Psychodrama allows complexes and conflicts to be concretized by casting group members to play roles from the life of the protagonist. It allows the protagonist to have a physical “encounter” with the self; to see and experience what he carries within his mind and body, so that it can be made explicit, concrete and can be dealt with in the here and now.

“A picture is worth a thousand words.” The purpose of psychodramatic role-plays is to resolve through action insight rather than talk alone. Through role play, thinking, feeling and behavior emerge simultaneously to allow for a fuller picture of what is being carried in the psyche to come into view. The “double” acts as an inner voice putting words on interior thoughts, sensations and emotions that may be less than conscious. This “doubling” from others helps to enhance awareness of self and provide the protagonist with a feeling of being seen, supported and understood. “Role reversal” allows the protagonist to actually stand in the shoes of other persons in the role play in order to see the self from the position of the other and to actually experience being “in the skin” of someone else.

The Basic Elements of a Psychodrama

The Stage: The designated area where the enactment is occurring, which can be a studio made to look like a group or therapy room.
The Protagonist: The person whose issues are being explored, this revolves through and around the group as each person does their psychodramas while others witness, identify and share.
The Director: The facilitator or therapist, who leads the group and directs the psychodramas.
The Auxiliary Egos: The role players in the protagonist’s drama, these are group members engaging in spontaneous role plays. They become the person that the protagonist carries inside.
The Audience: The group who witnesses the action and is part of the constantly evolving and interactive process. The group is active, engaged and part of the dialogue: The Human Dialogue

Encounters with the Self: The protagonist can select a role player to represent any part of themselves e.g. their inner addict, crazy person, wounded self, dreamer, fraud, star, etc. They can also dialogue with the person they were or the person they want to become.

Encounters with Others: The protagonist can explore and unravel conflicts with real or imagined others, e.g. their partner or their wished for partner that they want to meet.

Encounters with Group Members: Group members encounter each other in very direct ways and can explore their feelings toward and with each other openly and through the lens of therapy, thus the interactions provide not only entertainment but insight and growth.

Encounters with Real or Imagined Situation, Past or Future Selves: Through role play, protagonists can literally construct past scenes and talk to themselves about what they regret having done or been like or what they see now but didn’t see then. They can talk to themselves as a child, an adolescent or young adult. Or they can meet a future self, the person they are afraid of becoming or want to become. The protagonist can dialogue with a feared self, a wished-for self, a hidden self, a denied self, a wounded or humiliated self, a grandiose self or literally any aspect of self that they can imagine encountering.

Encounters with Disowned Parts of Self: Through role plays, protagonists and group members can talk with their addiction, their dissociated self, their resentment. They can talk “as” themselves to the addiction, then reverse roles and talk “as” the addiction back to themselves. They can be interviewed by a therapist in the role of addiction or self in order to deepen their understanding of the role. They can stand behind themselves and “double” for either role in order to speak the inner life of the role.

Encounters with Dream Characters: Psychodrama allows the characters from a dream to come alive, even including dream symbols. Role players can, for example, play a bird, a rock or a flood, and the protagonist can both talk to the bird then reverse roles and talk as the bird back to themselves, exploring and deconstructing the deeper meaning and messages their dream is trying to tell them from all angles and directions.

Sociometry

Sociometry is essentially the group dynamics system of psychodrama in which member-to-member connections, disconnections and relationships can be concretized and examined in group. Sociometry can also be used to build group cohesion and explore issues relevant to and shared by group members.

I have created an interface between sociometry and educational research in the form of the exercises below. For some 20 years, I have tried to come up with user-friendly ways to make experiential work psycho-educational so that clients can have a therapeutic experience while learning about current research related to issues they may be struggling with.

Relationship Trauma Repair (RTR)

A model for addictions facilities, clinics and therapists in working with PTSD, Addiction and Codependency.

RTR is a multisensory and experiential model created to help those suffering from relationship trauma or post-traumatic stress disorder (PTSD). RTR is designed to be used in treatment centers, clinics or as an adjunct to one-to-one therapy. It’s user-friendly and helps therapists to have an easy-to-follow format to work with groups around the issues that surface throughout the treatment of addiction, PTSD and codependency.

RTR Includes 8 Units. Each Unit has:

• Psycho-educational DVDs with psychodramas of living case studies.
• A Therapist’s Guide of psychoeducational/experiential exercises for groups.
• A Personal Journal for each client to use in treatment and take home.
• Guided imageries with specially composed music for healing trauma and learning skills of self-regulation for use in treatment and to take home.

The exercises below are from the first unit of the model. The full model can be seen at relationshiptraumarepair.com.

Feeling Floor Check:

Examining and Expanding My Feeling Palette

Goals:

1. To expand a restricted range of affect that can be the result of trauma.

2. To allow the group to become comfortable identifying, articulating and sharing emotion.

3. To allow the group to connect with each other around vulnerable emotions, share and take in sharing and support.

4. To teach and develop emotional literacy and emotional intelligence.

5. To help clients learn to tolerate and talk about painful emotions so that they are less likely to act them out and relapse over them.

6. To help clients learn to tolerate and talk about positive and self-affirming emotions so that they are less likely to relapse over them.

Notes to Therapist: Learning the skills of self-regulation and regulation of basic emotions, thoughts and behaviors is core to trauma treatment and relapse prevention. The feeling floor check is designed to facilitate this learning process. Those who have experienced relationship trauma can have trouble tolerating their intense feelings without acting out, imploding, exploding or self-medicating. The feeling floor check allows clients to get in touch with both what they are feeling and how much they are feeling (i.e., emotional intensity). They learn to share emotions and listen to others do the same. Trauma shuts down emotions; the feeling floor check reawakens and categorizes emotion. One of the main tasks of recovery from trauma is to learn how to feel strong emotions and translate them into words, so that the thinking mind can bring order and balance to the limbic brain/body (read: emotions and sense impressions) through insight and understanding.

As with all parts of this model, keep interpretation and advice to a minimum. The idea is for clients to take a hold of their own inner world and learn to manage it without the use of substances or compulsive behaviors. As much as possible, allow the healing group to work its magic through mutual sharing, identifying and support. The more that clients come to their own ahas and learn to get in touch with their own internal healer and teacher, the more they will be able to bring themselves into balance when triggered once they leave treatment. That is what this experiential model is designed for, to create an experience that has teaching and therapy inherent within it, so that clients feel that they are learning organically and coming to know and manage themselves, in a sense, on their own.

Steps

1. On 8×10 pieces of paper, write feeling words, such as angry, sad, anxious, content, hopeful, frustrated, desperate, happy. Always leaving a few pieces of paper blank for the group members to write in their own feeling words. Have one paper marked Other so clients can write in their own emotion.
2. Place the words a couple of feet apart from each other, scattered around the floor.
3. Ask participants to stand on or near the feeling that best describes their mood of the moment.
4. Say, “Whenever you are warmed up, share in a sentence or two why you are standing where you’re standing.”
5. After all who wish to have shared have done so, allow the group to repeat the process and stand on another feeling that they might also be experiencing (Note: learning to “hold” more than one feeling at a time helps clients to tolerate living in gray rather than black and white), then share as before.
6. At this point you can vary the next criterion questions by asking, “Which feeling do you avoid feeling?”
7. If the group still has energy to continue to explore more questions, you can further vary criterion questions by asking, “Which feeling do you have trouble tolerating in someone else?” Or, if you want to build resilience you might ask, “Which feeling would you like to experience more of in your recovery?”
8. Next, invite the group members to “place their hand on the shoulder of someone who shared something with which you identified.” Group members can share directly with the person why they chose him or her. The entire group can do this at once.
9. Psychodramas may emerge out of the sociometry at any point in this process.
10. Next, sit down and share about the entire process and what came up throughout.

Variations: For each question asked, group members can share so that the entire group can hear them or, if the group is large, they can share with those who are standing on the same word that they chose. If they share on the same word they are sociometrically aligned and sharing with those who are feeling the same as they are, this helps to train clients to take in sharing and support and reduces isolation. The word choosing can go on as long as it is useful, depending on the needs of the group. Generally, the group is saturated by the third or fourth choice and needs to move into the sociometric-choosing phase.

Talk to the characteristics: The client can also enroll several of the characteristics that they feel most troubled by and talk to each of them, one at a time incorporating role-reversal, doubling and any other psychodramatic techniques that the director wishes to use (see The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy).

Symptom Floor Check: Learning About and Assessing PTSD Issues and Emotions

Goals:

1. To educate clients as to the range of symptoms that can accompany relationship trauma.
2. To provide a format through which clients can decide for themselves which symptoms they identify as experiencing in their own lives and relationships.
3. To create opportunities to hear about how symptoms manifest for other people and in other people’s lives and relationships.
4. To encourage connection, sharing and support around facing difficult personal issues.
5. To educate clients as to how to trade a pathological symptom for a healthy trait.

Notes to Therapist: This is a cornerstone exercise. It will help to educate clients about the pathological characteristics that are a part of the PTSD syndrome so that they can develop a language through which to understand and work with them. The idea here is to normalize symptoms by making them conscious, translating them into words and sharing them with others and to bring them out into the open, hear others share and accept identification and support. This process helps to breakdown isolation and make feeling intense, split-off or repressed emotions less threatening. What we don’t know can hurt us. While these symptoms remain subconscious, they can exert significant power over the lives and relationships of clients.

Steps:

1. On large pieces of paper write these symptoms or characteristics of relationship trauma:

• Emotional Constriction
• Relationship Issues
• Somatic Disturbances: Body Aches and Pains
• Learning Issues
• Loss of Trust and Faith: In Relationships and an Orderly World
• Hypervigilance/Anxiety: Waiting for the Other Shoe to Drop
• Traumatic Bonding
• Unresolved Grief
• Cultivation of a False Self
• Problems with Self-Regulation
• Hyper-reactivity/Easily Triggered
• Learned Helplessness/Collapse
• Depression with Feelings of Despair
• Distorted Reasoning
• Loss of Ability to Take in Caring and Support from Others
• Tendency to Isolate or Withdraw
• Cycles of Reenactment: Repeating Painful Relationship Patterns
• High-Risk Behaviors: Speeding, Sex, Spending/Debting, Working
• Survival Guilt: Shame
• Development of Rigid Psychological Defenses: Denial, Dissociation, Splitting, Minimization, Intellectualization
• Desire to Self-Medicate With Drugs, Alcohol, Food, Sex, Money, Work

2. Place the papers with symptoms on them a couple of feet apart scattered around the floor.
3. Ask participants to stand on or near a characteristic that they identify as being a problem for them in their lives.
4. Once group members are standing on the characteristic that they identify with, invite them to share a sentence or two about why they are standing where they are standing.
5. Next, invite group members to stand on or near a trait or symptom that they feel was present either in someone in their family of origin or in their family of origin as a whole that created problems.
6. Once group members are standing on the characteristic that they identify with, invite them to share a sentence or two about why they are standing where they are standing. A resilience-building question might be, “Which characteristic do you feel used to be a problem for you but you have worked your way through?”
7. After group members have shared about one, two or three characteristics say, “Walk over to someone who shared something that you identified with or that moved you, place a hand on their shoulder and share with them what moved you.” (Note: the sharing will be taking place in dyads and subgroups that will naturally and spontaneously form as a result of this question.)

At this point the group may be ready to 1) sit down and share about the experience so far; or 2) move into psychodramas.

Variations:

When doing #7, group members can share so that the entire group can hear them or, if the group is large, they can share with those who are standing on the same characteristic that they chose. When they share around their characteristic or symptom, they will be sociometrically aligned by symptom: i.e., all those experiencing a particular symptom will be sharing with others experiencing that symptom. This subgrouping can make sharing feel safer and can allow clients to feel seen, supported and more open. The symptom-choosing can go on as long as it is useful, depending on the needs of the group. Generally, the group is saturated by the third choice and needs to move into sharing, journaling or psychodrama.

Questions can be varied. For example, the therapist may ask “which symptom do you have the toughest time dealing with in other people?” or “which symptom seemed to be the most present in your family or origin?” or “which symptom do you feel you re-create the most in your present-day life?” A resilience-building question might be, “walk over to someone from whom you feel you could learn something and ask them for help.”

Talk to the characteristics:

The client can enroll several of the characteristics that they feel most troubled by and talk to each of them, one at a time incorporating role reversal, doubling and any other psychodramatic techniques that the director wishes to use (see The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy for in-depth information on these techniques).

Silver Linings and Upgrades:

There are always silver linings present in adverse circumstances, qualities of strength and resilience that we develop in going through painful circumstances. Invite clients to share what qualities they feel they developed through adversity, or what the silver linings are for them in having gone through a particular circumstance. You may also invite group members to “upgrade” their symptoms, to trade in one for a trait they would like their symptom to morph into such as: “I would like to trade learned helplessness for a chosen position of surrender”, or “hyper-vigilance for awareness”, or “a loss of trust and faith with renewed faith in Higher Power” and so on. As they do this, let them write their new upgrade on a sheet of paper and place it next to or on top of the symptom. Allow them to do this for any symptoms with which they identify.

JOURNALING

1. Letting the Child Speak. Mentally reverse roles with yourself while in the throws of any one of the trauma characteristics and journal from that place. For example, “I feel helpless… I get this way whenever…” and so on. Or “I am feeling so emotionally constricted I just want to…”
2. A Moment of Repair. Journal about a time when repair occurred; write about how you felt during or after a moment of repair (apology, reconnection, repair of some sort) within the relationship and what positive lessons you learned about relationship repair from it that you might still be living out today. Journaling in this way helps to build new neural wiring for repair that can help to ameliorate and regulate the painful experience. It also builds resilience, strength and new learning about how to operate in close relationships. For example, “I was feeling completely ashamed and like withdrawing or just running away or screaming at someone, and then someone…  And that helped me to…”

Joseph Campbell refers to a journal as “Your sacred space is where you can find yourself again and again”.

Journaling elevates the immune system and calms the autonomic system, smoothing out the heartbeat, breathing and perspiration. In his book, Opening Up, James Pennebaker M.D., professor of psychology at the University of Texas at Austin, talks about how he uses journaling to help people understand and work with the contents of their inner worlds. Pennebaker paints the picture of journaling as a very active, rather than passive, pursuit in which the body, as well as the mind and emotions, benefit. As we freely write our thoughts and feelings on paper, the associative process of our mind goes to work, and feelings and imageries emerge, struggle to find expression and so find their way from emotional muteness to emotional literacy. Journaling allows emotions that may have been numbed out, repressed or split out of consciousness, held wordlessly within our limbic world, to be felt and translated by the thinking brain into meaningful and descriptive language, so that we can better understand the contents of our inner world. What we may have been carrying in silence finds a voice, what we may have been unable to see, takes a shape. The fog begins to clear and we can better see who we are and why we do the things we do.

Pennebaker asked participants in his study, to write about traumatic events of their lives for 15-30 minutes on four consecutive days. Writing continuously about a problem, he feels, allows participants to thoroughly examine how it has affected them. “People have to stick with it,” said one participant. “I get to the first page and it’s pure anger or frustration.” Pennebaker feels that people “need to get beyond the emotion and discover a better understanding. They need to find the ending of the process.” Developing a deeper understanding of the event and the emotions it generates, he feels, helps the brain digest the information. When you analyze a traumatic event, your brain turns it into a story, the prefrontal cortex can make sense of limbic material that may be held in the body or thrown out of consciousness and make conscious sense of it. “Storytelling simplifies a complex experience.”

Health Benefits of Journaling Stressful Feelings

In further studies conducted by James W. Pennebaker, and Joshua M. Smyth, Ph.D., Associate Professor of Psychology at North Dakota State University, the researchers found that people who write about their deepest thoughts and feelings surrounding upsetting events have stronger immunity and visit their doctors half as often as those who write only about trivial events. And more recent research conducted by Joshua M. Smyth at the State University of New York at Stoneybrook, revealed that writing about a stressful experience actually reduces physical symptoms for patients with chronic illnesses. The research team monitored 112 patients with arthritis or asthma. Two groups were asked to write in their journals for 20 minutes, three days in a row. One group was asked to write about an emotionally stressful incident; the other group was asked to write about their plans for the day. The group who expressed their emotions on paper showed a 50% improvement in their disease after four months. The group who wrote only about neutral topics showed a 25% relief of symptoms.

Journaling about the anxieties, fears and feelings that surgery brought up actually doubled patients’ symptom relief. The study’s medical advisor, Dr. Pamela M. Peeke, M.D. observes, “More importantly, 22% of the people who only wrote about their daily plans worsened substantially over the four-month period, while only 4% of those who wrote about their stressful events did so.” Dr. Peeke reflected that “one of the least studied techniques so commonly taught in spas is journaling. Now, there is intriguing evidence that journaling has a direct impact upon the status of chronic disease.”

How to Journal

The basic method is to simply put pen to paper and let your thoughts and feelings pour out freely. Give the editor who lives in your mind a vacation, and let go of worrying about saying things in a coherent or readable way. Simply start writing and trust the process. This is your private space for a full and unedited expression of self; no one need see what you write other than you, this is for your eyes alone unless you choose to share it.

The more completely we can abandon our internal governors and trust the process of writing, the more penetrating our associations and glimpses into our inner world will be. Through journaling, we integrate thought and feeling, we translate emotions into words so that they can be momentarily held out in the light of day and given space to breathe. We express what may have been nebulous or vague and bring it into some form of clarity. We gain insight and perspective, we flush out concealed or veiled material and bring it out onto the page where we can see and reflect on it, creating new meaning to replace the old. We see an old problem in a new light. What may, for example, have bewildered us in childhood, gains shape and clarity as we lay it out in front of our own, more mature eyes. We begin a dialogue between our adult selves and our child selves. Our adult self can listen and “hold” the powerful feelings that our child or adolescent self may be experiencing. Then the adult can talk to the world on behalf of the child, rather than the child or adolescent blurting out emotion in a raw form that may cause unnecessary conflict, misunderstanding and not serve to communicate effectively.

Author Vladimir Nabakov expresses beautifully the relieving process of writing: “The pages are still blank, but there is a miraculous feeling of the words being there, written in invisible ink and clamoring to become visible.”

*All material is adapted from Dr. Dayton’s trauma model Relationship Trauma Repair.

Relationship Trauma Repair is an experiential, multisensory model, created to help those suffering from “relationship trauma” or post-traumatic stress disorder (PTSD) to heal and restore body/mind calm and balance. RTR is designed to be used in treatment centers, clinics or as an adjunct to one-to-one therapy. Its can be used as a whole or parts of the model can be adapted to the needs or requirements of the particular setting. For further information on how to purchase Relationship Trauma Repair and get CEUs online, log onto relationshiptraumarepair.com.

Which characteristics do you identify with and to what extent? This is something of a self-test and a survey. If you are an Adult Child of Alcoholism or Addiction (ACOA), you may have been both traumatized and strengthened by that experience. Following is a survey of both the positive and the pathological characteristics that can be the result of growing up in a family where there is trauma. Each list is culled from the research in each area that has spanned the past two decades. Can you please take a moment to fill it out, and we will get back to you with the results of the data once it’s crunched? Thank you for your time!

http://www.surveymonkey.com/s/WWTNTML

The nature of traumatic memory is that the feeling and sensory data related to a traumatic event or series of events are thrown out of consciousness because fear has triggered the shutting down of the prefrontal cortex, or the thinking part of the brain. An experiential approach to treating PTSD allows the body to tell its story through role play and experiential exercises through action before we ask clients to tell us their “trauma story”. Due to the way the brain processes experience, feelings related to having been traumatized are oftentimes frozen – they have remained, in a sense, unfelt. When the client is suddenly being called upon to reflect on what they may have defended against feeling or even knowing, they can feel intimidated, angry or simply stupid. In their anxiety to get it right, they may 1) make something up that sounds plausible; 2) create a sort of story based on what they have heard or read; or 3) adopt the therapist’s version (co-dependency in the making!).

Psychodrama allows the mind and body to tell their story, which makes it an ideal modality for doing trauma resolution. It is also relational, that is, through role play the object relationships or those people who have been introjected, through repeated exposure and limbic bonding, into the self system can be dealt with not only in absencia, but directly through a role-playing experiencing. Role play allows for the body to move in a fashion that is natural to the human being, rather than to ask them to so do that one thing that victims of trauma find so difficult – mainly sit still, disengage from the body and talk exclusively from the head about their trauma. Therefore the intense and often split-off emotions and body sensations that are stored in the limbic system become naturally stimulated through role play, after which words can be added to that direct experience rather than the opposite.

Sociometry focuses on the dynamics within the group; it helps group members to connect with each other and explore the relationships between and among them. Because I work mainly in the addictions field, and because therapists all around the country were constantly asking me to train them in experiential approaches that did not require the level of training that psychodrama requires, I created exercises that interface theory with sociometric group exercises (spectrograms, locograms and the like). This met a very necessary goal of treatment centers to both teach and provide a healing experience in an integrated fashion.

There are few things more difficult for a survivor of trauma than to be asked to “talk about” their painful experience. The very nature of trauma is that feelings become inaccessible that are related to frightening or terrifying events. In that moment of intense fear or terror, the thinking brain (the prefrontal cortex) shuts off so that the limbic brain, the fight/flight brain can operate without the interference of random thoughts to help us flee for safety or stand and fight. When we can do neither, which is so often the case in families where escape is not really so possible (particularly for children and, all too often, women), we freeze or shut down. RTR deals with that frozen material that gets shut down through trauma; it deals with the disturbing body sensations that often accompany fear states, such as stomach aches, headaches, muscle tension, backaches and sizzling/queasy feelings. It deals with the kind of despair and helplessness that we collapse into when we feel that our best efforts get us nowhere. It deals with our inability to connect feelings to words and words to feelings. It offers hope, healing and a way out of the kind of chronic pain, anger and hopelessness that, if not dealt with as aggressively as one might deal with any spreading cancer, become intergenerational.

Some Points for Healing Relationship Trauma

1. Essentially trauma work includes making unconscious, split-off limbic emotional and sense memory impressions conscious, so that fragmented sense impressions and emotional memories and responses can be given context, meaning and reintegrated into a working model of the “self”.
2. Trauma work consists of feeling frozen or split-off emotions so that they can be drawn forward, translated into language and elevated to a conscious level where they can be reflected upon and thought about.
3. We need to connect the limbic (feeling) mind with the thinking mind so that the thinking mind can create meaning of our experience.
4. We need to allow the body to have a voice, to inquire about what’s going on in the body and to find out what interrupted action patterns emerge.
5. We need to allow the client to come forward slowly, rather than expect them to be able to immediately self-reflect, which they cannot, since their painful memories are stored as sense impressions, feeling or perceptual flashes and often detached from genuine emotion.
6. We need to create space for clients to re-inhabit their bodies at the time of the trauma, to be with them in the here and now and help them to tolerate their state of hyper-arousal and feelings of fragmentation. Then they will slowly knit the fragments of memory back together again. Show us don’t tell us: the story emerges in both body and mind, in action and words. The body leads. We reflect afterward, not the opposite.
7. The idea is not to ask question after question but to “hold” the affective environment with the client as the story unfolds so that they can heal themselves.
8. We need to help the client to reconnect their sense of self before the trauma occurred, before numbness and memory loss made them lose access to it (if applicable).
9. Physical mechanisms, or sensory impressions, are what produce our experience of the world, and we need new sets of physical impressions to change or alter those impressions. Therefore we need a model of treatment that allows new relational forms of connection.
10. We need to understand how trauma impacted normal emotional development.
11. We need to help the client to find emotional middle ground and self-regulation.

RTR is modular; that is to say it has several moveable parts that interact, hopefully to make the therapist’s job easier and to allow the material to be delivered clearly and smoothly. It is hands-on an user-friendly. It is designed so that it can fit into whatever length of stay you use at your particular facility. It can also be done as separate units, e.g. three to five days on any one subject area.

Therapist’s Guide: You are now reading the therapist’s guide, which will take you through the model step-by-step and tell you exactly what to do with your group.

Client Workbook: The client workbook interfaces with the exercises in the therapist’s guide, the DVDs and the guided imageries. Each group experience has journaling exercises to go with it that are coordinated by title. Clients can write in their workbook, either in the group or on their own. Or, if this is used by individual clinicians, the work book can be homework.

DVDs: These are a combination of lecture and demonstration; the model will tell where to pop them into a TV so that they can be watched by clients then shared in the group.

CDs, Guided Imageries: The guided imageries are designed to support both group exercises and workbook journaling. They can be listened to either in the large group and processed together or individually. I will indicate where these imageries fit in to the various exercises throughout the book. The RTR model is available for purchase at unrivaledbooks.com

Dr. Dayton will be giving a training in New York City on November 18, 2011, sponsored by Freedom Institute 212.838.0044, as well as a three-day training at Onsite, in Nashville, Tn., Jan 26-29, 2012, 800.341.7432.

We are what we think about all day. The thoughts that we think and the feelings that accompany them can shape our experience of the day. A Harvard study looked at how what we think affects our immune systems. The findings were that negative thoughts actually cause us to maintain elevated levels of stress hormones, while positive thoughts fill our bodies with the types of chemicals that soothe and regulate our moods. While antidepressants can help us artificially maintain elevated levels of serotonin in our blood streams, positive thoughts do the job naturally.

Thinking positive and uplifting thoughts will give us a different body to live in. The Harvard study set up two control groups to measure how thoughts affect our bodies and our emotions. The first control group was asked to watch films of Nazi war crimes. The second, films of Mother Theresa at work. After watching the films, each group had blood drawn. The group that had been watching Nazi war films had elevated levels of stress chemicals, such as adrenaline and cortisol. The group watching the Mother Theresa film had elevated levels of feel-good chemicals, such as serotonin and dopamine, nature’s antidepressants, that made them feel emotionally regulated and calm. Blood chemicals went back to normal after about 20 minutes.

But here’s the interesting stuff: In a second part of the study, subjects were asked to continue to run the images of the films in their minds throughout the day. Hours later, the results were the same. The group that had been watching Nazi war films had continually high levels of stress chemicals coursing through their blood, while the group that had been watching Mother Theresa experienced continued levels of feel-good chemicals.

So, not only does what we think about all day really affect how we feel, but thinking positive, affirmative thoughts is actually a proven approach to living a better and more balanced life. Those of us in the recovery world have known this for a long time. Treatment centers have been making affirmations a part of their community for decades. Try it – spend a few minutes consciously thinking thoughts that make you feel calm, happy and good inside and see what happens to your emotional state. And if you’re not convinced yet that calm is better, try thinking upsetting thoughts or watching something scary or disturbing on TV (easy to find), and see what happens to your emotional state.

If you want to bring calm to your emotions, you now have two powerful tools: calm your breathing and think uplifting thoughts or affirmations, which are positive thoughts.

TAKE A HEART BREAK

Calming your heart, or achieving what researchers at HeartMath call heart coherence, brings emotional calm to your whole body. Regulating heart rhythms also brings calm to blood flow and every body organ and system that the heart influences. You can achieve this coherence in heart rhythms in as little as one minute. Try the following next time you’re feeling stressed:

• Take a break and mentally disengage from the situation.

• Bring your attention to the area of your heart.

•Recall an experience in which you felt happiness, love or appreciation, or just meditate for a moment on those kinds of thoughts and feelings.

• Re-experience these feelings while keeping your attention on your heart. Let your breathing be relaxed and regular.

When I wrote Forgiving and Moving On 20 years ago, I did it to help myself and my clients see a painful circumstance in a positive light. I wrote affirmations each morning and they truly set my mind in a positive direction. That book has been my best seller and has now been made into an app along with One Foot in Front of the Other, an app for early recovery designed to disseminate program principles in an easy, available, user-friendly way. (Both are available on iTunes.)

How Growing Up with Abuse and Addiction Affects Development

Development in the young child is a continuous interaction between the child and his or her primary caretakers. The hardwiring of the child’s brain is set up through countless, tiny interactions. The manner in which the child is treated affects who the child becomes, and the ever-growing and changing child, in turn, affects the caretaker’s response. This synergy, according to Alan Schore, seminal researcher on affect regulation, creates a fluid rather than static picture of development. Imagine then how addiction and trauma affect each aspect of the child’s developing personality. Factors that influence a child’s response to a traumatizing family environment are 1) the child’s stage of development, 2) the child’s organic structure and 3) the available support network for the child.

Young children are particularly vulnerable to developmental deficits because their personalities are yet relatively unformed and their primary support network is the family, which, in the case of abuse and addiction, is causing them damage. They may be forced to contort their personalities in a variety of ways to maintain a sense of connection and some semblance of stability. They live in two worlds: sober and using. In addicted or abusive families, there is a front-stage that appears to the world and a backstage that often remains hidden; the rules, morals, thinking, feeling and behavior are often different for both.

At times, the family dysfunction may surface through a symptomatic child and, if this is the case, a target child or a “symptom carrier” may be created. This designation may affect the child’s personality, and his or her developing identity may wrap itself around a negative core. It is difficult for the underage child trapped in this system to get help if the adults do not do so first or at the same time. If the adults get help, the child’s symptoms may clear up. The older the child gets, the more embedded their personality issues become and the more these problems invade the overall organization of their identity.

The Effect of Trauma on Family Organization

A family that is containing trauma in the form of addiction or abuse produces relationship dynamics that perpetuate relationship trauma. One theory, according to Steven Krugman, describes the impact of trauma on the family system as having three main components. First is constriction leading to enmeshment; second is avoidance leading to disengagement; and third is impulsive behavior leading to chaos. Constriction of emotional and psychological expression can make the authentic expression of pain feel threatening. Family members learn not to talk about what’s going on right in front of them. They learn to hold on to painful emotion that could “rock the boat.” In avoidance, family members see the solution to keeping pain from their inner worlds from erupting as avoiding subjects, people, places and things that might trigger it. This leads to an emotional disengagement among family members. With impulsive behavior that leads to chaos, that inner world is surfacing in action. Painful feelings that are too hard to sit with explode into the container of the family and get acted out in dysfunctional ways that engender chaos.

Constriction, avoidance and impulsive behavior are dysfunctional attempts at dealing with pain. This family becomes fertile ground for producing trauma-related symptoms in its members. In addition, its strict taboos against genuine and authentic expression of the emotional pain and psychological angst that family abuse is engendering ensure that pain does not get talked about. Consequently, it does not get processed, worked through and put into any context that might allow family members to move through it. Rather, it sits within the family system, a buried land mine waiting to explode when it gets stepped on.

It is no wonder that families such as these produce a range of symptoms in its members that can lead to problems later in life. This is how the mantle of dysfunction gets passed down through the generations.

The following are some of the symptoms that may develop and be carried into adulthood:
•    Learned helplessness
•    Hypervigilance
•    Depression
•    Anxiety
•    Numbness/Emotional constriction
•    Traumatic bonds
•    Loss of ability to take in support
•    Cycles of re-enactment
•    Problems with self-regulation
•    Emotional triggering
•    Loss of trust and faith
•    Survival guilt
•    High-risk behaviors
•    Relationship Issues
•    Development of rigid psychological defenses
•    Desire to self-medicate (Dayton, 2000)

Treatment Implications

In my clinical work, I observe that PTSD symptoms in children who grew up with addiction and dysfunction can appear to lie dormant for many years. Often, clients arrive at my office in their mid-30s, quite discouraged and wondering why their relationships aren’t working or they cannot seem to organize themselves into a productive work life. The traumatic memories often get re-stimulated when clients again attempt to enter intimate relationships where the very attempt at deep connection brings up the trauma that previously surrounded it.
Trauma survivors may experience a sense of a foreshortened future, having trouble envisioning, and as a result taking steps toward, a future they wish to create. In children who grew up in traumatizing/addicted families this is particularly cruel because the trauma robs them not only of part of their childhood, but of significant pieces of their young adulthood as well. The energy they need to “get their lives together” has been partly spent and their youthful dreams and hopes have undergone disillusionment. It is sad that because of this loyalty bind and the developmental timing of the problem, there can be significant life complications during young adult years.

Traumatic Memory

Because of the way our brain stores them, traumatic memories do not get “thought about”, reflected upon and put into some sort of context. The defenses that are engaged during situations of threat are fight, flight and freeze, all of which are associated with the amygdala or the “old” part of the brain. The cortex, which is where thinking, reasoning and long-range planning take place, was developed later in human evolution. That’s why when we’re “scared stiff” or “struck dumb”, the content of the experience that would normally get thought through and placed into memory storage gets more or less flash-frozen instead. Because these memories are stored in the cells of the body (Pert, 1997) as well as the mind, these un-integrated memories may resurface in the form of somatic disturbances such as headaches, back problems and queasiness or as psychological and emotional symptoms such as flashbacks, anxiety, sudden outbursts of anger, rage or intrusive memories. The person experiencing this may find him or herself in an intense bind in which traumatic memory stimulates disturbing physiological sensations and disturbing body sensations stimulate traumatic memory. This can create a sort of black hole, an internal combustion that can send a client into an ever-intensifying downward spiral that becomes fraught with fear and anxiety. Clients may experience this as panic, feeling “stuck” in treatment, intense fear or being flooded with feelings and/or memories.

A Mind-Body Approach to Treatment

Traumatic memories are often somatized, repressed, disassociated or lost to consciousness through some form of defensive exclusion, according to Jonathon Bowlby, British psychoanalyst and researcher on attachment and loss. Because the cortex was not fully involved in the storage of traumatic memories, those experiences did not get thought about and put into a logical context and sequence. Consequently, they can be difficult to access through reflective talking alone. J. L. Moreno, the Viennese psychiatrist who created the method of psychodrama postulated that, “the body remembers what the mind forgets.” Willheim Reich felt that we store our “character defenses” in the tissues of our bodies, and Candie Pert’s pioneering research, described in Molecules of Emotion, on cellular memory supports this. Sigmund Freud understood that if we cannot “remember” we are destined to act out or repeat the unconscious content of traumatic experience. It is remembering that allows for a change of pattern. Without it we are blind to our inner world, but that inner world presses nonetheless for action and resolution. Through psychodramatic role-play, long-forgotten thinking, feeling and behavior that are attached to roles we’ve played emerge. Words are spoken, feelings are felt and thoughts become present and accessible in the here and now. After they are in their concrete form they can then be reflected upon, understood, deconstructed and meaning can be made out of them.

For information on the treatment model Relationship Trauma Repair RTR, log onto relationshiptraumarepair.com.

A movement was born. Not a political movement, but a movement based on a need to reveal and a desire to heal.

As these “inner children” began to open up, they found they weren’t alone in having frozen and forgotten parts of themselves that they didn’t know what to do with. These hidden parts, not surprisingly, were triggered when, as adults, they began having families of their own. Sitting in their own living rooms, with their own spouses and children, they felt disturbed by scenes from yesteryear. All over again, they found themselves smack in the middle of the very situation that had traumatized them to begin with. Namely, a family.
Why Is Having a Family like a Car Backfiring for the ACOA?

The natural feelings of intense closeness and dependency, that are a part of living in a family, can become potential triggers for the ACOA. In just the same way a soldier with post traumatic stress disorder (PTSD) “hits the dirt” when he hears a car backfire because his unconscious reads it as gunfire, an ACOA “hits the dirt” emotionally when he fears a repeated rupture to his sense of self or the family he needs and loves.

This is why the ACOA syndrome is a form of PTSD. Long after the stressor is removed, the ACOA lives as if it is still present. Long after they have left home, gotten jobs, married and had children, their unresolved pain from childhood still lives inside of them, waiting to be triggered to the surface through events that mirror the situations that hurt them to begin with. Like, for example, within their own family relationships. Beneath the level of their awareness, ACOAs get scared all over again. Their natural neediness makes them feel vulnerable; they wait for the proverbial roof to cave in the way that it did when they were kids; for life and love to hurt and betray them all over again. Ghosts from their past dance around their present. Unconsciously they see chaos, humiliating scenes and out-of-control behavior lurking just around the corner, mocking and mimicking their early childhood experience. In fact, they may be so convinced that distress is looming that they may actually feel distrustful and suspicious if problems are solved too smoothly. They may even push a situation in a sort of convoluted attempt at self protection, trying to ferret out potential danger until, through their relentless efforts to avoid it, they actually create it. And so the pattern of emotional closeness and dependence leading to chaos, rage and tears is once again reinforced and passed along.

The Brain in a State of Fear:

Our thinking brain shuts down when we’re very scared, but our feeling brain keeps going and absorbing what’s around us. The cortex, which is where we think about what we’re feeling and make sense of it, shuts down when we’re in a state of terror. When we’re really scared, our limbic system takes over and we go into fight-or-flight. Nature doesn’t want us thinking about running for safety when confronted with a charging, wild boar, it wants us simply to run.

But for a child, a drunk and raging or neglectful parent, is just as terrifying as a saber-toothed tiger and can throw them into a state of extreme stress. They freeze in fear – like a deer in the headlights, they get caught in a startle response. Following that is the attempt to fight or flee. If escape is possible, the experience of the near-trauma will be temporarily stressful, but the person is unlikely to develop full-blown PTSD. If, however, the intention to flee is thwarted, the result is a freeze response. What is a child supposed to do? If they fight, they will eventually lose; the parent, after all, has the keys to the front door. And if they flee, where will they go?

For children who grew up in addicted homes, there may have been nowhere to run. So all of those fear-laden memories may well have remained unconscious and unprocessed because the adults who they would normally have gone to for comfort and to help them understand what was scaring them, were unavailable. And to make matters even worse, it may have been the adults themselves causing the fear and stress. For the child living with addiction, the COA, this becomes a double whammy. Not only are they being hurt and terrified, but the adult, who they would normally go to for comfort and to make sense of the situation, is the one causing the pain to begin with or even blaming it on them. There is, in other words, no escape. This child is at a higher risk for developing PTSD.

The ACOA: How Childhood Pain Gets Played Out in Adult Relationships

When children are unable to make sense of frightening childhood experiences, those experiences do not necessarily disappear. Rather, the images, impressions and feelings that surround them can remain locked within their unconscious, waiting to be triggered to the surface. Unfortunately, when they do surface they often get projected onto the situation that triggered them, with little or no awareness of their deeper origins. They may see the circumstance of today as the sole cause of their intense emotional reactions and be entirely unaware that pain from their past may be driving an over-reaction in their present. Needless to say, this can make adult intimacy feel confusing and unmanageable because the past becomes mixed up with the present and problems become bigger and more complicated than necessary. This is why I call what I work with relationship trauma, because childhood relationship trauma gets triggered and played out in adult relationships.

But there is a solution, and it is likely in your neighborhood. The good news is that relationship trauma is very treatable, and treatment itself becomes a journey of personal growth and a deepening of self-awareness. A good place to start is a twelve-step room such as ALANON or an ACOA meeting. For more information, log onto NACoA.org, the National Association for Children of Alcoholics.

Recent research in neuroscience is helping us to decode this mystery.

Trauma – whether it is a one-time catastrophic event, or the cumulative trauma that is part of most any alcoholic family – affects both the limbic and the nervous systems. The effects of living with intense fear, pain and resentment can seep into our brain and body, causing emotional deregulation. So when we experience childhood abuse, it can actually affect our hardwiring throughout life.

The limbic system is responsible for such wide-ranging functions as appetite and sleep cycles, mood and emotional tone. Problems in the limbic system can cause long-term effects in our ability to self-regulate and maintain emotional and psychological balance.

We arrive in life only partly hardwired by nature; nurture finishes the job. Each tiny interaction between parent/caretaker and child actually lays down the neural wiring that becomes part of our brain/body network. This is how our early experiences inscribe themselves onto our nervous systems. It is how our environment shapes our emotional being and our limbic system.

Early Attachment and Self-Regulation

Our nervous systems are not self-contained; they link with those of the people close to us in a silent rhythm that helps regulate our physiology. Children require ongoing neural synchrony from parents in order for their natural capacity for self-directedness to emerge. In other words, it is through successful relationships that we achieve a healthy sense of autonomy.

Thomas Lewis, author of A General Theory of Love, describes limbic or emotional regulation as a mutually synchronizing hormonal exchange between mother and child that serves to regulate vital rhythms. He explains that human physiology does not direct all of its own functions; it is interdependent. It must be steadied and stabilized by the physical presence of another to maintain both physical and emotional health. “Limbic regulation mandates interdependence for social mammals of all ages,” says Lewis. “But young mammals are in special need of its guidance: their neural systems are not only immature but also growing and changing. One of the physiologic processes that limbic regulation directs, in other words, is the development of the brain itself, and that means attachment determines the ultimate nature of a child’s mind.”
Children internalize the ability to self-regulate through being in relationship with a parent who slowly and over time teaches and models self-regulation.

The Link between the ACOA/Co-Dependent and Childhood Trauma

Alongside and intertwined with the ACOA movement is the co-dependency movement. Co-dependency was a term that emerged initially in twelve-step rooms. The co-dependent, or the co-addict, like the ACOA, was that person who got sick through living with the distorted, unregulated and out-of-balance thinking, feeling and behavior that surround addiction.
Fear is a driving factor in terms of survival. Human beings have built-in defensive strategies that are designed to keep us out of harm’s way, commonly known as fight-or-flight/freeze responses. When we’re frightened, stress chemicals — such as adrenaline — course through our bodies, so that we’ll have the energy necessary to flee for safety or stand and fight. These get mobilized when we sense any kind of danger, from a saber-toothed tiger to an oncoming truck or an irate parent.
But this isn’t all that happens. There are a few other interesting body/mind phenomena that occur when we’re feeling frozen with fear, that affect the way we make sense of and remember frightening events. For example, when the survival part of our brain, often referred to as the “animal brain”, becomes aroused, the language part of the brain partially shuts down (van der Kolk, 2006). Our cortex, the part of our brain responsible for logical thinking and long-range planning, freezes up when we’re in fight-or-flight mode. We lose some of our left-brain functioning, or the ability to organize our thoughts, integrate them into a coherent context and communicate them to others.

What doesn’t freeze up, however, is the emotional scanning system in our right brains. This means that even when frightened, we retain our ability to scan our environment and those in it for signs of threat or danger (van der Kolk, 2006). In alcoholic homes, this may consist of attempting to read the emotions and divine the intentions of those around us. Both ACOAs and co-dependents may learn a lesson that can lead to problems later in life: that they can fend off trouble by remaining hypervigilant, reading the moods of those around them.

Family Dynamics that Can Lead to Emotional Deregulation

Alcoholic homes are often unpredictable, characterized by broad swings from one extreme to the other. This lack of balance becomes, over time, highly stressful to the brain/body. The kind of trauma we experience within the alcoholic family occurs slowly and over time; it is cumulative. For this reason, it affects emotional and psychological development.

Repair is an important deterrent to relationships problems, having lasting and repeating effects. But repair in alcoholic systems is not necessarily forthcoming, and if there is repair, it does not always last. Repair allows our shame/pain response, for example, to become part of personal growth. We see that something went wrong and we learn ways of setting it right, of mending what was broken or restoring a lost sense of connection. This process, that occurs in the context of a relationship, actually creates new learning, hence new neural wiring in the child. When we cannot make repairs, our feelings of shame, pain, fear and confusion go underground and can affect the way in which we function in intimate relationships.

The ability to escape perceived or real danger is one of the factors that determines whether or not a person develops PTSD. For the child in an alcoholic home, escape is often not possible. For this reason, ACOA issues often surface in adulthood as a post traumatic stress reaction. That is, the symptoms that stem from childhood pain and abuse, surface after the fact in adulthood. When ACOAs attempt to have their own families, the intensity and vulnerability of intimacy may trigger unresolved, childhood pain.

Recovery

I am constantly hearing clients say things such as, “Why isn’t this over yet?” or “I know I should be past this.” But we don’t leave our bodies behind when we grow up. We bring them right with us into adulthood. We live in them, sleep in them, eat in them and love in them. Our bodies contain a sort of neurological map that informs and guides us, a flesh-and-bones root system from which we flower into life. Changing neural wiring that has been laid down over a period of years doesn’t happen overnight.

I have created Relationship Trauma Repair (RTR) to help therapists to learn to treat the kinds of emotional deregulation that is the direct result of living with the kind of trauma that interferes with adult intimacy and can lead to self medication. RTR is a resource designed to be used in any treatment facility or clinic. It includes DVDs, a Therapist’s Guide, a Personal Journal and guided imageries to learn the skill of emotional processing and self-regulation. To learn more, go to www.relationshiptraumarepair.com.

“I closed my eyes and made it so with the power of my mind,” said Sheen about his newfound sobriety. He describes his transformation from a user and abuser to a non-user and non-abuser as “primary patient-achieved radical success,” calling those who relapse “trolls” and “weak.” These nasty, non-empathic little epithets sort of tip us off as to his state of mind. What is Charlie Sheen thinking? Clearly he has not “come to terms” with the disease that led to his losing custody of his children and to CBS and Warner Bros. Television firing him from his show, “Two and a Half Men”.

Sheen is denying his ex-wife Brooke Mueller visitation rights. Their twins were born mid-term, in part because of Brooke’s drug-related high blood pressure and liver problems. When interviewed in his luxurious home with his two live-in girlfriends (who are also porn stars, according to TV reports) Sheen said that he will let his ex-wife see their children when she tests clean: “Blood, hair and all of it… just like me.” Once again, the children suffer silently, caught in the perfect storm of arrogance, blindness and tyranny that surround addiction.

Charlie Sheen is not acting clean and sober. He may not believe in relapse, but he is virtually becoming a poster child for signs that experts recognize can lead to relapse, such as denial, crisis-building, feelings of omnipotence, complacency, cockiness, argumentativeness, impatience and an it-can’t-happen-to-me attitude.

And Charlie Sheen doesn’t believe in AA. I think it’s safe to assume that he hasn’t exactly taken the first step in which one admits to their powerlessness over the disease of addiction. The one about surrender. He touts not being “held hostage” by AA anymore on national TV. Sheen says he isn’t worried about relapse (that should tell us something). Actually, he is probably doing more to help the cause of recovery than hurt it by being so flagrantly AA-bashing, anxious, tense and critical, and generally just such a clear example of what recovery does not look like. He is obviously not sober in the kind of way that involves a “spiritual awakening,” “humility” or a “new design for living.” What Charlie Sheen is being held hostage by is clearly the disease of addiction. Whether or not he has temporarily tested clean is not the point; he is trapped by the disease either way, living in the grip of it. And so are his children, being around a dad who is acting emotionally drunk.

“Sober Valley” is Charlie’s nickname for his house. But even if there is physical sobriety at Sober Valley (and even this seems questionable), there is certainly little emotional sobriety. Charlie Sheen is the very picture of a man who is living in emotional extremes: edgy, always on the verge of bursting open, an accident waiting to happen. Physical sobriety is only the first step in healing from the disease of addiction and the wreckage that it has caused. Emotional sobriety, which involves humility, personal responsibility and balanced living, is what makes recovery sustainable and renewable, what keeps it clean and green.