Transcript Trauma-Sensitive 12-Step Recovery

Trauma and the 12 Steps:
Clinical Keys For Enhancing
Recovery Services
Jamie Marich, Ph.D., LPCC-S, LICDC-CS
Mindful Ohio
Author, Trauma and the Twelve Steps,
EMDR Made Simple & Trauma Made Simple
About the Presenter
Ohio: LPCC-S, LICDC-CS
 Fourteen years of experience working in social services
and counseling; includes three years of experience in
civilian humanitarian aid in Bosnia-Hercegovina
 Specialist in addictions, trauma, abuse, dissociative
disorders, performance enhancement, grief/loss,
pastoral counseling, mindfulness
 Trained in several specialty interventions for trauma,
most extensively in EMDR Therapy
 Author, qualitative researcher
 Creator, Dancing Mindfulness & Founder of Mindful
Ohio
What led you to today’s
workshop?
Objectives
O Describe how certain 12-step approaches, slogans, and customs
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may be counterproductive when working with a traumatized client
Define trauma in a biopsychosocial/spiritual manner and explain
how honoring this holistic conceptualization of trauma enhances
addiction treatment
Explain how certain features of 12-step recovery are productive for
working with addicted survivors of trauma stress and identify how
these features can be implemented into treatment
Develop a plan for working 12-step recovery strategies alongside
appropriate treatment for the traumatic stress issue(s)
Apply at least three clinical techniques from various psychotherapeutic approaches to help clients attain addiction recovery in
a trauma-sensitive fashion
Dr. Marich’s Working Definition
O Addiction is continuing to do something
(e.g., drink alcohol, smoke cigarettes,
gamble, engage in sexual activity), even
when the activity causes repeated pain
and consequences.
SOURCE: GWC, Inc. (1993), Human Addiction
Models of Addiction
Rigid acceptance of the disease
model, or any alternative model,
is not optimally trauma-sensitive.
Trauma
Etymology
What does the word trauma mean?
Etymology
• Trauma comes from the
Greek word meaning
wound
• What do we know about
physical wounds and how
they heal?
Etymology
Appreciating the wound metaphor
is the heart of understanding
emotional trauma and how to
treat it.
DSM-5® Nutshell Definition of PTSD
Posttraumatic Stress Disorder
(APA, 2013)
O Exposure to actual or threatened a) death, b) serious
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injury, or c) sexual violation: direct experiencing,
witnessing
Intrusion symptoms
Avoidance of stimuli associated with the trauma
Cognitions and Mood: negative alterations
Arousal and reactivity symptoms
Duration of symptoms longer than 1 month
Functional impairment due to disturbances
Trauma: “small-t”
• Adverse life experiences
• Not necessarily life threatening, but definitely life-altering
• Examples include grief/loss, divorce, verbal abuse/bullying, and
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just about everything else…
The trauma itself isn’t the problem—rather, does it addressed?
Is the wound given a chance to heal?
If it was traumatic to the person, then it’s traumatic.
According to the adaptive information processing model, these
adverse life experiences can be just as valid and just as clinically
significant as PTSD-eligible traumas.
A Client’s Perspective:
from Marich (2010)
Fadalia (pseudonym), a recovering heroin addict with complex
trauma reflected on where she was at before receiving the
integrated treatment that led to her longest sobriety to date
(3 years):
“Before [treatment], my feelings, thoughts
and experiences were all tangled like a ball
of yarn. I needed something to untangle
them.”
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Putting it Simply…
O Cognitive-behavioral therapies primarily target
the prefrontal regions of the brain (e.g.,
thinking, judgment, and willpower).
However, when a person gets activated or
triggered by traumatic memories or other
visceral experiences, the prefrontal cortex is
likely to shut down and the limbic brain (e.g.,
emotional brain) takes over.
Putting it Simply…
O Simply talking about the trauma can trigger this
volatile, limbic region, and if the client has no
skills to regulate these intense emotions, a
client can be re-traumatized.
Putting It Simply
O What does not seem to change with traditional talk
therapy is that uncomfortable experience of being
triggered at a visceral level, (bottom of the brain) when
the person is faced with reminiscent features of the
original trauma in the present (Brown, 2003)
Putting it Simply
O Thus, our therapeutic interventions must
address the entire brain.
O Another way to look at processing is to think
of these three brains “linking up”
Let’s Discuss…
O What are your thoughts/feelings on 12-step recovery?
O What limitations have you encountered with 12-step
recovery in certain populations?
O What does it mean for an intervention, such as 12-step
recovery, to be trauma-sensitive?
Common Criticisms of
12-Step Recovery
O Too much emphasis on spirituality
O Too one-size fits all
O Emphasis on powerlessness and character defects is
counter-therapeutic
O Certain 12-step groups and treatment centers can get
too fanatic
O Disease model of addiction is not acceptable
Common Problems in
Treatment
O Rigid application of 12-step principles
without considering role of trauma
O “They’re just addicts”
O “You’re here to work on your addiction, not
the trauma”
O Tricky scenarios in group work
PROBLEM #1
Rigid application of 12-step
principles without
considering role of trauma
Potentially Problematic
12-Step Slogans
O Just For Today/One Day at a Time
O Take the Cotton Out of Your Ears and Put it in
Your Mouth
O Your Best Thinking Got You Here
O Think, Think, Think
O We Are Only as Sick as Our Secrets
O Any misplaced spirituality slogan…
And The Gauntlet…
4th and 5th Step Work
4. Made a searching and fearless moral
inventory of ourselves
5. Admitted to God, to ourselves, and to
another human being the exact nature of
our wrongs.
What makes these steps nearly impossible
for someone with unresolved trauma
issues?
Case Study: Nancy (Marich, 2009)
You can’t put anything in the proper perspective. And you can’t
really get a heads up on what really happened because you were so
traumatized and you had such bad experiences and like in my case, I
had the trauma then I had the- I call it the after-effect of my exhusband- pounding over and over and over and over it for like 14
years after that. I took so much responsibility for it. It was almost like
I victimized myself all over again in my mind.
PROBLEM #2
“They’re just addicts…”
-and/or“You’re here to work on your
addiction, not your trauma.”
Evans & Sullivan (1995):
Living in the Solution
1.) A large portion of clients presenting for treatment in
any setting have a history of childhood trauma.
Respecting this history enhances treatment.
2.) Successful treatment of the trauma must include
working through memories of the trauma in an
experiential way, after the clinician and client have
established a foundation of safety and coping skills
Evans & Sullivan (1995):
Living in the Solution
3.) Substance use disorders are a significant part of the
clinical picture for a substantial number of survivors of
childhood abuse, thus:
-Treatment of the abuse issues that does
not address the substance use issues will
be ineffective
- Treating only the addiction in those with
survivor issues will likely be ineffective
Evans & Sullivan (1995):
Living in the Solution
4.) The disease model of addiction and conventional 12step approaches to treatment are productive in treating
the addicted survivor of trauma
5.) Treatment models for addicted survivors of trauma
must be integrated, and must address the synergism
of trauma and addiction. A two-track approach is
generally ineffective.
Practical Tips for
12-Step Facilitation
O Get to know the local meetings in your area that
are known for tolerance
O Encourage gender-specific meetings
O Advise looking for a sponsor who has at least a
basic understanding of trauma and/or someone
who is not strictly “letter of the law”
Practical Tips for
12-Step Facilitation
O Encourage clients to bring their concerns about
what they see/hear at 12-step meetings to
counseling
O Work with clients to build a set of practical, body-
based coping skills (e.g., breath work, muscle
relaxation, exercise, music, journaling) especially
before 4th and 5th step work
Practical Tips for
12-Step Facilitation
O Consider using individual counseling to help clients
identify their roadblocks to successfully completing
4th and 5th steps (may also apply to 8th and 9th
steps)
O Evaluate with a client whether or not the 5th step will
be best completed with a trained
professional…remember, the step just says another
human being
Practical Tips for
12-Step Facilitation
O Be prepared to process pejorative slogans or
insults to self that clients may hear in meetings or
from traditional counselors
O Name calling and hot seat strategies, even if done
in a spirit of “tough love” can be incredibly
damaging for the traumatized client
PROBLEM #3
Tricky scenarios in group
work…
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:-$
;-)
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:-o
Wrap-Up: Best Practices for
Interacting with Clients
Do not re-traumatize!
Do be genuine
Do ask open-ended questions
Do be non-judgmental
Do make use of the stop sign when appropriate
Do assure the client that they may not be alone
in their experiences (if appropriate)
O Have closure strategies ready
O Do consider the role of shame in addiction,
trauma, and grief
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“When we honestly ask ourselves which
person in our lives means the most to us,
we often find that it is those who, instead
of giving advice, solutions, or cures, have
chosen rather to share our pain and
touch our wounds with a warm and
tender hand.”
-Henri Nouwen
www.traumamadesimple.com/cumberland.ht
ml
www.traumamadesimple.com/videos
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www.Recovery2point0.com
To contact today’s presenter:
Jamie Marich, Ph.D., LPCC-S, LICDC-CS
Mindful Ohio
[email protected]
www.jamiemarich.com
www.drjamiemarich.com
www.TraumaTwelve.com
www.TraumaMadeSimple.com
www.DancingMindfulness.com
Phone: 330-881-2944