The Meadows Blog

Sunday, 09 August 2009 00:00

Trauma Treatment for the Troops

The Meadows is pleased to announce its commitment to supporting members of our military who have selflessly served our country and who now suffer from the debilitating impact of service-related stressors, particularly those associated with combat conditions. An inpatient treatment facility that has treated more than 16,000 patients over the past 30 years, The Meadows has worked with post-traumatic stress disorders ("PTSD"), alcohol addiction and drug addiction, and a broad range of other mental health concerns. Recognizing the impact of these issues on career military members and their families, The Meadows offers a cutting-edge program of confidential and caring treatment addressing the trauma issues underlying current behaviors. At the same time, our individualized treatment plans enable the formation of skill sets and support systems that help clients re-enter the military or enter civilian life with new tools to manage stressors.

The Meadows is a multi-disorder inpatient facility in Wickenburg, Arizona; it is licensed as a Behavioral Health lnpatient Facility with detoxification, crisis services, and partial care in the state of Arizona and is accredited by JCAHO.
The Meadows is offering to support a designated number of appropriate admits of active-duty military personnel for this program by accepting the daily rate from TriCare, with all other fees waived.
For more information, please contact The Meadows at 800-632-3697.

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Note: This article was originally published in the January 2008 edition of Cutting Edge, the online newsletter of The Meadows.

Primacy of the Affect System: A Support for The Meadows' Model
by John Bradshaw, MA

Almost a half century ago, research psychologist Sylvan Tompkins (referred to by some as 'the American Einstein') wrote:
"I see affect or feeling as the primary innate biological motivating mechanism, more urgent than drive, deprivation and pleasure and more urgent than physical pain. Without its amplification, nothing else matters, and with its amplification anything can matter."

This statement summarizes Tompkins' long-term research, verified by cross-cultural studies with five literate and two pre-literate cultures (Eckman, 1971). Tompkins isolated nine innate affects and showed that they compose "the affect system," which operates like other human systems (endocrine, nervous, immune, etc). Tompkins supplanted Freud's libidinal energy theory with the energy of affect as the primary motivator of human behavior.
During the 1990s, often called "the decade of the brain," neuroscientists such as Joseph LeDoux, Allan N. Schore, Antonio Damasio, and Daniel Siegel offered extensive clinical evidence supporting and expanding Tompkins works.

Following are a few significant ideas from these researchers, each clearly identifying affect regulation as the critical factor in the organization of a functional human. I believe that the work by Tompkins and many contemporary neuroscientists supports, validates, and offers new depth to the "feeling work" being done at The Meadows.

Joseph LeDoux is the Henry and Lucy Moses Professor of Science in the Center for Neuroscience at New York University. He has presented strong clinical evidence that there is no single part of the brain that houses a separate limbic, or emotional, brain. He has shown how emotion is involved in most aspects of human behavior, and he has done pioneering work on the Amygdala, a primitive part of the brain that operates much like home alarm systems. Our right-brain Amygdala records traumatic events. Whenever a situation bears a resemblance to a past traumatic event, the alarm goes off. Amygdale reactivity can bypass and greatly distort rational thinking, but it has survival value and is a right-brain form of intelligence. Tompkins concluded that affect is the right brain's form of cognition, an intuitive intelligence.

LeDoux supports this position: "Subjective emotional states, like all other consciousness, are best viewed as the end result of information processing occurring unconsciously. The activity goes on in the right brain, which is intuitive, nonverbal, and non-logically analytic." It is, however, deeply intelligent. Parts of the emotional system are involved in cognition and choice. Feelings involve "conscious content," says LeDoux.

Antonio Damasio, in his book Descartes’ Error, presents a severe blow to the ratio-logical bias that has dominated Western philosophy for several hundred years, from René Descartes' "I think, therefore I am" to Hegel's Phenomenology of Mind. Many of us grew up under the umbrella of Descartes' rationalism, hearing our parents say things like "Don't be so emotional" and "Emotions are weak." Our parents also stuffed their own feelings, both conscious and unconscious. This set us up to "carry their feelings," as Pia Mellody has pointed out. The shaming of our feelings caused us to numb our feelings and set up codependency, which is the core of addictiveness.

Damasio presented the case of Mr. X, who has suffered damage to a part of his brain that has cut off his ability to experience feelings. Mr. X can think logically and abstractly, but he cannot make simple decisions, such as where to eat. Damasio shows that, without feelings, we are unable to make real decisions. It is no wonder that the severely co-dependent make such bad decisions.

In my forthcoming book Bradshaw On: Calling Forth the Better Angles of Your Nature (due in September 2008), I offer plentiful evidence that moral and spiritual choices depend on emotional literacy. Since the time of Aristotle, we've known that the last act of any moral or spiritual judgment is dependent on affective (feeling) inclination governed by good will (right appetite). It is no wonder that co-dependents and addicts are morally and spiritually bankrupt.

In his book The Developing Mind, Daniel Siegel shows us the social nature of the brain, i.e., how relationships and the brain interact to shape who we are. For Siegel, the interpersonal bridge of the secure attachment bond is critical to a healthy emotional life and healthy sense of shame. Healthy shame is the affect that most determines and guards our sense of self, honor and dignity. The breaking of the interpersonal bridge is the root of toxic shame and the first step in forming a shame-based self.

Siegel asks, "Why does a child require emotional communication, attunement and alignment of emotional states in order to develop a solid sense of self?"
Emotion is how the mind establishes meaning and places value on an experience. Both meaning and value are integrally linked to social interactions. Following his colleague Allan N. Schore at UCLA, Siegel posits that self-regulation with reality is fundamentally rooted in the education of the emotions, or emotional literacy.
Schore, in his three poignant books Affect Regulation and the Organization of the Self, Affect Dysregulation and the Disorders of the Self, and Affect Regulation and the Repair of the Self, stresses the importance of affect regulation, especially the relationship between infant attachment, affect regulation, and the organization of a healthy functional self. Following the pioneering work of John Bowlby and his student Mary Ainsworth, Schore uses the growing body of evidence showing that the neural circuitry of the stress system is locked in the early development of the right brain. The right brain is dominant in the control of vital functions that manage stress, regulate emotion, and preserve a consistent sense of self.

Schore quotes copious studies that cite trauma as having significant negative impact on early bonding and maturation of the right brain during its most crucial period of growth. The most serious damage of early relational trauma is a lack of the capacity for emotional regulation. This adverse experience results in an increased sensitivity to later stresses. The Meadows' Senior Fellow Bessel van der Kolk reiterated this conclusion in 1996 (see Proceedings of the National Academy of the U.S. of America, 1996).

Schore suggests that these neuroscientific findings call for a greater affective bond with our clients, who must disclose personal issues around shame. Schore makes it clear, as did Tompkins, that we can't take our shame-based clients further than we are willing to go. As the great psychotherapist Milton Erickson modeled, we must meet our clients at their map of the world. By mirroring and utilizing another's meaning systems, we can lead him to a larger view of the world. This requires that we have done our own feeling work.

During the eight years of my PBS show and workshops, an estimated 300,000 people did the "Inner Child" and "Healing Shame" workshops. Among the thousands of volunteer therapists at these events, many had difficulty handling the deep feeling work. It was common to find professionals reticent to work with participants who went into an age regression. The work can be frightening, as I am sure many of us experienced in our early professional careers. But it is paramount that, as professionals, we not hide behind talk therapy or prescription giving, when what would most help the client is feeling work.

New insights in neuroscience point to "affect" as the primary motivating energy of life. Affect work has been a missing piece in many therapeutic models, and I am sure this will change in the coming years.

About the Author
John Bradshaw, Fellow of The Meadows, has combined his exceptional skills as counselor, author, theologian and public speaker for the past four decades to become a world-renowned figure in the fields of addictions, recovery, family systems and the concept of toxic shame. John has written three New York Times best-selling books: Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

Published in Blog
Wednesday, 17 June 2009 20:00

Sharing the Disease

Note: This article was originally published in the Summer 2006 edition of Cutting Edge, the online newsletter of The Meadows.

Sharing the Disease
by Claudia Black, PhD, MSW

It has long been known by addiction professionals that, for every person addicted, approximately another four persons, usually immediate family members, are directly affected - husbands, wives, committed partners, mothers, fathers, siblings, and young and adult children.

Would the impact of addiction be reduced if four times the number of family members took part
in recovery programs? Would the impact be reduced if educational and treatment programs addressed the confusion, fear and pain suffered by families and children when the addicted person enters treatment? How might the lives of family members be altered if interventions were directed to them?

As the addict deserves his or her recovery, so do codependent family members. When family members recognize their codependency and its similarities to the addict's addiction, they can recognize the mutuality of their recovery processes.

The following, excerpted from my recently published Family Strategies: Practical Tools for Professionals Treating Families Impacted by Addiction, helps therapists working with family members to link the addict's behaviors with similar behaviors experienced by the family. This approach allows family members to realize they also have issues from which to recover.

The following provides examples of each disease symptom as experienced by the addict and by the family member (codependent).

Preoccupation
Addict
"I wonder if there's enough booze at home or if my dealer will be home or if I have enough money for my drugs."


"I will need to cover my bases with my family by ..."

The addict has a repetitive focus on behaviors connected to his/her acting out behavior.
The codependent experiences the inability to focus on other things without intrusive thoughts about the addicted person and his or her behaviors.

Codependent Family Member
"I wonder where my husband is, who he is with and what I will say to him when he gets home."

Increased Tolerance
Addict
"I used to get drunk on six beers. Now it takes a dozen."


"I used to be satisfied with pornographic magazines; now I need contact with someone on the Internet who will interact with me."

The addict needs to engage more frequently in the behavior or the substance to garner the desired effect, which is usually related to a neurochemical change.
The codependent displays an increase in psychological tolerance as he/she increases acceptance of inappropriate and/or hurtful behavior with lower expectations.

Codependent Family Member
"He used to be critical of me and I would get really upset; now he calls me horrible names and it's no big deal to me."

Loss of Control
Addict
"I told myself I was only going to spend 50 dollars at the casino and lost my whole paycheck before I left."


"I told myself I would only have one glass of wine at the wedding, and I got drunk and passed out."

The addict is no longer able to predict engaging or using behavior.
The codependent is also no longer able to predict his or her own behavior.

Codependent Family Member
"When I know that he is going to be late for dinner again, my plan is to give him the cold shoulder and go about my business. On occasion I'll snap. Yesterday I planned on ignoring him, but I ended up screaming in front of the kids. I, not my husband, was out of control."

Blackouts
Addict
"I don't know where I was, what I did, or who I was with last night."


Blackouts are the one symptom the addict experiences that is not an exact carryover to the codependent. The substance addict has a period of amnesia, usually lasting from hours to days. He/she is conscious and interacting, but the memory is not imprinted on the brain, and therefore it cannot be recalled.
The codependent's blackout, often referred to as a "brown-out," is due to the stress of heightened emotions; there is too much emotionally charged stimuli for details of what occurred to be recorded. It may not be a well-delineated block of memory as a substance abuse blackout. It is more a sense of something occurring without clarity. This could be referred to as a trance-like or dissociative experience in which the memory may or may not be recorded and is not readily available for conscious memory. The process addict's (gambler or sex addict) blackout is more similar to the codependent's than the substance abuser's.

Codependent Family Member
"We had a screaming fight the other night. I don't remember exactly what I said."


Craving
Addict
"I wanted cocaine so bad I could taste it."


The addict has a severe physical or psychological urge or craving to reengage in the substance or behavior.
The codependent experiences a deep obsessive psychological urge or longing for the times when things were better. Frequently, craving goes hand in hand with euphoric recall (romanticizing the good times).

Codependent Family Member
"I really miss him. When he is gone, I ache for him."


Compulsive Behavior
Addict
"When I had a craving, I knew I shouldn't drink, but I found myself in the bar last night anyway."


Addicts begin engaging in behavior in a manner that they feel driven and obsessed, and they do so repeatedly, which often reduces cravings or preoccupation.
Codependents may begin engaging in behaviors such as snooping, spending money, eating, sex, etc. Codependents' compulsivity may be acted out in perfectionistic tendencies.

Codependent Family Member
"My house is clean, with everything in its place. It makes up for how I feel inside."


Decreased Tolerance

Addict
"I used to be able to stay out for hours using, and now I am in trouble shortly after I begin."


Progressively the addict cannot engage or use to the extent he/she once did and begins to experience negative symptoms more quickly.
The codependent becomes less patient, is less likely to stay in denial and may experience an emotional bottom. Usually these symptoms transpire more in the latter stages of the addictive process.

Codependent Family Member
"I can't take any more. Everything he does irritates me."


Medical Problems

Addict
"I thought running marathons was proof I was healthy, fueling my denial about my substance abuse - to find myself slowly and silently becoming physically sick."


In the latter stages of addiction, particularly if the addict is a substance abuser, physical problems can run the gamut from heart and lung disease, brain disease, liver damage, throat and mouth diseases to diabetes and digestive disorders.
Medical problems may also be related to unsafe sexual practices, accidents, and injury.

Codependents are more apt to experience stress-related health problems ranging from headaches, stomach or digestive problems, hives, back problems, ulcers, depression and/or anxiety. Many diseases codependents suffer are fueled and complicated by stress, most specifically autoimmune disorders.

Codependent Family Member
"I went to one doctor after another, thinking my problems were all physical, to find after months in a 12-Step program my physical ailments disappeared."


In conclusion, it is important to continue to talk about disease-related behaviors such as lying, sneaking, etc. and the many feelings related to living with addiction. To understand the addict's process and then consider the family's similar experiences helps family members understand that they are in need of recovery as well. Family Strategies offers a wide variety of tools to assist families in their healing processes.

As family members share in the disease, they may now share in the recovery.

About the Author
Claudia Black, PhD, MSW, Clinical Consultant for The Meadows, is a lecturer, author and trainer internationally recognized for her pioneering and contemporary work with family systems and addictive disorders. She serves on the Advisory Board for the National Association of Children of Alcoholics, and has been a keynote speaker on Capitol Hill in Washington,DC. Claudia has been featured in numerous publications, appeared on many national television shows, and written several well-known books, including Changing Course, It Will Never Happen to Me, A Hole in the Sidewalk, Depression Strategies, Straight Talk, Relapse Toolkit, The Stamp Game: A Game of Feelings, and her latest book, Family Strategies.

Published in Blog

How do we become enslaved by addiction? That question is asked - and answered in a recent issue of the GOOP newsletter devoted to the topic of addiction. GOOP is a lifestyle website written by actress Gwyneth Paltrow.
Paltrow wonders, "How do we become enslaved by addiction? What is addiction?" and "What makes so many of us prone to addiction in its various forms? What causes us to be open to this enslavement? And how do we begin to undo it?"
These questions are put to various sages, including a Kabbalah scholar, a Zen master, a bestselling mind-body author, an Episcopal priest, a psychologist and a Sufi shaikh. See the newsletter for their insightful and diverse responses.
The Meadows was included in Paltrow's list of further resources.

Published in Blog
Wednesday, 03 June 2009 20:00

The Therapeutic Genius of Pia Mellody

Note: This article was originally published in the Spring 2007 edition of Cutting Edge, the online newsletter of The Meadows.
The Therapeutic Genius of Pia Mellody
By John Bradshaw, MA
Pia Mellody joins the company of those who have created highly effective therapeutic models and who can put their theories into practice with unusual skill. Pia's approach is phenomenological, resulting from her own painful struggle with codependency, as well as from thousands of hours spent interviewing and working out healing strategies with patients at The Meadows.
Pia began her unique journey as the head of nursing at The Meadows. In her early days, she suffered from low self-esteem, unhealthy shame, and a hyper-vigilance that accompanied her need to be perfect in every aspect of her work and life. She lived in that lonely place of non-intimacy, polarization and silent anger that most codependents experience.
Pia decided to get some help for her problems at another treatment facility, where she found the experience not only frustrating, but ineffective. Her problems did not seem to fit into any consistent category of the Diagnostic Manual. When she completed treatment, she continued to try to make sense of her raw pain and confusion, reaching out to others to try to get assistance in alleviating the distress. She was grappling with an inner distress exacerbated by a sense of defectiveness, the inability to engage in really good self-care, and living in reaction to other people. Thanks greatly to her, this condition is now called "codependence." At that time, there was no coherent theory or therapy for the problem.

Early Roots of Codependency
Prior to Pia's work, some relevant work had been done concerning the reality of codependence. Ludwig von Bertalanffy's work titled General Systems Theory had filtered its way into several arenas of psychotherapy, notably Ronald Laing, Virginia Satir, and The Palo Alto Group (Gregory Bateson, Don Jackson, Paul Watzlawick and John Weakland).
In 1957 in Ipswich, England, John Howell concluded that the entire family itself was the problem, rather than just the symptom-bearing individuals. Dr. Murray Bowen developed "The Bowen System" of family therapy. He clearly posited the whole family as the problem, maintaining that the most distressed and under-functioning person in the family triggered the rest of the family into over-functioning behaviors. The more the family members over-functioned, the more the distressed person under-functioned. Thus, the more the family tried to change, the more it stayed the same. Bowen was convinced that the whole family was in need of therapy. Bowen did not use the word "codependency," but he emphasized that, like a mobile, every member of a diseased family was dependent on his or her other family members.
Dr. Claudia Black, currently a Senior Fellow at The Meadows, wrote a now classic book called It Will Never Happen To Me. In it, she described the symptoms she carried as an adult that stemmed from living with an alcoholic father and a co-alcoholic mother. Dr. Black made it clear that her whole alcoholic family was diseased, and that each member was codependent on the alcoholic father.
Soon hands-on clinicians like Dr. Bob Akerman and Sharon Wegscheider Cruse (a protégée of Virginia Satir) were describing the symptoms of the adult children of alcoholic families as "codependent," although no one knows who first used the term "codependency."
I did a 10-part series on PBS in April 1985 that met with a huge public response. In it, I used a mobile to describe the family system, moving it energetically to show how the whole family is affected in dysfunction, and allowing the mobile a lightly moving homeostasis to show its functional state. I devoted two parts of this TV series to issues I called "codependency," although my grasp of the concept was still vague and lacked a consistent theory of explanation.
Outside the recovery field, which deals with addictions of all kinds, was the work of Karen Horney and Theodore Millon. Horney's Neurosis and Human Growth presented many descriptions of a dependent personality. Horney's description touched upon many of the primary symptoms of codependency, which Pia Mellody later organized into a coherent theory. According to Horney, those lacking healthy adult autonomy and interconnectedness sought their fulfillment and a sense of self from other people. For these people, relating to other people became compulsive and took the form of blind dependency. Horney used the phrase "morbid dependency."
In the International Encyclopedia of Psychiatry, Psychology and Neurology, John Masters wrote: "I think that mainline academic psychology has not done enough extensive work on dependency as it relates to codependency as an identifiable personality disorder. Codependency is now seen by many to constitute a painful problem for certain clusters in our society. We are on a primitive frontier with regard to understanding codependence."
Psychiatrist Dr. Timmon Cermak, in Diagnosing and Treating Codependence, argued that codependency was on par with other personality disorders. "To be useful though," wrote Cermak, "codependency needs to be unified and described with consistency. It needs a substantive framework and, until this is done, the psychological community will not recognize codependence as a disease."
Enter Pia Mellody
It was at this point that a young nurse stepped onto the arena of modern psychology and made an extraordinary contribution.
One day, Pia Mellody walked around the corner of a building and had a moment of clarity. She thought of AA and how alcoholics start recovery by simply telling the stories of their troubled drinking. They share their experiences and strength in embracing their shame and their first glimmers of hope.
Pia realized that hundreds of people had passed through her office at The Meadows with stories very similar to her own. For one thing, a large majority had been abandoned, abused and neglected as children. Pia had long suspected that her own symptoms stemmed from her traumatic childhood and severely dysfunctional family system.
At this point, Pia began interviewing the many people who came to The Meadows with stories of abandonment, neglect, abuse of all kinds, and enmeshment with a parent, the parent's marriage or the whole family system.
As Pia interviewed person after person, a unique and clear pattern emerged. All had five similar symptoms:
They had little to no self-esteem, often manifested in the carried shame of their primary caregivers;
They had severe boundary issues;
They were unsure of their own reality;
They were unable to identify their needs and wants;
They had difficulty with moderation.
These symptoms together marked an extreme level of immaturity and a level of moral and spiritual emptiness or bankruptcy. Patients shared their sense of relief in just being able to identify and talk about the distress they were in.
With an interviewing approach fueled by her intuition, Pia Mellody had discovered what she called "codependency." She had come to understand the word "abuse" in a much broader context than clinicians had previously understood it. Pia also showed how codependents carry their abusive caretakers' feelings. Our natural feelings can never hurt or overwhelm us; their purpose is to aid our wholeness. Our anger is our strength, a boundary that guards us. Our fear is our discernment, warning us of real danger. Our interest pushes us to expand and grow; our sadness helps us complete things (life is a profound farewell). Our shame lets us know the limits of our curiosity and pleasure; it becomes the core of modesty and humility. And our joy is the marker of fulfillment and celebration. "Carried" feelings lead to rage, panic, unboundaried curiosity, dire depression, shame as worthlessness or shamelessness, and joy as irresponsible childishness.
Pia later saw the five core symptoms as leading to secondary symptoms: negative control, resentment, impaired spirituality, addictions, mental or physical illness, and difficulty with intimacy.
Pia believed that alcohol and drug addiction, sex addiction, gambling addiction and eating disorders must be treated before the core underlying codependency can be treated.
Understanding that addiction is rooted in codependence is another contribution that Pia helped to clarify. Years ago, Dr. Tibot, an expert on alcoholism, saw that there was an emotional core to alcoholism that he called the "disease of the disease." Pia's work has certainly corroborated that intuitive insight.
Pia Mellody's most important contribution may be how she and her groups of suffering codependents worked out strategies of healing. They did this through trial and error. The results were so striking that The Meadows encouraged Pia to develop a workshop titled "Permission to be Precious." It was an instant success, and Pia began to take it to different cities around the U.S. Soon she wrote a book, Facing Codependence, with Andrea Wells Miller and J. Keith Miller. Later she developed a powerful approach to treating love addicts and their counterparts' avoidant addictions. Her most recent book, The Intimacy Factor, is the only relationship book that treats the core "grief feeling work" around early abuse, neglect and abandonment. I believe that other self-help relationship books fail because they do not address these fundamental issues. "Feeling work" involves exposure, vulnerability and what Carl Jung called "legitimate suffering." Pia has done her share of that and has the know-how to gently nurture others through this work.
Pia's work has become the core model in treating addictions of all kinds and the core of codependence they rest upon. She has personally led hundreds, probably thousands, of people suffering from codependency into recovery and wholeness.
Pia answered Dr. Timmon Cermak's challenge to do the work that established codependency as a treatment issue. She not only found a consistent way to conceptualize this source of suffering, but she found the know-how to address it.
The time has come for a broader recognition of Pia's art and genius.

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