The Meadows Blog

http://www.washingtonpost.com/national/health-science/link-between-ptsd-and-violent-behavior-is-weak/2012/03/31/gIQApYFZnS_story.html

The political and emotional complexities of PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury) can lead to stigmatization and inaccurate attributions. It has long been assumed that soldiers, especially those who have served in combat, are at higher risk for violence. Following WW II several congressmen introduced proposals to send returning combat troops to islands for "retraining" before returning to civilian life. Following Vietnam we had Rambo movies and veterans "going postal". The facts are both simple and confusing: sudden outbursts of violence are rare and very hard to predict.

The article referenced above summarizes some of what is clear: PTSD and TBI can produce shifts in emotional management and changes in "executive brain function" resulting in possible impulsiveness. Complex phenomena like PTSD and TBI are difficult to study and data is scattered, sometimes inconsistent or contaminated by selective sampling or agency agendas. What is clear is that spectacular episodes of sudden violence are extremely rare, despite media attention. There are often multiple factors involved and these include co-occurring disorders, use of drugs or alcohol, lack of sleep, number of tours, severity of symptom or injury, just to name a few. We would love to have instruments that predict these rare outbursts, but they do not exist. We are reduced to the old maxim I learned decades ago: "the best predictor of future behavior is past behavior".

I do not wish to oversimplify; however, I want to reassure readers, especially military readers, that they are not likely to explode in some horrific headline-grabbing fashion. The title of the Washington Post article is generally accurate. Put aside the complexities of multiple tours, diminished capacity, head injury, partial recall, fugue episodes, sleep deprivation, isolation, and alcohol, and let's focus on the reassuring take-away message. There is no data supporting the worst fear carried by many. Most veterans are well trained, restrained, disciplined, highly ethical, and filled with a sense of justice, loyalty and honor. Most veterans I have treated live with the dread that they could lose control of their impulses and inadvertently hurt someone. Newspaper headlines about sudden violence and suicide add to their burden of fear. As a 66 year old combat Marine with severe health and mobility problems recently stated, "I am still afraid of what I could do to others.- That's why I need to stay away from others." The fear of losing control results in isolation, self-medication, avoidance, and a whole host of symptoms we see with PTSD.

I would argue that the most common symptom is not violence but extreme dedication to work or mission. I do not have the statistics, but from my years of experience I see pro-social zealousness- not antisocial outbursts- as the most common coping mechanism. Over dedication to work/mission becomes almost addictive. It is easy to get lost in working excessive hours, and it is rewarded by recognition and increased revenue. Channeling one's anger is difficult, but workaholism is an extreme response rewarded in our culture. However, family members can be angry and confused, and the internal burden remains hidden. Sleepless nights, avoidance, occasional road rage and other symptoms flourish, often visible only to a few. Spectacular outbursts are rare. PTSD tends to be a condition that most often fits the following: "Great souls suffer in silence." (Friedrich Schiller). The articulation of suffering is often the first step toward recovery.

Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at www.jerryboriskin.com.

For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.

The Meadows trauma and addiction treatment center in Wickenburg, Arizona, is pleased to announce Heidi Dike Kingston, LCSW, as the new Workshops Manager at The Meadows. In this new role as part of the Intake team, Kingston is responsible for providing clinical screenings and scheduling for The Meadows week-long workshops program.

Kingston began her career at The Meadows in 2004 as the Midwest Community Relations Representative while living in Chicago. In 2005, Kingston was promoted to National Community Relations Representative. After working for the Fort Carson Warrior Transition Unit as a Social Worker in 2010, Kingston returned to The Meadows as a Business Development Liaison before accepting her new responsibilities as Workshops Manager.

Kingston has worked in the field of addiction and mental health treatment since she was 19 years old, serving as a tech for Crestview Center Addiction Recovery Services in Anderson, Indiana. Prior to her time with The Meadows, Kingston worked for Hazelden Foundation as a Primary Counselor and Clinical Case Manager.

"We are very pleased that Heidi Dike Kingston has assumed her new role at The Meadows as the Workshops Manager," said Kevin Berkes, Director of Intake at The Meadows. "Heidi is most passionate about connecting individuals with the most clinically appropriate services available."

The Meadows' Workshops include topics focusing on grief, trauma, and addiction, to name a few. While these workshops specifically cater to the needs of those who are not enrolled in inpatient treatment, they also are a source of renewal for patients who have undergone treatment.

To learn more about The Meadows' workshops contact (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 centers or 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 is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

Is it possible that trauma is good for you? Is there such a thing as Post-traumatic Growth? Are we supporting soldiers coming forth for assistance or are we engaging in denial when we strip away the "D" (disorder) from PTSD? As a clinician and advocate for those who develop PTSD and its more severe variant, Complex PTSD, I am tortured by the contradictions and questions.

Like many in my profession I have read the research and the controversy associated with resilience training. I am critical of many aspects of these endeavors; they promise more than is reasonable and have been implemented prior to empirical validation. Also, the assessments done during training have resulted in lawsuits due to soldiers objecting to being ordered for additional training on spiritual development (viewed as a resilience booster). Nonetheless, there is such a phenomenon as Post-traumatic Growth. I see it all the time, and in fact have been a strong advocate of this construct for decades. I have always encouraged clients with PTSD to "find meaning from the misery", something much easier said than done. It is no great surprise to observe that like heroes of mythology and bible, adversity is often the precursor of strength. Many soldiers and civilians suffering from PTSD go through a long "dark" period before finding hope, meaning and strength. Some never find the positives and withdraw from life or die from their condition(s). On the other hand, it is possible that some individuals skip the downside and move spontaneously toward "growth".

Whether this is common, rare, or the result of training or genetics is still not known.

The military does an outstanding job in training soldiers to survive in combat. However, is it possible to prevent PTSD? The armed forces would love to be able to select those who are most resilient and train them in all ways to become "immune" to trauma, perhaps even strengthened by trauma. I am reminded by the headline in a recent military newspaper: "Bullet-proof Your Brain". Perhaps this concept can be taken a bit too far. We are already struggling with questions about how many tours someone should have before they "break". I seriously doubt we will be able to precisely predict an individual's breaking point, find a medication that will prevent PTSD, or have cognitive techniques that permit individuals to tolerate the impossible. As cited in the article, "These programs were designed to make people happier and healthier," says George Bonanno, a professor at Columbia University who studies trauma and resilience. "That is not the same thing as inoculating people for serious urinate-in-your-clothing type stress - once-in-a-lifetime stress."

So, how do we make sense of the contradictions: is trauma neutral, negative or a positive? Can we expect resilience, growth or a lifetime of symptoms? Will a mistimed introduction of "the positive" possibility help or hurt someone with active PTSD? I am concerned that the expectation of "Growth" can add burden, perhaps shame to those who have PTSD or Complex PTSD. I recall a very powerful example. My client, a high school teacher who had severe PTSD, was being evaluated by a renowned psychiatrist as part of her lawsuit against the physician who misdiagnosed her near-fatal colon cancer. She lived in dread of a recurrence of her cancer; she had severe anxiety symptoms and was not adjusting well to her colostomy bag. The psychiatrist was representing the defense team and his objective was to gather information to deny the existence of her PTSD. She was expecting critical questions and did very well during the hour, no signs of anxiety or anger at his attempts to undermine the reality of her PTSD. At the very end of the interview the psychiatrist switched tone and tried to display empathy. He was an elderly man, partially blind, and said to her, "I had some health problems myself and medical errors were made. I decided that I had to put my memories and emotions in the attic of my brain and then I was over it. You need to do what I did." Ironically, he was trying to be kind but the result was powerful; my client burst into tears, felt invalidated and humiliated. It took us a full hour to help her recover from the trauma expert's mistimed attempt to validate and encourage. She felt shamed and criticized. In this case, a positive message delivered at the wrong time had unintended consequences.

So, while focusing on the positive results of surviving trauma is empowering, it can be invalidating as well. It is all a matter of context and timing.

Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness.

For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.

Wednesday, 28 March 2012 20:00

THE MEADOWS ANNOUNCES NEW LIAISONS

The Meadows is pleased to announce the addition of Joan Sputh and Peter Stavropoulos to their Business Development team.

Sputh has 30 years of successful sales and sales management experience covering territories coast-to-coast with her primary focus in the medical industry.   Eighteen years were spent with Johnson & Johnson in wound management and infection control.  Most recently Joan’s work focused on adolescent behavioral health and substance abuse issues. Sputh will oversee outreach activities for The Meadows in the Northwest region of the United States, including Washington and Oregon with coverage of Montana, Idaho and Utah.

Stavropoulos has been a Certified Rehabilitation Counselor for over 12 years; he has five years of experience providing case management services to individuals with physical disabilities and behavioral health issues, as well as over six years of experience working as a Regional Sales Manager in the pharmaceutical industry. Stavropoulos will oversee New York, New Jersey and Connecticut outreach activities for The Meadows.

"We are delighted to have Joan and Peter join The Meadows team," said Patty Evans, Senior Vice President of Business Development for The Meadows. "Their passion for helping people in need of trauma and addiction treatment will be a great asset to our program. I am confident they will help behavioral health care professionals in their areas gain a better understanding of the important work The Meadows is dedicated to doing; helping patients deal with life's most difficult challenges, including addiction, trauma, abuse, depression, divorce, grief and loss, or psychiatric disorders."

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 centers or 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 is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

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

By

Bonnie A. DenDooven, MC, LAC

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

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

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

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

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

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

Attachment style of Moving toward People:

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

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

Attachment style of Moving against People:

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

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

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

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

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

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

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

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

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

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

Bonnie A. DenDooven

mailto: dendooven7@aol.com

Bonnie A. DenDooven, MC, LAC is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work disorders. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").

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

Footnote 2: http://www.chabad.org/blogs/blog_cdo/aid/1073778/jewish/Why-Hasnt-the-Self-Esteem-Movement-Given-Us-Self-Esteem.htm

The Meadows is pleased to sponsor a lecture by Dr. Peter Levine titled "In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness," on March 30 from 9:30am to 4:00pm (Pacific Time) at the Westin San Francisco Airport.

With doctorates in both medical biophysics and psychology, Dr. Levine, a Senior Fellow at The Meadows, is the developer of Somatic Experiencing®, a naturalistic body-awareness approach to healing trauma. In his lecture, Dr. Levine will discuss that it is possible to live robustly with pleasure and creativity even when dealing with the most devastating experiences - and deceptively trivial ones.

Dr. Levine will address the nature of trauma, how it is a condition that can be healed from, as well as how the body is utilized to make that happen. During the lecture, Dr. Levine will describe how traumatic healing can be strengthened by learning to attend to the "unspoken voice of the body." The roots of addiction in unresolved trauma, insecure attachment and habitual childhood frustration will also be explored.

Event Information:

Friday, March 30 from 9:30am to 4:00pm (Pacific Time)

Cost: $125

Westin San Francisco Airport
1 Old Bayshore Highway
Millbrae, California 94030

Registration available at http://www.regonline.com/builder/site/Default.aspx?EventID=1059970

Monday, 19 March 2012 20:00

What Caused Sgt. Bales to Snap?

A group I facilitate for Vietnam Veterans struggled with this question even before the name of the accused sergeant was released. Violence, injury, death and war stir intense emotions in all, particularly among veterans who have been up close and personal. The issue of atrocity and slaughter of civilians is, naturally, an incredibly intense and sensitive subject.

My group members wrestled with this for 90 minutes; most had extreme empathy for the cumulative damage war has upon warriors. They could not even begin to grasp the immense pressure put upon younger soldiers, some of whom serve three, four, and up to nine tours. They/we are humbled by shocking reports of soldiers committing sudden violence, some of which is toward family, but more often towards self. They embraced the contributing factors that need be considered: alcoholism, traumatic brain injury, post traumatic stress disorder (PTSD), financial problems, issues of unemployment, possible relationship problems, a passed over promotion, an unwanted next tour, recent injury, and experiencing the wounding or killing of fellow warriors.

Reports indicated that Sgt. Bales was suffering from many of these factors; he was also reported to be highly decorated, a model soldier, and has saved lives of civilians and Americans in some of the hottest conflicts in Iraq. How could a highly trained soldier, a member of an elite unit, trained sniper and leader of men possibly commit such an atrocity? Our group struggled with this question and did not come to a clear explanation. They had empathy and contempt; some launched into politics of the current wars, some blamed the military for too many rotations, some defended the military, others discussed the role of combat, loss of recent friends, PTSD, alcohol, and tbi (traumatic brain injury). The discussions were intense and a few favored certain factors, but no consensus or full explanation was derived.

One thing we did derive: in certain situations our usual narratives fall apart. If the conditions are right, we are all capable of sudden violence or extreme behavior. The media will no doubt speculate on which factor(s) were critical in this current horror. Forensic experts will attempt to definitively opine, but we may never fully know why this particular soldier "snapped" in such a dramatic and horrific fashion. Thousands of soldiers carry the burdens of war. Most struggle in silence and harm no one, and if they do injure anyone, they hurt or punish themselves.

We may never know the full explanation of what went wrong. My personal speculation is that alcohol played a large factor. It is the most common variable in violence: domestic, self or toward others. It also works in tandem with PTSD and traumatic brain injury. What will probably emerge is a complex picture of a determined and accomplished soldier worn down by many variables, military and domestic. Early reports suggest Sgt. Bales and others were drinking heavily that evening, against military rules. Those early reports also suggested drinking to levels of blackout. Sgt. Bales allegedly had a drunk driving hit and run episode while stateside. Whereas not the sole factor, alcohol might have been the "tipping point". Alcohol is a common way of "self-medicating" or "de-stressing", but it can have an almost "evil" impact in unleashing primitive emotions. In fact, it is a common but often understated factor in the surging suicide numbers in young soldiers. Alcohol has a long history of violence in so many settings, especially the home. Unfortunately, we continue to deny alcohol's power or even its presence. Mr. Bale's attorney alleged his client had not been drinking.

We will know more as facts emerge, but we may never fully grasp what went wrong or why. We do know that war is ugly; it changes people and distorts mind, body and soul. The results of war can make you feel "untouchable" and unique. My hope is that veterans or military personnel reading this blog will recognize that their worst fears are not reflected in the rare disasters. Most people, even civilians, have a fear of "snapping". Exposure to the horrors of war intensify that fear beyond that which most observers can express or comprehend. The vast majority of those who develop PTSD do not snap. Instead, they suffer quietly and deconstruct their lives. PTSD, especially with co-occurring addiction, is complicated and destructive, but highly treatable. Recovery requires Sleep, Safety and Sobriety, the three "S's" that are the first steps in separating you from the demons of war.

Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness.

For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.

The Meadows, a world-class trauma and addiction center in Wickenburg, Arizona, is a gold sponsor of The American Foundation for Suicide Prevention (AFSP) Out of the Darkness Campus Walk at Arizona State University in Tempe, Arizona, on Saturday, March 31 from 10:00am to noon. A team from The Meadows will also be participating in the walk.

Last spring, AFSP launched its inaugural Out of the Darkness Campus Walk campaign. The Campus Walk, patterned after AFSP's highly successful Community Walk will take place again in 2012 at colleges and high schools across the country. Suicide is the third leading cause of death for people ages 15-24, only accidents and homicides are higher. For college students specifically, suicide is the second leading cause of death, just behind accidents.

The goal of the ASU Walk is to create awareness and raise more funds for aggressive mental health research and programs for college and high school students within the local community. The ASU Walk hopes to raise $20,000.

"We are pleased to support this very important event," said Jim Dredge, The Meadows CEO. "The Out of the Darkness Campus Walk campaign helps bring attention to the need for more suicide prevention education."

Steve Schiro, the AFSP Field Advocate in Arizona, became involved with the organization after his son, who was a senior at ASU, took his life last year. "My wife and I are both educators and we didn't see the signs. We needed to learn more and we found AFSP," Schiro said. Both he and his wife now serve on the board of the Arizona Chapter." Schiro added that awareness for students to see the signs of depression and suicide will bring the subject out into the open so people can talk about it and realize that there isn't a stigma and there are alternatives.

For more information on how to participate in the walk, please call 480-227-4230 or visit http://bit.ly/Anb19O.

A body of research indicates that there is a correlation between trauma and suicidal behaviors. The Meadows is the industry leader in treating trauma through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 807-3778 or visit www.themeadows.com.

AFSP is the leading not-for-profit organization exclusively dedicated to understanding and preventing suicide through research and education, and to reaching out to people with mood disorders and those impacted by suicide. Since 1987, AFSP has invested over $10 million in new studies, as well as provided education and information through public workshops, trainings, our adolescent and college educational films, publications and public service announcements addressing teen depression.

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 centers or 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 is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

Attachment Theory in Action: Feeling Attachment Security in the Body

Several months ago, as I sat waiting to board a flight, my attention was captivated by an active toddler sitting (for the most part) on her mother's lap. Beneath naturally curly locks of hair, her eyes, bright and curious, darted about the busy terminal, feasting on the smorgasbord of novel stimuli. When a scruffy-looking man passed by in a wheelchair and offered a gnarled hand to the young child, she fearfully buried her face in her mother's loose-fitting sweater. The girl's mother instinctively pulled her close and whispered softly in her ear while giving the grizzled man an apologetic smile. As the man pushed on, his course laugh still lingering in the air, the girl gingerly emerged from her safe, sweater-cocoon to survey the scene. Still within her mother's secure embrace, the girl stood-up and ventured an inquisitive glance in the direction of the retreating man. Her fear had been down-regulated and she was able to explore the environment once again.

Interactions like this between a parent and child are repeated on a regular basis throughout early development. From the perspective of attachment theory, these dyadic experiences are the foundation for all social-emotional development. It is noteworthy that, from the earliest moments of life, attachment experiences are interactions between two minds and two bodies. As illustrated by the example above, the mother sensitively responded to the nonverbal intentions and emotions of the child by communicating safety and security through an embodied interaction with her child. In this way, attachment experiences, whether secure or insecure (as in the case of relational trauma and abuse), are incorporated into the body's self-regulatory systems, and as a result, can play an important role in how the body reacts and responds in close relationships later in life.

This article is part of a series on attachment theory and relational trauma (see the first article for an overview) and is meant to illustrate how attachment theory can guide a therapeutic approach that incorporates working with emotions and the body. To ensure patient confidentiality and anonymity, the clinical example in this article is a fictional account based on many different patient histories and various treatment experiences. Although the following clinical information isn't associated with one particular person, it is representative of many people who have experienced relational trauma.

Karen, as I will call her, was a 37 year-old divorced female who entered treatment after becoming depressed and suicidal following a breakup with a boyfriend. She reported that symptoms of depression and anxiety had been a problem for most of her life, but they always got much worse during periods of relationship turmoil. Similar to previous episodes, when the most recent relationship ended, she turned to alcohol and binge eating to numb the pain.

Karen reported that whenever a romantic relationship ended, she felt a profound sense of emptiness and loss. After her partner left, she couldn't stop thinking about what she might have done wrong and she feared that she would never have a healthy relationship. She fantasized incessantly about getting back together and about how she would "fix" herself to make the relationship work.  These kinds of thoughts plagued her day and night until the helplessness and despair were overwhelming.

As a child, Karen's mother struggled with alcoholism and her father with workaholism; she remembered feeling like she was constantly hungry for their attention and love. In fact, as a young girl she was certain that her father had a trap-door in his office where he would disappear and carry out his "secret life". Even when her parents were available, she often worried that she was "annoying" and she feared that her desire for attention actually drove them away.

Karen's parents divorced when she was nine-years-old and their separation only intensified her father's distance and her mother's alcoholism. The pain and loneliness associated with her parents" divorce was partially ameliorated by a warm and loving relationship with her maternal aunt, who had been a stable figure throughout her life. However, at thirteen-years-old, her aunt died, and not long after that, Karen began using food and alcohol in excess to alter her mood.

Karen's childhood history indicated that she likely had insecure attachment relationships with both parents that could be categorized as ambivalent/preoccupied. In other words, her early development was marked by implicit feelings of insecurity because she was unsure whether or not her parents could consistently provide a safe and secure presence in her times of need. Additionally, she believed that this lack of security was her own fault, which led to a pervasive fear of abandonment and a preoccupation with maintaining closeness. These patterns of thinking and feeling seemed to carry-over into adulthood where her romantic relationships were characterized by an anxious attachment style and showed clear signs of love addiction (as described in Pia Mellody's work).

This kind of assessment of Karen's attachment relationships was very helpful in formulating her treatment plan at The Meadows. Recognizing that she would likely harbor tremendous fear and anxiety about rejection and abandonment, treatment providers were careful to establish a secure therapeutic environment with clear limits/boundaries and a consistent, warm, and responsive presence (elements that were missing from her early attachment relationships). Through various forms of treatment (including highly experiential inner-child work), she was able to acknowledge and process long-held feelings of pain, fear, anger, and shame regarding her early attachment relationships.

Although Karen strongly identified with the concept of love addiction, halfway through her treatment she was still struggling with intense thoughts and emotions regarding the unhealthy relationship that preceded treatment. During a session when she was particularly emotional about this subject, the therapist asked Karen to close her eyes and imagine what it would feel like to finally end the relationship and say goodbye to the relationship partner. Karen said, "It would feel like saying goodbye to a part of me... there would be a hole in there." She pointed to her chest. The therapist asked, "As you imagine that hole in your chest, what does it feel like in your body?" Karen's face winced and her eyes shut tight as she responded, "It's like a sharp, stabbing sensation."

The therapist inquired further, "As you are feeling the stabbing sensation in your chest, do you notice any other thoughts or emotions?" Karen paused, her hand over her chest now, "I worry that the hole will never be filled - that I will never find anyone else." The therapist tenderly implored, "How does it feel in your body as you say that?" Her breathing increased and her shoulders tensed upwards, "Now I feel tightness in my chest and throat." Knowing that the tightness was likely defending against something even more vulnerable, the therapist deepened the approach, "What would happen if you never found anyone else? What would that say about you?" Karen's shoulders released, she bent over slightly and began to cry, "Maybe it's me... maybe I'm just unlovable." The therapist gently asked, "How does that feel in your body?" Through streaming tears, Karen replied, "There's a deep ache in the pit of my stomach - that's where the hole leads - that's where it ends. It really hurts."

Karen was invited to stay in-touch with the deep ache in her stomach while the therapist guided her in some breathing exercises. Once Karen's emotions were more regulated, the therapist asked her to think about a relationship in childhood where she felt unconditional acceptance and love. Karen immediately identified her deceased aunt and tears welled-up in her eyes once again. The therapist queried, "If your aunt were here right now, how would she respond to the deep ache you are feeling?" Karen was still crying, but a faint smile came across her face, "She would give me a big hug and then she would just stay here with me." The therapist asked, "When you think about your aunt's response, how does that feel in your body?" Her frame straightened and her smile broadened, "It feels warm all over... more open and free inside my body." After a few moments of quiet introspection, she spontaneously added, "The ache is gone."

Relying on the wisdom of her body (and with help from the therapist), Karen was able to drop below the habitual thoughts and feelings associated with love addiction and actually experience the pain associated with early attachment insecurity (i.e., "I'm unlovable"). More importantly, she was able to contrast, and even dissolve, this deep pain through an embodied experience of secure attachment (i.e., "unconditional acceptance and love"). Later she had great difficulty describing this therapeutic process in words, but it proved to be an "emotionally corrective experience" that she carried with her throughout her treatment. Gradually, by bringing awareness to feelings in her body, and the associated thought processes, Karen learned more about her love addiction patterns and she developed tools to tap into a hidden wellspring of compassion and positive regard for herself.

Like most people, Karen's childhood experiences with attachment figures profoundly influenced how she felt about herself and her relationship partners. Indeed, the mental and emotional scripts associated with early attachment relationships are written into the neurobiology of the developing child and, often without conscious awareness, are acted out on the stage of romantic relationships. Fortunately, meaningful and lasting alterations to these scripts can be facilitated by a variety of therapeutic techniques, particularly those that are experiential in nature and involve working with emotions and the body.

ADHD, Income Taxes, and Unopened Envelopes

by Bonnie A. DenDooven, MC, LAC

Many Americans have a visceral, gut-wrenching reaction to the terms "IRS" and "taxes". It is a response quite similar to the way certain war veterans with PTSD over-react to the sound of a car backfiring. For those who suffer from financial disorders, fear of unopened envelopes and misplaced financial records is the norm, but at this time of the year, the fear of the IRS combined with ADHD and unprocessed trauma from childhood could exacerbate the problems. Research now shows that 67 percent of adults who are diagnosed with ADHD have problems with money management (1). The additional mental concentration required to gather and process tax forms sends many reeling into a spiral of shame and panic.

Managing finances is a unique challenge for an individual with ADHD. The major features of procrastination, disorganization, and impulsivity can wreak havoc. Surveys have shown that when compared with their non-ADHD peers, adults with ADHD may be three times more likely to be currently unemployed and forty-seven percent more likely to have trouble saving money to pay bills. Financial disorders follow ADHD adults.

Evidence is starting to show that for some, it is more than ADHD causing problems. Childhood financial trauma is frequently at the root of financial mismanagement. This helps to understand why purely behavioral solutions such as creating budgets, making spending plans, writing down all expenditures, or even putting money into envelopes has not worked for certain people. When emotions are involved in finances and fear dominates, cognitive behavioral remedies must be preceded by affective and somatic therapy to bring resolution to the fear.

The greater effort some people exert at changing their money behaviors by focusing on them, the more chaos they encounter. It may be like hearing a car backfire every time they think about money.

What happens to make a mature adult reduced to feeling powerless over finances and afraid like a helpless child? Peter Levine says in a video interview, "ADHD is a very complex . . . but when I work with kids who have ADHD they look like kids who had trauma." He goes on to say, "When we work with ADHD from a trauma model the symptoms appear to go away. The hyper-arousal, hyper-vigilance, inability to attend to the here-and-now, the inability to focus, those are key elements of trauma."(2) Psychological trauma is a violation of the person's belief that their world is safe and secure. A highly charged and emotional argument between caregivers over money can create extreme emotional confusion and insecurity for a child who may not understand the details of their parents' conversations, but do understand the powerful emotions at a deep limbic level. Children understand the power of money in an argument, just as they understand the power of alcohol over an alcoholic parent. In the world of financial disorders, we are treating many Adult-Children-of-Money-Trauma-Families.

Fighting over money is the one disagreement over all other disagreements that can predict divorce. A 2009 study(3) by Jeffrey Dew, a faculty fellow at the National Marriage Project, Utah State University, showed that couples who disagree about finances were over 30 percent more likely to divorce than those who did not. For women, arguments about sex ranked second with money arguments first as a precursor for divorce, but for men, financial disagreements stood alone at the top for breaking up a marriage. Nothing strikes fear and creates trauma in the heart of a child as severely as the fear of losing a parent. Divorce means a loss. In the eyes of a child, an argument between Mom and Dad can be scary enough, but a resulting divorce co-mingled with the topic of finances can create a situation where any future conversation about money is trauma-bonded to the panic of survival and loss.

The first 30 days of each year, most people receive important tax documents in the mail. Individuals stuck in the FREEZE arousal state of PTSD will fail to open the envelopes for several more weeks and will procrastinate, sometimes until the last minute or after. The "unopened envelope" stack is a familiar phenomenon to speakers at a Debtors Anonymous or Business Owners Debtors Anonymous meeting. Some 12-steppers need to get help to just sit with them while they open the envelopes - to help them unfreeze from the panic.

Many people respond to the perceived financial danger with FLIGHT. While some have a desire to flee any financial discussion, the tendency is never more pronounced, obvious, and identifiable than in the weeks leading up to April 15th. The angst of having to deal with records, receipts, statements, forms, and most of all, submitting to financial authority, becomes a secret horror. Those stuck in the FLIGHT are likely to misplace documents, checks, forms, receipts and writing utensils in an unconscious attempt to flee and get some distance from the task itself - out of sight, out of mind.

Those stuck in the FIGHT arousal state can be expected to take extraordinary risk by literally cheating on their taxes - creating their own private battle and attempting to win at any cost. It is an emotional, fearful fight to end all fights. The fear of having cheated on ones taxes creates ongoing fear of getting caught. It is trauma repetition every time an envelope comes from the IRS.

The most common recommendations of money management do not work for some because each budget, each bill, each envelope re-traumatizes. The therapy required is to resolve the unprocessed trauma and become free from emotions of the past.

Bonnie A. DenDooven

mailto: dendooven7@aol.com

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").

(1) 2003 - 2004 UMASS studyhttp://psychcentral.com/news/2007/12/18/care-management-for-adult-adhd/1676.html

(2) http://www.youtube.com/watch?v=FkBFJN5vRTw

(3) http://economix.blogs.nytimes.com/2009/12/07/money-fights-predict-divorce-rates

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