EMDR Therapy Phase 2.5: Honoring a Wider Context for Enhanced Preparation by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
As an EMDR educator, people are constantly asking me what I think of the latest trend in EMDR therapy. In the last year or so, Phillip Manfield’s Flash Technique has become all the rage. My students will tell you that I am not easily impressed by the latest spin on the standard protocol or twists on time-honored strategies for resourcing and regulating affect. I’ve long maintained that if you learn the standard protocol well and have a sense of how to mindfully modify with respect to special populations, dissociation, complex trauma, and the art of embodied resourcing, you have what you need. To be clear, I do not oppose use of the Flash Technique if it makes sense to the therapist using it and the technique helps the client. I also want to make my assessment clear that the Flash Technique, like many other trends that have captivated the attention of EMDR practitioners, is not a panacea or a quick fix. Indeed, it can prepare more complex clients for full reprocessing. Yet Flash is not the fullness of complete reprocessing and it is not a substitute for EMDR Phases 3-6. Indeed, there are many other strategies, especially from the tradition of embodied mindfulness, which can also engender more active preparation for reprocessing. Explaining my assessment of flash in this larger context led me and several colleagues on the Institute for Creative Mindfulness faculty to coin the term EMDR Phase 2.5.
Interventions that are more robust than traditional EMDR therapy preparation (Phase 2) that get a client fully ready to handle the affect that may emerge in Phases 3-6 belong in this critical middle ground. Many others and I have long taught that in working with complex trauma and indeed with most clients, doing one Calm Safe Place exercise is grossly insufficient. While the popularity of Resource Development and Installation or RDI (Korn & Leeds, 2002) and Resource Tapping (Parnell, 2008) inspired EMDR therapists to expand their scope on how to conceptualize preparation, many trauma-focused EMDR clinicians see that there are still other needs to be addressed. Namely, how do we help clients not just to stop, pause, or return to equilibrium when they abreact or when a session is due for closure; rather, how do we help prepare them for intensity? The intensity of affect release and shift that can help EMDR therapy to be so effective can also make it so scary for clients who have long been phobic of both affect and mindfulness.
This phobia of both affect and mindfulness develops as a legitimate response to unhealed trauma and dissociation (Forner, 2019), especially if a person was imprinted with negative cognitions such as: “I cannot show my emotions,” “It’s not safe to show my emotions,” “Showing emotions makes me weak,” among others (Marich, 2011; Marich & Dansiger, 2018). I’ve long taught trainees that even though their tendency may be to get nervous when a preparation skill like Calm Safe Place or container doesn’t seem to work, the client is still getting something valuable out of the exercise if you handle it well. These traditional preparation skills, if you follow the textbook, are supposed to bring about pleasant and resource-worthy experiences. Yet if they “go bad,” you now have an opportunity to guide a client through an experience in distress tolerance. For me, teaching a client that they can sit with unpleasant experiences for a time and/or use other resources to shift the focus is the best possible preparation skill that we can give clients in advance of moving into the reprocessing Phases (3-6) where discomfort will happen. For me, this is the essence of EMDR therapy Phase 2.5.
Our program and my approach to EMDR therapy is known for its focus on mindfulness. While Dr. Shapiro herself was a practitioner of mind-body healing modalities and studied with renowned west coast meditation teacher Stephen Levine, many EMDR therapists are not sufficiently grounded in the fundamentals of mindfulness and embodiment. Having these fundamentals is just as important, if not more important, than knowing an advanced preparation technique like Flash. Especially because Flash is not full-proof; many students and consultants have reported to us that it can “go bad” or open up into full reprocessing before a client is ready. As my colleague Dr. Stephen Dansiger and I explain in our 2018 book EMDR Therapy and Mindfulness for Trauma-Focused Care, the standard EMDR protocol is filled with invitations to mindful awareness. Use of questions like what are you noticing now? (Phase 4), when you scan your body from head-to-toe, what are you noticing? (Phase 6) and prompts like Go with that give us all the evidence we need that Shapiro developed EMDR therapy in a mindfulness context. Often defined as the practice of coming back to non-judgmental awareness, many have posited that mindfulness is one of the potential mechanisms of action in EMDR’s success (Logie, 2014; Shapiro, 2018). Yet if the first time a client is asked to be mindful or embodied is during their first run through the protocol, it may be too late.
As Christine Forner (2019) explains in her brilliant new article on connections between dissociation and mindfulness, dissociation is essentially a state of missing mindfulness. Mindfulness is about connection and dissociation is about surviving disconnection. Thus, many individuals who have spent their entire lives dissociating are literally phobic of mindfulness, and in the standard EMDR protocol we are asking them to be both mindful and embodied. This request is not necessarily a bad thing because learning to be mindful and processing mindfully is a major component of what can help us heal. As EMDR practitioners, we must do a better job of preparing clients for what the standard protocol expects.
Mindful and embodied EMDR therapy preparation requires more than just reading a script out of a book on mindfulness or showing a client a video. While I make several video resources in this area available online, I urge that EMDR practitioners must have a personal grounding in mindful and embodied practices to help clients deal with difficulties when the scripts don’t flow as planned for the client. Complex trauma and dissociation is messy and while we can do our best to give you a step list of what to follow for teaching these skills, drawing from your own personal experiences will help you to respond in the moment and guide clients through distress tolerance as safely as possible. In the Institute for Creative Mindfulness curriculum, we teach trainees to offer skills in all of these areas as part of Phase 2 preparation:
While we are not alone as a training program in teaching this widened scope, we see active exploration of these resources and the problems that they can bring up for the client as real opportunities to work with distress tolerance and engage in EMDR Phase 2.5. If a skill “goes bad,” we work with it to help a person notice the affect it creates or return to the present moment from any shut down that it caused. If a client protests, “I can’t do it,” we ask them how we might be able to modify a skill, which can include shortening the length of time that we spend in a skill.
A particularly strong skill from the mindfulness tradition that, in my view, should be taught by every EMDR therapist as part of EMDR Phase 2.5 is Mindfulness of Feeling Tone. Mindfulness of Feeling Tone is the second of four primary foundations of mindfulness. In this meditation, we ask the client to bring up their present-moment experience, scan the body briefly, and ask them if what they are noticing is pleasant, unpleasant, or neutral. Too often we have to orient clients to the language of what are you noticing now and if you’re doing it once they are activated in Phases 3-4, it’s too late. Many of our clients lack the vocabulary and practice with feeling or sensation to begin to even answer this question. This exercise is an elementary yet vital start to the process for it gives them three words to start with that are similar to the EMDR therapy constructs of adaptive, maladaptive, and neutral. You can take Mindfulness of Feeling Tone a step further by deliberately asking a client to bring up some association they would describe as pleasant and then guide them through noticing how they experience pleasant in the body. Do the same thing for unpleasant, which will be more challenging, yet ultimately more preparatory for what is to come in later Phases of EMDR Therapy. They don’t have to sit with the unpleasant experience forever; thirty seconds may suffice. Then you can move on to neutral and if needed, shift back to pleasant, strengthening that adaptive resource with DAS/BLS if appropriate. To watch a video demonstration of me guiding this exercise, please click HERE.
A resource such as Mindfulness of Feeling Tone is similar to the processes of titration and pendulation that Peter Levine actively calls upon in his creation, Somatic Experiencing®. I’ve trained many individuals well-schooled in both Somatic Experiencing and Sensorimotor Psychotherapy® and indeed one of the biggest criticisms they have of EMDR therapy is that we can blast a client in too quickly to the heart of the trauma without easing them into it using processes like titration and pendulation. Titration calls for a slowing down and only working on small pieces of a trauma at a time and then retreating into resources. While this process may go against what many EMDR therapists believe, stringently following Shapiro’s (2018) teaching that “preparation is not processing,” (p.36) I argue that for some complex clients titration is warranted. To me, this is where the Flash Technique is filling a gap in enhanced EMDR therapy preparation. For many years I have addressed this gap, if it appears with a client, by asking them what part of a target memory are they willing to work on first, even if it’s not necessarily the image or worst part. If needed, in the spirit of titration, we retreat into resources and then go back into this gentle test of processing. Sometimes the process of going with what we set up leads us to the worst part, other times it does not and we have to go back and set up the target again to address the worst image or worst part. My modification is another example of an EMDR Phase 2.5 that can lead into full Phase 3-4 that may be appropriate for complex clients. Yet in and of itself, the modification would be incomplete for optimal resolution of the memory.
The Flash Technique also seems to be helpful in the process of pendulation. Levine describes pendulation as the shifting of body sensations or emotions between those of expansion and those of contraction (Levine, 1997; Payne, Levine, &Crane-Godreau, 2015). A key principle of pendulation as practiced in Somatic Experiencing® is that a resilient nervous system is one that can move back and forth between alertness/action and calm/rest without getting caught in the extremes. Pendulation invites a fluctuation between resourced states and activated states as a mechanism for training our nervous system, which can help with long-term integration.
The Flash Technique, as described in this wonderful review by Ricky Greenwald (2017) (click HERE for the link), resonates for me as a practice of pendulation. This makes the Flash Technique a more robust form of EMDR preparation and thus meets my classification of it as EMDR Phase 2.5. I have long felt that EMDR therapists have much we can learn and integrate from Somatic Experiencing® and Sensorimotor Psychotherapy® and I believe that Manfield has given us a way to bring in some of these ideas, especially through the visual channel.
However, Flash Technique is not the only way to prepare our clients more effectively for the intense affect and embodied shifts that will inevitably happen once EMDR Phases 3-6 commence. Some of the mindfulness and embodiment skills that I covered in this article are a mere overview of what EMDR therapists can learn to more effectively prepare clients. I’ve long admired that the flexibility of EMDR therapy Phase 2 allows practitioners to bring in other modalities or approaches that they feel can strengthen the skills a client acquires in preparation. On my team, in addition to traditional mindfulness work, my faculty members and I make use of yoga, dialectical behavior therapy, expressive arts therapy, 12-step strategies, well-established work like Seeking Safety®, and creative interventions offered to us by other leaders in the EMDR therapy community like Jim Knipe and Ana Gomez.
All of these strategies are available to you and to your clients! Learning them and implementing may not feel as simple as reading a script or following a simple set of steps. I know that many EMDR therapists want these steps spelled out and this is natural for adult learners. However, it seems that every few years I talk to therapists who get caught up in the latest trend without learning the context that surrounds it and this is problematic. Even more problematic is if practitioners believe that the latest thing will replace their need to do other, more comprehensive resourcing. There are no short cuts in EMDR therapy; it takes hard work and personal commitment to become fluent and responsive. Committing to the expansion of your skill set using some of the other strategies we described here and your own personal practice with many of these skills means that you will excel at working in EMDR Phase 2.5!
Please, let’s make this an active blog. Share in your comments if this “2.5” concept resonates with you and what you have done to foster this level of preparation other than using the Flash Technique. I look forward to hearing from you.
Special thanks to Institute for Creative Mindfulness team members Amber Stiles-Bodnar, Dr. Stephen Dansiger, Suzanne Rutti, Adam O’Brien, Ramona Skriiko and several others for their contributions to this piece.
Forner, C. (2019). What mindfulness can learn from dissociation and dissociation can learn from mindfulness. Journal of Trauma & Dissociation, 20(1), 1-15.
Greenwald, R. (2017). Flash! Trauma therapy just got easier and faster. Trauma Institute & Child Trauma Institute Blog. 28 November 2017, available at www.childtrauma.com/blog/flash/
Korn, D., & Leeds, A. (2002). Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex post traumatic stress disorder. Journal of Clinical Psychology, 58, 1465–1487.
Levine, P. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
Logie, R. (2014). EMDR- more than just a therapy for PTSD? The Psychologist- The British Psychologist Society, 27 (512-517).
Marich, J. (2011). EMDR made simple: Four approaches to using EMDR with every client. PESI Publishing (Premiere): Eau Claire, WI.
Marich, J. & Dansiger, S. (2018). EMDR therapy & mindfulness for trauma-focused care. New York: Springer Publishing Company.
Parnell, L. (2008). Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. Boulder, CO: Sounds True Books.
Payne, P., Levine, P., & Crane-Godreau, M. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 4 February 2015, DOI: https://doi.org/10.3389/fpsyg.2015.00093
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures, 3rd ed.New York: The Guilford Press.
Ancient philosophers talked about the good life.
The good life is a sort of craft – the Greeks used the word techne. A call from and response to the world around us, requiring adaptation and contextual awareness. The blacksmith, for example, carefully integrates understanding of his material’s malleability, the temperature of his fire, and the resistance of his anvil in hammering out metal goods. Crafts, nay arts, are doings. These aren’t things that are thought about in the abstract. They require the thoughtful and active integration of material conditions in one’s world in order to produce an put forth or express a product. Likewise, the good life, is an active process in which one’s life is carefully crafted like a work of art.
But somewhere along the way philosophers began talking about what it means to live morally - searching for the correct set of rules or principles to which ones’ behavior or internal compass must conform. Kant is most famous for this with his categorical imperative: “Act only according to that maxim whereby you can, at the same time, will that it should become a universal law.” It’s a rather wordy command, that suggests that we ought to take no actions that give rise to logical contradictions. For example, the notion that “stealing is acceptable” is immoral, since stealing wouldn’t be possible in a world where everyone was stealing from everyone all of the time – it would result in a logical contradiction. Ergo, stealing is morally wrong. What is wrong is always wrong and what is good is always good. We can determine right and wrong, good and bad without any reference to the conditions in which a person lives.
Understanding morality this way is certainly a tidy way to look at the world. But humans are full of contradictions. For example, in one moment I might desire your approval, while in the next I could care less of what you think of me. Some might even say that the contradictory nature of our desires and thoughts are the distinguishing feature of what it means to be human. It is certainly one of the things that makes human beings such fascinating creatures. Humans grow, change, and adapt. We look back on the past in light of new experiences and rethink what those past events mean to us. We look into the future with the baggage of past experiences coloring what we see in front of us. We very often have our minds made up only to let all our old ideas go in the face of a new feeling, experience, or idea, and reform our minds again and again over the courses our lives. Very often we are confronted with experiences thrust upon us by conditions outside of our control, and we are forced to grow and adapt to accommodate these changes.
If we suppose that a “good” life can be understood in moral terms – that is right and wrong – we run the risk of losing what it means to be human at all. Because as much pain as there might exist in growth and change, there is also a great deal of beauty.
Over the course of my life I’ve had the privilege of mentoring and coaching a number of women through life challenges. Of watching them crawl through suffering, wash out their wounds, and trudge along. Inevitably, I find a moment in which we are sitting across the table from one another laughing about something completely inconsequential. And there she is. A fully realized human being, flourishing in her own right. It’s like a dance, an artform, to watch another person begin to integrate the pieces of their lives and reorganize their own narrative moving from tragic victim to laughing friend. It’s a dance that invites us to participate ourselves, reconsidering our own stories and rewriting our own endings.
Living morally is living abstractly – divorced from the world in ivory towers determining what is right and wrong for everyone. Living beautifully, crafting a good life, is done in concert with the world in which we live and each another, taking the time to integrate life lessons, and opening our hearts to grow. To rewrite our own unique stories and invite others to do the same.
In the summer of 2000, I set out on my first proper backpacking tour of Central and Eastern Europe. For six weeks I would be visiting all of these historical places that I studied about for years, and I was ill-prepared! The cheap $20 rolling duffle bag with pieces of things pretending to be straps just would not do, especially on the trains. During my first stop—Prague—I saw how much easier it was for other young travelers to navigate the trains having proper backpacks. So at my next stop—Krakow—I found an outdoor shop and paid $80 for my first real backpack. She was amazing! Blue with black trimming, she was so easy to pack, and so wonderful to carry on the trains. I feel like she opened up the world for me and the possibilities in it even wider. For the next nineteen years, she would literally help me carry the baggage of my life and my transformation.
The word “baggage” has taken on an interesting emotional connotation in modern times. My mother always warned me not to date a guy with “baggage.” By the time I got to my mid-thirties, I was brave enough to respond, “Um…mother, I got quite a bit of my own baggage by now.” There’s even a Game Show Network series called Baggage hosted by none other than Jerry Springer where dating show contestants evaluate each other by whether or not they can live with each other’s baggage. And as a trauma therapist I’ve long helped people come to terms with their baggage, a word they often use for the burdens they carry. Sometimes I help them to shed the load that’s weighing them down and other times I help them to make peace with their past and how they carry it. Using the backpacker’s metaphor, sometimes we just need to get a more efficient piece of luggage.
Recent events prompted me into some deep introspection about baggage and all of its metaphors and meanings. I am currently on a one-month tour of the U.K., teaching and writing. When I got to the airport, I noticed that one of the last two functional buckles holding my old girl together had cracked and broken. Over the years everything that once made the old girl an ideal backpack went bad—the waist buckle, the chest strap, some chords and zippers. The two back straps were still intact which made her still okay to use. And suddenly that was no longer the case. I checked in at Cleveland for my flight to London. Yet trying to haul a month’s worth of gear into London city from the airport with a broken backpack was exhausting. I gave her one more go as I proceeded up to Scotland last week and the strain wreaked havoc on my shoulder and back. Knowing that there was no way to fix or to replace the buckle, it was time to lay her to rest and get a new pack.
I was surprised at how difficult that was for me. I’m not really the type to get attached to material things, yet there I was, attachment sick over literal baggage.
“Wow, Buddha would have a field day with this,” I snickered.
The old girl was different. She carried me through the healing journey of the second nineteen years that sought to unravel the confusion and pain that tangled me up in the first twenty. Setting out to travel the world was a major component in my recovery for it showed me new perspectives and different energies. When I ended up moving to Europe for three years in November 2000, I carried everything I needed in the old girl. She came with me on every international trip that followed as I connected with these lost pieces of myself.
When I walked into the outdoor shop in Inverness, Scotland, I reflected on just how far that 20-year-old girl who walked into a similar shop in Krakow had traveled. Two marriages come and gone, sobriety, a doctorate, seven books written, a successful business established, major mental health relapses healed and still healing, coming out in various ways, a story of transformation still in process… Most importantly, we’ve achieved liberation by connecting to the certainly of who we really are and what we stand for—we are total and yet continually evolving towards wholeness. Traveling, embracing the journey—both literal and metaphorical—brought me these gifts.
And now the time had come to get a more functional, efficient pack for the next nineteen years and beyond. When Mark, the lovely salesman in Inverness, explained all of the features on the state-of-the-art red Osprey pack I was privileged enough to buy, my first response was, “But the pouches on the new pack aren’t like the old one—I liked that feature better!” I chuckled at myself—realizing how it’s so easy for all of us to do that during the change process. Without a doubt my new pack is better for my body, contoured for a larger woman’s back and hips and full of efficient features. This new pack is 15 gallons smaller than the old girl, which will force me to pack more efficiently. That’s probably a good thing! I knew in that moment that as attached as I can get to the things I’ve gotten used to, they may no longer be what serves me the best presently.
I’ve learned to travel lighter in the last nineteen years, both literally and metaphorically, and this adjustment certainly helps. I am also a human being struggling to make sense of attachment and heal or release the storylines I carry. In trauma focused therapy, working with attachment is a topic du jour. As an EMDR therapy trainer, I often entertain questions on how well our curriculum can help trainees to work with attachment trauma. While it’s clear that many people with complex trauma were severely wounded in early childhood by the caretakers with whom they should have formed healthy attachment, I’ve never felt that repairing attachment is the entire answer. As a mindfulness-focused EMDR program committed to East-West integration, detachment is just as important. I heartily believe the Buddha’s teaching that attachment or clinging is one of the three main causes of suffering. Yet we are human and healthy attachment is a legitimate need—so how do I reconcile this one, Buddha? Contemplating this question in meditation has taught me that acceptance and letting go are vital to the change process. We can do this at the same time as we grieve the childhood we needed and never received. We can also bring healing to the younger, wounded parts that may still live inside of us, modeling healthy attachment for them. Letting go of the storylines and the attachments that no longer serve us in the present is paramount. Letting go clears the path for healing at all levels.
I ended up letting go of the old girl in my hotel room in Scotland with a note for hotel staff to do what they saw fit. It felt appropriate laying her to rest on the international road, especially in a place as magical as Scotland. I was also blessed to stumble upon a teaching from de-cluttering guru Marie Kondo during the days I wrote in Scotland. She advises, “Have gratitude for the things you're discarding. By giving gratitude, you're giving closure to the relationship with that object, and by doing so, it becomes a lot easier to let go.”
I don’t think I’ve ever read anything so wise and so applicable for people on any path of recovery. Gratitude is a quality of recovery that directly helps us to let go of unhealthy or unserving attachments, yet in modern times gratitude can become so difficult to practice. We are socialized, especially in the West, to focus on what we don’t have instead of celebrating what we do. Further, practicing gratitude can feel impossible especially when you’ve been so hurt and so wronged by life and the people in it. Hopefully this will not block you from at least giving the practice of gratitude a try in your process of letting go and lightening the load.
I thanked the old girl vocally before I left the room that day, and writing this article is a way of publicly offering my thanks. Yes, it’s to an object, yet think of how much this wisdom can also help us let go of the so-called “baggage” from our past that weighs us down—memories, shame-based scripts, unhealthy coping skills, and the impact of wounding relationships. We can thank those things and those people for the role that they played for us at the time. Even the horrible stuff—if you are willing, thank it for its role in bringing you to where you are today, hopefully on the precipice of a major shift in your continued healing and recovery.
I chant to a monkey.
No really, I do. I chant to a monkey.
There was a time in my life where I never would have put this out there in public, especially as a young professional afraid of being labeled as too fringe or hippy-dippy. The time is now to out myself: Every night for the last year I’ve chanted a 16th century hymn from the Hindu tradition called The Hanuman Chalisa. As a monkey, Hanuman is seen as a bridge between the wisdom of the animal world and the human world. As a symbol for breath, he is the bridge that unifies feminine energy and masculine consciousness. Many devotees of Lord Hanuman engage in this chant as a daily practice; it would be similar to those with great devotions to St. Francis singing any version of a Prayer of St. Francis hymn daily. And I’ve been known to sing to him too. Plus, I pray an Our Father and Hail Mary every morning—in Croatian (my family’s ancestral language)—do Japa meditation (prayer beads), practice yoga in various ways, read from my 12-step meditation books and pray some of those prayers. Those are just my daily practices! On any given week I may also consult with my Ayurvedic clinician, see my expressive arts therapist and spiritual director over Skype, or saunter up to Buffalo for some of my own EMDR therapy. And then there’s the penchant I have for receiving bodywork and energy work…shall I go on?
There is a very important reason why I am going here, letting the weirdness of my daily and other regular practices shine out so directly. These practices help me to stay mentally healthy, especially in being able to navigate the judgment and cruelty of the world at large. In the last several years, and with increasing frequency lately, many friends, students, and folks I mentor have shared with me their concerns about being perceived as too weird. Whether it’s a feeling of self-consciousness about their cleaning regimens, their spiritual practices, or having ways of seeing the world that may clash with the mainstream, people can viciously judge themselves based on the fear of how others will respond. In a recent conversation about weirdness and perception, I blurted out the “I chant to a monkey” response. I’ve found this phrase to be such an empowering anthem that I now use it when clients, students and folks I train come to me with a hesitancy to share, fearing how I will perceive them.
“I chant to a monkey… try me.”
For many of us who have survived the trenches of academia or currently hold a professional license as a clinician, the fear of being persecuted for our weirdness or differentness has merit. I and many others in the Dancing Mindfulness community could fill a whole book of horror stories documenting how professors and other colleagues have treated us for taking an interest in Eastern meditation, embodied practices, and anything that is outside of the talk therapy, medical model norm. In essence, we are the weird ones for going back and reclaiming the merits of ancient healing systems and endeavoring to make them work for modern clients, students, and practitioners. Not creative, not integrative…weird.
The professional standards committee of my state’s licensure board has challenged me as an educator three times for offering programs in the area of dance, mindfulness, expressive arts therapy, and yoga. Of course, I’ve been able to support their merit, with literature, of offering such programs for clinicians who will pass the valuable learning on to clients who are desperately needing more than what the field has been giving them. Yet every time I presented before the committees, I have had to address the issues coming up for me about them labeling me as too weird or flaky. Like many of us, my wounding around weird goes back to family of origin baggage and getting bullied by peers in elementary school for being the oddball. Of course, the board challenges made me angry and even sad at first.
Then I learned to embrace the challenge to calmly show them that there is another way to exist as a professional in our field. This involved a great deal of time and effort cleaning out and healing my old stuff and drawing inspiration from the monkey I chant to, Hanuman—be a bridge. Don’t be afraid to be yourself, especially with others who get your weirdness. If someone you work with or interact with in life needs to see an example of weird as healthy and functional, show it. Yet when working with the mainstream of any given field, a good deal of translation may be required. This is always possible when you are not ashamed of who you really are and know how your weirdness (and all the oddities and rituals that may come with it) helps you live and hopefully even thrive in this world.
In working with my latest expressive arts student to have the weirdness conversation with me, some wisdom from the Croatian language struck me like a bolt of lightning. The Croatian word for weird or strange (čudan) and the Croatian word for miracle (čudo) come from the same root. Both imply something supernatural or out of the ordinary. Yet we can think of a miracle as being a gift and weirdness as being a curse. What if we started to view them as one in the same? Would more of us feel comfortable coming out as weird, or more widely acknowledge that we all do some pretty weird things? Can I learn to embrace my weirdness for what it is—a miraculous gift that helps me to see the world in a way that we need in order to smash existing paradigms and bring about some deep healing?
Whenever someone I mentor professionally expresses fear about being perceived as too weird, I take pride in telling them that they are not alone and that there are others of us who feel similarly. One time I referred to the Dancing Mindfulness community as the island of misfit therapists, and that’s a descriptor I use proudly to this day. Connect with the other weirdos out there and before long you may even learn to see yourself as a trailblazer who is in an amazing position to liberate others from the confines of judgment and condemnation in which they find themselves. If you can be proud of your weirdness as a professional of any kind, imagine how inspirational you can be to the people you serve. If more of us learned to embrace the weirdness that we are in our daily lives, regardless of what we do or where we live, that would truly be miraculous, and it will take such a miracle to heal the world.
I chant to a monkey… what of it?
Risks are fucking scary. Even a cursory glance at the most banal dictionary app’s definition makes my spine shudder: to expose oneself to the chance of injury or loss; a hazard or dangerous chance. In contemplating a massive risk that I recently decided to take in my own life, I found myself saying, “I fear death less than I fear giving this a chance, even though my gut and my spiritual practice suggests that I’ll regret it if I don’t take the risk.” When I stepped back, I realized the gravity of such a statement. How is it that my journey has allowed me to become so comfortable with my own death, yet so scared of many aspects of my life?
I travel quite a bit for work—I’m on a plane anywhere from 2-3 times a month and I regularly deal with questions from family members asking if I ever get scared traveling so much, especially internationally.
“No, not at all,” I answer, without reservation or fail.
Maybe it comes as no surprise that I have a recurring dream about dying in a plane crash. Perhaps it’s because, with the nature of my life, dying in such a way is a possibility. Yet I always wake up even more excited to travel. Having this dream about 4-5 times a year has never once made me scared of flight. Indeed, they usually make me more excited to see the world. The most powerful version of my recurring dream gave me some insight as to why.
The dreaming state taught me the lesson on the night of the Tree of Life synagogue massacre in Pittsburgh, PA (October 27, 2018). Although I was away teaching in Montana, I went to bed with a heavy heart because of my many ties to the community of Squirrel Hill where the tragedy happened. At some point that day, in talking with a friend, I even uttered in frustration, “Is trying to make a difference doing the things we do even worth it?” And the dream delivered the answer.
I was on a flight sitting next to two veterans who had recently been in Iraq. I was not clear on my destination in the dream, although very likely it was work-related. A few minutes after take-off, as I turned off my music and began to reach for a book, the plane began to take a deep dive. There were screams and wails all around me and I heard one of the veterans say, “Here we go.”
They knew what was coming, and then so did I.
I closed my eyes and surrendered my life over to spirit in a way I never had. I don’t recall the impact because shortly after closing my eyes, I just went blank in the most effortless way imaginable.
A short while later the dream continued. I found myself in a holding space, some type of hangar, with others who died in the crash. I learned that 10 survived and 300 of us perished, mostly from smoke inhalation as we tried to get out. I had some vague thoughts about my best friend Allie and many of my other friends being there to carry on my business, although they fleeted quickly. Instead, I became enraptured by the kinship I experienced with the others in that sacred space. We all started moving towards a ladder at the other end of the hangar.
One-by-one, people started to climb the ladder. A beautiful Indian woman adorned in a gold scarf was in front of me in the line.
She turned back to me and said, “I don’t know if this is the most appropriate thing to say right now but—wow! Wasn’t that the most powerful blast of shakti (energy) ever! That crash was amazing!”
I smiled, knowing exactly what she meant.
“Yup, I get it. I’ve never been so relaxed in my whole life. Pure peace.”
We laughed, kept climbing the ladder, and she said, “So let’s get ready to do this thing again…knowing what we know now.”
“Let’s do it again!,” I responded.
I awoke the next morning with the clearest understanding of karma ever—the chance to do it over again with all the visceral knowledge of what we learned the time before. The chance to make it right. In my case, the chance to surrender into life’s divine flow instead of letting it devour me in fear. The most obvious interpretation of my dream suggests that my death and subsequent transition to the next cycle of rebirth will give me that chance. Yes, such an interpretation is in my personal belief system. And yet when my feet hit the ground to engage in my morning practices in preparation for teaching, I knew that message was meant for me in this lifetime.
What if, Pragya, you could surrender into the uncertainties of life with the same degree of unconditional faith and peacefulness that you accepted your death in the plane crash? What if, every time you were presented with a chance to start over knowing what you know now, you could embrace it with the enthusiasm of let’s do it again!? The same way a faith-filled, resilient child who just fell off of their bicycle might, eager to try once more, equipped with the spirit of their new learning? What if you could embrace each new day with the wisdom of what you have learned and with the faith of what you cannot possibly know?
My intention in this next season of my life is to say yes—resoundingly, enthusiastically, and faithfully to all of these questions. This intention is becoming my daily prayer, as my practices help me to integrate all of these pearls into the grand process of living. Yes, I will relax into the uncertainties of life with faith and peace. Yes, I will meet my new opportunities with a spirit of let’s do it again, releasing the burdens of my past. Yes, I will approach life with the beginner’s mind of a resilient child and yes—I will greet each new day fortified with the wisdom of what I have learned while also approaching it with faith of and in the unseen.
It is often thought that someone with a speech or communication disorder must be fixed. They’re broken. The identified disorder is viewed as pathological and treated as such. I know this, I have one. From the age of 2 years old to 15 years old, I spent many a day in the speech therapist’s office focused on pronunciation, how to place my tongue, how to move my lips, how to move my jaw, how to breathe as I speak. So do a multitude of others who visit those very offices.
However, when you think of speech disorders, have you ever thought of understanding that individual? Instead of the passed down language, we inherited our own language and are merely struggling to learn yours?
I bring this up, because this is an important concept to take in consideration when it comes to therapy. When you have someone sitting across from you who speaks a different language, you find ways to communicate with them: a translator or someone who speaks their language. However, with an individual with a speech disorder, that bridge of understanding is rarely crossed. Yes, there is circumlocution in regards to what we’re trying to communicate. Yes, eventually an understanding is meet. Usually through frustration and anxiety. Embarrassment. Irritation. Shame. D) all of the above. All this frustration can be seen in memes posted about speech disorders (either from those living with one or those making fun of it). So why not try to find other ways to support that person sitting across from you?
Language, speech, and communication do not come to fruition until the neocortex, while emotions occur within the midbrain; Way before conscious thought sees the light of day (for more information on this, you can look up the triune brain). Typically, with speech therapy, you’ll see various types of art or games to help bridge this gap. I remember multiple times in sessions, we’d be blowing bubbles, doing artwork while working on pronunciations, learning how to breathe, and what not. This helped the other kids and me tremendously.
Therapy is where all the emotions are meant to be greeted and dealt with. This is where I’ve fallen in love with Expressive Arts Therapy and Eye Movement Desensitization and Reprocessing (EMDR), because they don’t necessarily require that much language. The understanding comes from within and the art. If an individual is having difficulty expressing themselves, they can use art to get it across. This is true for the main populace in general, however, has so much meaning for an individual who struggles with speech on a day to day basis. Trying to fight oneself to pronounce shit isn’t an issue when art is involved. This subtracts a good amount of embarrassment and shame from communication, because the focal point is on the piece or with EMDR, they can motion to keep going. No speech necessary.
While this is only a small insight into the world of speech and communication disorders, I encourage you to take a step back and reflect on how you communicate. To reflect on how difficult it would be to have your own body and mind fighting you against communication. Take this reflection a step further and consider how would you bridge a gap of understanding between yourself and another, to support them. How would you redefine you approach to see the individual and meet them where they are?
What makes something art? When we walk into an art museum, what do we see? Paintings, sculpture, perhaps some ancient pottery or baskets. They are shelved on glass-cased pedestals or housed in frames in a building surrounded by kept grounds and large parking lots. To experience these items is an event. Perhaps something undertaken as a Saturday afternoon treat. They exist outside of my everyday existence. Separated and categorized as products of “fine art” that are distinct from the things or experiences that populate my life the rest of the days of the week.
The invention of fine art is relatively new, with Charles Batteux coining the phrase “beaux arts” in 1746, grouping together what we now think of as “fine arts.” Certain forms of art such as painting, and sculpture became distinct from craftsmanship on the basis that the former exist only to inspire contemplation of beauty, while the latter had function and purpose. Over time these fine arts were gathered up and deposited in a museum. Even though much of what we see in museums doesn’t conform to this Enlightenment era idea that art is exclusively for the contemplation of beauty, Batteux’s legacy is intact, in that we often think of these things as fundamentally separate from our everyday experience. They are much more special and somehow distant from us. For me this has manifested in thoughts like, “I’m no artist,” or “I’m not a creative person.”
I couldn’t do what those artists were doing.
However, for most of history there hasn’t been a distinction between fine art and crafts. Rather, works of art were intimately tied to a historical period and existed in a cultural context. Music and poetry came from monasteries written for religious services, metal smiths forged incredible items in the name of wars, and detailed pottery was crafted for service in fine dinners. The artistic act has been intimately tied to daily life for most of human history, existing in a complex network of social, cultural, and historical conditions.
So, in order to understand what art is, we might first ask what constitutes human experience. A heady question, I know. Upon reflection of my own experiences it's a mishmash of anxiety, depression, joy, excitement, anticipation, gratitude, sorrow and more. Often, it is all of these things at the same time. It’s the tension between bringing the component feelings, people, places, and ideas together in resolution. It’s the integration of these moments of past regret and future anticipation into the present, when I’m most fully alive. When I find myself keenly aware of the way in which the past informs me and how the possibility of the future exists like a halo in the present moment, watching a sunset, or listening to the frogs jump in the pond, that is when I am most fully experiencing life in the moment. It’s what John Dewey calls an experience. It is the refined form of everyday experience, in which each component of that experience, whether its physical, emotional, or temporal are harmoniously interwoven and complimentary.
Art then, is concerned with living. It is the process of weaving thoughts, events, and feelings into that moment of integration. It encompasses the tension we feel in attempting to piece together what feel like disparate ideas and competing feelings, as they are brought together in the present moment. This is fundamentally what the artist does – she applies paint to the canvas, stands back and readjusts, picking up a new color or medium in response to what is felt from the canvas. It’s a process of interplay, adjustment, harmonizing, acting, and reacting until each component part comes together in just the right balance. The act of the artist is no different than the integration that occurs for each of us when we struggle through the tension to find the right balance in any given present moment.
At the end of the day, although our mediums may vary, we are all capable of being artists, because artistry is not about housing pieces in museums, it is about how we live our lives. The tension and resolution may occur for some in the studio, for others it may take place in the garden, or in listening to the frogs jump in the pond while reading John Dewey. Or it may take place while watching the sun set behind the mountains in northern Thailand while writing a blog, considering the events that led me to this moment, what it means for my future, the sounds of the crickets, and dinner being washed up beneath me in the stillness of the evening, punctuated by the chanting of monks in a nearby temple, in solitude and peace. Although I am surrounded by paints, canvases, ceramics, its these moments in which I am most fully alive, crafting life as a work of art.
On the Monday after Thanksgiving eighteen years ago, I ran away to Europe. My addiction and untreated emotional problems left me in a state of chronic suicidal contemplation. Every time I used drugs and drank that autumn, I hoped that I wouldn’t wake up. There was nowhere I could really turn for help without being met with answers like, “Just go back to church,” or “Tough it out, you’re too smart for all of this.” Something that I can only describe as a shimmer of clarity woke me up on Black Friday with a clear message: Go to Europe.
The few months I’d spent backpacking through Central and Eastern Europe earlier that year were some of the happiest times in my life to that point. Moreover, getting to connect with my Croatian relatives that summer and in the two previous years I spent traveling and studying in my ancestral homeland was like finding a part of myself I’d been desperate to meet. So over what remained of Thanksgiving weekend I made the arrangements—got my money out of savings, bought a cheap ticket to Prague with the intention of taking the train further south to Croatia and then Hercegovina, and wrote letters explaining to the people in my life that I needed to leave to be okay. I took the gamble, left that Monday, and stayed for almost three years.
I recently recounted the story to one of my oldest and dearest friends. He said in reply, “Jamie, stop saying you ran away to Europe. You moved to Europe.”
I chuckled and sighed when I heard his reframe. Indeed, everything truly wonderful that happened to me—especially finding my recovery and my life’s vocational path—was a direct result of taking that risk to move. In the English language the concept of motivation comes from the Latin word meaning “to move.” So, the very concept of being motivated is rooted in movement. And we don’t give movement (and all the ways we can engage it) enough credit in the change process.
In recovery circles we can be quick to condemn the so-called geographic cure, or the notion that just changing locations is the magic bullet that will make all of your problems disappear. Of course, you take yourself with you wherever you go, and if nothing changes inside then nothing will change overall. Some people would describe what I did by moving to Europe as a geographical cure in the pejorative sense. Even when I share my lead or qualification at a 12-step speaker meeting sometimes I tease myself about it. Janet Leff—my very wise first sponsor and fellow humanitarian aid worker who I met while living in Europe—once made a powerful distinction.
She offered: “Sometimes it’s necessary to make a change—change jobs, change relationships, change cities. We have to ask ourselves though, are we running away from something or running towards something better? Like recovery, our self-dignity, an opportunity that’s better for us and our growth?”
These questions are useful for all of us in recovery as we contemplate making changes, especially if those around us try to shame us for our choices. When I reflect back on those moments in the Fall of 2000, there is no doubt that moving myself in the most radical way possible was needed in order to survive. When I arrived back in Croatia and then to Bosnia-Hercegovina where I settled, I struggled a great deal. It was certainly no geographic cure! I thought that church was the only answer at first and that working for the Catholic Church (which I did) would save me. I thought that I could still drink like a fish and hang out with men who weren’t good for me, as long as I wasn’t popping pills.
And then 12-step recovery found me in the person of Janet Leff, who first befriended me and then asked me to translate a recovery council meeting in the local community for her one day. This powerful system of help, which was devised in my home state of Ohio, found me in the hills of Hercegovina in the years following a brutal civil war in that region. Janet, whose story I tell more fully in Trauma and the Twelve Steps (2012), was there to answer all of my questions I struggled to piece together about my life in chemicals and my emotional demons. A retired clinical social worker, Janet was the first person to give me the framework of unhealed trauma as the main explanation for my mental health and addiction concerns. Because of her commitment to carry a message of recovery to others and lead by example in her life, I’ve been continuously sober since July 2002. There are not enough words to express my gratitude to her and the cosmic flow that brought me to her.
The other layer to this story is how my move to Europe impacted my professional development. If you’re reading this blog on the Institute for Creative Mindfulness site, chances are that you’ve taken a training with me, have read one of my books, or have worked with me in some capacity. What I do today is a direct result of the seeds that Janet and others planted during my work there from 2001-2003. When I moved to Europe, I was starting a graduate degree in history; I took two psychology courses in my undergraduate studies and hated them! So, when both Janet and the priest who was my immediate supervisor suggested that I go to graduate school for clinical counseling, I laughed at them. Janet chuckled in response and said, “Trust me, you’ll be good at it.”
As I reflect back on this time in my life that set the course for the road ahead, I am grateful to be a mover in every sense of the word. Friendships that I made, some very deep, last to this day and continue to shape me. I learned for certain that the world is much bigger and full of wonder than the American bubble of success and failure in which I’d been raised to imprison myself, and there are parts of me to be found everywhere if I’m only brave enough to look. I pray every day that the work I do as I move about the world in the present time honors Janet’s memory.
To be a mover is to embrace a challenge with forward momentum, even if the temptation is to judge yourself as a coward for what may seem like running away. For you, moving halfway around the world may not be required. Although for change to happen, taking actionable steps in the direction of change is an imperative. Movement heals—a simple phrase I often teach in my Dancing Mindfulness expressive arts therapy work. Now, as I spend Thanksgiving weekend of 2018 clean, sober, and mostly sane on holiday in Slovenia and Croatia, two of the places that revived my spirit all those years ago, I realize the deeper truth in this simple teaching.
In memory of Janet Leff (1941-2017)
Hello, my name is Marnie and I have a question: What is in a name? It’s a question I’ve been pondering lately. Our parents decide what to call us before our voices can be heard. These names usually have some sort of significance for them and I remember school assignments on the discovery of name meanings. Our birthnames become our labels. In a world full of labels, our birthnames end up as our number one label we strive to fulfill.
We try to fit into these names. Take into account the name lists that float around Facebook. Being able to find our names on Coke bottles. Our names mean something to us. However, what if we don’t identify with our birthname? It becomes this scratching walls that is suffocating.
You see, I have a speech impediment from childhood trauma and it impacts my processing (mental stutters) and my ability to pronounce anything with a “R.” “R’s” can go to Hell for all I care. And of all the “R” sounds that could possibly exist, my birthname has one of the hardest configurations of that godforsaken sound.
There have been many speech therapy sessions spent on pronouncing my name. Many. Over time, I developed a sense of shame and embarrassment. My number one label, my number one identifier, and I can’t say it. When out and about with friends and family, it intuitively became a thing that they’d pronounce my name for me. I don’t know if they perceived my shoulders dropping in, my split-second hesitation, whenever anyone asked, “What’s your name?” My voice would get caught in my throat and I’d shrink into myself. “Just call me, M.”
It got worse when people asked where my accent was from. From as far back as I can remember to when I was 26, every day I was asked where my accent was from. When I was younger, I would tell people I moved around a lot. It wasn’t until I was 23 that the internalized shame branched off into anger and I dreaded every interaction with new people.
“Where’s your accent from?”
“It’s a speech impediment.”
Whenever I dropped that bombshell, people would begin to squirm. How does one come back from that? This moment is the opportunity I take to remove myself from the conversation. I remember a couple of times when people would learn about my speech impediment and the fact I couldn’t say my name, they kept trying to pressure me into speaking. Into saying my name.
Oh man, I felt small and that shame bubble only got bigger. Each interaction, I shrunk a bit more. It’s not to say I didn’t like my name, but I didn’t feel comfortable with it. There were points when I mentioned it to my family and was met with various responses, “but your name is pretty,” “It’s a good name,” “I like it.” All responses kept me quiet. However, that need to identify with something else, that need to change my name, followed me around.
This past year, the urge to change my name has only gotten stronger. If anyone read my last blog, know I have a pretty strong intuition. It wasn’t until a recent drive down to an Expressive Arts retreat that I felt comfortable playing with another name. “Tell them to use, Peyton,” bounced around my skull until I shared with road trip buddies to use it for the remainder of the trip together. Thankfully, they took it well and supported it. The entire trip I responded to Peyton like it had always been my name. We also realized it sounds like “painting,” which is something I am passionate about. It felt like coming home.
It dawned on me that my speech impediment has become my identity. Who I’d interact with, how I interact, how I presented myself, all revolved around my speech. I put myself in a corner over time and lost my voice in the process. Picking a name for myself has helped me find my voice I previously locked away. A sort of reclaiming a piece of myself.
So, what’s in a name? For me, everything. My birthname has kept me stuck in a loop of “I’m defective,” because I don’t speak like everybody else. It created this identity of something being wrong with me. A reminder of my trauma history. A reminder of feeling small and powerless. A name is a powerful thing, and everyone should have the opportunity to express who they are, even if it’s a name change. It’s how we introduce ourselves to the world, to people, to ourselves. It can keep us in a box or set us free.
So, hello, my name is Peyton.
Peyton Cram LPC, LCDC III (pronouns They, Them, Theirs) is a Dancing Mindfulness Facilitator, EMDR Therapist, Expressive Arts Therapist, artist, and life-long learner. They received their MSEd in Clinical Mental Health Counseling at Youngstown State University and is currently the Outpatient Program Supervisor at Valor Recovery Centers. Peyton is also a Reiki lvl 2.
As a trauma and addiction clinician and a person in long-term recovery from my addictions, I recognize my, and the clients I serve, need to answer the question “what is addiction?” I find that most people struggle with making sense of addiction initially because it is often paradoxical but when I share my perspective on addiction, people readily and agreeably understand. So, this led me to the question of “Can Addiction be Made Simple?” In my quest to answer this rather large question for myself, (before heeding Dr. Jamie Marich’s warning in her chapter “The Addiction Imperative” from Trauma Made Simple (2014) that she has seen many people go down as a result of chasing this answer), I found that simplifying addiction through philosophical understandings and reframing the psychological symptoms of addiction through a trauma-informed perspective offered the answer that addiction is a series of stuck memories i.e., trauma. As a result of this finding, it is clear to me that addiction and trauma are inseparable because they are a part of the same process.
As I began to better understand trauma and how the memory systems work in the brain and mind, I saw addiction present itself in a way that was relatable. I believe the journey I took to answer this question and the conclusions I have drawn will help others define addiction for themselves but also provide insight into how we conceptualize, categorize, and diagnose mental health disorders.
From a philosophical point of view, the question of “what is addiction?” revisits the age-old question, “Is the essence of human nature good or bad?” In the ever-telling pursuit of truth, the answer lies in the journey as the philosopher sits patiently and waits to have you quantify two extremes. “Who is asking the question?” the philosopher asks while waiting to observe a spark of enlightenment. Any two extremes exist in contrast to one another; hence they are a part of the same process. For example, night and day are relative to the observer and the truth of the answer lies in timing of the question. Pain and pleasure, an obvious example of opposites, are understood by reference to one another. This is illustrated in the Taoist concept of Mutual Arising and the Buddhist concept of Dependent Origination (Watts, 1975). Both of these concepts imply that you cannot have one without the other - if one ceases to exist, so does the other i.e., existence and non-existence must co-exist.
Here we enter into the paradox of addiction. What feels good is actually bad. The addicted person’s “choice” to pursue a course of action that is ultimately harmful isn’t logical! The person who is addicted and the outside observer understand addiction from different perspectives. Both understandings are right since the context of each perspective is important for shaping the ways in which we come to define, know, and treat addiction: The person who is in an addicted state is much more feeling or emotionally oriented, while the outside observer is more focused on the illogical nature of the outcomes. These are often the result of short-term vs. long-term thinking, hence adding to the dualistic nature of opposites.
Addiction’s Paradox in the Brain
These two perspectives come from different sides of the brain. The left side of the brain houses logical processes that use verbal language and the right brain houses emotional processes that use non-verbal communication (Siegel & Bryson, 2011). The different sides of the brain speak two different languages and represent the argument of “choice or disease.” The choice argument, associated with the logical or left side of the brain, is correct in saying that there is a choice in any behavior. But I had to ask myself, where does the brain get the information to make those choices? The answer lies in memory systems, which include our unconscious reptilian brain. The reptilian brain has one mode and primary function: survive by any means necessary and is only interested in short-term outcomes. Survival needs include staying alive in dangerous situations (pain) as well as ensuring that procreation happens (pleasure). The fact that pleasure is a survival need means that pleasure is a main motivator for addictive behaviors.
Survival mode fluctuates due to environmental stresses and stimuli, but also it is not alone in processing information. There are higher levels of brain functioning like decision-making processes that take place in the neo-cortex and mid-brain and with which the survival brain must communicate. However, when the survival brain is activated, it dominates the higher levels of functioning by controlling the information through regulation of the blood flow in preparation for fight, flight, freeze, or appease when a perceived danger or opportunity for pleasure is present. So, the innate drive to survive is what informs our decision-making process or “choice”, particularly when confronted with danger or our need to satiate with pleasure to ensure procreation.
So what are the physical and psychological symptoms of addiction (pleasure)? Intrusive reminders, dreams about the experience, mood irregularities based on whether or not the pleasurable experience is going to happen, strong emotions related to everything, and distorted beliefs about anything and everything… “Wait a moment, trauma, is that you? It is like I am looking in the mirror and it is me but not me.” “Yes. It is me, trauma. I have been hiding in addictive behaviors.” So, trauma and addiction are a part of the same process and that is why I say that addiction is trauma (in its positive form and relative to the observer). Conversely, I can also say that trauma is addiction but will have to save that twist until the end.
In order to see how addiction is traumatic, we have to see beyond the idea that addiction is a choice (which ultimately implies fault and produces the stigma of addiction) and the disease argument. These are not the only options. If we attempt to observe addictive behavior without the “addiction is a choice or disease” framework, what is happening? The body is being injected with poison, smoke is in the lungs, neurological systems are being physically stressed by being overloaded and flooded with neurotransmitters, or one is drowning oneself with something flammable – the survival of the organism is being threatened and it likes it. The body remembers experiences like chicken pox or environmental toxins because it might have to defend itself again, just like it remembers the addictive behavior and the effects of the behavior as means of survival. In this sense the body is practical and functional in performing this neutral action and as Deb Dana (2018) points out, the autonomic nervous system does not calculate “good or bad” it just performs its obligation to survival. With respect to understanding addiction as a disease, we must see how addiction behaviors produce trauma in the organism and create traumatic memory. At a symptoms level, active addiction is more reflective of Acute Stress Disorder (ASD) or Post-Traumatic Stress (PTSD), which boils down to unresolved traumatic memories (Shapiro; 2001, ver der Kolk, 2014; Ecker, Ticic, & Hulley, 2012).
Body and mind meet when memory is formed or accessed. Both the body and the mind access memories to guide their decision-making process and when these experiences are referenced; this is what informs the decision-making process. There are different types of memory and they perform different tasks with different responsibilities to help us get through the day. What in our understanding is not based on memory? Genetics, language, and the entire universe are all series of events, remembrances, and links in a chain connecting the present moment to the past. Both trauma and addiction create stress in the body and mind. Positive stress is still stress. Biological symptoms of addiction speak to withdrawal, cravings, and triggers but these can be understood as physical manifestations of PTSD symptoms because bodily operations and responses are a form of memory. Yet if there is a disconnect between the higher and lower functioning’s of the brain or the lateral exchange of logical and emotional content then there is going to be dysfunction. So, fundamentally addiction should be understood as a manifestation of PTSD. Moreover, Addiction and trauma can be understood as two poles on the spectrum of dissociation
Dissociation is the Relationship Between Addiction and Trauma
Van der Hart, Nijenhuis, and Steele (2006) cite Pierre Janet’s early observations from 1887 that dissociation is a “division of the personality or of consciousness” and that these include “systems of ideas and functions that constitute personality (2006).” In essence, dissociation is the process of disconnecting from the conscious or present moment due to a stress and acts as a defense mechanism for the “personality.” Both addictive behaviors and occurrences of trauma induce dissociation due to the impact on the state of consciousness that occurs during the response or act. The types of events and frequency ranges from a single incident to way too many to count, so they can be seen as on a spectrum as well. Ross (2013) sees PTSD as on a dissociation spectrum but does not identify addiction as on the spectrum of trauma-related dissociation. Yet Ross and others miss the point that the body is neutral when a toxin, which creates a trauma, invades the body, mind, and memory system. To include addiction on this spectrum, even if it is induced-dissociation (which I think that there is more to it then just that), means that we have a fuller picture of our pathology and of human behaviors like self-harm, sexualized behaviors, all forms of abuse, dependent issues, obsessive-compulsion, suicidal ideation, eating disorders, perfectionism, entitlement, abuses of power, and personality disorders.
I propose, as Ross suggests (2013), that trauma is really on a dissociative spectrum but I would also like to include addiction-induced dissociation because the impact is similar on the psyche i.e., Dr. Jekyll and Mr. Hyde as different aspects or parts of the personality emerge when under the influence. All addictive behaviors mimic existing states in the body and mind (Inaba & Cohen, 2007) and so dissociative states are going to be produced in addictive behaviors. This is why I believe that we should be focusing on trauma and dissociation when understanding, treating, or making addiction simple enough to understand.
Traumatology has provided a roadmap for categorizing mental health disorders. I feel that a better understanding addiction would lead to a similar understanding, i.e. would create more space for trans-diagnostic treatments. Over the past two decades, Traumatology and Trauma-Informed Care has greatly increased our understanding of trauma but has not identified one core ingredient as its cause. We still must ask, under what conditions do most traumas occur? I would suggest that our addictions (being in a state of trying to satiate unmet survival needs via harmful behaviors) are an answer to that question. Here we can see the intimate relationship between trauma and addiction, wherein addiction is a function of trauma, and the core ingredient of trauma can be understood in terms of addiction. This is why our human drama unfolds the way it does. We become addicted to our stories and our stories become addicting and create the traumas from which we can heal. At its core, our addictions are wants labeled as needs. The results of trying to get our mislabeled needs met, we creates trauma. Our addictions are traumatizing to society and culture and represent a major disconnection between our logical and our emotional world.
To make addiction simple, we simply need to look at it as if it were a trauma because they are a part of the same process. To redefine addiction in this light we see that it is the relationship between trauma and addiction that needs to be defined and determined whether or not it is healthy for ourselves. When we define addiction accurately and categorize it appropriately we find that it is traumatic and produce ASD/PTSD symptoms and dissociation. Luckily we have effective treatments for addressing both, we just need more clinicians experienced in treating all three.
Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. New York, NY: W.W. Norton & Company.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Inaba, D., & Cohen, W. (2007). Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Sixth Edition, Medford, OR: CNS Publications, Inc.
Lanius, U., Paulsen, S., & Corrigan, F. (2014). Neurobiology and treatment of traumatic dissociation: Toward an embodied self. New York, NY: Springer Publishing Company.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment and working with survivors. Eau Claire, WI: Pesi Publishing & Media.
Ross, C. (2013). Structural dissociation: A proposed modification of the theory. Richardson, TX: Manitou Communications, Inc.
Siegel, D., & Bryson, T. P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Bantam Books Trade Paperbacks.
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.
Watts, A. (1975). Tao: The watercourse way. New York, NY: Pantheon Book.
Adam O'Brien LMHC, CASAC (EMDRIA Approved Consultant through ICM) - is a Licensed Mental Health Counselor and Credentialed Alcohol and Substance Abuse Counselor in New York State. He is in the certification process to become a Certified Expressive Arts Therapist with Dr. Jamie Marich. Located in Chatham (Albany/Hudson area) where he maintains a private practice. In his writings, he is actively seeking to destroy the stigma of addiction.
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.