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…”

I remember being a student at Notre Dame and reading some classic CS Lewis in those required theology classes; a quote of his always stuck with me. Somewhere along the way he was asked in a class he was teaching to define humility; he answered in a clever way that described what it isn’t. He said, “Let’s just say the humble man never tells you that he is humble, for in doing so violates the very thing he is proclaiming”.

This nuanced insight is quite profound and has always stuck with me working as a personal and executive coach for people seeking transformations and wanting that “hidden” nugget of truth and excellence not found in the myriad self-help exploitations on the market. Amid these stories, and the recent headlines of stars, politicians and businessmen “disappointing” us in some way, ethics has become an ever-increasing attribute on the list of what we desire in people.

Gone are the days when ethics was a concern when one approached a “bad” situation to decide between two options; rather, we have come to realize in the light of let-downs and scandals that we ache for people who can decide between what is good and what is essential in non-conflict-oriented times. Even in politics we are faced with such wild irrationalities that call for a higher level of influencing understanding and behavior change. Take, for example, a recent CNN headline that noted, “At least 62 people were killed in Syria on Thursday as diplomatic efforts continued.” What may make this goal trickier in actualizing than we originally thought may have everything to do with the brain’s irrational patterns and hidden illusions around situations when we self-proclaim a value that has some “social desirability” or merit to it.

Take a new study that was recently released by Harvard Business Review: “About one-third of drivers of Prius hybrids failed to yield to pedestrians in a series of experiments on crosswalks in the San Francisco Bay area, giving the brand one of the highest rankings for ‘unethical driving,’” say psychologist Paul Piff of the University of California, Berkeley, and a team of colleagues. Drivers of hybrids “who believe they’re saving the Earth may feel entitled to behave unethically in other ways,” says Piff.

What is most fascinating about the results of this study are the implications. Does this mean that those who most verbally espouse never cheating on their spouse may indeed be the ones that are most susceptible to doing so? Does this mean that the more “religious right” you are in your ideologies and potentially judgmental tones of others implies you are the one that reeks of those “sins”? Or is it implying that we could use our truly valid good natures on behaviors x-y-z to give us wiggle room on behaviors a-b-c? Though I believe much of these are self-protective patterns of the brain that are quite difficult to change, I do believe you can do more to accomplish your behavioral goals by doing the following rather than spending tons of dough on an expensive self-development seminar that assumes too much that you are a rational person:

• List your top 10 values you say you live your life by
• Write out evidence from behaviors you regularly show that these are well-lived by you
• Find the opposite word of each of these values and write those down
• Then ask yourself, “If I am at times between these two words in my life, what types of behaviors or decisions do I make that show some ambivalence?”
• Examine those times as ethical grey areas protected arguably by an espoused ethical orientation
• Add in additional behaviors that you feel you do because you follow other value-based areas in your life. This linking is powerful.

If you think this is hard to do, you are correct. For your brain is wired to be right, not ethical. But the good news is that some schools are doing something about it. My alma mater, the University of Notre Dame, and Deloitte have partnered to beef up the training and education of traditional ethics to include such wildly diverse areas of neuroscience and behavioral economics. Though it may be heretical to say, only when we do this can we understand why the filmmaker Dan Merchant, who made a great documentary about the hidden hypocrisies in religious living, entitled his documentary, Lord, Save Us From Your Followers.

But that may not be nuanced and “true” enough without adding—“by first saving us from our brains.”

People who engage in drug or alcohol abuse, who have an eating disorder, or who struggle with any addictive pattern or behavior are acting according to the prescriptions of a destructive thought process, the critical inner voice. If someone struggles with an alcohol dependency, this internal enemy may try to tempt them with seductive, seemingly friendly thoughts (or “voices”) saying, “You’ve had a rough week. Have a drink. You really need to relax.” If someone is dealing with a food addiction, it might lure them with rewards: “Have a piece of cake. You did well on your diet all week.”

The critical inner voice always plays two roles in an addiction: seducer and punisher. After indulging, the deceptively soothing voice transforms into a cruel enemy, tearing the person apart and maliciously punishing them for indulging in the very behavior it encouraged. “You weak-willed jerk. You said you weren’t going to drink anymore!” “You’ve ruined everything. You’ll always be a fat cow.”

Addictive behaviors and the thought process that accompanies them represent a direct assault against a person’s physical health and emotional wellbeing, while limiting one’s ability to pursue meaningful personal goals in life. Therefore, it is important that a therapist help a client to identify the critical inner voices that govern these habit patterns and to challenge their dictates by learning more constructive ways of dealing with emotional pain.

In Voice Therapy, a therapeutic approach developed by my father, psychologist and author Robert Firestone, therapists help clients pinpoint the specific triggers that precipitate the painful emotions and negative thought patterns, which, in turn, influence them to engage in addictive behaviors. In addition, by encouraging the pursuit of genuine wants, desires and goals, therapists strengthen clients’ real selves, a process that enables clients to achieve freedom from addictive, self-destructive behaviors. Here I have outlined the steps of Voice Therapy that are valuable to the therapeutic process of treating addiction.

The techniques of Voice Therapy consist of five steps: (1) the process of eliciting and identifying negative thought patterns and releasing the accompanying emotions; (2) developing insight into the origins of one’s voice; (3) answering back to the voice from one’s own point of view; (4) understanding the impact of the voice on one’s behavior and lifestyle; and (5) counteracting behaviors regulated by the voice through the collaborative planning and the application of appropriate corrective experiences.

Step 1: Identifying and Verbalizing Destructive Thoughts, or “Voices”

The principal technique of Voice Therapy consists of verbalizing negative thoughts in the second person, as though someone else were speaking the thoughts. For example, the statement, “I feel so stupid and worthless” would be changed to “You’re stupid and worthless.” This particular format is important for two reasons: (1) this is the form in which most people think critically about themselves (as though another person were talking to them, coaching, accusing, and enticing them in ways that are self-defeating and often self-destructive); and (2) this technique usually brings out considerable affect (often anger and/or sadness).

Step 2: Developing Insight into the Origins of One’s Voice

After clients have verbalized the voice and expressed the accompanying feelings, they frequently develop insight spontaneously into the origins of their negative thought processes. They may recall events from their past, names they were called as kids, or ways parents or influential caretakers treated them that left them feeling self-critical or unkind toward themselves. The understanding that they gain from this process enables them to develop compassion for themselves.

Step 3: Answering Back to the Voice from One’s Own Point of View

It is important that, after verbalizing their self-attacks, people answer back to these voices with a compassionate and realistic appraisal. Answering back always takes the form of offering a rational, realistic evaluation of one’s actual point of view. It can also involve countering each attack by responding with strength, anger and emotion. The point of the exercise is not to feel victimized by one’s critical inner voice, nor is it to build oneself up. Rather, the goal is to separate from this destructive point of view and see oneself through caring and truthful eyes.

Step 4: Understanding the Impact of the Voice on Present-Day Behavior

Through sensitive questions, therapists can encourage clients to identify the connection between their destructive thoughts and the addictive behaviors they wish to change. What kinds of thoughts lead up to the behavior? Do certain events trigger self-soothing thoughts and self-destructive behavior? By identifying these triggers, a person can become more conscious of his or her voice and better able to act against its directives.

Step 5: Collaborative Planning of Corrective Experiences

Client and therapist collaborate in planning suggestions for behavioral changes that correspond to the client’s special interests, goals and motivations. These generally fall into two categories: (1) corrective suggestions to help control addictive habit patterns; and (2) corrective suggestions that expand the client’s world by encouraging him or her to gradually overcome fears related to pursuing wants and goals.

Taking actions that break a self-soothing, tension-reducing habit pattern is often a first step toward change. The next step is dealing with the emotions that the addiction has been keeping at bay, most often pain and wanting. The therapist can help the recovering addict grieve for past losses and process old hurts. Clients can learn to expand their window of tolerance for pain, and develop healthy coping strategies for dealing with pain when it arises.

As individuals combat an addiction by challenging their destructive inner voices, they strengthen their true selves. They achieve a better balance that leaves them stronger in the face of destructive temptations and hurtful behaviors. Most importantly, they break free from any internal chains that hold them back from experiencing who they are at their fullest potential and from actively pursuing what they aim to accomplish in their lives.

To read more from Dr. Lisa Firestone, please visit PsychAlive.org.

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.

Some stimulant medications used to treat ADHD decrease appetite, creating a risk of abuse among girls with ADHD who are also struggling with body-image issues and/or an eating disorder.

While boys with ADHD tend to externalize their acting-out behaviors through aggression and substance abuse, girls, by contrast, tend to internalize their symptoms through mood symptoms and eating disorders.

2. Social Problems Among Girls with ADHD (Ohan & Johnston, 2007)
Even more so than their male counterparts, girls with ADHD tend to have a high incidence of peer difficulties. These difficulties include:

• Basic social-skill deficits
• Alienation of their peers (Gaub & Carlson, 1997)
• Aggression (Silverthron, 1996)
• Gossip and social exclusion (relational aggression)
• Deficits in pro-social behavior
• Fewer friends (Blachman & Hinshaw, 2002)
• Less awareness of social cues
• Decreased ability to regulate anger in social situations
• Lack of specific positive behaviors necessary for acquiring and maintaining friendships
• Social awkwardness
Not only are the symptoms of ADHD exaggerated in girls, but the consequences of these symptoms are exacerbated by basic differences in how girls and boys socialize. The social deficits caused by ADHD may be more destructive in the context of a girl’s tighter, more intimate social milieu than they are in a boy’s looser, more active social network (Crick, 1996; Maccoby, 1998).
3. Increased Risk of Anxiety and Depression (Bauermeister, 2007)
Girls with ADHD also struggle with higher rates of separation anxiety, generalized anxiety disorder and depression than boys with ADHD.

4. Difficulties with Executive Functioning (Hinshaw & Carte, 2007)
Again, girls even more than boys, experience a high rate of difficulty with executive functioning. These cognitive functions include some basic abilities critical to day-to-day social, academic and work activities. Girls experience a high rate of difficulty with:
• Planning
• Mental shifting (i.e. from one mental task to another)
• Interference control
• Working memory

5. Difficulties with Detection
Girls with ADHD are more likely to go undetected than their male counterparts because their symptoms are less obvious. They tend to exhibit, for instance, inattention rather than outward hyperactivity. Girls are also less likely to be identified and treated for ADHD because their “acting-in” behaviors are less frustrating to parents and teachers than a boy’s acting-out behaviors. Girls are more likely to be diagnosed for ADHD when comorbidity is present; in other words, when one or more secondary issues capture the attention of parents, educators, and/or professionals. It is, therefore, when a girl is being diagnosed and treated for a secondary condition that the primary condition of ADHD is typically detected.
Sources:
• Ohan & Johntson (2006) What is the Social Impact of AHDH in Girls? A multi-Method Assessment Journal of Abnormal Child Psychology, 35:239-250
• Ascribe Newswire: Health (2008) Adolscent Girls With ADHD at Increased Risk for Eating Disorders
• Woosely, L (2006) ADHD Ignores Gender: Neurological disorder also proves debilitating to girls Tulsa World
• Mikami & Patterson (2008) Eating Pathology Among Adolescent Girl With Attention-Deficit/Hyperactivity Disorder Journal of Abnormal Psychology, Vol. 117, No.1. 225-235
• Bauermeister, J (2007) ADHD and Gender: are risks and sequela of ADHD the same for boys and girls? Journal of Child Psychology and Psychiatry 48:8

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.

Perhaps these were regulars who serve in these on-and-on-and-on irregular bloodings. If so, they likely represent only 1 percent of our population. Maybe they were even part-timers? Yet, their families… The troops are coming home, so many with PTSD, so many suicides, so many divorces, so much alcoholism and drug abuse. And, as we know from Vietnam, so much homelessness to come. A mental health counselor has reason to sit, and wonder and play with a fork.

Having death glare into a person ’s eyes, it willl take another 30 days before we can estimate whether it will be a post-traumatic event. Until then it is “only” definable as Actute Anxiety. If the intensity and immediacy recycles, it has become encoded on the very brain. Yet – can younger counselors believe it? – it was not until DSM-IV that we began to get a enlarged picture of this disorder.

What is only beginning to be recognized is that more women than men suffer from the haunting of violence than veterans. And, as a recent New York Times article added, children. We can count off the recent calamities that produce the flashbacks: 9/11, Hurricane Katrina, the tornado wiping out a midwest town.

What is far greater even than these are the stark black-and-white headlines we all see daily in the news – the wrecks, the shootings, the abuse. From a world perspective, is there a greater mental health issue from being exposed to all this “news”?

What we are seeing is as old as Cain and Able. In reality, it is Cain and Able, a description of our humanity, victim and victimizer. I write a blog, http://theapostlepaulandposttraumaticstress.blogspot.com/ , and this week we had multiple hits from the U.S., of course, but also as many from France, Russia, Sweden and the Ukraine. On this week, and any week, I may see single hits from places such as Egypt, South Africa, New Zealand, Singapore, China, Estonia, Moldova, Macedonia…about 35 countries now. So many wars, so many earthquakes, so many walls of sea water rushing in, carrying away all before it. We are so very vulnerable, we earthlings . You do not have to choose to be human, but recovery can begin with a sense of our humanity, a fresh grip on reality.

My wife, Annelie, and I know this well. We have sat on both sides of the counseling office – although I didn’t know it at the time. Annelie did. She was born on the night of the first air raid on Wiesbaden in WWII. Years later, she was in a city bus trapped in a traffic jam. It all flooded back, that night when everyone in the basement crawled panicked through a small upper window. She turned the bus experience first into a realization as to the causation of her sudden panic, and then broadened that insight. Added to her armament is the ability to create a beautiful, emotionally filled fantasy if she has to do something like a medical scan.

My experience was different, in a civilian setting, as most PTS events are – a syndrome more than a disorder. I was in the process of writing a third book on Obsessive Compulsive Disorder, starting the day with a Bible reading, in Acts that day. Suddenly I realized that Saul of Tarsus on his way to Damascus was having a flashback. It set me off on a hunt for symptoms, and I found them: at least that 30-day delay after an intense experience of death (or deaths, in his case, it turned out later), the psysiological effect, being overwhelmed by emotions, consequently rage, alienation and withdrawal. PTSD left tracks, only gradually diminishing as we can see in his letters written as a free man.

What I did not expect, as I pursued this research, was that one night I would be staring into the mouth of a rattlesnake. I had not seen him in the original experience as a Boy Scout, only heard him buzz near my face as I crawled out of a tunnel I was exploring. I had frozen – which saved my life – but I had been in denial for years – as are so many – of that emotional experience. I had to work with that flashback for a while, as you can imagine, but I came to accept it – and the snake, too. I was invading his home, he meant me no harm, rather was warning me, and glad to escape from me. He, too, was God’s creature, and I accepted that as well. The snake is still a tiny figurehead somewhere up above my left eye, but I am doing well now, thank you.

Out of all these experiences, and our own ministries in the Church and in private practice as mental health counselors, we have come to co-author a book, The Apostle Paul and Post-Traumatic Stress: From Woundedness to Wholeness. It is a book that could not be written even 15 years ago, even though intimations of PTSD behavior are as old as the tale of the Greek poet, Homer. We simply didn’t have the information available to us then.

It is the biographical study of one of the classic heroes of our Western World. He was not only a victim, but a perpetrator. To our satisfaction, as the recent studies of that aspect of the PTSD condition come out, what we have written stands up well. Only now are we beginning to realize how complex that condition is.

Persons experiencing PTSD need a broader view of their suffering. It is a time for recognizing our individual and collective humanity. The person suffering from PTSD is frozen in time as the flashback is experienced in all its immediacy; they are frozen in a flashpoint of time by the grip of that particular Anxiety Disorder. It is a time we need a role model  – such as can be found in a new understanding of Paul – and a pathway into a refreshingly personal identity, a new way of understanding our lives, a re-tooling of meaning and motivation.

We feel we bring both a male and female perspective to the study, as well as personal ones, that is much needed. Hopefully the book will be frequently used in discussion groups.

CEO of Creative Change Conferences

Six weeks ago I started an Artist’s Way online course on Facebook. The course is 12 weeks long and 85 people signed up in anticipation of the author, Julia Cameron, coming to Palm Springs.

To quote what is happening to these participants after only six weeks, I would like to share the gist of the posts:

“These exercises are accelerating my growth, warp speed ahead.”

“Guessing it is the faithfulness to Morning Pages that causes a feeling of openness to possibilities.”

“I find myself writing now without paying attention to my usual excuses.”

Morning Pages are three handwritten pages every morning first thing. Participants write without the editor in their head being in charge; they write whatever is in their minds, a brain-drain, so to speak. Getting out all the gibberish helps participants move into the day with clarity. Morning Pages as one continues to do them can also be a place to explore dreams, plan futures, set goals…or not. The people I know who do them faithfully have had many transitions in their lives.

How does this all work? Creativity is the natural order of Life. Life is energy, pure creative energy. There is an underlying, in-dwelling creative force infusing all of life — including us.

If one really looks at it, we ourselves are creations and we were meant to continue creativity by being creative ourselves. ¹

There is evidence that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one’s own creative efforts can enhance one’s moods, emotions and other psychological states, as well as have a salient impact on important physiological parameters ²

Chronic diseases are a nationwide burden, with cardiovascular disease being the leading cause of death during the past century, and the incidence of diabetes increasing to now affect more than 20 million Americans. What’s more, these diseases are associated with psychosocial difficulties, such as depression and chronic stress. ^3.4

But engagement with creative activities has the potential to contribute toward reducing stress and depression and can serve as a vehicle for alleviating the burden of the chronic disease. In review of the research in the area of art and healing — and in this context, the word art means any expressive creative process — four primary therapies emerged: music engagement; visual art therapy; movement-based creative expression; and expressive writing. In these forms of expression, art therapy, arts modalities and creative processes are used during intentional interventions to foster health.⁵

Music

Music is the most accessible and most researched medium of art and healing. Music therapy has been shown to decrease anxiety. Music can help change moods, depending on the music that is played for the participant. Those in a sad mood listening to happy music, as in laughing yoga, helped the participants feel lighter, happier. It has been also shown that music can calm neural activity in the brain.

The Cleveland Clinic (2006) reached the conclusion that nurses can teach patients how to use music to enhance the effect of analgesics and decrease pain, depression and disability, and promote feelings of power. A listening group and a non-listening control group were evaluated on several accepted pain-measurement scales, and it was found that the music groups felt they had more power and less pain or depression than the control group.

In a study of patients admitted to a coronary care unit with acute myocardial infarction, Dr. Guzetta found that relaxation and music therapy were effective in reducing stress⁶, which, in turn, lowered the heart rate, promoting a sense of wellbeing. And studies show that active music therapy may be effective in improving mood.

Visual Arts

In 1990, a group of University of Florida physicians and Shands nurses from Shands at the University of Florida reached out to Gainesville community artists and began a collaboration that would have a lasting impact on patient care. What began as an investigation of how art might help reduce the stress of the hospitalization has grown into a philosophy of care for an entire institution. This philosophy centers on the belief that art is an integral component to healing.

Art helps people express experiences that are too difficult to put into words, such as the diagnosis of cancer. Some patients receiving this diagnosis explore the meanings of past, present and future during art therapy, thereby integrating cancer into their life story and giving it meaning. People in treatment for drugs and alcohol can use art therapy in the same way, doing a timeline of their use and trauma using art and writing as a way to own their story and see changes that can occur in the future. By doing a painting or drawing of a bridge, exploring where they are on the bridge, what was behind them and where they are walking to on the other side. Also, the placement of themselves on the bridge will tell their counselors how patients relate to their own healing process.

Movement-Based Creative Expression

Through the movement of the mind and the body in a creative way, stress and anxiety can be relieved; other health benefits can be achieved as well. A unique study involving the use of theater investigated the benefits of a short-term intervention for adults ages 60 to 86 that targeted cognitive functioning and quality of life issues important for independent living. After four weeks of instruction, those given theater training exhibited significantly greater gains than members of the no-treatment control group on both cognitive and psychological wellbeing measures, specifically word and listening recall, problem solving, self-esteem and psychological wellbeing. ⁷

Tai Chi has been gaining popularity. This ancient meditative form is now shown to help with balance, thus reducing falls in older adults. There is vitality, a life force, an energy, a quickening, that is translated through you into action, and because there is only one of you in all time, this expression is unique. And if you block it, it will never exist through any other medium and will be lost. ~Martha Graham

Expressive Writing

Imagination is more important than knowledge. ~Albert Einstein

We all relate to myths, stories and fairytales. Why is that? These stories tell our story; verbalizing our story may be difficult, but writing it down is often easier. Writing in longhand connects us to our heart, and our heart may be able to speak about our truth in ways our mouths cannot.

In the recent movie, The Help, the maids decide the only way to make a difference in the climate they were living in was to tell their stories to a writer who would write them down. Stories have existed since the beginning of time when our ancestors sat around the fire and told them. Stories get passed on from generation to generation. Studies have shown that, relative to control groups, those who wrote their story of a traumatic experience exhibited significant improvements. Writing increases health and wellness in varied ways.

Another form of expressive writing, poetry, has long played a role in the art of healing. Several authors have described the use of poetry to help people find their voices and gain access to the wisdom they already have but cannot express because they cannot find the words in ordinary language. Finding one’s voice through poetry can be a healing process because it opens up the opportunity for self-expression not otherwise felt through everyday words. ⁸

The poet lives and writes at the frontier between deep internal experience and the revelations of the outer world. There is no going back for the poet once this frontier has been reached: a new territory is visible and what has been said cannot be unsaid.

The discipline of poetry is in overhearing yourself say difficult truths from which it is impossible to retreat. ~David Whyte

Journaling

Journaling is the only way one can gain some objective insight, since journaling is another way to access the unconscious self. Journal writing has been linked to creativity, spiritual awareness and expansion of the self. In two studies, journal writing helped participants identify and work through feelings, improve relationships and learn new things about themselves. ⁷

In an in-depth study conducted at Boston University, Grossman, et al. explored how 16 resilient male survivors of childhood sexual abuse made meaning from their abuse experiences. Three main types of meaning-making styles were identified in the narratives: meaning making though actions included helping others and using creative expression to describe and process the abuse, use of cognitive strategies and spirituality. ⁹

References:

1. Cameron, Julia The Artist’s Way, 1992
2. Staricoff, R. Lopert, Integrating the arts into health care. The healing environment without and within. London, England: Royal College of physicians, 2003 63-80.

Heart Disease and Stroke Statistics 2008 Update, Dallas, Texas American Heart Association.

National Diabetes Fact Sheet 2005 Atlanta, Ga Centers for disease control 2005.

Camic, PM, Playing in the Mud psychology the arts and creative approaches to health care. J Health Psychol. 2008

1. Guzetta, CE Effects of relaxation and music therapy on patients in a coronary unit with presumptive acute myocardial infraction Heart Lung, 1989

1. Noice, H. A short -term intervention to enhance cognitive and affective functioning in older adults J. Aging Health 2004

1. Macduff, D. West B Arts in health care: developing the use of Poetry within healthcare culture. Br J Nursing 2002

1. Grossman, FK Sky H Journal writing a gale force wind: meaning making by male survivors of childhood sexual abuse. AM J. Orthopsychiatry 2006

For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same; there are no rules to this thing. We can make the best or the worst of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you’re proud of. If you find that you’re not, I hope you have the strength to start all over again.
—Benjamin Button, The Curious Case of Benjamin Button

I love this quote. So hopeful and encouraging! I want to remember it on a daily basis so as not to be stuck in a Groundhog Day repetition of my childhood experience.
Recovery work with addicts can be baffling. It’s hard to give up one’s self-medication. Some people change their minds.

An overwhelming percentage of addicts have been traumatized during a childhood of abuse and neglect in one form or another, which means that these survivors of trauma relive their childhood suffering over and over – in their minds and also by populating their world with people who remind them of their childhood. The lasting high-alert stress response is called post-traumatic stress disorder (PTSD) and refers to the fact that painful experiences have been imprinted on the brain.

The victim role can be compelling – people remain in permanent defense with distorted perceptions, where they resent others and sabotage themselves. A bold attempt to adjust perceptions, by suggesting that perhaps this or that person is not altogether “evil”, can instantly propel the well-meaning, would-be helper into the line of fire, where s/he gets hit with a dose of attack and blame.

If you look at abuse as an injury that occurred to the child, you could then make it a point to focus on healing of emotional wounds, rather than searching for blame. But traumatized children have been betrayed and abandoned and it can appear as though they must be loyal to the bleeding child they once were, or else that child would be forgotten and lost forever. PTSD may be an attempt to deal with trauma in such a way that healing of self is compromised for the sake of dealing with the outside, possibly in an attempt to prevent further victimization. This does make sense, but it also serves to prevent healing, thus extending the victim’s suffering indefinitely.

Survivors of trauma, especially when it occurred very early on, remain in survival mode filled with fear, distrust, disgust and resentments. Mental anguish can make sobriety undesirable and slowly destroy a person years after the events are over. The so-called chronic relapse mode is diagnostic. It can indicate that sobriety brings up unacceptable repressed memories. It’s an essential step, a promising beginning, but certain experiences may need to be worked through so that mental stability can gradually be established, with an eventual emergence of a positive sense of self and a sense of peace.

A lovely and loving bond between fellow alcoholics can be established and some helpful interactions can take place. But if the person for whom the alcoholic has come to depend on leaves, the anger at the mother who was useless and damaging can reemerge. However, re-parenting can take place within an ongoing relationship with a good sponsor or psychotherapist, and addicts can discover trust, hope and confidence, and with it the courage to let go of their victim identity and begin to enjoy continuous, meaningful and mutual relationships. It can happen!

It might help to keep in mind that the childhood is over – both the good and the bad. One must choose between oneself and the perpetrator and use this moment’s life energy for love rather than for fear. Ultimately, forgiveness is an act of self-love, which disables angry unhappiness and makes healing possible.

End Note: The concept of neuroplasticity suggests that it is possible to remap the brain through novel experiences at any time throughout life – especially after an experience such as detox. This means that early recovery is a great time to leave behind destructive old automatic patterns and replace them with something better.