this series include interviews with leading experts in addiction and trauma, including Dr. Jerry Boriskin and Maureen Canning. View the videos at www.youtube.com/themeadowswickenburg.

For more about The Meadows' innovative treatment program for addictions and trauma, visit www.themeadows.org or call The Meadows at 800-244-4949

Published in Blog

The holiday season can be a time of joyous celebration with our loved ones, a time when we begrudgingly drag ourselves to dreaded events, or a time when feelings of loneliness can be overwhelming. For many of us, some combination of all three is present this time of year. In many cases, the holidays are a time when stressors, triggers for relapse, and old wounds are more abundant.

This season also brings the opportunity to continue or start off the new year in recovery mode. We at The Meadows would like to offer you a 12 Step plan for doing just that. We honor the work that many of you have done to re-engage in your life, leaving old habits behind. We also honor those who continue to struggle with addiction. Below is a 12 Step guide for surviving the holidays in sobriety - "the 12 Steps of Holidays Anonymous," if you will. (Disclaimer: The steps below are loosely based on the 12 Steps of Alcoholics Anonymous and are not a replacement for them.)

The 12 Steps of Holidays Anonymous

1. Make sobriety your first priority. Acknowledge the vast amount over which you are powerless (your family situation, the location of events, etc.). Be aware that you are, however, empowered to choose to maintain what you have lovingly worked so hard to achieve. Assess what you want and need for your sobriety and relational engagements with others.

2. Believe that you can be restored to sanity. Plan ahead and have realistic expectations. If your family looks more like The Family Stone than Ozzie and Harriett, ground in reality and be open to the flaws and imperfections of your family system. Detach from expectations and practice acceptance and forgiveness.

3. Turn your care over to a higher power, or at least someone with more experience staying sober during the holiday season. Have a safety plan. Speak with your support network prior to the holidays and share any concerns and plans. Remember that, in previous years, many of your peers in the program have survived and thrived during the holiday season. Some common techniques used in the recovery community include driving yourself to events so you can leave whenever necessary, taking the number to a taxi service if driving yourself is not an option, asking a sober friend to accompany you, or hiring a sober escort. Keep in mind: The impact of bringing someone with you or leaving an event early is small compared to the impact of a relapse on your relationships with your loved ones and self.

4. Make a searching and fearless inventory of yourself, and practice boundaries and grounding. Setting limits is a loving and respectful thing to do for yourself and others. If you have awareness that you are willing and able to participate in a holiday activity for one hour rather than five, set a limit with yourself and share this limit with your loved ones or holiday celebration peers.

5. Admit to God, self, and one other person any concerns and potential triggers you may have going into the holiday season. Remember: Those around you cannot support you unless you are willing to be rigorously honest with yourself and your sober support system, i.e., your sponsor, home group, and therapist.

6. Be entirely ready to remove all defects of character. Remember this is for you only; your willingness to assist family members in identifying and removing their defects of character before they are ready avails no one and is NOT relational.

7. Humbly ask the higher power of your understanding to remove your shortcomings, recognizing that your shortcomings do not subtract from your value. Be respectful of others. If one of your tendencies is to judge others, make a resolution to contain your comments on Uncle Marvin's lovely twinkle-light reindeer sweater (not that there's anything wrong with battery-operated clothing).

8. Make a list. Chaotic, last-minute trips to the mall can be destabilizing and stressful. Honor yourself by not overextending to make others happy. Take a personal inventory of yourself and your finances. This is a self-care technique that can help you turn inward and avoid future resentments. Also, don't forget to include yourself on your gift list. Gifting oneself, in a moderate way, is an act of self-care and acknowledgment.

9. Make direct amends, except when doing so would injure others. Remember that one of the ways to make amends is with living amends. You can do this by maintaining your sobriety, acting within your value system, and being respectful of others. You may believe this is a good time to speak with those you have harmed, but do so with conscious thought. Grandma may prefer to spend her holidays watching the grandchildren unwrap gifts rather than discussing a way you can pay her back for totaling her car.

10. Continue to take personal inventory and, when you are wrong, promptly admit it. Remember HALT (the basics of self-care: Hungry, Angry, Lonely, Tired). In times of stress, we become more susceptible to allowing some of our defects of character to leak out. If you act outside of your recovery and value system, make prompt amends to avoid allowing unnecessary feelings of guilt to overtake the celebrations.

11. Seek through prayer and meditation; the holiday season can be busy and, in some cases, stressful. This is not an excuse to skip your morning meditation, meetings, or time with your sponsor. This is a time to hold these commitments even more strongly, or to kick it up a notch. Prearrange your meeting schedule and ensure that connection, sobriety, and self-care remain top priorities. It may come in handy to repeat the Serenity Prayer in your head as Uncle Jack attempts to dominate the season with his thoughts on the current political climate. This allows you to remain connected with your higher power and accomplish relational objectives, all while nodding your head during his share.

12. If you have had a spiritual awakening, try to carry this message: Acts of service can help us to reground, stay connected to our program, and just feel darn good! The holidays can be an important time to practice gratitude and giving. If your holiday plans this year are not what you had hoped for (or even if they are), volunteer to be a sober escort, speak at a meeting, or volunteer to clean up after one. Remember: Whatever your season looks like this year, it’s still a lot better than holidays spent living in addiction.

We at The Meadows wish you a sober, safe, and successful holiday season.

Published in Blog

Contact The Meadows

Intensive Family Program • Innovative Experiential Therapy • Neurobehavioral Therapy

(*)
Invalid Input

Invalid Input

(*)
Invalid Input

(*)
Invalid Input

(*)
Invalid Input

Invalid Input