Addiction is a dissociative response. Sounds like common sense, right? For many years we’ve operated in our practices fueled by this assumption. As individuals in personal recovery, the link between unhealed trauma/dissociation and addiction has been blatantly obvious. Even when we share our work with people on developing this new model of Addiction as Dissociation, we are met with a great deal of, “Well yeah, obviously.”
Yet the reality is that no contention in the literature has been directly made addressing this link… until now. The connection between unhealed trauma and addiction has been well asserted, with giants in the field like Gabor Mate, Bessel van der Kolk, and many others speaking to this link. What about dissociation? Dissociation comes from the Latin word meaning to sever. When an experience or a moment becomes too overwhelming for a person’s system to handle, we have a tendency to sever from that present moment, or from our core self. Dissociation is a very normal response of the brainstem that can activate when we are met with overwhelming distress. Dissociation can be adaptive (e.g., spiritual pursuits, proper use of guided imagery, daydreaming, the Netflix binge when you need to decompress) or maladaptive. When the manifestations of dissociation are maladaptive, they are likely to cause functional impairment. The various signs and symptoms of addictive responses can be examples of this phenomenon. Moreover, maladaptive manifestations of dissociation result when traumatic experiences or stressful events have not been processed and reconsolidated.
Both of us have been working very hard in 2019 to scour the literature and create a model that we are now calling Addiction as Dissociation. Regardless of your adopted stance on addiction (e.g., a disease, a response to trauma) or whether you even like the word (i.e., you may prefer behavioral compulsivity), this model will likely be relevant to your practice. We’ve prepared a table version of the model that you can examine in this blog. You are welcome to share it and we also value your comments on what resonates and what may still need refinement. Our scholarly paper that fully supports the contentions and flow of the model is currently under review and we will keep you posted about the more formal debut of this model to the world.
Too Cautious or Not Cautious Enough: Thoughts on the Need for Dissociation Training for EMDR Therapists by Teresa Allen, MFT
Since dissociation is the essence of trauma, it’s not possible to treat trauma without understanding dissociation. As EMDR therapists, we need to understand it. In my view, there are two opposite issues with EMDR therapists and dissociation, and therefore with how to approach education about it.
Some of us find dissociation intimidating and see it as too risky to work with, to the point of being spooked when it emerges in training practicums or in a session. Some of us refer out immediately when we see it. I’m calling this the Too Cautious group, sending clients to another clinician at the first indication of dissociative process, and thus missing an opportunity to help people with all that we know about the Adaptive Information Processing model and EMDR.
While some may be too cautious with dissociation, others know too little about it and so are not cautious enough. This group is not always aware of the potential risks that come with inadequate history taking and preparation. I’m calling this group the Not Cautious Enough group. While I realize there are different views on this subject, my belief is that premature, unprepared processing of memories can result in destabilization and put a client in serious jeopardy resulting in the need for significant therapeutic repair.
Both the Too Cautious group and the Not Cautious Enough group--all of us--need more information about working with persons with dissociative symptoms. What’s needed is training that normalizes and demystifies the subject, while at the same time informing us about ways to recognize and effectively work with it, using Adaptive Information Processing principles and EMDR Therapy Standard Protocol modifications.
Dissociation training should include direction in learning about our own dissociative tendencies and ego states. Reflecting and learning about ourselves in this way can help to make this important subject less “other.” In this way, we can approach learning about dissociation with much less fear. It is after all, something our brains were built to do. One problem is the question of what exactly is dissociation.
One group of authors in treating complex trauma, describes dissociation as “a continuum of non-realization: not real, not true, not mine, not me.” Kathy Steele identifies four ways dissociation is defined in the literature.
Steele points out that alterations in awareness and consciousness are treated with mindfulness; shutting down is treated with physical reactivation; and depersonalization (the most challenging) can be treated with mindfulness. Dissociation of self is treated with mindfulness, reactivation, and system, or “parts,” work.
So, I’m proposing that, as EMDR therapists, we find ourselves sometimes too put off by dissociation and think we cannot work with clients who dissociate. Or, in the opposite direction, a lack of caution with dissociative clients can lead to significant risk, since memory work might be done without proper preparation and stabilization.
Training about dissociation is needed for both groups of us--and everyone in between. The question is how to deliver training in a way that normalizes dissociation as something we all do, and in a way that empowers clinicians to feel we are competent in assessing and treating more serious dissociation and its many attendant issues. With proper preparation and modifications, EMDR Therapy and the Adaptive Information Processing model are powerful tools for helping persons with dissociative symptoms to heal and lead healthy lives. With adequate attention paid to preparation techniques and Standard Protocol modifications, we as EMDR therapists can more effectively treat clients with complex trauma backgrounds and dissociative symptoms.
Gonzalez, Anabel and Dolores, Mosquera, EMDR and Dissociation: The Progressive Approach, First Edition (Revised), 2012.
Knipe, Jim, EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation, Second Edition, 2019.
“Dissociation: Sharing From a Personal Place, An Interview with Jamie Marich,” in Go With That, EMDRIA Magazine, June, 2019, pp. 5-6.
Jamie Marich, “Session 424: Demystifying and Humanizing Dissociation in EMDR Therapy Practice” EMDRIA Conference, 2019.
Kathy Steele, Suzette Boon, Onno Van der Hart, Treating Trauma-Related Dissociation: a Practical, Integrative Approach. W.W. Norton & Company, 2017, p. 4.Kathy Steele, “Advanced Issues: Chronic Shame, Resistance, and Traumatic Memory,” Presentation at EMDRIA Kansas City Regional Network, March 1-2, 2019, Kansas City.
Kathy Steele, Webinar on Dissociation, May 25, 2019.
Mosquera, Dolores, Working with Voices and Dissociative Parts Disorders, Institute for the Treatment of Trauma and Personality Disorders, 2019.
“EMDR Adult, Complex Trauma & Dissociation Specialist Intensive Program
An Integrative Progressive Approach to Developmental Trauma: Working with Complex PTSD and Dissociative Disorders,” Dolores Mosquera and Kathy Steele, Agate Institute, Phoenix, July, 2019.
Over the years I’ve been met with, “Oh, you do qualitative research,” in a tone that suggests: That’s cute, but what does it really prove? The findings from qualitative research won’t really help to advance the scientific aspects of trauma therapy. The field and the people making the decisions about what constitutes evidence-based practice want the numbers, the empirical data. Especially when we promote approaches like EMDR therapy. We have to prove it works with science to the naysayers!
What if the important things just can’t be measured with numbers?
At heart, I am a phenomenologist and I believe that they can’t be. Phenomenology is more than just the study and observation of “phenomena,” as people often surmise. Edmund Husserl (1859-1938), the father of the phenomenology, emphasized the importance of lived experience. He rejected the Galilean notion that the human experience could be quantified. When I first studied Husserl during my doctoral program, it seemed as though my whole existence had been validated. When I absorbed that specific teaching, an audible, “Yes! This!,” came out of my mouth during a late night reading session on the couch. My declaration was so loud, it woke up my partner at the time.
Having been raised by a math teacher mother and cheered on by her math teacher father, I was encouraged to study science and math with top priority when I was in school.
“That’s where all the jobs of the future are,” my mother reasoned.
I advanced to organic chemistry and calculus II in my undergraduate studies, forcing myself to get A’s. And yet I truly failed to see how any of it mattered in making me a better person. To be clear, I’m not one of those anti-science types. I recognize the massive importance of empirical inquiry and believe that quantitative thinkers are necessary in an enlightened world. Yet they do not hold all the pieces of the puzzle as the black-and-white ethic that keeps us stuck in the fearfulness of modern times would have us believe. Sometimes what they measure in numbers doesn’t reflect the reality of others’ lived experiences. Intoning the wisdom of a professor in my doctorate program, quantitative inquiry may be like the skeleton of a system, but qualitative offers the muscles, the blood supply, and the vital organs. We need the entire system in order to move forward.
I’ve always seen the world in themes, colors, emotions, and stories. Savoring and reinventing communication is my favorite art form. When I was in school trying to make people believe I was good at math and science, I excelled the most in social studies, English, and the performing arts. They seemed to make my miserable life brighter and worth living. Oddly, I managed to qualify for the International Science and Engineering Fair my junior year of high school. Even my teammates wondered how the content of my project was strong enough to make it through the Ohio selection process. Quite frankly, it was on the power of my presentation skills and connecting the dots of relevance of the science to modern consumers. Indeed, in the field of counseling studies, empirical inquiry is often described as being able to prove that something works, whereas qualitative inquiry shows us how something works. Even as a kid, that was my strong suit!
When I “came out” to my mother during college to tell her I was not going to go the pre-med track, but rather, had decided to study History and English/Pop Culture, I thought she was going to have a heart attack.
“But math… science… that’s where the future is at.”
I told her I was willing to take the risk.
The flow of life brought me to a career in clinical counseling and I became a doctor, although not the type she wanted me to be. I quickly became the kind of counselor who knew I could not be guided by research alone. Client preference, context, culture, and clinical judgment emerging from my own lived experiences (all components of evidenced based practice according to the American Psychological Association[i]) also guided me. Working to heal and to understand myself translated into my enhanced clinical efficacy, as shown by more favorable client outcomes. I took to qualitative phenomenological research like a duck to water. Especially as someone with a mind that has always felt like a mosaic, in it I found beautiful lenses through which to study the world and the people in it.
During the 2008 EMDR International Association (EMDRIA) conference, I won first prize in the research poster competition for my dissertation pilot study on the use of EMDR therapy in addiction continuing care. I was the only qualitative study in the competition, and both research committee chairs, almost through gritted teeth, told me that I was the first qualitative project to ever win the award.
“What can I say, the methodology was solid,” one of them said.
That is an important point to emphasize. Qualitative research is not about pulling concepts out of mid-air or fishing for the lived experience of others’ just to prove your point. There is a systematized way to analyze themes in order to draw conclusions. For instance, Amadeo Giorgi’s Descriptive Phenomenological Psychological Method is a simple yet effective process for reading data—people’s descriptions of their lived experience with the phenomenon being investigated—to extrapolate the common threads. Elisabeth Kübler-Ross used a similar style of research in her work. Brené Brown, who is single-handedly changing the world with her teachings of overcoming shame through vulnerability and courage, is a qualitative researcher known for using such methods. The rich lessons of humanity reveal themselves in themes and stories in a way numbers may never do them justice.
So, that dissertation research went on to get me two publications in major journals of the American Psychological Association, Psychology of Addictive Behaviors and The Journal of Humanistic Psychology. Yet these studies from 2010 and 2012 are rarely, if ever, cited in literature reviews on EMDR therapy. Indeed, one of my major criticisms with Dr. Shapiro’s final edition of EMDR Therapy: Principles, Protocols, and Procedures (2018) was that aside from mentioning a few case studies in passing, not a single, substantial qualitative study was cited. And a lovely collection of qualitative literature exists on EMDR therapy that goes beyond case studies, yet the community at large rarely seems to look at them. In our desperation to prove that EMDR works, we may be missing vital information on why it works and how it brings about transformation in the lives of people we serve. I venture to guess this experience is not unique to the field of EMDR therapy.
Indeed, in another area of psychology that interests me greatly, the study of dissociation, I observe similar problems. My lived experience with dissociation is truly lived experience. As followers of my work know, I’ve talked and written openly about my own struggles with dissociation. I gently tested the waters as early as 2011 and in 2018, I came out very fully and unapologetically. I challenged people interested in dissociation to look beyond the heavy textbooks and the numeric inventories like the Dissociative Experiences Scale (DES) and the clunky Multidimensional Inventory of Dissociation (MID) and into their own lived experiences as a treasure trove of inquiry. Being dissociative is a fundamentally protective mechanism of humanity that we’ve all experienced in one form or another. There is nothing fundamentally wrong with using quantitative measures and other people’s scholarly writing to help yourself and the people you work with better understand dissociation, especially if it helps the client. Yet if you are only using the quantitative and other people’s citations to advance your study, you are missing big parts of the picture.
At the 2019 EMDRIA Annual Conference, my identity as a qualitative thinker connected to the beautiful circle that began eleven years earlier as an eager doctoral student. I won EMDRIA’s Advocacy Award for my willingness to be out about my own struggles and use platforms like YouTube and blogging to translate the how and why of EMDR therapy to the masses. Two other happenings at the conference, however, helped me further connect to why I love being a qualitative phenomenologist so much. First, Dr. Derek Farrell, an English EMDR scholar and only EMDR trainer in the world to offer a master’s degree specific to EMDR therapy, endorsed the importance of qualitative research during his Sunday keynote address. He expressed that quantitative research is very top-down in its orientation, whereas qualitative research is bottom-up.
I squealed with the same enthusiasm that woke my partner up back when I first read Edmund Husserl. Finally, a member of the EMDR establishment was making such a bold pitch for the necessity of what thinkers like me can do. In trauma therapy, we generally teach that top-down interventions are very cerebral, whereas bottom up interventions primarily address the body, emotions, and visceral experiences. In sum, we need both top-down and bottom-up, yet what EMDR therapist have long identified as missing from traditional talk therapy is the bottom up. This bottom-up has also been missing from psychotherapy research or dismissed as not that important. That attitude must change if we are going to maintain the soul of our work while also pushing for empirical data. People are holistic beings, so why can’t science be total and integrative as well? Qualitative is artful yet it is not just art. Rather, it is art with power to illuminate the science and make it more relevant and applicable to the people it serves.
Later that day I went on to give a ninety minute talk on my own lived experience as a woman in recovery from a dissociative disorder and how that’s informed my work as a clinician. Every other time I heard a presentation on dissociation at the EMDRIA conference, while not doubting its content and relevance, I felt offended that people like me were being talked about in such cold and technical terms. Something vital has been missing that couldn’t be measured by any score on the DES or the MID, both of which can be very difficult and even impractical for people with dissociative minds to take. Not only that, they attempt to measure in numbers a phenomenon that is experienced in qualitative layers. During the Q & A period I fielded a criticism that my presentation did not rely enough on the citations of others and that perhaps I misunderstood the intent of someone whom I did cite. I answered that by framing this presentation as a true sharing of phenomenology, I wanted to shift the paradigm, or at least open up another portal of inquiry. Some people are not ready for that, which I expected. And yet for the people who are, you are in for a treat.
A few questions later another individual came up to the microphone and asked about a case he was working on where an emerging seven-year old part perplexed him. I asked him a few questions back about his own lived experience as a seven-year old and as the parent of a seven-year old. I wish that other members of the audience could have seen on the big screen just how much his face let up when he realized the answer was with him all along. And when he realized that, he knew exactly how to proceed with his case.
In response, I said, “No citation will teach you that.”
While citations and research, even qualitative research, is important, what life as a phenomenologist has taught me is that your own lived experience have more to teach you than you’ve ever imagined. Learning about the lived experiences of others, with an open mind and heart, and letting them communicate with your own will change the world. That is the future of which I want to play a colorful, thematic, multifaceted, holistic part.
So Mom, I love you, and I respectfully disagree with your career guidance. My present—and my future—is qualitative.
[i] American Psychological Association Presidential Task Force on Evidence-Based Practice, “Evidence-Based Practice in Psychology,” American Psychologist, 61, no. 4 (2005), 271-285.
Photo Credit: Paula Lavocat
Even though I do my best to take off the clinical cap outside of session, friends often ask for my opinion about all things mental health. When a friend recently talked about their long-term struggles with anxiety, I mounted my usual soapbox about the importance of feeling your feelings fully and not stuffing them away. As a trauma-focused therapist and a yogi, I believe that most of the symptoms that trouble us are the result of unhealed emotional wounds that never got a chance to heal at earlier points in our lives. Until we permit ourselves to feel what we weren’t able, willing, or allowed to feel at these earlier points, we’ll remain in a loop of distress that manifests in a variety of symptoms.
“But I thought the point was not to engage my feelings? To not let them get the best of me?,” my friend replied.
My eyes rolled and my fury rose, knowing that they heard this from either a cognitively driven therapist or a psychiatrist. And in the spirit of feeling my feelings through, I am not afraid to disclose that I get incredibly angry when I hear that feelings phobia is alive and well among mental health providers. Once, a student reported to me that his psychiatric medical director was so nervous about clients not being able to handle feelings, she forbade any treatments at their clinic that might make patients cry. Even as I type this, I feel the Hulk rising up in my chest about to bust out, so infuriated that providers—either due to their own fear or restrictions that systemic forces placed upon them—are deliberately keeping people stuck in a rut when they offer such direction.
The major lesson that I have learned from people I’ve served in the last fifteen years as a trauma specialist is that our feelings are not the problem. Everything we do to keep from feeling our feelings and experiencing our emotions—even the dark and heavy ones—is the real problem. We engage in addictive behaviors, we isolate and cut off connection, and we begin to accept phenomenon like panic attacks, nervousness, persistent body distress, and dissociative numbing as the norm. As my friend Esther describes it, “I’ve parked diagonally in the depressive position as the lesser of evils for most of my life.” While I am not opposed to psychiatric medication that is responsibly prescribed within a larger context of care, I get concerned when people become so fixated on getting their medication type(s) and dosage just right. We believe that finding this medical solution will help us to survive the rigors of daily living, and for a time, it might. There are even some conditions and organic brain structures where psychiatric medication may even be necessary for survival.
But are we only meant to survive?
Or by refusing to listen to what our feelings, experiences, and sensations have to share with us about what needs healed, are we cutting ourselves off from the deepest well of healing that is available to us?
My answer to this question is obviously yes, and it may seem like that resounding affirmation comes from a place of tremendous privilege. True, I have extensive training in both EMDR therapy and classical yoga. I’ve invested a great deal of my own money in my therapeutic process and have gotten to a place where if I feel an emotional wave coming over me as I drive down I-80, I’m not afraid to cry until it passes. I take Rumi’s teaching in The Guesthouse to heart by welcoming and entertaining them all—the joys, the sorrows, and the meanness.
I also know how to put such waves of feeling into what therapists sometimes call a container, a visual or sensory strategy we can work on to hold the full expression of the feeling until the time and place is more appropriate. If I am still crying when I arrive at my worksite, I know how to use my container to keep it together in order to get through the day. Yet because I ride the waves as they come, I usually don’t need to use the container. The feeling will pass and I can get on with my day. If the same feeling keeps coming up as a pattern, I know to take it to my therapist, sponsor, spiritual teachers or friends, and they help me identify where I need to do the work. And as a woman in long-term recovery, I’ve had over seventeen years of practice in cultivating this art.
That is my privilege—yet remember, there was lots of stuff I needed to heal from in the first place! So many of my early childhood memories center around being made to feel weird because I felt things so intensely. I am the girl who cried for days when the bad people painted Big Bird blue in the 1985 Sesame Street film, Follow That Bird. I am the girl who was constantly told that she was too sensitive, whose caretakers didn’t really know how to handle her. I am also the girl who knew that if I expressed what I felt about many of the happenings of my childhood, my safety would be threatened. I still experienced emotions like fear, anger, disgust, and shame about the things going on around me over which I had no control. They just had nowhere to go or no healthy outlet through which to be expressed. So, I turned inward, first with eating. The arts eventually gave me an outlet that served as a bit of a release valve, yet when my perfectionistic tendencies shut those down in my life, drugs and alcohol became the natural way to temper my tendencies to feel things so damn hard. Fortunately, my recovery path led me back to the expressive arts as a healthy outlet for expression. And I can now embrace my sensitivity as a character asset. Yet getting to this place required time spent in healing practices and learning to remove the scripts of judgment around my feelings.
My clients, friends, and my own lived experience have also taught me a great deal about what makes it so commonplace to block the feeling and expression of even the most natural of emotions. The greatest hits of reasons include fear that I won’t be able to handle what comes up, fear of being judged, fear that I’m a bad person for feeling what I do, fear of being rejected, fear that they will never go away and so they’ll end up destroying me, fear of hurting others, fear of people taking advantage of my vulnerability, fear of doing the hard work, fear that no one will understand or get me, fear that my sense of safety or connection to people I love will be taken away, fear of being seen, fear of making real changes in my life…. With all of these fears, of course medicating alone seems appealing!
Consider, however, that these fears do not develop in a vacuum. We generally learn them from somewhere—from our families of origin, from society, from the systems in which we are educated and eventually go to work. For many of us, it’s literally the “systems,” like foster care, incarceration, and yes, the medical and mental health fields, that can teach us these horrid lessons. No wonder that so many of us are afraid to feel when people in positions of power, even people who we are told are there to help us, can literally be the source of our feelings phobia.
I’m not here to analyze whether your parents, guardians, teachers, or care providers had malicious intent when they first told you, “Don’t cry.” I do ask you to consider how this and other messages around feelings and emotions shaped your early experiences. A common thread for many of us is that some of our earliest wounding was also paired with damaging messages about what it means to express feelings, let alone have them. So whether, as a young man, you were taught that boys don’t cry, or whether you learned that crying only got you into more trouble, regardless of your gender expression, these source messages must be explored if it is your intention to overcome feelings phobia.
When I worked in addiction treatment, I offered this rather crude metaphor. Consider that trying to stop yourself from feeling your feelings is as futile as trying to stop the flow of a river, the waves of the ocean, or yes—as futile as trying to stop yourself from doing your business when your body signals that it’s time to find a toilet. Or at least somewhere to let it out, even if it’s a roadside bush or a makeshift litter box (which I once had to create on an overnight bus through India where no toilet was to be found on board). All whimsy aside, think about the last time you had to “go to the bathroom.” What if you were told, or even told yourself, I have to hold it in—indefinitely! Consider the level of pain and distress that would ensue, and how eventually what needs to come out will come out in an even messier, uncontained way.
As gross as it sounds, this is what we do when we do not allow ourselves the proper outlet to feel through our feelings, an experience of human living that is as natural as needing to do this physical business. Bringing this metaphor full circle, consider how most of us were toilet trained to be able to take care of this physical business in a safe and sanitary way. And yet most of us never received the same level of patient training and instruction about the naturalness of feelings and how to express them healthfully. So, show yourselves some compassion as you identify what’s kept you stuck and learn a new way of being in the world. Be kind to yourself. It may feel like you’re in toilet training all over again. Seek professional help with a provider who seems willing to do the deep digging with you in a supportive context. It’s not ridiculous to do a phone screen with a potential provider and ask them what their stance is on feelings and how they work with them in clinical practice. You can also turn to your friends and people in your life who relate to the struggle. In my experience, the daunting prospect of letting ourselves go there can feel less scary when someone can validate and affirm, yet also have the willingness to challenge us appropriately.
Every time you let yourself feel a feeling is a victory in this healing process or experiencing the world, not just surviving it.
It’s all training ground.
I’m sitting here…
And I am not having any palpitations in my chest; my heart is not beating fast.
I am not having any fluttering in my esophagus or my thymus.
I don’t have any painful little bumps underneath the skin on my stomach.
I don’t have any muscle spasms.
I am just sitting here.
It doesn’t feel like someone is choking me. There is no feeling of a hand clasping my throat.
It is not hard to swallow.
There is no electrical impulse near my left shoulder.
And there is no sharp pain in random places in my arms.
My eyes are not seeing double.
I have no vision disturbance.
It doesn’t look like the background is in front of the foreground.
People have only two eyes, not four.
I’m sitting here and I’m not dizzy or disoriented.
My eyes are not rolling back in my head; I don’t see lightning flashes when I close my eyes.
My lungs don’t feel like they are being crushed and sticking together.
I’m not struggling for breath and I don’t have a fever.
I’m just sitting here and there are no rising explosions in my chest.
Nothing feels like it is blowing up; there is no fire.
It doesn’t feel like I’ve broken my jaw, my nose, or my cheekbone.
I don’t have a rash that looks like stitches on my eyebrow.
And I don’t feel like I’ve been beaten up.
I’m sitting here and my whole scalp isn’t broken out in rashes either.
My cheeks don’t look chemically burnt.
It doesn’t feel like someone punched me in the stomach.
And there is no loud ringing in my ears.
There’s not a feeling of water flushing down my neck and back.
My brain doesn’t feel like it’s swollen or floating around.
It doesn’t feel like it is getting so big that it is ready to burst through my skull; there is no pressure.
Every individual hair follicle doesn’t feel painful and sensitive to the touch.
I’m sitting here and I don’t feel too tired to stand.
It doesn’t feel like something is vibrating in my pelvis.
It doesn’t feel like my chest is caving in.
And it doesn’t feel like every breath will be my last.
I’m sitting here and I don’t have a migraine or a headache.
It doesn’t feel like I have black n’ blues where there are none.
There is no feeling of a lightning bolt in my foot; no electrical impulses in my body.
It doesn’t feel like something is crawling under my skin; there is no “bug” on my lip.
I’m sitting here and I don’t feel overstimulated by everything I see, hear, taste, feel and smell.
My shoulders are not rounded forward for protection, nor are they creeping up to my ears with fright.
My neck muscles are not tense and painful.
My lymph nodes are not swollen.
There is no phantom pain moving all throughout my body.
In fact, I have no pain at all…I’m finally just sitting here.
There were so many different doctors. So many tests. They all said nothing was wrong; that it was all in my head. Now I know why. These were the effects of Psychiatric Drug Withdrawal. Many do not think it is serious or believe it exists. I wish I knew then so that I didn’t worry.
I wish I knew when I could barely even sit there.
One of the most common questions I receive from consultees is how to make EMDR therapy their main modality and transition into being an EMDR therapist. They see the ease and comfort I have in my own practice as an EMDR therapist as well as in the group practice I co-founded. They want to emulate this and are stuck, not knowing the steps to take. However, what they don’t see are the years of work, education, training, consultation, client sessions, blood, sweat, and tears that went into building my clinical practice into what it is today. Cultivating a culture of EMDR therapy in your individual work with clients as well as your clinical setting is possible by being mindful of the following considerations.
Jump right in. A challenge I hear from new EMDR therapists is how to get themselves on board with EMDR therapy. Especially after part 1 of the basic training, many clinicians are completely overwhelmed by all of the new information presented and have a difficult time shifting their clinical framework from the old way of doing things to this new, seemingly mystical clinical framework. My best advice is to not wait. Jump right into to it as soon as you leave the training. Come Monday morning, start phase 1 with your clients and look for targets you can process. Also, schedule consultation soon after part 1 to further discuss and consult on how to implement the 8 phase protocol with your current clients. Schedule part 2 within a few months of completing part 1 even if you haven’t completed many consultation hours or started really using EMDR therapy much within your practice. If you wait, you will lose momentum as well as get lost in the new information. Months may pass before you tiptoe into using any bilateral stimulation, even just for resourcing. It’s okay if you have to read from a script during the first 100 sessions or ask the steps out of order periodically. Your EMDR sessions will be messier than what was demonstrated in the trainings; just keep jumping into it over and over again. Practice makes perfect and your clients will forgive you or not even know the difference if you asked for the VOC before the SUDs.
Shift your focus from clinical tool to clinical modality. Since its conception, the view on EMDR therapy shifted from a tool to use within therapy to an all-encompassing treatment modality. By viewing it as such, the approach is altered from having specific EMDR sessions in which you wave your fingers in front of your clients to engaging in EMDR therapy from day one with a client even without bilateral stimulation. Working through the 8 phases of EMDR therapy and understanding the effects of traumas/adverse experiences, further integrates EMDR therapy as a clinical modality. There are many insights and breakthroughs that occur in identifying the origins of negative beliefs and their associated traumas/adverse experiences. Knowing the power of these insights takes the pressure off of rushing into phase 3-6 when a client is not fully prepared and resourced and further highlights the benefits that occur even outside of reprocessing sessions emphasizing a culture of EMDR therapy within your practice.
Have the motto “we can process that!” I constantly have my ears open to potential targets and am known to say, to a bit of chagrin of my clients, “we can process that!”. Not all traumas/adverse experiences are disclosed at the beginning of treatment. Sometimes they are slow to reveal themselves because a client isn’t ready or is just ignorant that these potential targets are affecting their current functioning. With all the advanced EMDR topic trainings targeting specific symptoms and issues, there is potential for an endless number of special protocols. However, you do not have to be specially trained if you have a strong understanding of the basic EMDR therapy protocol and are competent in working with the specific population. Though there may be special considerations with different populations, you can target and process anything that proves to be a trauma/adverse experience. Attend consultation sessions and EMDR networking groups to listen to other clinicians’ experiences in identifying shrouded targets. The more you practice your EMDR skills, the more you will hone your intuition about what constitutes a good target.
Identify yourself as an EMDR Therapist. It is a self-fulfilling prophecy; if you identify as one, you are one. Introduce yourself as an EMDR therapist, which will give you ample opportunity to discuss your treatment approach with potential clients and referral sources. As you become more established, clients will seek you out specifically for EMDR therapy further cultivating the culture of EMDR therapy within your practice. I regularly receive requests from potential clients looking specifically for EMDR therapy indicating a familiarity with this modality. Initially after being trained in EMDR therapy, however, I had to convince all my clients to try this new-fangled therapy. It was a shift from their conceptualization of traditional talk therapy to a culture of EMDR therapy in which we identified potential trauma targets and used bilateral stimulation to desensitize and reprocess these targets. Despite my immediate enthusiasm for EMDR therapy, not all of my clients were as convinced, and it took some time, effort, educating, and demonstrating to create a culture of EMDR therapy within my own practice.
Get the word out. The more publicity and discussions about EMDR therapy, the more mainstream it becomes as a treatment modality. We can cultivate a culture of EMDR therapy in our clinical settings by addressing the effects of traumas/adverse experiences on the brain and explaining the Adaptive Information Processing model. Share the EMDR love with your friends and family. Post information and articles about the effects of trauma/adverse experiences and EMDR therapy on your social media. Host informational sessions at your practice or place of employment and work EMDR therapy into any presentations you are giving as a mental health provider. Network with other EMDR therapists by joining EMDRIA and regional network groups. If you are at an agency, hosting an informational session as a brown bag lunch can help education your colleagues in EMDR therapy. Also, ask your clients to provide testimonials about their experiences with EMDR therapy to their other healthcare providers..
Cultivating a culture of EMDR therapy can be an arduous process. You will constantly have to explain, reinforce, and reframe people’s beliefs about EMDR as a whole therapy framework. By jumping right into the 8 phases and identifying yourself as an EMDR therapist though, you will quickly begin to shift your practice to an EMDR therapy framework. Looking for potential targets within the therapeutic setting and getting the word out about EMDR therapy whether it is within your personal circle or at your practice or agency further cultivates a culture of EMDR therapy within your individual clinical practice as well as within your practice or agency. It will be well worth the effort as you process your clients’ traumas/adverse experiences helping them to achieve a higher level of healing.
The study of subjectivity is broadly concerned with what it means to be an experiencing subject in the world. When I touch the book, “I” am the subject doing unto an object, namely “the book.” This subjective “I” touches the book, reads the book, has the book fall on her head, absorbs the ideas in the book, discusses them with another human being. So, when studying subjectivity, we ask questions about who I am, how I experience the world, and what gives me meaning as a being in the world. It invites us to think about the way in which we relate to the world around us and how we understand our place in it.
There is a long tradition of western philosophy that talks about how we can never really know the things external to us. Sure, I may touch the book, but my sense perception filtered through my brain is all I really have access to. I could be living in the Matrix and the book may not even be real. The outside world is of course experienced, but in some ways, it is always a bit of a mystery. This tradition presupposes that subjects and objects are fundamentally distinct – that I can never know the “truth” of the external world. They suggest that the subject, that I, am reducible to my brain’s processing power of figuring out the external world.
This has always struck me a very disconnected an unsatisfying way to look at my place in the world. The few memories I do have of my childhood are characterized by that feeling of disconnectedness and inability to make contact with the “external world.” Like many, my adolescence was characterized by a chronic striving to “fit in” with the popular kids, with the ever-present anxiety that accompanied a lack of knowing what they really thought about me. Even now, I have very few memories of my childhood before the age of fourteen, which incidentally coincides with the age at which I discovered the ability of alcohol and drugs to manufacture a sense of connectedness to the world – a pastime which would temporarily cure that sense of longing, but ultimately exacerbate the feelings of disconnect and loneliness. Even as an adult I have few belongings that suggest I even existed more than a few years ago. And so, with a lack of history in terms of geographic location, memory and material possessions, save for the ephemeral sense of disconnect from the world around me, I stumbled into this philosophical tradition that reified every negative cognition and somatic discomfort about my lack of fitting into this world.
But there’s another way to think about our place in the world. Maybe we aren’t just minds functioning as detached observers. Part of what it means to be human is to have experiences in the world. To both contribute to shaping the world and to be shaped by it. To bring an amalgamation of life experiences to bear in our interactions with it. Everything we know, we know from a place that has been informed by a geographic, historic, and cultural context that we bring to the table when making sense of a situation or experience. Such an approach to understanding the subject or self means that we are fundamentally evolving, unfolding and growing with each encounter in the world. We are part of the world, connected intimately to it, and it is part of us.
So, what does this mean for the kid with no memories and a chronic sense of isolation from the world? What has it meant for the girl from nowhere? It means the way I understood myself has shifted over time away from the desire to figure out what others think of me and how I can access the inaccessible. Treating the world like an object to be figured out or analyzed as means to manufacturing a sense of connection with it, somehow only puts greater distance there. But in embracing my own unfolding story and honoring oneself as an evolving, growing, and emerging creature responding to the world around her, rather than trying to figure it out, has paradoxically resulted in a deeper sense of connection and intimacy in relationships and with the world at large. The ironic twist here, is that in my experience when I let go of striving to figure it all out and instead am mindful of my own experiences and responses to the world, I actually somehow become part of it rather than a detached observer.
Moreover, if in every interaction with the world I bring with me a history of experiences that help me to make sense of those interactions, then I also bring those experiences with me as I look back at my past. This means I get to look back at a childhood and adolescence that I don’t fully comprehend, that is missing large pieces, and characterized by a sense of not belonging with the wisdom of experiences and memories acquired later in life. For the girl from nowhere, understanding myself in hindsight with the full weight of the experiences I do have, means I get to weave together a new story and claim that history for myself – to rewrite my own narrative.
There is one last important consequence that results from understanding subjectivity as evolving in response to a world with which we are intimately related and in communion. An intimate connection with and sense of belonging to requires responsibility. If we are connected with the world and therefore one another, we are responsible for both validating one another’s unique experiences and histories and challenging one another to continue to grow and evolve. It is not enough to simply honor from whence we’ve come. Comfort with self, community and other, means we must continue to submit to new experiences that challenge us to discard old ideas that are no longer productive and avoid becoming stagnant.
Understanding subjectivity as the embrace of one’s unfolding story in response to the world about her sounds lovely. yet even as I write this, I am keenly aware that I don’t always live in this space of communion with the world. I would be lying if I said I never gave a damn about what you thought about me, or how even this piece of writing might be received. I want you to like it. I hope you do. But it’s not something I can figure out how to make happen. Even with the full recognition that my striving only feeds my discomfort, I readily admit I still fall into these patterns, defaulting to my analytic brain. I have a choice today about how I want to engage the world, and it’s not always an easy one as I slip into old ways of thinking. So if you see me on the street, feel free to remind me that my own history, experiences, and insights are worth honoring or perhaps need challenged so that I might continue to grow and feel a little more comfortable in this world, and I’ll try to do the same for you.
I woke up this morning to the news that a mass shooting occurred in Dayton, Ohio, about 90 miles west of my home. This was the second mass shooting in 24 hours from which I am still reeling. Though these events did not affect me directly, it is still impactful because of the way it alters my thoughts, feelings, beliefs, and actions. I feel heavier, weighed down with worry, and just an overall sadness. Today, I was planning on taking my kids back-to-school shopping and can’t help but think “What if this happens there and should we even go?”
I hate this thought process and don’t want to live in fear of a tragedy happening to my family, but it’s something I can’t shake. These feelings reveal themselves in the conversations I have with my kids about what to do if a shooting occurs in a public setting. Not to terrify them, but to prepare them in a time of crisis. Unfortunately, this is a common dialogue I have with them to teach them how to keep themselves safe, and they have already gone through this narrative in their schools where they practice lockdown drills and have even been exposed to shootings within our own community. Again, though we weren’t personally affected by these tragedies by being there or having a friend or family member involved, these traumas do affect me personally as I move through the world and teach my kids how to move through the world. I have a heightened sense of worry and anxiety for my family and friends because you never know when it is going to happen.
As an EMDR therapist, I am acutely aware of how trauma can impact individuals in a variety of ways. It is important to understand how mass shootings and community traumas impact not just the direct victims but also impact the community as a whole. The obvious application of EMDR therapy is with any person who was directly involved in a shooting as a victim. There may be images, sounds, smells, somatic sensations, and other stimuli that are triggering and bring the experience flooding back into the present creating a fight, flight, or freeze response. All of these can be processed with EMDR therapy, releasing the emotional charge associated with these triggers and distancing the past from the present.
Survivor guilt is often talked about in conjunction with shootings. My friend was killed, and I survived. A stranger died saving me; if I was at that event that day, it would have been me that was killed. Our brain tricks us into believing that if I was there I could have stopped it, it’s my fault she died, it should have been me, or any number of negative beliefs that our brain uses to try to make sense of what happened. The problem is that these beliefs are just not true and most of the time our rational brain knows this (the neocortex). Our trauma brain (limbic and reptilian) just hasn’t caught up and is in fight, flight, or freeze mode. When you process the traumatic memories, the trauma brain links up with the rational brain, bringing an adaptability to these negative beliefs.
Hearing about these events on the news or through stories told by survivors can be traumatizing in and of themselves. This can instill the same trauma response as directly experiencing a traumatic event. These vicarious traumas can be reprocessed in the same manner using EMDR therapy by targeting the corresponding images you have about these events. Reprocessing these events with EMDR therapy can help desensitize the horrific pictures that go along with a mass tragedy. It allows you to bring these images and memories to an adaptable place letting go of the associated negative beliefs, putting the past in the past and building resiliency. By doing so, you can engage in everyday life and feel empowered.
As I take my kids shopping this afternoon for their first day of school outfits, I will still talk to them about what to do if some crisis occurs to prepare them to keep themselves safe. However, I will do this from a place of preparedness and not fear. I will also talk to them about the different tragedies in our community and how they can affect change just by treating others with kindness and respect and putting more positivity out into the world. I hope to instill in them a sense of safety, empowerment, hope, and love. I hope and pray nothing like this directly affects us, but with the frequency of these occurrences, I fear it is inevitable. My hope is that as we help people to heal and show loving kindness to others, the occurrences of these tragedies will diminish.
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 association 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.
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.