First, Dr. Tian Dayton generously shares her specialized techniques for teaching emotional awareness and processing in the group setting. She avails of us of the wealth of knowledge from her years of experience working with trauma and addiction. This is a true gift for any clinician in this field.

We are so blessed to have another contribution from Jerry Moe of the esteemed Betty Ford Center. His insights into the smallest victims of ravages of addiction – children – both move us to tears and reignite the desire to make sure the children do not become emotional and physical fallout from alcohol and drug addiction.

Similar to the drain felt by mental and physical health clinicians, the caretaker syndrome is practically inevitable for anyone living with and caring for someone with chronic pain. Dr. Stephen Grinstead lends his vast experience in the arena of chronic pain management to family members in his article, where he gives tips on how to better empathize with their loved one, and – most importantly – care for themselves.

New RecoveryView.com author, Dr. Sage de Beixedon Breslin, contributes her perspective on holistically treating clients with trauma. Having been classically trained as a trauma psychologist, as well as an emotional intuitive and in mind-body approaches, Dr. Breslin’s approach borrows from a wide range of healing traditions, integrating them into a truly valuable treatment modality of compassion and strength.

Lying and hiding are behaviors finely honed into expert skills by addicts, in general. Dr. Kevin Fleming posits in his article, How Thoughtless, Unethical People Might Just Save Our Planet, that this might not be the worst thing in the world – and, indeed an interesting twist attributed to our brain’s wiring.

Our clinical editor, Meredith Watkins, returns this issue with a look the increasingly trouble epidemic of sugar addiction. She explains the science behind it and how it has evolved into a legitimate addiction, requiring both our attention and understanding of the myriad physical and mental health conditions resulting from it, and to more appropriately treat it.

Dr. Lisa Firestone, new RecoveryView.com author, writes about Voice Therapy, a treatment approach created by her father, to address that nasty inner critic that drives addiction and relapse. This step-by-step process helps both silence the snarky commentator within while strengthening the true voice of the client.

We hope you’ll take some time to get outside and breathe in the fresh air of spring and renewal. Health and happiness ~ Josie and Jim

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…”

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.

Nearly two decades later, I’ve learned a few things. I used to think that the treatment of trauma was something that could be done by one person. I used to think that if you provided enough nurture and attention, everything would be OK. I used to think that if I tried hard enough, a patient could survive the ravages of trauma and Complex Post-Traumatic Stress Disorder (C-PTSD). I used to think that the training that I received in graduate school and at my internship would enable me to handle anything that crossed my way. I used to think that if a patient survived horrific violence, they could survive the memories of what had occurred.

I am wiser now. I know now that sometimes, no matter what I do, it might not be enough. I know now that it takes more than a graduate school education to embrace the treatment of trauma and to succeed. I know now that I am one cog in a wheel, and that without my team, my efforts would fall short. I know now that it takes a village to raise a client. It takes a village because trauma impacts every sector of a client’s being: it short-circuits their biochemistry; it distorts their cognition; it inhibits the ability to connect with others and to seek and use social support; it blocks their energetic meridians; and it confounds their connection with Spirit.

Trauma is a multifaceted demon that sucks the capacity for life from a person, one region at a time. Recovery from trauma requires a therapy protocol that attends not only to the mind, but to every piece of the fabric of who we are. Trauma recovery demands techniques that impact body, emotion, mind and spirit. And whether or not you have a specific faith, or worship at all, the treatment of trauma survivors mandates that you not only have an active connection to something that is greater than us all, but also requires that you can hold space for the client who feels abandoned by God, Source, Spirit, High Power – or whatever name you choose to use.

When the arrogance of graduate school wears off and you finally feel overwhelmed by your clinical work, you might begin to consider that multimodal toolkit. And, as you begin to treat those with mood disorders and addictions, you’ll grow closer to that village idea. When you lose your first patient to the rigors of trying to stay alive one day at a time, you’ll cross the threshold into ways of thinking you might never have considered before.

According to Sack (2012), who reports on a recent study published in Alcoholism: Clinical & Experimental Research, a history of childhood neglect or sexual, physical or emotional abuse is closely correlated with the development of anxiety, depression, addiction and suicidality.

Rates of historical physical abuse are reported to be as high as 24 percent for men suffering from alcoholism and 33 percent for female alcoholics. The rate of sexual abuse history among those with alcoholism is approximately 12 percent for men and 49 percent for women. But, most of us realize that trauma comes in many forms, not just physical, emotional or sexual abuse. The article in ACER cites a study of children who attended school near Ground Zero, suggesting that the more trauma-related factors the children experienced, the more likely they were to use drugs and alcohol. According to the study, children with three or more exposure factors were 19 times more likely to increase their use of drugs or alcohol.

Research suggests that trauma is associated with a range of unhealthy efforts to cope, not just with alcoholism and addiction. Even the Adverse Childhood Experiences study conducted with Kaiser Permanente patients indicates that those with a history of trauma also struggle with overeating, compulsive sexual behavior and other types of addictions. In their study, children with four or more adverse childhood experiences were five times more likely to develop alcoholism and 60 percent more likely to suffer from emotional and/or disordered eating. Boys who had experienced four or more of adverse experiences were discovered to be nearly 50 times more likely to become IV drug users than their peers.

When you begin to treat clients with histories of abuse or trauma, you begin to realize that you are also likely to be treating them for sexual compulsivity, gambling, eating disorders, alcoholism, drug addiction, prescription drug abuse and even Type-A workaholism. It’s at that point when you’re most likely to realize that your protocol needs to be beefed up.

Much of what I do in my practice is now standard of care: assessing for physical, biochemical and hormonal issues to address, evaluating cognitive function and distortion, analyzing the social support network, identifying resources and reviewing the psychosocial history. Common practice includes referring a trauma client to a team of healthcare providers, including a physician, acupuncturist, massage therapist and even a Reiki Master. You might even remember to ask about a client’s faith, or to recommend pastoral care, but how often do you really focus on that? If you were raised in a religion different than that of your client, do you even dare converse about their views? If you’re not religious, can you talk about God?

Over time, and through hundreds of phone calls like the one mentioned in the first lines of this article, I learned that I cannot treat a trauma survivor without being able to have those conversations. I’ve learned that despite my willingness to do so, and an unending supply of desire to facilitate the healing process of my clients, I am human. In order to uplift the human spirit, what is required is a source of energy so great that it can carry that broken, fragile core into a space where it can be restored.

As a trauma psychologist, I trained in a number of different models, one of which was Prolonged Exposure Therapy, or “Flooding.” Edna Foa (1991, 1999) originally developed this technique in the 1990s to address the symptoms of those suffering from resistant PTSD. Foa’s PET protocol incorporated three modalities. During the course of approximately 12 sessions, a clinician would provide:

• Psychoeducation about the reactions and symptoms being experienced by the trauma survivor, as well as some of the triggers for those reactions.
• Imaginal exposure that engaged the client to repeatedly recall and recount the traumatic memory, and
• In-vivo exposure that involved using reminders such as photographs or objects related to the trauma to enable the client to confront rather than to avoid the material and to learn to manage the reactions associated to the experience.

The research suggests that PET reduces the symptoms of PTSD, such as intrusive thoughts, intense emotional distress, nightmares and flashbacks, avoidance, emotional numbing and loss of interest, sleep disturbance, concentration impairment, irritability and anger, hypervigilance and excessive startle response.

However, I have come to understand that there are limits to what PET provides, especially to combat veterans. For those who cannot tolerate reliving the event, during which they feel as isolated and helpless as they were in that moment, or series of nights, days, weeks, months or even years, PET offers little assistance. Those trauma survivors do not return for further treatment, but rather self-soothe or self-medicate in ways that distract them from the revisitation of their personal apocalypses. They look for ways to deaden their memories, or at least to numb their responses to the memories they cannot seem to dislodge from their brains.

After 27 years of treating combat veterans, getting an MA and a PhD, training for five years as an Emotional Intuitive, and even after becoming an Ordained Minister, I’m not sure I know what the perfect protocol for the treatment of trauma is, but I have been able to develop strategies that work far better than those I’ve learned along the way. Perhaps, because my protocol takes into consideration all of the areas impacted by trauma, and the core issue that lays at the very foundation of traumatic experience: that of human abandonment at a time when comfort and connection is mandatory.

Modified Intuitive Prolonged Exposure Therapy (MiPET) is based on the concept that our ability to survive, and later to thrive, following mind-altering trauma, depends on our connection to something greater than ourselves. Unlike Foa’s PET, a survivor does not relive his or her trauma while a therapist listens faithfully. In the MiPET protocol, the clinician willingly and intentionally travels back in time with the client to the traumatic event, to bear witness for the atrocities committed against that person.

Not adept at time travel, you say? Didn’t take that course in graduate school? Well, whether or not you truly feel capable of energetically travelling back in time with your client, you would be surprised at how many of your trauma survivors are willing to take you back with them, if you allow it.

Using some of the same general principles proposed by Foa, a clinician need only encourage the client to breathe deeply, and to allow their minds to move back through time, alighting on the day (or year(s)) during which the trauma was experienced. But, before encouraging the client to move even a single step further, remind the client that you are just a few feet behind them, unable to change the events which are occurring, but bearing witness to what is happening. Remind the client that because you have travelled back in time without your body, no harm will come to you as you witness the events. Then, allow the client to describe the events in detail as they happen, encouraging the experience and expression of emotion that, while likely unavailable due to danger at the time, is now perfectly reasonable. When your client has been able to move through the traumatic episode, have him or her take a deep breath and travel forward through time to a seat in your office and divert their attention to your eyes. Have them breathe deeply while they ground in the current experience, and encourage them to rub their hands together or tap their feet on the ground. If they require further grounding, have them alternate from looking into your eyes and looking at a lamp or other light source. Offer water, or even food, as both further enhance emotional grounding.

This simple technique, used repeatedly, diminishes a client’s sense of being abandoned in his or her time of need. However, given that you can’t guarantee that you’ll always be available in a client’s time of need, MiPET encourages eventual transition to an even more effective witness to the trauma. As a client’s symptoms begin to diminish during repeated recollection of the trauma, you can incorporate the client’s spiritual beliefs or foundations (as long as they support the client’s recovery). As you move back in time and alight at the time of trauma, encourage the client to look behind them at rays of sunlight, or if they have a more traditional Christian belief system, at the vision of God, Jesus or Mary. For those for whom vision is not a primary sensory modality, try incorporating the sense of embrace, or of spoken words of reassurance emanating from their Higher Power. For those who continue to struggle in their relationship to Source, stick with a more pantheistic theme (e.g. incorporate the strength of Mother Earth below their feet, waiting to consume all the tragedy that they have experienced so that it can be recycled and new life can spring forth).

As symptoms resolve even further, you can prompt the client during his or her MiPET sessions to generate his or her own narrative about what supports him or her in the hour of greatest need. Have your client teach you the story that s/he has come to know as healing, regenerative and restorative. When the client is able to move back and forth through time freely, maintaining that relationship with Source, feelings of abandonment and panic will give way to resignation, understanding and eventually compassion.

And, in the end, survivors will thrive through the knowledge that although the past may have shaped them, in need no longer define them.

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.”

Sugar consumption and addiction fits the classic DSM criteria for substance dependence, including increased physical tolerance; substance taken in larger amounts than intended (whom among us hasn’t eaten an entire bag of cookies or chips?); persistent desire or repeated unsuccessful attempt to quit; use continues despite knowledge of adverse consequences; adverse effects on work, relationships and social functioning; and physical withdrawal symptoms (such as headache, fatigue, irritability and poor concentration).

However, the physiological, mental and emotional effects of sugar addiction on a person frequently mimic other disorders, further muddying the waters in terms of accurately identifying the real culprit. Common symptoms from a sugar high or crash look very much like classic anxiety and depression, and a host of other disorders, including:

• Nervousness
• Exhaustion, weakness

• Faintness, dizziness, tremors, cold sweats
• Drowsiness
• Forgetfulness, confusion
• Constant worrying, unprovoked anxiety
• Craving for sweets or alcohol
• Heart palpitations, rapid pulse
• Indecisiveness
• Lack of coordination
• Lack of concentration
• Muscle twitching and jerking
• Sighing and yawning
• Irritability
• Depression
• Headaches
• Insomnia
• Internal trembling
• Numbness
• Crying spells
• Leg cramps
• Blurred vision
• Itching and crawling skin sensations
• Unconsciousness (The Mood Cure, Julia Ross, 2002)

How many DSM-IV-TR diagnoses could we make out of this list? ADHD? Depression? Anxiety? PTSD? Alcohol intoxication? Psychosis due to Substance Abuse? Yes, yes and yes. This sugar-fueled wild goose chase can lead many-a clinician down a dead-end path. We think we’ve rooted out the problem when a client quits cocaine, only to experience ongoing symptoms as they pound their Red Bull and donut-shop fare.

It’s time to broaden the lens and look at the whole picture of health and illness. A few facts to start: Sugar consumption in America has skyrocketed to disturbingly unhealthy amounts. “We ate 25 pounds of sugar a year in 1900. We now eat over 125 pounds a year, five times more sugar a year than we did then. We also eat lots more starchy white flour products (white bread, bagels, pasta), which act almost exactly like sugar in the body” (The Mood Cure, Julia Ross, 2002).

The insidiousness about this addiction is that sugar is literally hidden everywhere, making a simple trip to the supermarket a veritable minefield of stealthy toxins, waiting to wreak havoc on our wellbeing. Jarred marinara sauce, salad dressings and even whole wheat crackers harbor sugar in their ingredient list, going by such aliases as sucrose, glucose (any –ose, actually), evaporated cane juice, corn syrup, turbinado and malt.

Yes, I’m being a bit overly dramatic in my verbiage, mostly to make a point about the far-reaching effects of sugar on our bodies and minds. And for good reason. Here’s a brief tutorial on what happens when we consume sugar in any form.

Any sort of sugar or carbohydrate (simply, a substance that breaks down into glucose) triggers your pancreas to release insulin to “remove the excess carbohydrate from your bloodstream and store them as fat. The insulin sweeps away most of the amino acids out of your bloodstream, along with the carb. Only one amino gets left behind – tryptophan – and it goes right to your brain, unimpeded by the other aminos that usually get crowded out” (The Mood Cure, Julia Ross, 2002).

This pleasure-producing amino acid is highly addictive, so naturally we want more. This begins a nasty cycle of consuming too many calories and too few nutrients, for which the body must pull from its reserves to assimilate the glucose into the blood and cells. This depletion leaves you feeling…depleted – low energy, low mood, poor motivation – and needing a quick fix.  You can see how the language of addiction is the same here as it is for alcohol and drugs.

Dr. Mark Hyman, a pioneer in the field of Functional Medicine details the mechanics of a sugar addiction in the making:

“Eventually we become resistant to all this insulin in our blood, just as we would become resistant to a drug. The body needs more and more of it to do the same job it once did with far less. So our insulin production system spirals out of control, pumping ever more into our bodies.

All this insulin tells us we are starving (that’s literally the message our bodies get), so we crave foods with high-sugar content – the very same foods that caused the problem in the first place.” (The UltraMind Solution, Dr. Mark Hyman, 2009)

But the bad news does not end with endless cravings (as if that weren’t bad enough). The list of physical problems that result are long and, quite frankly, depressing: “Excess sugar (especially the devilish white stuff) robs your body of minerals, lowers your precious pH, rots your teeth, wigs out your pancreas, feeds candida, fires up inflammation, osteoporosis, diabetes, and cancer, stresses your nervous system and adrenals, and screws with normal hormone function. It also makes you feel crappy after the initial jolt subsides. Sugar taxes your immune system and is highly addictive” (Crazy, Sexy Diet, Kris Carr, 2011).

Some of the precious vitamins sugar robs from your body are the good-mood-essential B vitamins. Absent these critical nutrients, we are more susceptible to depression and anxiety, as well as PTSD and obsessive-compulsive behaviors (The Food-Mood Solution, Jack Challem, 2007).

So what do perennial sweet favorites contain that makes them so irresistible? Let’s start with chocolate:

“Chocolate contains not only plenty of sugar, but at least five drug-like substances: theobromine, caffeine, salsolinol, PEA, magnesium, and amandamide (a marijuana-like brain chemical). All are either stimulating or opiate-like. This extraordinary collection of psychoactive ingredients explains a great deal about chocolate’s super-addicting allure.

Sugar, especially combined with chocolate, forces a rise in endorphin levels. It is the ultimate ‘pleasure’ drug food, but many people can attest to the addictive pleasure of bread and cheese as well” (The Mood Cure, Julia Ross, 2002).

Long-term exposure to sugar in all its forms continually wears down the body until new physical and emotional issues surface. The biggest havoc sugar wreaks is creating a hospitable environment for cancer to grow and proliferate. “Healthy cells love oxygen; cancer cells don’t. Their clunky anaerobic metabolism produces a lot less energy. So to stay alive, cancer cells need a bigger fuel supply. What’s the best way to get quick fuel? Sugars and carbs!” (Crazy, Sexy Diet, Kris Carr, 2011).

As if cancer wasn’t enough to worry about, the issue that will stop most people in their tracks is right under their noses. Literally. I’m talking about good old-fashioned fat. Insulin is a fat-storage hormone, so it not only tells you to eat more empty calories than you need, but it then holds on to them in the form of fat – and won’t let go. So it is literally insulin that is making you fat and keeping you fat.

But wait! There’s more! “It makes your blood sticky and more likely to clot, leading to heart attacks and stroke” (The UltraMind Solution, Dr. Mark Hyman, 2009). It increases inflammation (the source of all pain and disease) and oxidation in our bodies, which increases your odds for Alzheimer’s. It also disrupts healthy sex hormone functioning, which contributes to infertility and unwanted hair growth.

The inflammation of the brain’s cells and neurons contributes to dementia and even autism. Additionally, sugar feeds the “bad bugs” in our gut: parasites, yeast and toxin-producing bacteria. Symptoms from these bugs can mimic many mood disorders, as well as physical symptoms seemingly unrelated to the stomach (The UltraMind Solution, Dr. Mark Hyman, 2009).

Dr. Hyman relates a story about a six-year-old girl who came to him with OCD, aggressiveness and suicidal ideation:

“She loved sugar and refined pastries and carbs… The bacteria and yeast [in the stomach] literally ferment the sugary, starchy foods in the diet, producing ‘auto-intoxication’ with alcohol – a by product of this process. Violent, aggressive behavior so commonly seen in drunks can occur from alcohol produced by yeasts in the gut. I wonder if this little girl had a little auto-brewery in her belly…

The cure was a gluten- and dairy-free whole foods, organic diet; some cod liver oil; magnesium; methylation helpers like B₆, B₁₂, and folate; a multivitamin; and some probiotics…[and] antibiotic to clear out the bad bugs in her gut, followed by an antifungal. [S]he transformed into a well-behaved little girl. Her aggressiveness, negativity, and hopelessness were gone” (The UltraMind Solution, Dr. Mark Hyman, 2009).

And this is just one of hundreds of thousands of anecdotes from integrative doctors and clinicians who looked a little deeper to find what was causing the symptoms that are typically treated “topically” – as Dr. Hyman describes it: “Name It, Blame It, Tame It” – treated them at the root level and saw complete amelioration of symptoms.

Fortunately, treatment for sugar addiction is fairly straight-forward: go cold turkey on sugar, and flood your body with oxygen-producing, nutrient-dense and -rich foods, such as dark, leafy greens, veggies of all sorts, low-glycemic fruits and grains, as well as proteins, such as eggs, fish, turkey and chicken, nuts and beans and a lot of water. Certain nutritional supplements can also help restore depleted vitamin and mineral deficiencies, and are typically recommended. If all symptoms do not clear after a couple of weeks consistently following this plan, clients may need to be test for adrenal fatigue and thyroid issues, both of which can be taxed when insulin works too hard for too long.

But while the treatment is not complex, the ability to successfully complete it can be very challenging. This makes finding a holistically-trained doctor or health counselor to assist in the process especially important. And the rewards for breaking sugar addiction are well worth the effort: increased energy, reduced cravings, effortless weight loss, increased mental clarity and elimination of many physical, mental and emotional side effects. Sweet.

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.

Our latest adventure has brought us to Astoria, Oregon, when the board of Astoria Pointe and The Rosebriar residential treatment centers asked us to come on as CEO (Josie) and medical director (Jim). You can find more about what we’ve been up to, as well as these remarkable centers, in this month’s featured member article.

In the meantime, we want to thank each of our faithful readers and members for continuing to support us and provide us with invaluable feedback. This winter we have been laboriously updating our site server to make sure we can offer the best services in the most efficient manner. While there have been a few glitches along the way, we are grateful for your patience and promise that you will find the new-and-improved RecoveryView.com well worth it.

Kicking off this issue, Dr. Tian Dayton delves into the healing power of journaling in recovery. She explains why not rehashing the mundane details of the day, but taking an honest look at the more difficult memories most people would prefer to avoid may actually bring profound healing in a very empowering, but gentle way.

We are pleased to welcome renowned addictions and codependency expert, author and trainer, Claudia Black to our fold of authors. In this issue, she shares her experience at a camp organized specifically serve children who have been affected by addiction, highlighting the importance of addressing the family system in recovery.

Another new author this issue is our very own clinical editor, Meredith Watkins, who is also an MFT and holistic health counselor. She brings this combination of experience and interests together to share about the significant effect of nutrition on mental health. Often the missing piece of the puzzle in the treatment, nutrition’s role is becoming increasingly understood and used in effective treatment modalities. This will be the first in a series of nutrition-related articles on mental health and recovery.

Coleen Moore also joins us for the first time with a fascinating look at women and gambling. This population is often overlooked in favor of the prominently male population in problem gambling, but the number of women continues to grow. Additionally, the reasons women turn to gambling as a maladaptive coping mechanism may differ from men. The light Moore sheds can undoubtedly lead to more effective treatment in this demographic.

Veteran RecoveryView.com author Andrew Kessler returns with the latest View from the Hill, giving us the update on federal funding for needle exchange programs. He also elucidates legislation that aims to require anyone applying for employment benefits to undergo drug testing, and discusses the potential fallout from each. As always, great food for thought.

Sherry Gaba also returns this month with a look at the toll hours on Facebook and Twitter may be taking on our personal relationships – not just a reduction in personal contact, but an actual increase in divorces based on the ability to find anyone at any time and learn more than you should probably know about them. It’s a fascinating look at what may be the addiction of the new century.

As St. Patrick’s Day nears, those in recovery tend to cringe and pray that it passes in a quick, green blur. Ruth Riddick can relate. It is also why she is so thrilled to share about New York City’s first Sober St. Patrick’s Day – an event we can all get behind.

As we mentioned earlier, our featured member is Astoria Pointe and the Rosebriar. The major changes that have taken place and continue to happen are transforming and building the treatment centers into an even stronger option for residential treatment in the Pacific Northwest. You won’t want to miss out on what’s ahead.

Leading our Book Club this issue are Claudia Black’s series of books, dubbed the Strategy Series: Anger Strategies, Depression Strategies, Family Strategies and Relapse Toolkit. Each grew out of Black’s clinical experience working with families and addictions and are meant to be practical tools for clinicians.

In EMDR Made Simple, author and psychologist, Dr. Jamie Marich, does just that – demystifies the technique, restoring its relevance in the treatment of trauma, depression, anxiety and the like.

Co-authors, Patricia O’Gorman, Ph.D. and Phil Diaz, MSW, explore the outgrowth of co-dependency in the face of trauma in their new book, Healing Trauma Through Self-Parenting: The Codependency Connection. A follow-up to their first book, The 12 Steps to Self-Parenting for Adult Children, this sophomore publication will undoubtedly strike important chords with a wide audience.

So wherever this issue finds you – under five feet of snow or a flowering tree with sun streaming down – we hope that the spirit of spring finds you and fills you with anticipation for a new season and new opportunities. Health and happiness to you all.