When I first met the person who would become one of my spiritual teachers, he told me that I wasn’t ready. I asked him a series of challenging questions from the crossroads at which I found myself in life. I struggled to make sense of deeper yoga teachings that would help me move from a place of doing to being. Ever the good student programmed to challenge what I was told at face value, I persisted with my questioning.
“You’re not ready,” he said.
On one hand, he had a point. I hadn’t been ready for quite some time—but I was there. Present. Doing the work. Asking the questions. Preparing myself in a manner that would allow me to become ready. Yet on the other hand, I felt incredibly insulted to be told I wasn’t ready when I was clearly willing and making preparations. It made me think of every time I’d told a client, “You’re not ready yet,” and I suddenly chided myself, realizing how demeaning and degrading that could have felt for them. Since that incident in the Fall of 2015, I stopped using the word ready in clinical settings with my clients or in teaching with my students.
A visceral reaction overcomes me every time that I hear the word ready. Maybe because I realized how ugly it sounded when pelted at me. I also became attuned to how often people say, “I’m not ready.” And I recognized how frequently my clinical consultees, primarily learning EMDR and other trauma therapies, worry that their clients weren’t ready to go further with their work. When they express this worry, the subtext is usually that they do not feel ready to take a client further. Folks that I mentor can doubt their ability to teach a class or accept a professional opportunity I present, claiming they are not ready. Why did I suddenly hate the word so much? In addition to it feeling like an insult towards me, it felt like others were using I’m not ready as an excuse or an easy word to express distrust in their own abilities within the natural flow of process.
For years I taught the importance of client readiness in moving forward with deeper phases of 12-step work or trauma therapy. Yet my experience caused me to reevaluate the word and everything I believed about it. Like I do at any crossroads in inquiry, I turned to word origin for some answers. The word ready traces to the 13th-14th century Middle English where it is largely conflated with the word prepared or preparedness. Although there is an element of the original word usage that also implies promptness; i.e., not dragging out the process. Ready and prepared may seem like synonyms, yet there are subtle differences that may offer some solutions.
I’ve been posing the question quite a bit lately—to my friends and to the hivemind that is my social media following—about the difference between ready and prepared. Most seem to associate readiness as a state of mind or a mental quality whereas preparedness or being prepared is more logistical. There are plenty examples out there of people believing they are ready for something (e.g., marriage, a hike on the Appalachian Trial), only to find out that they are ill-prepared. For me, embracing the full meaning of prepare and all of its forms (preparedness, preparation) is where we find our freedom to grow and to realize our intentions. The Latin root from which we draw the English word prepare draws from the same root as to parent. To bring something to life! Taking the action to get ourselves prepared inevitably impacts our attitude of readiness. If we declare that we’re not ready and do nothing to get ready (i.e., prepare), we can find ourselves in an excuse-making loop for years. Moreover, consider that such a thing as perfect readiness may not even exist.
Amber Coulter, an artist I follow on Instagram, recently published one of her visual journaling pages that declared, “If we wait until we’re ready, we’ll be waiting for the rest of our lives.” My body rejoiced with an enthusiastic YES when I read those words. The answer to the question of why I held so much disdain for the word “ready” began to take shape. A few weeks later I taught a workshop on my Trauma and the Twelve Steps book. A participant posed a question about readiness to do the steps, especially the fourth and fifth step (the inventory and sharing the inventory with another human being steps).
“Who is ever really ready to do a fourth step?” I replied.
I offered that letting people off the hook from doing a fourth and eventually a fifth step is not the answer. Rather, how can we better prepare them for the challenges of these steps and guide them through the difficulty? I’ve heard too many sponsors tell people to “just do Step 4 and don’t come back until you’re ready to do the fifth.” With that lack of guidance, no wonder that people don’t feel ready and keep putting it off! To be clear, forcing people to do the steps is not the answer. I still believe there is value to not rushing any process. Yet playing the “I’m not ready” card, even if it is out of legitimate fear, can keep us stuck in the rut of life behaviors and emotional states that cause us problems. I have found that doing these steps are a lot less scary with proper preparation and guidance. Preparation and guidance can assuage the fear.
What if we could learn to replace the declaration of “I’m not ready” with the question “What can I do to get myself prepared?” There are other helpful questions too: “What kind of support will I need to grow into readiness?” or “How will taking action and making necessary preparations help me to get ready?”
The founder of EMDR therapy, the late Dr. Francine Shapiro, made a brilliant move when she named Phase 2 of the therapy Preparation instead of Stabilization. While many other trauma modalities use terms like stabilization, I find that this word can frustrate clinicians and clients alike. Clinicians can believe that a client has to be totally stable before they can handle deeper phases of trauma healing. Yet it may be impossible to achieve stability in a total sense until the person whose life is ruled by unhealed trauma engages in some deeper healing that allows them to process the impact of their trauma. When new trainees pose the very common question, “Are they stable enough?” or “Are they ready?” to handle deeper level EMDR, I generally respond with, “What are you doing to help them prepare? Remember, the phase is called Preparation. The objective is for the client to acquire enough mental resources and skills so that they can reasonable handle or tolerate what may come up when the work gets harder.”
I assure my clients, and pass this along to my trainees, that if they begin the deeper journey and realize they are not adequately prepared, we can always take refuge back in the Preparation phase and work on more skills and strategies. To simply say “I’m not ready,” especially when you have a goal of getting better, is generally not helpful. True, some people just need some time. Yet I encourage people to productively use that time by taking proactive steps, no matter how small, towards their own healing.
Perhaps my overachieving, good student tendencies that I’ve carried throughout childhood have simply carried over to how I approach the healing process. I recognize that my tone in this piece may come with an air of “no excuses” and I am aware of my privilege. Since I decided to get sober and well 18 years ago, I’ve had the ability to access healing resources in the form of counseling, psychiatry, 12-step meetings and other holistic practices. I also had seasons of my life where unhealed trauma rendered me paralyzed and unable to fully take advantage of them. Yet realizing what I do have and mustering enough willingness to prepare myself has long been the key that’s opened the door to readiness. I’ve seen people without the resources I have access to make up for it the willingness to prepare themselves in whatever way is possible. Which leads to a final question: When we say, “I’m not ready,” are we really declaring that we’re not willing?
Maybe. Maybe not.
I’ve seen the answer to that question go both ways for people. And in both contexts, the lynchpin seems to be preparation. Taking action steps. Change will come as it is meant to when we put one foot in front of the other with a minimum of stalling. There’s a recovery saying that it’s easier to act your way into better thinking than to think your way into better acting. This approach is generally more trauma-informed than change the thinking, change the behavior mantra that can dominate cognitive-behavioral discourse. Acting your way into better thinking recognizes that our thoughts keep us stuck. Our thoughts tell us things like “I’m not ready.” Our actions move us towards a different reality and eventually a different attitude and outlook on life.
If there was a category in my high school yearbook for “Most Likely to Become a Junkie,” I would not have been a contender. Indeed, I was voted “Class Brain.” And none of my smarts could prevent me from developing an addiction problem on top of an already budding mental illness. I spent the Fall of 2000 in a state of suicidal use, not caring whether I’d ever wake up. Even as I tried to get sober and well shortly after turning 21, I didn’t think I’d make it past 24.
These period of days from July 4-July 8 are quite celebratory. Most everyone in the U.S. is in a festive place on July 4th, my belly button birthday is July 6th, and my sobriety anniversary is July 8th. This year I turn 40, a momentous occasion for me who once believed I couldn’t ever survive this long. And I celebrate 17 years of sobriety. At the start of these special days, my spirit was somewhat dampened when I saw a friend post a “joke” from a parody account set up to represent an Ohio municipality. The post apologized to members of the city for having a scaled-back fireworks display this year, due to the fact that they’ve spent so much money on Narcan. And they “thanked the junkies” for ruining everyone’s freedom celebration.
I have a very crude sense of humor and I am not a person who easily offends. And this “joke” infuriates me in a way I struggle to put into words. Whenever you talk shit about alcoholics or addicts due to your own ignorance, misinformation, resentments, or unhealed wounds, you are also talking shit about me and scores of people that I love. There are many others who would look at me and the life I’ve built today and say, “But Jamie, you’re different.”
I’m really not.
Yes, I am successful by every conventional American definition of the word.
That’s because recovery defines my lifestyle today.
And it began in a place where I was just as desperate as any other “junkie” who may need revived in the back of an ambulance.
People who meet me now or only knew a very public version of me as a child can have difficulty attuning to this reality. A few years ago after marriage equality became the law of the land, I attended my first same-sex wedding in my hometown. The ceremony was beautiful. I cried through most of it, not ever believing I would see this in my lifetime. And my illusions of liberal paradise were short-lived. I was seated randomly with one of the groom’s family members. He came around at the beginning of the reception and introduced me, “Dr. Jamie Marich,” to everyone at the table. He gushed about how accomplished I was, that I was an author, and everyone at the table seemed impressed.
Towards the end of the meal, the opiate crisis came up as a topic of conversation. One of the family members stated quite bluntly what a travesty it was that we wasted so much money on Narcan, especially for frequent fliers.
“They should just let the junkies die already.”
Of course this was not the first time I’d heard talk like this. A few years prior at an extended family event, I heard someone opining that the government should euthanize people who fail treatment after three tries. And yet this was at a gay wedding, where most in attendance seemed to be tolerant.
My stomach churned, unable to finish my meal, realizing just how much of a stigma problem we still have on our hands. I found myself in that familiar position of freeze, wanting to say so much, yet fearing danger if I did. I wanted to ask that guy, “What if it was your child in the back of that ambulance,” or challenge him with, “And what issue is happening in your life that you’re failing to address? I’m sure your stuff is causing harm to those you love, just maybe in a different way? Have you ever considered that scapegoating addicts may help you feel better about yourself and the role that people like you play in perpetuating a trauma epidemic that people take opiates for?”
At one point the mother of the person making the comment said to me, “I’m sorry if this is upsetting you, this isn’t the best dinner conversation.”
In fairness, the mother, a nurse, challenged her son and also seemed put off by his comments.
“What’s upsetting to me,” I finally managed through that pain of freeze, “Is that I am a person with 15 years in recovery. Alcohol and opiates. And I could very well have been one of the junkies you’re talking about.”
Everyone seemed embarrassed and tried shifting the conversation to congratulating me on my recovery and how “well I had done.”
I’m just glad I had the chance to start somewhere.
I never needed Narcan or professional assistance to come out of an overdose or withdrawal, but I was getting close to the point where I could have. And many people in my network of recovery today, including sponsees who are working to make a difference in the world, required professional assistance for their lives to be saved. Yes, some of them had to go through the system of care multiple times before they got it. And I’m so glad they did. Because many parts of the medical and care system (however flawed they may be) did not give up on them, they eventually learned not to give up on themselves. A person I interviewed for my dissertation research was pronounced dead on arrival twice during overdoses, and would go through twenty-six rounds of professional treatment. And she eventually got access to the proper trauma-focused treatment that she required, later going on to make a big difference in her community.
Every day I get to see what happens when we don’t give up on people. Many people who work for me or with me are in long-term recovery. As a professional serving people at all levels of recovery from addiction and mental illness, I am privileged to behold miracles and know that recovery is possible. I know that it can be frustrating—for as many recovery stories as I witness, I see just as many people struggling to get it. And I’ve known way too many people who have died far too young. If you are a first responder, work in the hospitals, or in criminal justice, seeing the consequences of addiction play out in full living color, I realize that you may be jaded. It’s not easy trying to deal with people who are in the grips of it. I invite any of you to come and hang out with people like me some time. See what happens farther down the road when people get well.
I also recognize that an addict or alcoholic may have caused great pain in your life and this can be a hardening experience. I am the first to admit the damage that we can cause in the lives of others around us, and I realize that no apology can ever begin to heal those wounds. For those of us who make it through, we do our best to make amends through changed behavior. And please realize that even those of us in recovery have been impacted by the consequences of others’ addictions. I’ve been married to two people in active addiction. The son of my recovery sponsor was killed by a drunk driver. And although there has been pain to wade through, we’ve both chosen to be part of the solution, which first and foremost means being present for people who need recovery.
There’s always a fear when we advocate for these compassionate approaches to recovery that such softness will only give people more excuses. So let me share the piece of direction that changed my life which, I believe, embraces the delicate balance between validating and challenging people. When Janet, my first recovery sponsor, heard the story of my life and the progression of my disease she said, “Jamie, after everything you’ve been through, it’s no wonder you became addicted. What are you going to do about it now?”
People only respond to challenge and direction when they have first been validated and humanized. It’s not the other way around. Shame fuels the progression of addiction, and the comments and jokes on social media—no matter how innocuous they seem to you—are part of the problem. Intoning the wisdom of Anais Nin, shame is the lie that someone told you about yourself. For most of us, that starts with unhealed trauma and escalates by contact with others who would have us believe the lie. We say in the treatment field that guilt is when you feel bad about the things that you do, and shame is when you believe that you are those bad things. Shame teaches that those messages of defectiveness define you.
I’m grateful that I hung around long enough to learn the difference. And I’m even more grateful that I met people along the way who helped me to uncover a deeper truth about who I really am. For as much professional therapy as I’ve received and as much time as I spend growing in my spiritual practice, I am further grateful that I can still acknowledge my vulnerability. I am only human. If I stop taking care of myself, the chance is very real that I could be in the back of an ambulance, even after seventeen years in recovery, for reasons connected to my addiction and mental health.
To the people that will inevitably need revived from an overdose somewhere in the world today, I send you my love, my empathy, and if you want them, my prayers.
We are not separate.
As a certified therapist in both Eye Movement Desensitization and Reprocessing (EMDR) therapy and Dialectical Behavior Therapy (DBT), many times therapists give me the “huh” look when I say that I use them both – together. You know that look, head cocked to one side and brow furrowed. “I don’t see how that could work”, “my clients don’t like DBT”, “I don’t like DBT” and/or “it’s too structured”. “HOMEWORK?!?!” However, over my thirteen years of working in the field I have found EMDR and DBT to be a beautiful fusion. Just like fusions with food, two things that might seem counterintuitive to put together can turn out being even better than their standalone ingredients. Think about it: chocolate and chili, sea salt and caramel, brown sugar and ketchup (BBQ sauce). Dialectics hard at work!
Like my colleague Dr. Mary Riley, the culinary arts and metaphors have been a large part of my life. Many times, the metaphor of baking has helped me to make sense of new ideas, learn new concepts, or put my thoughts together more seamlessly. Before we dive any further into the kitchen with EMDR and DBT, let’s explore some introductory information first. For those in need of an orientation, the proceeding paragraphs will give a short explanation of EMDR and DBT. Note, trauma in this context is considered to be a “wound” not necessarily just the big traumas many of us usually identify such as war, a lethal accident/occurrence, or sexual assault/rape.
EMDR therapy is defined by World Health Organization in this manner:
“[EMDR] therapy is based on the idea that negative thoughts, feelings, and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (Marich, 2019).
Regarding DBT, Marsha Linehan the developer of the therapy states:
“Dialectical Behavior Therapy is a broad-based cognitive-behavioral treatment originally developed for chronically suicidal individuals diagnosed with Borderline Personality Disorder (BPD). Consisting of a combination of individual psychotherapy, group skills training, telephone coaching, and a therapist consultation team, DBT was the first psychotherapy shown through controlled studies to be effective with BPD. Since then, multiple clinical trials have been conducted demonstrating the effectiveness of DBT not only for BPD, but also for a wide range of other disorders and problems, including both undercontrol and overcontrol of emotions and associated cognitive and behavioral patterns Furthermore, an increasing number of studies suggest that skills training alone is a promising intervention for a variety of populations…” (Linehan, 2015).
Merging these together, just like chocolate and chili, if we look at the theoretical frameworks alone (cue the eye rolls from us more expressive arts types), EMDR’s AIP model is closely related to DBT’s Biosocial Theory. They both assert:
Now that we have our foundational principles in place, let’s bake a cake, shall we? The use of metaphors is frequently implemented in DBT and can help clients understand weightier concepts; just as the baking metaphor has helped me in my life. Let’s put on our aprons and get to work! The 8 Phases of EMDR can be considered the recipe while the application of EMDR is putting the ingredients together to bake. DBT’s role is that of fusion, again, the chili to the chocolate. With this idea of baking, DBT’s modules and skills (ingredients) can easily align with EMDR’s phases (recipe with ingredients). The recipe is as follows:
Voila! A perfectly baked therapy cake with all its yummy fusion goodness! To finish off our baking masterpiece, let’s talk about icing. Icing is what usually draws us to the dessert. Seeing those lovely frothed peaks of icing begging to be eaten, how can we say no? Icing, in this case, can be identified as the “sell” to the client; the explanation of why EMDR and DBT work so great together. In Phase 3 of EMDR, when we are getting the client activated, we can compare this to a raging fire or the extreme temperatures of an oven. When making the “sell” Arbeitman, Goodwin-Brown, and Loomis (2016) give the example that “DBT manages the fires. EMDR Therapy extinguishes the fires.” By educating clients that the fires of life will always be there in one form or another, we give them a choice. They can choose to use those fires and temperatures to bake a cake or choose to have those same fires burn them alive. I’m guessing your clients might want cake instead of ongoing emotional 3rd degree burns. So why not invite them into the kitchen and have them sample how the combination of chocolate and chili might sound odd?
Odd, and yet oh so tasty!
Arbeitman, D., Goodwin-Brown, R., & Loomis, G. (2016, April). Integrating dialectical behavioral therapy (DBT) and EMDR with suicidal and self-injuring clients. Presentation at the 12th Western Mass Regional Network Spring Conference, Amherst, MA
Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide (Guides to Individualized Evidence-Based Treatment). The Guilford Press. New York, NY.
Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.
Linehan, M. (2015). Skills Training Manual for Treating Borderline Personality Disorder. Second Edition.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment, and working with survivors. Eau Claire, WI: PESI Publications & Media.
Marich, J. (2019). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Training Course Part 1 and Training Course Part 2 Manuals. The Institute for Creative Mindfulness 2015. 8th Edition.
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.