The response to COVID-19 is unlike anything I’ve witnessed in my forty years on this planet. Seeing so many events and yes, even whole sporting seasons being suspended, has me wondering if I’m living in some kind of twilight zone. Or in one of the apocalyptic movies that I love so much. While I appreciate the arguments I’ve read about mitigating risk and slowing the spread of the potentially deadly virus, my mixed emotions about everything are boiling over, prompting me to write this piece and share something I want to scream from the rooftops. Why don’t you care this much about risk and contamination when it comes to trauma?
There is so much rhetoric out there, much of it legitimate, about putting the vulnerable at risk by exposing them to the virus. Even though I’ve soldiered on to finish some planned events this week, a concern exists over how people may judge me for potentially putting others at risk. Where is this same level of concern in a country and indeed a world where violence against women and children is the most brutal pandemic of them all? What about the endless stream of brutality and invalidation that developmentally vulnerable children can be exposed to on a daily basis from parents, other family members, teachers or peers? And have you ever stopped to consider the systemic injustices that the poor, underprivileged, and underrepresented minorities in our society have to battle consistently? All of these are a short list of risk factors living in our midst every day that, if left untreated, will tragically blossom into complex post-traumatic stress disorder, addictions, “personality disorders,” dissociative disorders, and cause or complicate a whole host of other physical health conditions like heart disease, hypertension fibromyalgia, or cancer. Read the Adverse Childhood Experiences study and the public health initiatives from that study for a primer if you don’t believe me.
The heart of my teaching as an author and clinical specialist in traumatic stress disorders is that to truly understand the human phenomenon of unhealed trauma and how to treat it, you must break down the word origin. The English word trauma is a direct translation from the Greek word meaning wound. My working definition of trauma is any unhealed wound. You can check out my TEDx talk on the trauma as wound metaphor from 2015 on YouTube for the full teaching. Here are the highlights: understanding how physical wounding, illness, and injury works is the key to understanding all other kinds of trauma—emotional, sexual, spiritual, etc. Think of everything you know about physical wounds. They come in all shapes and sizes. Some may require more urgent care than others or they can be fatal. Whether you are talking about a scrape or a gunshot wound, all wounds need care. Sometimes that care is to wash it out and then give it time and space to breathe, and other times the care needs to be professional. Of course, people with compromised immune systems or other health problems are naturally more vulnerable and professional care may be imperative.
Wounds generally need treated from the outside-in to stabilize, although true healing occurs from the inside-out, over time. Check out the talk if you want even more of the metaphorical parallels between physical and emotional wounding; believe me, I can’t shut up about them. A major point to highlight is that it can feel easier to deal with a physical injury or illness, especially one that is visible like a broken leg or an audible cough. Because they are visible in the realm of the five senses, they are more likely to be validated by others as problematic. And if the risk of a more immediate fatality looms, the concern is generally worse. I argue that this is due to humankind’s overall fear of death and dying, but there’s not enough room in this blog to even begin to go there. Maybe the next one…
Yet if wounds are unseen, like the kind we experience in our hearts, through our emotions, and in our souls, we are more likely to get told things like “get over it,” or “pick yourself up by the bootstraps.” Or my favorite: “You’re triggered all the time! Enough already.” Usually it’s the people who complain about our triggering that are the ones who have done some, if not most of the wounding. Let me be clear—we’ve all hurt other people and we’ve all been hurt by other people. The severity of some wounds may require professional intervention, just like with physical wounding, while other wounds may simply need a little space, time, and tender loving care from another human being like a friend or confidant in order to heal. Having an awareness of how we are wounded and how we’ve wounded others is the key to understanding the risk of contaminating others with the blood of our own unhealed trauma. Hopefully this awareness can inspire willingness to proactively heal ourselves so that we do not contaminate others with our words, actions, behaviors, and the sordid fruit of our own unhealed wounds. Because it is often those we love—our partners, our children, other members of our family, and our friends—that we can harm the most. Until that widespread awareness happens, perhaps we can at least do less harm. In physical healthcare there is a greater sense of awareness that safety measures must be taken to minimize the spread of bodily fluids and pathogens in order to prevent disease. When we heal ourselves emotionally, we engage in similar prevention and initiative for mental health…see the parallel?
There’s another angle for me to share this week, this one much more personal. Like many in the clinical professions, my own struggles with trauma, mental illness, and addiction led me to this work. In recent years I’ve been much more public about my seventeen year journey in recovery from addictions, a dissociative disorder, and bouts of persistent depressive disorder (formerly called dysthymia). Due to reasons having nothing to do with the Corona virus, the last three months have been hell. I’m struggling to date again after an adulthood filled with poor romantic relationship choices resulting from the impact of childhood and adolescent trauma. Just before Christmas, one of my best friends died by suicide and I’m still dealing with a flurry of emotions stemming from his loss. And the mounting pressure of growing a business and becoming a more public figure in my field, I have to admit, is getting to me. I am privileged to have access to the best possible mental health care. I have the most kickass recovery support system in the world, an inner circle of friends that would walk through the fire for me or with me, a daily wellness practice, grounded spirituality, and a solid commitment to self-care. Yet the sheer volume of work and travel, coupled with a growing disconnect from relationships I value, is causing a level of exhaustion unlike anything I’ve ever experienced.
Two weeks ago, I experienced my first significant suicidal impulse in years and earlier this week, it flared up again. There are plenty of factors that keep me protected, yet the reality is that I just want off the fucking merry-go-round. Exhaustion was the main culprit, coupled with a persistent conflict I’ve been feeling over having such success in my professional life while still struggling with interpersonal relationships and my inner world. I hate that the more honest I can get about my suffering, the better that I teach. People draw strength from it, and it can also make me feel like all I was put on this earth for is to teach and to help others. I struggle knowing that so many people see me as someone who inspires them when I still feel like such a train wreck who has been having trouble getting out of bed in the morning on more days than not. On the day of the second major bout, I told my manager and friend that when I meditated and listened to my body, the one word that came up was, “Rest.” I had this overwhelming sense that my body needed a good few weeks to rest and reset herself, in the larger scope of reevaluation I’ve been conducting about my life, my work, and how I spend my time.
Of course, Dr. Jamie the public figure was hesitant to cancel anything—I have commitments and a reputation and a business! Although I have taken time off for my mental health in the past, I feel like I’m in a whole new territory now regarding my schedule and how many people rely on me. I’m not proud to admit this, but I actually said to my manager, “Maybe if I get this Coronavirus thing, I would actually get some rest and nobody would question it.” That was a wakeup call. And when widespread suspensions forced me to cancel my upcoming teaching tour of the UK and Ireland, it was even more of a wakeup call for me that I wasn’t really disappointed. I adore traveling and teaching abroad. And yet my body, mind, and soul needs the rest more. I’ve been granted it due to the risk and contamination precautions around a physical virus, and yes, I feel less guilty taking the time because of this physical manifestation of a disease and its implications for spreading. Yet would people in my work world—the people who book me, the people who come to my trainings, the people who depend on me in my life—have been as compassionate if I needed to rest citing a preventative mental health concern?
Maybe yes, maybe no.
The bigger problems is that me—Jamie—wasn’t even compassionate enough with herself.
Could this be the result of some healing in me that I still have to let happen? Of course. Yet I also believe it’s the result of societal conditioning that none of us are immune to—this idea that physical health care will always take precedence over mental health care. That the medical model trumps the holistic model. And that what shows up in, on, or through our physical bodies and appearances is more important than what is inside.
Enough of this already.
Let’s connect in a way that honors the physical in a healthy way, yet values that who we really are as people is so much more.
The healing power of human connection rests at the center of my work, and this week I’ve been given multiple personal reminders about how this power is where our hope rests. Nothing is more important to me than human connection, and I want to reestablish this primacy before the endless grind of touring and “being public” makes me resent it. My manager and long-time friend Mary, my best friend Allie, and countless other people in my kickass support village have breathed me back to life this week. Whether in person, on the phone, or even through the sometimes cold medium of text, my people were there for me and I am grateful beyond measure for their time and their love. Allie, who lost her own father to suicide, reminded me that in order to get through this I would have to be fully honest about what I am feeling, especially with the inner circle. I teach this stuff all the time! It’s not lost on me that the teacher can be the most likely to forget, especially when she’s flirting with burnout. In those moments, the healing power of friendship and being rigorously vulnerable helped me to hear my own lesson.
I wasn’t expecting to share this vulnerably with my readership this soon, and yet here it is. With the healing power of human connection a potential casualty on the COVID-19 chopping block, a reminder is in order. If my story as its unfolding this week has done this in some small way, I’m truly glad I shared it.
Speaking truth to power is not easy. I recently spoke out from the depths of my soul to a male public figure whose teaching style is—in my professional viewpoint—far from trauma-informed. I’ve listened to this teacher for quite some time as there has been enough good stuff to keep me engaged. Yet I reached a boiling point when some of his rhetoric crossed the line into what I assessed as victim blaming and making excuses for upholding abusive systems and power structures. To stay silent and passive would have been tantamount to tolerating abuse. With other female sexual assault survivors in the room, not speaking up seemed enabling.
Any previous interactions I had with this teacher attempting dialogue could be described as a barrage of interruptions and mansplaining as a response to my questions. On the day I finally spoke up with the fullness of my voice, I first asked to be listened to without being interrupted. When he nodded his head in agreement, I launched into my criticism, addressing trauma dynamics from a personal, professional, and spiritual perspective. After the very intense course session ended, many women approached me and remarked on my bravery and courage by speaking up in that way. One even called me heroic.
I appreciated them honoring me with their compliments and realized that giving voice to many of the things they also wanted to say may be the only good that came out of publicly challenging this man. Yet something bothered me—why do we still conceptualize it as brave for women to speak up to men? Especially when we are challenging their inaccuracies or blind spots in public discourse? Bravery suggests staring fear in the face when taking on a task that is new and radical. I long to live in a world where how I spoke up to a male is regarded as the norm, not as a groundbreaking act or heroic feat of courage.
How do we, as women, make this happen and continue a very necessary paradigm shift that the #MeToo movement and the work of other advocates began? To be proactive, it is not enough to look up to the outspoken women that we admire, especially those that have a public stage. We must also begin to make small changes at a micro level, in the theater of our daily lives, if significant change is to happen culturally.
A first step is to begin examining our speech on our day-to-day basis—are we speaking like we have something to apologize for? Are we constantly tentative, inflecting our sentence endings, making everything sound like a question? Do we insert nervous words and phrases such as like, you know, you know what I mean?, we’re gonna, okay, just wondering, but anyway excessively? Do these patterned ticks hamper the impact of what we need to say? Does sinking into a higher pitch feel comforting when we are uncertain? Do we say what we mean at the appropriate times, or are we constantly censoring ourselves?
Sure, holding the tongue may be appropriate in certain societal contexts, and speaking with kindness may be an important part of our value system. Yet what do we do with the thoughts, feelings, sensations, and words that we’re holding on to? Do we swallow them, allowing them to fester, playing out in the body or in a variety of other emotional distress symptoms? Or do we find another outlet at a more appropriate time to express them? And if we are constantly censoring our expression, especially in speech, what is the reason? Are we afraid of being perceived a certain way (e.g., disrespectful, unladylike, aggressive, bitchy)? Do we fear that others may withhold affection and regard from us if we speak up and claim the fullest expression of ourselves? Does the high, demure pitch seem to get us somewhere, especially with men? Men who we want to love us, admire us, respect us, or perhaps simply take us seriously?
I realize that I am asking many questions here and not providing any concrete answers. As a professional speaker, I’ve learned to constantly engage in self-inventory using these questions. At least once a year I make sure that I listen to a public recording of myself giving a talk and notice what I notice about my patterns of speech and expression. About five years ago, I was horrified to hear how much I used the phrase you know in a day-long course. The constant use of this nervous phrase made me seem less sure of myself and my message. I made a point to look out for it in future talks. I still have a tendency to slip into the you knows from time to time, and now I have the awareness that it’s typically a sign that I’m nervous or I’m doubting myself. To combat this issue, I make sure that I take more time to ground every morning before I face the day, especially if I’m teaching or giving a talk. I also make more spaces to deliberately breathe when I am speaking, as it keeps me in a calmer flow and less likely to sink into the uncertainty…which inevitably translates into my voice. Of course, the deeper work of therapy, other healing practices and setting boundaries in my life has also facilitated a greater sense of flow and strength in my speech.
As a writer, I’ve also noticed and actively addressed similar patterns. In 2012, I wrote the first edition of a book called Trauma and the Twelve Steps: A Complete Guide to Recovery Enhancement. A publisher contracted me to write a second edition to this work, which is due out in 2020. As I went back through the first edition of the book to make edits and conduct rewrites, I was shocked by how apologetic I sounded in so many places, and how many qualifying phrases that I used to cushion my points (e.g., “This is just my opinion,” “In my personal experience, etc.”) Even though my writing is known for its bridge-building quality, it seemed as though I played it too safe, afraid that I would piss people off. I believe there is an art to not tearing into people. After all, if I chew off their heads, metaphorically speaking, how will they have ears to hear me? Yet in this second run through the book, which also reflected an additional seven years of healing, recovery, and standing up for myself, I was able to take out so many of those qualifying phrases and simply present my position. The book is filled with my personal experience, opinions, clinical perspectives, and voice. There is no need for me to keep saying that in order to soften the power of my message. A second step that we can take as women is to give our emails and written communication a closer look before clicking send. The same questions I offer for speech can also offer us insight for the written word. You may find that practicing with writing is a good training ground for addressing speech.
The more I’ve deepened my awareness about these issues of presentation, the more difficult it is for me to listen to other women speak to each other. Even as I write this piece at an airport during my travels, I can hear two professionally dressed women talking to each other from the row of chairs behind me. Even in casual conversations with each other, the pitch is high, there is an overabundance of like and just to cushion what we are saying, and every sentence can sound like an apology for existing, like we are walking on egg shells. In being attuned to this throughout my travels, I notice it from women of all backgrounds. Sometimes it’s so painful I have to put my earphones on at the airport or on planes just so I don’t have to listen to it. And before I come across as a totally judgmental human being, I admit--I still catch myself doing it with my own girlfriends. These tendencies are that ingrained. These tentative, feminine tropes are how we have been socialized to communicate with each other and the world.
Personally, I’ve had enough, and I make a commitment to stop talking to myself, to my fellow sisters, to men, and to the world like I have something to be sorry for. I deserve to say the things I must say, and I can release expectations of how other people will receive me. I know that this commitment will be a work in progress and I will slip into old habits. When this happens, I will be compassionate with myself and recognize when my friends and I may just be lighthearted or joking with each other. Yet I will take it seriously if it feels like I’m apologizing for speaking or taking up space. If more of us are willing to commit to this at some level, I believe a day will come that speaking up to men in power like I did to that teacher will be just another thing we do because we know that we are worthy and we will be heard.
Photograph of Dr. Jamie by Brandy Llewelyn
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.
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 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.
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.
Not So Much of a Rebel: Making Peace with the Standard EMDR Protocol by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
When EMDR clinicians learn that one of my specialties is addiction, I usually get asked, “Which protocol do you use? FSAP? DeTUR?”
I’m often met with surprised looks when I respond, “I use the standard protocol mixed with good common sense about how addiction works, which informs my preparation approach. I don’t find any of the specialty protocols particularly useful.”
I realize you may be gasping right now since, in EMDR circles, lots of buzz can be heard about the specialty protocols and methods that EMDR practitioners are developing. I participate in several Facebook EMDR groups and almost every day I read a question to the tune of, “What protocol do you use for addiction?,” “What about dissociation?,” or, “Is there a specialty protocol for condition x, y, z?”
So many times I have bluntly responded, “Um, the standard protocol mixed with clinical judgment about preparation needs and how to use appropriate interweaves.”
One of the reasons I decided to write this piece is so that I can cogently share my position as an EMDR therapy trainer, author, long-time clinician, and notorious EMDR therapy rebel. What’s funny is that when I wrote EMDR Made Simple in 2011 I called out many problems that I saw with party line EMDR. Yet as I’ve matured as a person, a clinician, and a trainer, I’ve realized that maybe I’m not so much of a rebel after all. For me, the standard protocol really is where it’s at. Learn the standard protocol well within the context of the client’s goals for treatment and know where to point the targeting sequences, and you really have all you need to do successful EMDR with a wide variety of presentations. The adaptive information processing model will guide you, as will the larger breadth and depth of what we as trauma-focused clinicians are learning about the importance of embodied, somatically-informed affect regulation skills.
In this piece I further explore my position by explaining my approach as a trainer to client context and adequate preparation. Then I explore my thematic perspective on client history, which allows me to direct the standard protocol in the direction it needs to go in order to work with a particular client presentation. Finally, I look at where interweaves and modifications may be appropriate depending on the complexity of the case involved. Since addiction and dissociation are my two main specialties in EMDR therapy (and the two main conditions for which I have been personally treated), I will draw on several case conceptualization strategies for these special populations.
One of the first pieces of wisdom I internalized from reading Dr. Shapiro’s early works is not to do EMDR with a client you wouldn’t normally feel comfortable treating anyway. In my interpretation, this means that the task falls on us as clinicians to learn more about a particular condition that may be stumping us as a general best practice. One of my biggest concerns with the rising popularity of addiction protocols is that well-intentioned EMDR clinicians who know little about addiction are simply pulling out the protocols and hoping for the best. When this happens absent the larger knowledge about the various models of addiction, the interplay between trauma and addiction, and the impact of the stages of change, inadequate care can be delivered. In one of her first books Shapiro wrote that “addiction should not be treated in a vacuum,” (Shapiro & Forrest, 1997) yet I fear this is what happens when EMDR therapists just pull out one of the specialty protocols without educating themselves more on the intricacies of addiction first. The same applies for dissociation and dissociative disorders, or any other specialty presentations that may puzzle you—start by reading up or furthering your continuing education on the generalities of that population and their needs.
Adequate preparation in EMDR therapy involves much more than just doing one Calm Safe Place exercise. Although I train the skill in my program, I discuss its limitations, and it’s one of only many strategies that I teach. While the classic skills of Calm Safe Place (which often involves changing up the descriptive adjectives to meet the client’s needs), Light Stream and Container are still very useful, they can all be very visually biased if not modified. Furthermore, to truly help a client manage affect, tolerate distress and be prepared for what may arise during trauma reprocessing (Phases 3-6), we must explore other skills.
In our program, we teach a wide variety of mindfulness strategies in a trauma-focused way (i.e., allow for modifications, emphasize not just reading the skills out of the book, rather, having a personal practice yourself as a clinician and teach from that experience). Mindfulness strategies can include traditional sitting meditation, moving meditations, mindful exploration of the expressive arts, and learning how to turn all activities of daily living into chances to practice present-moment awareness. Teaching a client breathing strategies and body scanning skills in a trauma-focused way is also imperative. Existing skills or approaches that you utilize in other modalities like dialectical behavior therapy, 12-step facilitation, or yoga can all be very helpful in teaching principles of lifestyle change and grounding. In the spirit of true trauma-focused care, the needs will vary from client-to-client depending on their existing experience with such skills and the intricacies of their presentation. I’ve learned that the more complex the client, attending to preparation in this total matter is more helpful than any specialty protocol just slapped into the treatment process. You can visit a comprehensive library of these skills and watch how I use trauma-focused language in apply them by visiting the resource site Trauma Made Simple by clicking HERE.
And no, I cannot give you a script about how many of these skills you’ll need and in what dosage. That is where clinical judgment and having done your own personal work comes in to make you as effective as possible. Personal work with these skills is important so that you know what it means to modify and adapt skills for your optimal benefit, which puts you in a better position to do this with clients. While scripts can help us build our skills, a practice that most adult learners need and that I endorse, scripts can rarely help you apply them in the absence of practice and context. To intone the wisdom of Jennifer Emch, one of my program graduates and director of Ubuntu Wellness in Chardon, OH, “Life isn’t scripted and neither are people.”
In addition to understanding the imperative of trauma-focused and enhanced preparation in EMDR therapy, we must also consider as EMDR therapists that taking a chronological history is not the best way to go. Although I agree with Shapiro’s essential position that targeting the earliest memories first is ideal for getting to the root of any given problem, due to the nature of how complex traumatic memories are stored in the limbic brain, taking a chronological client history may be impossible. Or at very least, impractical. Most clients I’ve worked with over the years cannot track a chronology, have blanked out significant pieces of time, or get very tangential when we try to take a conventional history due to the disorganization in the limbic system. When I was trained many years ago I learned the 10 best memories and 10 worst memories method for taking client history, and I’ve also found this ineffective. The most effective approach to holistic client history taking I’ve found over the years, and the approach I teach in my program, is to discover potential targets thematically. Let’s use an addiction-specific example.
For many clients new to a recovery process, there is a willingness to do EMDR therapy reprocessing and yet there may be insufficient affect tolerance to go to the earliest instances of abuse or trauma. For optimizing engagement, you may be better suited to work with their goals for recovery first, while respecting the trauma history that led to the problem in the first place. Many individuals struggling to get better, regardless of their specific goals, carry a negative belief like, “I cannot deal with my feelings without alcohol (or other drugs/behaviors). That is a negative belief that can be “floated back” using questions like, “Thinking back over the course of your whole life, when is the first time you got the message that I cannot deal with my feelings without alcohol.” You can also ask the question for the worst or most recent. What you get from the client all represent potential areas that you can target. Might these targeting sequences link in to earlier, more impacting traumatic experiences? Of course. Yet targeting them this manner is, in my experience, a kinder, gentler way to go and helps them to see the relevant connection of the EMDR work to what may be their biggest issue of concern in therapy. To see some examples of how I conduct client history in a thematic way, please visit the video demonstrations section of the Institute for Creative Mindfulness website by clicking HERE.
One of the wisest pieces of direction I received in my rather traditional basic training many years ago is that the greater the degree of complexity in the case, the more level of interweave you will need. I feel that learning the principles of cognitive interweaves (as described by Shapiro in her texts and further elucidated by other great minds in the EMDR community) is essential to doing EMDR with addiction, dissociation, and other special situations that may throw you for a loop. Yes, the classic directive in EMDR therapy is to stay out of the way as much as possible. Yet I was delighted to see Shapiro (2018) use the phrase proactive measures so much in the third edition of her text. To me, solid interweaves work as a plunger of sorts. When the flow of reprocessing is clogged, we can apply good open-ended questions, gentle pieces of encouragement or psychoeducation, and mindful or somatic techniques to get the flow going again. Although I teach a list of common interweaves in my program and Shapiro offers some solid examples of them in her text, the best interweaves are the ones that you develop through constant practice of EMDR and working with consultation to hone your craft.
Sometimes we can get nervous talking to consultants or other EMDR therapists about modifications, fearing that we’ll get “called out” on deviating from protocol. Yet consider how all of these specialty protocols that we can get so excited about in the scripted books or special trainings are really just twists and turns on the standard protocol anyway. They are proactive measures. One final modification tip that I can offer from my clinical experience on working with complex issues like addiction and dissociation related to the part of the standard protocol where we are asked to get an image (or worst part) from the client. I’ve always liked the language of worst part because it recognizes that some memories, especially pre-verbal ones, may not be stored with an image. With folks who may not have sufficient affect tolerance to handle going to the “worst part,” yet who have done all they can with preparation skills, you may be better suited to ask, “What part of this target memory are you willing to work on today?” Then proceed with the standard protocol from there. This may make reprocessing more digestible for the client in the spirit of EMDR therapy Phase 2.5. Yes, you will likely have to go back later and check to see if there is an image or worst part in a separate targeting sequence in order to achieve completion of the target in a technical sense. Yet consider how this modification may be more tolerable for individuals.
If you are the type of adult learner who needs more of a scripted protocol to learn new information, that is more than okay. I know that as a trainer I could not survive without using scripts with my students. And yet there comes a point in your development as an EMDR clinician when you must realize that the scripts are just modifications. These specialty protocols we can all get excited about are just very necessary modifications. No, modification is not a dirty word as long as you are able to clinically justify why you are making the modification or, in the case of Phase 2 preparation, enhancements. Doing this well and in the most trauma-focused manner will eventually involve you moving away from scripts and other peoples’ protocols and working to hone your own clinical common sense.
Shapiro, F., & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy for overcoming stress, anxiety, and trauma. New York: Basic Books.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing therapy: Basic principles, protocols, and procedures, 3rd ed. New York: The Guilford Press.
“Jamie, when we first met, you brought up all of my popular girl issues and I didn’t know how to act around you.”
My mouth was agape when Ramona, a member of the Dancing Mindfulness community and now a senior affiliate trainer in our program, revealed this to me several years ago. While I didn’t wish to negate her experience, there was a part of me that wanted to rage back, “But you don’t understand! I’m anything but a popular girl. After all, the popular girls in school gave me a complex that’s taken years of therapy to repair!”
The images of that chubby girl with a bad perm being teased and set up on the Catholic school playground in elementary school came flooding back. The panic I experienced in junior high that I would never be “liked” in that way by a boy or a girl rose up in my chest. The despair in which I found myself as a competitor in high school speech because I never felt pretty enough, talented enough, or likable enough to win the top prizes came into the clearest view. Then I realized—even as an accomplished professional with a public image, I still let the kids I perceive as more popular affect me. And it turns out that many of us still do, long into adulthood.
There’s a great deal of talk about impostor syndrome in pop psychology literature and on social media—the fear that one day people are going to expose us as the frauds that we are and realize that we’re full of shit and have no business to be working in our fields. What I am putting out there for consideration is related and yet essentially different—the popular kid complex. This is the fear that no matter how hard we try, how great we look or how talented we are, we’ll never be invited to sit with the popular kids at their lunch table. While we can argue that in an ideal, spiritually enlightened world there ought to be no such thing as lunch tables and that external metrics of this nature shouldn’t matter, we do live in that world. And no matter how hard we work on ourselves or how deeply we invest in our spiritual practices, things like this can still matter even to the steadiest among us.
This idea may feel like just another variation on the keeping up with the Joneses concept, always wanting more out of a sense of competition. To explain how I see the popular kid complex as fundamentally different and even bigger problem, I’m going to call myself out on my own shit. Many years ago, I set out on the path of my teaching career as an extension of service and continuing to live in the eleventh step as described in a 12-step program—to pray for knowledge of my Higher Power’s will and the power to carry it out. At first I was simply over the moon that people wanted to book me for trainings and read some of my articles. The more I kept putting myself out there, I gratefully received more teaching invitations and my first book contract in 2011, primarily to write for other therapists.
Then at some point, I found myself getting intimated and maybe even a little jealous by the likes of Brené Brown, Gabrielle Bernstein, and Anne Lamott. They are popular! They are on the New York Times best seller list! They have a reach beyond just their niche market. Oprah invites them onto Super Soul Sunday, the ultimate cool kids lunch table for modern times. Here’s the kicker—I like their stuff, I adore their teachings. They put themselves out there the way that I would like to, and what still stops me short is this fear that I will never be as pretty, whimsical, charming, likable, talented, relatable, or popular as they are. I am even prone to thinking thoughts like, “Why does the world need teachers like me when they have teachers like them?”
Fortunately those thoughts come and go, as I know at my core that what I do in my work is a direct fruit of me asking my Higher Power and the universe to make me a vessel, in whatever form that may take. But as much as that spiritual perspective keeps me grounded, I am still human. My meat suit and all its programming can get the best of me. In the language of recovery, I can still get in my own way.
Sometime last year I looked at jealousy—is it that I’m just jealous of people who are better than me and can get things done where I can’t? The teachings of the Kripalu-Amrit lineage in which I study yoga helped me through that one. I accepted that jealousy is a fear that, at my core, I am not enough. Jealousy is about being cut off from the reality of my true Self and my true nature where none of us are separate. Spiritual me gets that. Human me still struggles.
I was recently doing some of my own EMDR therapy on this matter and the Brené Brown brings up my popular girl issues and I’ll never be likable enough to get a Netflix special was tripped-wired. The therapist working on me said “go with that” and I immediately blurted out, “Brené Brown is my Marla Carano.”
Marla Carano was the best speaker in the Ohio region where I competed my senior year of high school. Tall, articulate and charming, she looked about ten years older than the rest of us, wearing a stylish olive green suit for major competitions. She went to one of the powerhouse suburban high schools where her father was the legendary head coach. As a kid from a city school with a small team, I believed I could never be as cool as her. To be clear, she won on her talent. Also to be clear, Marla was always a gracious competitor and genuinely nice to me. I never felt anything like a “mean girl” vibe coming from her. Yet I could never shake the fact that I would perpetually be second or third next to the likes of her because I wasn’t as pretty, whimsical, charming, likable, talented, relatable, or popular as she.
And the reality is, in what has since become the classic Dr. Jamie Marich move that has defined my adult career, I wrote a pretty avant-garde original oratory for high school speech tournaments. My speech created conversations with other students and even other judges even if I didn’t necessarily win top prizes. The move I made that year to put my voice out there is the gutsiness that I celebrate and applaud in my own students. That move, I believe, made me the speaker I am today whose primarily livelihood is literally forged on my ability to go up there and speak truth without fear.
So why isn’t that enough? At seventeen, one could say I was still in high school and having a place in the spotlight matters. But I’m nearly forty. Why can I feel, especially within myself, that life is still a damn speech and debate competition? Maybe it is. After all, I’m still vying with others to win teaching contracts, spots as a keynote, deals with publishers. The cynical and yes, human, side of me knows that there will always be an element of competitiveness to life. As I continued to “go with it” in my own EMDR session that day the larger, spiritual truth filled my heart—teaching and being public in my field must never be a competition.
Our purpose as healers is to alleviate human suffering, bringing one of Buddha’s noble truths into beautiful fruition in this world. This task takes all kinds of people—those who have mass appeal and those who have niche appeal—and all types of talent. Working the front lines of community care in places like correctional facilities, treatment centers, and poorly funded public mental health facilities requires talent and commitment. People who will never give a training or write a book have a different yet wholly essential talents that I do not. This is where the heart of our work is happening and when I get into crazy places with my own ego, I must remember this truth.
In preparing to write this piece, I reached out to Marla Carano Honen, as we’ve been in touch on Facebook through the years. I wanted to make sure she was okay with me putting an article out there in which she is my nemesis of sorts. Marla is anything but a villain; she has helped me to see a higher truth. And in speaking with her about the premise of the popular kid complex—guess what? It affects her too! I firmly believe we are all that “popular kid” to someone who brings up their issues, and all of us have popular kids who bring up stuff that as adults we must learn to heal and to manage.
I also had the chance to spend some time on a retreat (Ram Das: Spring on Maui) with one of my legendary popular kids, Anne Lamott. And guess what? Anne has struggled with the perils of comparison and can still face her own share of dark thoughts. What I learned from her so robustly on retreat is that she continues to put one foot in front of another by working a 12-step program and reaching out to safe people with whom she can be honest. And in a story I ended up sharing with her, Anne helped me to sink into much of the solution.
After sitting through another beautifully folksy talk by Anne in her awkward loveliness, I walked to the back of the pavilion to get some tea. I thought to myself, “Jamie, even though you are getting more public with your work you will never be as likable as that.” And literally in the next breath a lovely young yogi comes up to me and says, “I like watching you dance at the kirtan. It’s so inspiring!”
Okay, I’m human enough to admit that part of my thinking went to, “Wow, a perfect looking young yogini likes the way I dance, I matter... I am valid! Roll credits.” Fortunately the spiritual truths of what I’ve been learning and studying kicked in and gave me the real lesson: When I dance, I am my most authentic self. I dance absent any kind of technical prowess. Dancing and responding mindfully to the music is the purest experience of being a vessel for Divine energy to flow. That doesn’t make me popular, and yet it does something much more magical. It attracts the people who need to feel it too so that hopefully they will be inspired to open up and be their unique expression of Divine flow.
And hmmm... doesn't this sound like something Brené Brown would teach in her groundbreaking work around vulnerability? Turns outI just had to work on my edge around her to fully open myself up to the teaching. From the bottom of my heart, I thank you Brené and all of my other popular kids for allowing me to "go there" and receive your wisdom.
For as long as I can remember, I have adored flowers. Looking at wildflowers in the fields or noticing several varieties alongside houses in my neighborhood are some of the first pictures that come up in my head when I float my memory back. I remember having to ask my mother’s permission before picking them in my own yard or my grandfather’s yard nearby because I once got in trouble for plucking some of the neighbor’s tulips. I’ve only recently started to appreciate the awesomeness that my mother is named Rosie (which she prefers to Rose)—and that literally makes me a flower child!
I can’t remember when I first received flowers—it was likely when I made my first communion around age seven. I fondly recall getting flowers from my friends and family when I was in my first big stage show at twelve. The confirmation name I chose for myself when I received the sacrament in the Roman Catholic Church is Marie-Therese. I selected the name to honor St. Therese of Lisieux, also called the Little Flower. The first tattoo I got was of a flower (a peace lily on my hip). Even though both of my marriages ended in bitter divorce, I still have several fond memories from both relationships that involve receiving flowers. On a recent pilgrimage to India, one of my drivers—a lovely man named Ratan—climbed a tree to pick me the state flower of Uttrakhand in the foothills of the Himalayas. This gesture had me beaming from ear-to-ear and made me realize just how much I love receiving flowers.
So what better way to honor the sacredness that I am than to practice buying myself flowers? We can put so much weight, especially as women, on what it means to receive flowers as a gesture of love or appreciation. But who is to say that for flowers to have such appreciative value, they have to be gifted by someone else?
Although I’ve picked flowers for myself over the years, I do not consciously recall buying myself a bouquet of flowers until about two years ago. I purchased a beautiful dozen of pink roses to celebrate my separation from marriage number two and all of the pain it represented. After that marriage ended, I entered into a period of deep inquiry to investigate and ultimately heal the remaining layers of relational trauma that kept me in this loop of unserving relationships. And in my sadhana (spiritual practice), my guides led me back to a favorite poem from which I’ve drawn great strength over the years, After A While by Veronica A. Shofstall. After my first divorce, I wrote a song called “Grace of a Woman” (which became the title track to the last album I recorded in 2012) based on a line from this poem. The repeating line in her poem is “after a while you learn”… During that period in my life, this line most resonated for me:
And you begin to accept your defeat with your head up and your eyes ahead
With the grace of a woman, not the grief of a child
Clearly that was the lesson my foolish heart needed at the time. Yet with one of the classical definitions of foolish being “slow to learn,” there was still more healing to be done…
Within a few weeks after my second husband and I parted ways, I remember standing at the entrance to the grocery store near my home where the florist is located and Veronica’s poem came back to me like a lightning bolt. Specifically the wisdom:
After a while you learn that even sunshine burns if you get too much
So you plant your own garden, and decorate your own soul
Instead of waiting for someone to bring your flowers
Thus, as a ceremony representing the new phase of healing that life was bringing me through, I bought myself that bouquet of the most beautiful pink roses. I brought them home, put them in a vase, and all felt right with the world.
“I can do this,” I resolved, “I can be okay by myself, as I am.”
During the period of initial healing I bought myself flowers regularly to keep reminding myself of this lesson. Truthfully, I fell out of the practice after about six months. I started to feel much better. And then, about a year after the separation, I started seeing someone. Although not to the same extent as in earlier seasons of my life, I noticed some of the same patterns about needing to be wanted pop back up and disturb the peace in my life. Even though I’m slow to learn when it comes to my personal healing, I do learn and I’ve been able to nip much of this potential destruction in the bud.
Getting my latest book Process Not Perfection prepared and ready for publication happened alongside me doing some deep therapeutic digging about the remnants of relational trauma. Healing those wounds has proven to be the greatest process of my life. The day that the book officially released, I allowed myself to sit on my couch, breathe, and take it all in. And then the wisdom inherent in Veronica’s poem came back once again—go out and buy yourself flowers. Celebrate you! Celebrate not just all that you’ve accomplished, celebrate the wonder that you are! Indeed, decorate your own soul…
We can decorate our soul in a variety of ways along our healing path in ways that are not entangled with attachments to others. Even if you are in a committed relationship, please consider nourishing yourself in this way. Perhaps planting a garden is more your style than buying flowers. Do it. Do whatever is going to help you celebrate your own wonder while cultivating beauty in your life. I am worth it, you are worth it. And perhaps if we deepen into this practice of gifting ourselves with the beauty we deserve, we will indeed spread that healing like wildflowers through this suffering world desperately in need of that colorful energy.
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.