Co-Dependence and Addictions

In Codependence, relationship and life problems become worse over time.

These roles of victim, rescuer and persecutor are often caused by intergenerational trauma or unfairness. What holds these three roles together is denial. At some level, Persecutors have convinced themselves they are right to do what they do to the Victim and refuse to see their actions as abusive or manipulative. Victims wonder how they ‘always end up in this situation’ and feel both powerless and blameless. Rescuers tell themselves they ‘are just trying to help’ and are ‘good people’, when really they get to control by keeping Victims helpless or feeling needed. Davis and Frawley discovered that there is also a fourth position called the passive or neglectful bystander. All of these roles are interchangeable, and none of them are healthy.

To heal this relationship pattern, we need to practice doing the opposite of what we normally do.  The opposite of the destructive-fuelled by control, guilt and enmeshment, as in the co-dependence pattern above, toward a better way of loving that honours us and the people in our lives.

An honest look at the behaviour patterns we’re engaged in is often helpful. But don’t expect those around you to want to change the pattern even if you do! This pattern is often called the Drama Triangle!

Things to be curious about

  • When you were growing up, what sort of role did you play in the family?
  • What aspects of self-did you or others -have to deny, in order to play that role?
  • Do you still play the same role today, or have you adopted other roles?

To escape the co-dependence pattern I suggest that you start by learning positive skills and boundaries for yourself and others as illustrated below.Interdependence the solution for codependence

I hope this blog evokes curiosity and perhaps even a moment of clarity and self compassion. More help with changing patterns is available through CoDA or Al Anon, or via a trauma therapist on sites such as the Blue Knot Foundation or addiction therapy groups via organisations like Odyssey. 

 

 

Sexual Abuse-Healing the Aftermath

Healing and the Aftermath

Sexual abuse creates long term problems for many people, which may not show up until years after the abuse. Abuse can be open or subtle, can be part of a “special relationship” or secrecy. The victim may be blamed by the abuser for the abuse, or worse, be told that this is “love” or that they somehow  “deserve” the abuse.

ABUSE IS NOT LOVE!

Ross and Halpern (2009) describe many of the effects of  childhood sexual abuse. Abuse impacts the development of the sexual and personal identity of the victim in profound ways, even if the survivor can’t remember the abuse at all. Common problems include a sense of discomfort with one’s femininity, masculinity or other orientations, being uncomfortable in one’s body, hypersexual or hyposexual behaviour, alteration in how a person dresses or grooms, sexual addictions, anxiety, depression, dissociation, or confusion around sexual orientation.

On the emotional level, there is often self -blame, self- doubt or self- attack. People wonder if there is “something wrong” with them (shame or guilt). There may be fear of sexual arousal or the content of sexual fantasies. People often question whether their fantasies or behaviors are normal. Others avoid sexuality and intimacy to protect themselves. Others may dissociate from their body altogether and become a “walking head” as a survival based response.

Adding to this, any form of sexual contact, even sexual thoughts, can trigger anxiety, guilt, shame or flashbacks of past abuse. This can be frightening and distressing for the person. The situation may also be distressing for their partner who may be the unwilling, and often unknowing, catalyst for flashbacks, and who may be cast in the role of the perpetrator. This puts painful strain on both people in the relationship.

Some people do not have flashbacks but instead experience a range of problems with arousal, orgasm, or have other difficulties with sex. Boundaries with others may be confused. Intimacy or connection become complicated. Some experience gender dysphoria or gender identity confusion. Others may be fused with their partner and find it difficult to say “no” or to be an individual, while others convince themselves they don’t need anyone. Trust is often be a major issue.

Miraculously, I have seen many people with symptoms of trauma like this make changes, even late in life, that transform and heal many of the problems above. The journey to healing can be slow, but hope is always possible. People experiencing any of the problems above should seek professional help, from a trauma specialist or the Blue Knot Foundation.

Adapted from: Ross and Halpern (2009) “Trauma model therapy, a treatment approach for trauma, dissociation and complex comorbidity”, TX:Manitou Communications Inc.

Clinician guidelines for working with complex trauma

Clinician Guidelines for Working with Complex Trauma

Part 1 

To work effectively with complex trauma, we must challenge habitual ways of doing therapy, unlearning old habits and making room for new ones. In this three part blog I explore why treatments and approaches have changed, some system problems that prevent effective treatment, suggest some ways in which working with trauma is different from traditional therapy and invite the clinician to cultivate the attitudes and qualities which are most helpful, and reflect current best practice in the field. I mention a number of world leaders in the field for those who wish to know more. 

What is Complex Trauma? 

The term complex trauma or C-PTSD has come to mean the type of trauma which is not a one-off event, and is relational. Complex trauma can include mental, physical or emotional cruelty or abuse, witnessing abuse done to others, or neglect. It can also include adverse experiences such as the loss of a significant caregiver eg through divorce or death.

The aftermath of this type of trauma shows up in relationships, where it is more difficult to trust others or ourselves. Survivors may feel too little or too much, be fragmented or compartmentalized, have difficulties with resilience, or have a cruel inner critic. They may carry intense shame or a sense of being unlovable for which there appears no antidote. This and a host of other problems of loving and living, shadow the lives of people who have experienced complex trauma. However, we also know that healing is possible.

Why has Trauma Treatment Changed?

We know a lot more now. For example, the Adverse Childhood Experiences Study (ACES) in the US is a longitudinal study of around 17,000 people, started in the eighties to help understand why some members of Kaiser Permanente health fund were obese. Researchers randomly picked ten criteria for the study. Unexpectedly, this study has since shown that the greater the number of adverse childhood experiences, the greater the risks of adverse sequelae- including physical, mental and emotional issues. Also, the signs and symptoms of adverse experiences may not show up for many years.

For more information, go to https://www.cdc.gov/violenceprevention/acestudy/

The ACES study tells us that people who have experienced complex trauma are more likely to have difficulty maintaining stable employment or stable relationships and are over represented among those who are admitted to hospital, attempt suicide or suffer from addictions.

Also, many branches of science have advanced massively in the last two decades. Fields including endocrinology and neuroscience are providing astonishing new facts about the brain and body which includes the discovery of neuroplasticity and a growing awareness of how stress harms the body.

Neuroplasticity is how we learn, and it is also the way the brain adapts to different environments to enable survival. Thanks to people like Schore and Siegal, we now know that how the brain works is shaped by the environment -especially our earliest experiences with people. Experience changes the brain, body, and emotions, and vice versa.

People with complex trauma show brain structure changes visible on scans, for example their amygdalas may be enlarged. Their nervous system is wired to be more sensitive to threat, harder to calm down or relax, or sometimes harder to get going. Stress hormones such as adrenaline are oversupplied, causing difficulties with sleep, gut and many other issues.

Steven Porge’s work tells us that when activated/anxious (in Sympathetic Nervous System arousal) we cannot listen properly, make good decisions, or digest the past. Therefore it is essential to help create a calm and settled state in the patient before we start any therapy. 

Also, many survivors of childhood trauma carry implicit or procedural patterns, tendencies and memories in the body. These are not accessible via the prefrontal cortex (thinking brain), eg wordless terror, shame or disgust that is pre-verbal- so doing talk therapy alone is of limited usefulness. 

There is higher risk of mental health issues such as depression and anxiety, addictions, psychosis, paranoia or OCD, difficulty regulating emotions, and more risk of physical health issues such as obesity or other food issues, sleep disturbances, poor self-care, chronic pain issues, sexually transmitted diseases, heart attacks and immune system disorders among other consequences.

Clinicians who are untrained in complex trauma may try their best to treat the presenting symptoms while missing the underlying cause. In a recent report in the Neuropsychotherapist, they report on a study showing childhood trauma is often missed or not enquired about at all by treating clinicians.

Luckily, there is growing momentum in the world, from people like Lou Cozolino, Allan Schore, Bessel Van Der Kolk, David Wallin, Steven Porges, Pat Ogden, Janina Fisher, Martin Tiescher, Peter Rossouw and Dan Siegal. These are among the many new thought leaders that are inspiring change and illuminating the path for effective treatment for complex trauma. Interestingly, there is a limited role for medication in the new paradigm, as the biological approach is not effective on its own.

For example, Porge’s polyvagal theory has been widely adopted as part of the new understanding of how the nervous system is impacted by complex trauma, and what to do about this. His theory is, in my experience, extremely useful, as it explains and normalizes many common difficulties, and leads to many non- drug ways of treating distressed states.

Pioneers like Janina Fisher have adapted the work of Richard Schwarz (Inner Family Systems) to help work with the complexity of the individual who is fragmented in both subtle and obvious ways.

Based on research by the Blue Knot Foundation (formerly ASCA – see ASCA Guidelines for Trauma Informed and Trauma Sensitive Service Delivery, 2012), it is recommended that clinicians who work with complex trauma are trained in at least three different modalities, at least one of which is body oriented.

We who work in the field should also be aware of the broader societal issues that impact care and treatment for this already disadvantaged group, and be able to advocate for education and change where this is appropriate.

In summary, over the last two decades there has been a revolution in the treatment of complex trauma, moving away from traditional labels or approaches to encourage a more holistic framework which includes the body and relies less on talking or simply taking medication.

 

In the next blog I will write more about the system issues that impact effective treatment, and in the third and final blog for clinicians to start the year off I write about how to shape practices to be more consistent with world best practice in treating complex trauma.

Relationships that Work

Many of us want to have better, stronger or more connected relationships, but don’t know how to get there.

Dr. Stan Tatkin suggests that what we should be aiming for is secure functioning attachment. This means that the way the relationship works is to make each person feel more secure. We become more secure by building the trust and love between the couple into what he calls a “couple bubble”.

To do this, couples need to focus on what is best for the relationship rather than playing “me first” . Sometimes we need to step up and become the love we seek in others. Also, we need to be vulnerable and allow others to really see us. We may have to learn how to soothe and settle the other and ourselves at times. And perhaps give up addictions to technology and other “thirds” to become more present and available to each other. Sound scary?

Maybe. But as someone who has walked this path, I can say it is really worth it! Secure functioning attachment can heal the past and make the world a really beautiful, magical place. And if children are involved, it protects them and benefits them in so many ways!

I would love to hear from you about this.