He walked into the group room and cast a wary eye, especially at the few adults sitting in the circle with the other children. This nine-year-old wore a scowl on his face and herded his two younger siblings to their chairs with much skill and aplomb. He kept a watchful eye on them virtually every moment and was quite attentive to their needs, be it a tissue for a runny nose, a blue marker when they couldn’t find one, or help in opening their juice containers. I was struck by how Timmy never smiled and yet what an incredible big brother he was to Ellie and George. It appeared that he had been doing this for a very long time.

Foster Parents with Heart

Timmy, Ellie and George were brought to the children’s program by their foster parents. They were kind, caring, nurturing adults who had taken a genuine interest in these three, who, underneath the surface, desperately craved love, structure, guidance, and positive attention. Their birth parents were both addicted to drugs, and their family life had been filled with chaos, unpredictability and insanity. These three angels had been through way too much for any child to contend with and witnessed things – like violence, abuse and severe neglect – that no young eyes should ever experience. Despite all this, they really cared about these foster parents, as evidenced by the barrage of hugs they liberally doled out upon getting picked up at the conclusion of the first day.

Phil and Claire had been foster parents for years. When they took these children in about six months ago, Timmy, Ellie and George were reunited, as they had previously been split up in their two prior placements. Phil and Clare sought out our program on their own as they could see the three desperately needed coping skills to deal with Dad’s incarceration and the persistent worries that no one knew Mom’s whereabouts for more than a year. As Phil brought the kids in for our second day, Claire asked to speak with me briefly. “I don’t know what you did yesterday,” she began, “but all the kids could talk about going home was the program.” I was amazed at this because they had said so little. I don’t believe Timmy said three sentences throughout the day. He watched everything and everyone very intently, and Ellie and George took cues from their big brother. Now Claire’s eyes started welling up with tears as she shared, “Mornings are so hectic at the house just trying to get everybody up, dressed, fed and ready for school. Today when I got up they were sitting near the door, all dressed and ready.” As she sighed Claire continued, “They all raced over, hugged me and declared, ‘Hurry, hurry, we don’t want to be late.’ It was still an hour before it was time to leave.”

Courageous Steps

In group that morning, Steffie spoke about the stepdad who hit her when he was drunk. The kids got very quiet as Steffie bravely told us what happened to her and then buried herself in a female counselor’s warm embrace only to sob. When the time was right I looked at Steffie and told her that I felt sad and angry that this had happened to her. I could feel my eyes filling with tears as I emphatically stated, “It’s not okay for a child to be hurt like that. It’s not okay for anyone to ever get hurt like that.” Timmy’s hand instinctively shot in the air before he had a chance to think about what he was doing and stop himself. Now the others turned their focus and attention to this nine-year-old.      “I’ve been hurt many times, too,” he began, as the words just started tumbling out of his mouth. “I’ve been hit many times like Steffie, but can I talk about getting hurt on the inside?” he asked the group.

“I’m so sorry this has happened to you,” I offered. “Please tell us about that.”

Speaking the Truth

Timmy took a couple of deep breaths, looked over at George, and then shared, “My old foster parents hurt me and George. That’s when we were split up and not with Ellie.”

“What happened?” I gently replied.

“We were having a barbeque with steak, chicken and corn on the cob. I was so excited because we never had a cookout before. George put a bunch of food on a paper plate, but the foster lady screamed, ‘Put that back. There’s not enough for you.’” Now Timmy started crying and shared, “She comes back out with a bowl of Cheerios for each of us. I wanted to yell, but I knew I’d get in trouble so I kept quiet. ‘They don’t give us enough money for you two so that’s what you get.’” Timmy talked about how he just stared at his bowl and quietly ate the cereal. “George started to cry, and she screamed at my little brother. ‘It’s all your fault. You misbehave all the time.’” By now most everyone in group was in tears.

Soon all the kids were looking in my direction. They could see that I was feeling angry, and I think they were actually glad about that. “That is not okay,” I broadcast to the group. “I want the names of those foster parents.” I looked at the other counselor, and we nodded in agreement for the group to see. “We’ll do absolutely everything we can to keep you safe and protect you.” What a group! What sharing! Such courage and strength from Timmy.

Moving On

Timmy especially appeared lighter and playful throughout the rest of the program. That would not be the only time he took a healthy risk and let us a bit further into his world. As we came back from playing hide-and-seek later that day, it was George who grabbed my hand and held it as we walked across campus. At one point I looked down at his angelic face, and I caught him looking at mine. As I smiled he simply said, “Thank you, Jerry.”

Phil and Claire are such caring and nurturing adults. As for those other two, they are no longer foster parents.

The Betty Ford Children’s Program is for seven through 12-year-olds who come from families hurt by alcoholism and other drug addiction. With locations in Southern California; the Dallas/Fort Worth Metrople;, and Denver, Colorado, no child is ever turned away due to an inability to pay. For more information go to www.bettyfordcenter.org.

I’ve seen many marriages and partnerships end due to one of the partners living with an undertreated or mistreated chronic pain condition. Sometimes family members and significant others develop their own healthcare problems while trying to help someone they love cope with chronic pain. Family and significant others often get burned out, or they become frustrated and resentful toward the person living with chronic pain. A spouse can become just as hopeless and helpless as their family member who is suffering with pain, and may even develop a severe depression or sleep problem.

For those of you helping someone living with a chronic pain condition who don’t have a personal experience of living with chronic pain, I want to ask you to follow the steps below to see if you can develop a better understanding of what it must be like to live with chronic pain. To get the most out of the following exercise, please make sure to do it when you have the time and space where you won’t be interrupted. It’s also helpful if you journal your reactions to this as soon as you’ve completed the four steps.

Step One: Think back to a time when you hurt yourself or had a painful condition such as a surgery, toothache, broken bone, or headache, etc.

Step Two: Try to remember what that felt like and what you wanted to do to stop the pain.

Step Three: Now imagine that you have that level of pain right now and have had it for the past six months without any relief. Every day when you woke up it was there. Every night you wonder if you’ll be able to sleep because the pain is so disturbing.

Step Four: Now imagine trying to explain this to your family and friends or your healthcare provider. What would you say? What would you want from them? Please make sure write down your reactions to this brief exercise.

What kind of healthy support can friends and family provide if a loved one is undergoing chronic-pain management, experiencing significant quality-of-life problems and a decreased level of functioning? The most important thing is to understand what it must be like. If you answered the four questions above and reflected on what you learned, you should have a much better idea. Here are six additional starting points.

1. Make sure that you are practicing good self-care: take time to relax, sleep, play, eat healthy, etc.
2. Develop compassion and even empathy for your significant other — but never sympathy since that can cause even more problems. Remember the old saying, “Sympathy Kills”, that is often heard at Al-Anon meetings.
3. Do not do things for your significant others that they can and should be doing for themselves.
4. Don’t keep secrets from your significant other. This is especially true concerning medication use or abuse issues.
5. Remember the three (3) Cs of Al-Anon: You didn’t Cause it, you can’t Control it, and you can’t Cure it.
6. Seek out a professional with experience in pain and any coexisting problems for you and your family.

However, these are just starting points. In order to help someone else, you first must make sure to take care of yourself. You also need to be aware of the two major traps: enabling and resentment. Enabling is when you find yourself doing something for your friend or loved one that they can and should be doing for themselves.

When supporting someone living with chronic pain for long periods of time, many people are at risk for burnout. What started as loving care and support sometimes turns into a major chore, and the helper becomes angry and resentful of the person living with chronic pain. Just like many people who are living with chronic pain become isolated and depressed, many helpers also fall into these problems.

I’m currently working with a man, Joseph, who was injured at work, had to have surgery and is now on disability. He became severely depressed because he could no longer provide for his wife and young son. Joseph constantly lives with extreme guilt and shame and is grieving his lost level of functioning. It got even worse when his wife had to go to work to support the family.

So far his wife has been either unable or unwilling to come to his sessions with me. I personally invited her and even offered to see her alone. In addition, he says his son is now saying his daddy doesn’t love him anymore. When I asked Joseph why he thought his son would say that, he said because I can’t play with him like I used to. When he tries, he ends up experiencing severe pain flare-ups.

Our last few sessions have focused on ways that Joseph can demonstrate his love for his son without hurting himself. This challenge leads to the importance of developing an appropriate activity pacing plan and learning his limits. At our last session, Joseph shared that it was starting to work and he and his son are now getting close again. It’s a good thing because Joseph is now the primary caregiver for his son since his wife is working full-time.

Just like someone living with chronic pain is impacted biologically, psychologically, socially and spiritually, so to are friends and family members. When working with people — whether people in pain or their support team — I help them develop a multi-faceted plan that addesses the whole person. Unfortunately, our Western healthcare system often does not address the spiritual component at all.

I believe that for many people, spiritual healing can be an important component of a multi-faceted treatment plan. One goal of spiritual healing is to improve your well-being and quality of life, rather than to cure specific diseases or, in this case, eliminate problems obtained due to witnessing and helping someone suffering with chronic pain. Components of spiritual healing may include visualization, prayer, meditation and positive thinking.

When chronic pain and helping someone living with chronic pain impacts your body mind and spirit, the solution must address all of these areas. This takes a multi-faceted approach that is vastly improved by including a spiritual healing practitioner on your team. The ultimate goal of effective heathcare and wellbeing is to increase your quality of life on all levels.

It is important to take a look at all areas of the self: (1) the physical self; (2) the psychological (thinking and feeling) self; (3) the social/cultural aspects of self; and (4) the spiritual aspects of self. These are also the four areas that are impacted on a daily basis. If the treatment plan does not adequately address all four areas, healing will not be as effective — or it may lead to ongoing suffering.

As mentioned before, many times in the Western medicine approach, one area is not addressed at all: spirituality. I see the spiritual aspect of self as the glue that contains and nourishes all three of the other areas, and always ask my patients to explore this important part. Please see the diagram below.

I believe healing must address the whole person in order to obtain the best treatment outcomes and an effective healing plan — not to mention freedom from suffering. Part of my initial evaluation session with my patients includes scoring each of the four areas of self: Bio-Psycho-Social-Spiritual. Each area is scored on a 1-to-25-point scale and this score is your starting point. If it’s low, don’t worry we can bring it up; if it seems high, don’t get complacent because it can always come down.

I also explain some of the important components needed in each of the four areas before I ask them to give me their score. In the Biological area, I cover interventions such as diet/nutrition, sleep hygiene, activity pacing, stress management, eliminating or reducing nicotine, caffeine and sugar, etc., as well as having an effective medication management plan in place, if needed. Then I explain the scoring; if the score is 1 to 3, you should probably be hospitalized in the intensive care unit and if you score 25, you’re ready to run a triathlon.

In the Psychological area, I list examples, such as managing self-defeating defense mechanisms (AKA denial); positive thinking and feeling-management plans; therapy or counseling; daily balanced structure and the like. Here, I explain that if this score is 1 to 3, they need to be in the hospital, but this time in the psych ward. If their score 25, they’ve reached enlightenment or guru status.

Next is the Social area where I list ideas such as letting go of enabling friends/family members; setting assertive limits and boundaries; developing a healthy support system; and connecting and communicating with family and friends in a healthy manner. This time if the score is 1 to 3, they are hermits ready for a cave, and if it’s 25 they are a well-connected social butterfly.

Finally, the Spiritual area is where I list ideas such as prayer; meditation; finding peace in nature; working the steps, if in a 12-Step Program; and spiritual practice or religious practice. This time if the score is 1 to 3, they are totally cut off from their spiritual connection, and if it’s 25, they are in total harmony.

Then I have them pick a goal in their lowest-scored area and commit to a proactive plan of action that will raise that score. When that’s accomplished, I have them go to the next-lowest box and do the same thing, then complete that process for the final two areas as well. I explain the goal is to keep moving forward. This healing process is like walking up a down escalator; if you stop, you go down.

People who are willing to develop a self-care plan that includes appropriate healthcare, psychological/emotional healing, social/cultural and spiritual growth have a much better chance of obtaining freedom from suffering. Remember that this is a right, but it is also a responsibility — your responsibility.

At Camp Mariposa, I loved watching the tools the staff used to calm and refocus 24 very active kids. They actually had them knitting — and yes, the boys loved it. They would do a yoga pose, and then shake out their stress, learning about letting go. To see mindfulness practices integrated into the program reinforces that such practices need to be a part of prevention work today. This camp included an outdoor challenge and ropes course, as well as singing and s’mores. I had to laugh as one of the songs belted out at the campfire on Saturday night was a song I use to sing when I went bar-hopping as a child with my father. (He went to the bar — I just waited in the car for hours, but we sang between bars.)

I enjoyed the creativity of the staff working with the kids, using analogies of trees or animals, talking about feelings, family roles and self care. Of course, when the kids acted out family scripts, you realized just how much they’ve seen and internalized. It was a lot of fun for them to be on stage, to be seen and heard and to own so much of the reality of their lives. What these children were receiving is what so many kids in addicted families don’t receive — the validation, support, time and safety to work out their traumatic experiences via play. Throughout the weekend, knowing that the kids were still in some very difficult situations, the focus was on taking some of these new skills into their daily lives. To see them have so much fun while learning to trust, learn skills of self care and talk honestly…well, you get the picture. It was touching and inspiring to see these kids have such a good time just being children in a traditional camp setting. As of this writing, Camp Mariposa is presently expanding into Indiana and Florida, with plans to move into Pennsylvania.

Over the years, there have been other camps, with similar models throughout our country sponsored by local agencies in their areas. Today, thanks to people such as Rosemary Tisch, Jerry Moe, Cathy Brown and the National Association for Children of Alcoholics, educational and support groups are still provided in some schools and other community settings. A few addiction-treatment programs in Canada and the U.S. offer two-to-five-day programs specifically for children, with the Children’s Program at the Betty Ford Center leading the way. And for those of you who were a part of the early years of the adult child movement, the National Association for Children of Alcoholics is nearing its 30-year anniversary. I encourage you to check out its Website at nacoa.org; it is a wealth of resources for individuals and agencies needing assistance in prevention and treatment programming for children.

Yet, as the needs of children of addicts are escalating along with our population, services are lacking in most communities. Left to deal with the stresses in an untreated family, or a family where only the addicted experience a treatment or recovery process, the children remain not just alone, but lonely. They carry false guilt and shame. They don’t want others to see their feelings. It has not been safe to talk honestly and they don’t readily trust others. They struggle with issues of abandonment, neglect and, often, abuse. And if you were to talk with them, in an environment such as Camp Mariposa, they know what is happening at home. When they acted out tough situations in scripts, they had the fine nuances of daily home life painfully accurate. And yet, as is sadly true for most who grow up in such homes, their survivorship skills were apparent. I saw them use humor, compassion and creativity in their coping skills. Let’s not only rely on their resiliency, though — rubber bands only stretch so far. We need to offer support and give them the validation and skills to be able to reject living out a family script and live a life with choices.

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

By Dr. Jack Hinman

Divorce, even under the most amicable of circumstances, represents a trauma for the family system, impacting not only the couple, but all members of the family. Many parents in therapy quite aptly describe their experience of divorce as a kind of death. It is a loss of shared dreams and goals as well as a loss of the third “person” in your partnership that was the partnership itself. It’s a safe bet that most of us do not get married with any intention of divorce; as such, and because of the traumatic impact of divorce on all family members, there is likely no such thing as an easy divorce. But couples can aspire to a good divorce by managing the process and its outcomes consciously and compassionately. The following tips for managing divorce can help mitigate the trauma that you and your children experience. As you pursue a good divorce, it might be helpful to remember that:

The vast majority of children with divorced parents and/or stepfamilies develop into competent individuals well within the normal range on all measures of adjustment (Kelly, 2007).

Family Events

As a divorcing parent, it’s important to think through the reality that — especially when children are involved — a divorce changes, but doesn’t end, your relationship with your heretofore spouse. How will you, as divorced parents, manage future weddings, graduations and holidays with your children?

As you think through the implications of a changed relationship, it is important to find ways to foster hope for a positive parenting experience. If you have been divorced for some time, remember that it is never too late to improve your relationship with your ex-spouse and create a good divorce (Ahrons, 2006). It is vital for both parents to look at potential power struggles with their former spouse and the potential this creates for painful loyalty conflicts in your children.

This kind of rational forethought and planning is incredibly difficult to achieve in the throes of a painful divorce. It is, therefore, most important to create a supportive network of friends and family, as well as to engage the services of a therapist who can give you objective, third-party advice and support.

Divorced Fathers

Research reveals that divorce has more of a tendency to negatively impact the fathers’ relationships with his children than the mothers’. Fathers who pursue role models for positive post-divorce parenting, along with parent coaching have been shown to have more positive relationships with their children than those who do not engage these opportunities (Ahrons, 2006). Fathers do well to pursue parenting support in the form of therapy, groups, parenting programs and friendships with other single or divorced fathers whom they respect.

Divorced Mothers

It has been shown that divorce has less of an impact on the relationship between mothers and their children. It is, however, important for a divorced mother to know that the quality of her relationships with her children is profoundly impacted by the quality of her relationship with her children’s father. Mother’s better serve their children and improve their own parenting relationships when they honor their children’s need for a continued relationship with their father (Ahrons, 2006).

Generally speaking, the better your child’s relationship with your former spouse, the better your parenting relationships, and your children, will be.

Parental Conflict

Continued parental sparring not only impacts your relationship with your children, but it also negatively impacts your children’s relationships with extended family and family friends. Children often feel the need to choose sides in an attempt to create or maintain consistency and predictability in their environment. Good divorces are those in which the children can comfortably maintain relationships with both parents and their extended kin networks (Ahrons, 2006). It has been theorized that conflict among divorced parents threatens a child’s emotional security by causing them to worry that their parents will no longer care for them (Fabricius & Luecken, 2007). We are becoming more aware that conflict between former spouses has a significant impact on the long-term health of their children. The lack of emotional security that this causes has been shown to create dysregulation in the child’s physiological stress response, promoting pathology in the brain and body (McEwen & Wingfield, 2003).

Frequently, conflict among divorced parents stems from difficulty letting go of old resentments. Ex-spouses sometimes resist letting go of anger, pain or hurt for fear of invalidating their own pain and allowing their ex-spouse off the hook for the pain they have caused. Revenge is sometimes used to produce the feeling of mastery that comes from moving from a passive to an active position, thus enhancing self-esteem (Bernstein, 2007). In addition, research has shown that maintaining anger toward the other parent can be a strategy to ward off depression and grief. These strategies are usually short-sighted, however, and can perpetuate dysfunction in the family system. It is vital to your child’s emotional and physical wellbeing, therefore, that parents resolve old resentments toward their ex-spouse.

When Parents Remarry

It is crucial that parents and children understand and engage the challenges that remarriages and family blending can create. Developing realistic expectations for these new relationships is critical (Ahrons, 2006). Divorced families and blended families are forced to rethink and re-conceptualize what a family is. It is often an idealized pre-divorce view of family that sets parents and children up for failure and unhealthy expectations.

Each family member has a separate and important opinion and perception of the divorce. It is vital to create space for every family member’s perception rather than projecting one’s own views onto the children. Often the child’s voice is smothered — especially during very difficult divorces. Allowing, hearing and validating your child’s experience can increase positive outcomes in coping with divorce.

Finally, it is important to empower children in divorce situations; children who see themselves as victims in a divorce situation can struggle more than those who do not. Language that promotes the notion that they are victims or damaged goods is best avoided, as should labels that anthologize divorce, such as ACOD (Adult Children of Divorce). This type of language can send a message to children that they are victims (Bernstein, 2007).

Remember, it is the parents’ behavior in response to divorce, rather than the divorce itself, that has the greatest and most long-term impact on children.

Sources:

• Ahrons (2006) Family Ties After Divorce: Long-Term Implications for Children Family Process Vol. 46, No. 1
• Bernstein, A (2006) Re-visioning, Restructuring, and Reconciliation: Clinical Practice With Complex Postdivorce Families Family Process Vol. 46, No. 1
• Fabricius & Luecken (2007) Postdivorce Living Arrangements, Parent Conflict, and Long-Term Physical Health Correlates for Children of Divorce Journal of Family Psychology Vol. 21, No. 2

An enraged mom pulls her son into my office. At her wits end with her 10-year-old’s acting-out behavior at school, she demanded to come into his private counseling session without notice. Across town, his dad had a different reaction — on his son’s weekend visit, while staying very calm, he put his misbehaving boy over his knee — and whacked him.*

Though parenting books and classes abound, parents are still at a loss for how to discipline their children. They tell me they have no patience to set up a clear behavioral program; for them it takes too much time and is ineffective. Sometimes they’re looking for a quick fix, other times the idea of a regulated system is too foreign to them. But parents are also missing something critical — they are forgetting their heart, forgetting that love is not just a noun, but also a verb. That means acting lovingly, with kindness and awareness.

My 25 years of working with families, plus my own personal meditation practice, have shown me the value of connecting to and coming from the heart, of stepping back — of time-outs for grown-ups as well as for children. Too often when parents “discipline” their child, it is done in a moment when their own buttons have been pushed. Whether it’s at home after a long and stressful day or in public when they’re horrified that their child’s misbehavior reflects on them, parents often react from their inner kid’s frustrated position. They forget that their behavior is the best role model for teaching good behavior.

I find myself helping parent and child heal the wounds that they have inflicted on each other. Not so much with their minds, but with their hearts. Bottom line: parents must calm themselves. Kids tell me screaming is a close second to hitting in what they fear most from parents. So I start by inviting parents to visualize the kind of family atmosphere they truly want, focusing on their heart’s desire — and the heart of their child. If they set their intention of having a loving, calm home, then they can take the steps to get there.

I teach families simple breathing techniques (a basic meditation style I call “the balloon breath”) to help center themselves and be able to respond, rather than react to a situation. The balloon breath is simply focusing your awareness and breathing two to three inches below your navel. Because it takes just minutes, balloon breathing is easily incorporated into a busy day.

To create an atmosphere of loving calmness, I suggest parents imagine a favorite place. It may be a coveted vacation location, a childhood memory or a place they create on the spot. While they are in this special place, I propose putting themselves in their child’s position by remembering what is was like to be a young boy or girl, and what they would have preferred their parents doing. Adults learn to be aware of how their behavior is affecting their children. They can then re-evaluate and develop a new set of personal parenting goals.

Another simple exercise that has helped many families connect to each other is “sending love on a beam of light.” Pose the question, “If you would like to send love to your child (parent) what color would it be?” Then, while doing the balloon breath, have them imagine sending love from their heart to the other on a beam of light. They can practice in your office and later at home and see who “feels” the love first. The idea is to make it fun like a game rather than a chore.

With a new intention and viewpoint, parents can create a heart-centered, loving behavioral program that meets everyone’s needs. Although that entails many traditional steps, from setting limits to focusing on the positive, the difference here is staying mindful and connected to their heart, with kindness and gentleness. And the mom who dragged her son into my office? By her own admission, after our exercises, she left a changed woman. She told her son, “I’m feeling totally different — I feel my anger is gone and only love remains. We can work this out.”

That’s the heart of discipline.

* To protect privacy, a composite is used.

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.