clyde angel, dmin., bcc, lpc john sullivan, lcsw presented to in-arms annual conference friday,...
TRANSCRIPT
Clyde Angel, DMin., BCC, LPCJohn Sullivan, LCSW
PTSD- Families -Addictions and Spirituality: The Common Thread?
Presented to
IN-ARMS Annual ConferenceFriday, March 6, 2015
c
Trauma is about wounding The initial wounding is the trauma event
Trauma as defined by patient:
Trauma = earthquake & Flashbacks = aftershocks.
The metaphor of an earthquake is a good one because a trauma event can shake one's very foundation. This is what prompts some to remark, “When x happened, nothing seemed to matter anymore.” While others say, “At my core, I’m NOT the same.”
TRAUMA
J
Wounding occurs on many levels:
Initial Wounding (The Trauma Event)Secondary Wounding
Third Level of WoundingFourth Level of Wounding
Trauma = Wounding
J
Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.
Spiritual distress arises when one of these relationships that provide meaning is threatened or broken… the individual becomes disconnected from their system of beliefs … there is conflict between a person’s held values and perceived reality.
Spiritual recovery is a journey of establishing, rethinking, and redefining one’s sense of self and relationship to life.
Spirituality
c
Signature wound is loss of trust
Compromise of one’s core values or
beliefs
Trauma event is greater than the spiritual
formation formed prior to the traumatic
experience
Need for Spiritual Re-Formation
The shattered soul
c
Relationship Road Map IThe Logic of Emotion and Bonding
BIOLOGICALLY BASED NEEDS
Air – Food – Water – Shelter
BONDING(Emotional Openness/Physical Closeness)
SYMPTOMS OF UNHAPPINESS
Illness, FatigueDepression
Rigidity of PersonalityConstriction, Isolation
Closed, Guarded, Wary
Anti-Social BehaviorRange of Addictions:
Drugs, Alcohol Food, Shopping,
Work Gambling, Internet
SIGNS OFHAPPINESS
Health, EnergyWell BeingFlexibilityCreativity
Open, SharingPersonal
ResponsibilityCapacity for
Intimacy
EASEEU-STRESS
TRUSTHAPPINESSPLEASURE
DESIRELOVE
DIS-EASEDISTRESSDISTRUST
UNHAPPINESSPAIN
DANGERFEAR/ANGER
WB-17
What exactly is the disorder in PTSD?
While it is true the DSM-IV lists PTSD as an anxiety disorder, it is also a
Disorder of Recovery
D - DISORDER
J
The treatment of patients suffering from PTSD is facilitated when they are already successfully working a Recovery Program such as AA or EA. As they discover there are concepts that are interchangeable between recovery programs many gain hope and confidence that they can achieve further success in recovery.
Examples “Stinkin’ thinkin’” (cognitive distortions) “½ Measures” (proper medications w/o therapy or vice
versa) “Sick as your secrets” (denial/repression/avoidance)
RECOVERY
J
As people make the subtle move from I FEEL TO I AM…what had been at first a feeling becomes their identity
as they move from:
I feel Incompetent TO I am incompetentI feel inferior TO I am inferiorI feel careless TO I am carelessI feel immoral TO I am immoral
The move from I feel immoral TO I am immoral is an indication of a 4th level of wounding……
Transition from Third Level Wounding to Fourth Level Wounding
J
When one moves from: “I feel immoral” to “I am immoral”
….accompanied by debilitating feelings of shame and guilt and a shattered sense of trust….
This is a reflection of fourth-level wounding. That is, wounding at the level of one’s essence as in “My core is NOT the same.”
Fourth Level of Wounding
J
In the 12-Step Recovery Model people are the most highly invested in treatment when they “hit bottom”. This in part explains why it is so long before many seek help with PTSD—they eventually hit an “emotional bottom” when various means of avoiding no longer work for them.
“I kept pushing it down, now it is pushing back.”
As with other recovery disorders, those suffering with PTSD may have enablers who attempt to convince the patient and the provider to end treatment in its early stages as they observe the patient getting worse before they get better.
More Parallels - Seeking Help
J
A big piece of what needs to be processed relates to certain questions that are forced to the forefront of one’s conscience and consciousness following a trauma.
Answering these questions is basic and fundamental to our peace and well being which is what gives them such urgency.
When such questions are viewed primarily as “profound” this narrow view can actually promote avoidance behavior.
Avoidance is the lifeblood of PTSD
FUNDAMENTAL Not “Profound”
Why did this happen to me? What caused this trauma event? Was this a test from God? If it was a test, is there a way to pass this test? When is this test going to end? If it was a punishment, what did I do to deserve
punishment? Why did I survive when others died? [SE variation on this
question] If God has forgiven me and I have not, can I ever be
forgiven? If God forgives me and I do not, does that place me above
God?
FUNDAMENTAL QUESTIONS
c
Recovery entails:Finding MEANING in trauma events and Discovering
ANSWERS to pressing fundamental questions related to these events
The key to recovery via meaning and answers is ACCEPTANCE
Answers and meanings must be those one can literally LIVE with since “recovery” is movement from survival mode to LIVING.
One is better able to move on with life as the impact of memories becomes less disruptive to functioning during the course of treatment.
RECOVERY
c
Answers to fundamental questions/beliefs and attaching meaning to events is important.
Acceptance of these answers and meanings is Crucial.
“I saw his reflection in the wall…”
ANSWERS/MEANINGS/ACCEPTANCE
c
The only way to get BEYOND traumas is to go THROUGH the traumas…
this is a scary proposition…
You can’t go over, under or around them…Avoidance will not get you BEYOND them
Avoidance is the lifeblood of PTSD
Getting Beyond the Trauma
J
Anger Management vs. Anger Resolution
Loss and Grief
Shame, Guilt and Forgiveness (to include self)
Spiritual healing
c
When patients believe they have betrayed their own values, morals, conscience, their essence/core or what was once referred to as their very SOUL and that they did so because every one of their so-called "choices“ were morally reprehensible and emotionally devastating leaving them feeling coerced into this self-betrayal, we as providers need to ask ourselves:
Can our current approaches to treatment address the gravity and depth of one’s social-psycho-spiritual reaction to this perceived self-betrayal?
Question
J and C
Certainly spiritual wounding involves “moral injury”. However, the cluster of symptoms that make up spiritual wounding is broader than moral injury.
Spiritual Wounding
c
Spiritual Wounding Symptom Cluster
c
The Shattering of Trust
Disconnection and alienation from:FamilyFriendsOne’s Higher PowerSELF
Guilt Issues
Shame
Moral Injury
Unresolved grief (so many losses)
Issues related to Conscience
Love Knots are commonly held beliefs that seem to be true. However, they are not true because they are not based on logical, realistic thinking. Love Knots can be very harmful to relationships.
Love Knots
WB-50
LOVE KNOTIf you really loved me, you would know what I want, and you would do it. Since you don’t, you obviously don’t
care.
UNTANGLEDI cannot assume that you
know what I want and need. I will ask for what I want and not expect you
to know.
LOVE KNOT #1: You would know …
WB-50
LOVE KNOTWhen I tell you how I feel, you
interrupt, disagree, give advice, judge, or dismiss my
feelings. That’s not what I want. I stop telling you. I
distance myself from you.UNTANGLED
If I want you to listen to me and to hear me without
comment, I need to ask for that. Advice is not helpful when
the person does not want it. Learning how to listen
attentively is often more important than giving advice.
LOVE KNOT #2:When I tell you …
WB-51
LOVE KNOTIf you are in pain, I believe I
should be able to fix it. I don’t know how to fix it, so I feel
inadequate. I get angry with you for making me feel
inadequate. I withdraw from you and blame you for being in
pain.UNTANGLEDWhen you are in pain, I can be supportive without believing I have to provide a solution. I can listen, empathize, and
acknowledge what you say. I will respect and honor your
feelings as well as your ability to ask for what you want.
LOVE KNOT #3:If you are in pain …
WB-51
LOVE KNOT
If I tell you what I want and you do it, it doesn’t count (because I had to tell you). If you try to
guess what I want and you don’t get it right, I get
angry.UNTANGLEDI cannot expect you to
know what I want. Nor can I expect you to do
anything exactly the way I would. I can still
appreciate the gift of whatever you do because you believe I would like it.
LOVE KNOT #4:If I tell you …
WB-52
LOVE KNOT
If I let myself get close to you, I will need you. If I am too dependent and
need (love) you too much, I will not be able to
survive without you. I will become weak.UNTANGLED
I can enjoy being close to you yet still survive on my
own if I need to. As an adult, I am not helpless. I can make a new life for
myself if I have to. Meanwhile, the pleasures
of intimacy are among life’s most fulfilling gifts.
LOVE KNOT #5:I will need you …
WB-52
LOVE KNOT
If we don’t agree, one of us must be wrong. If it’s me, that means I am bad,
stupid, ignorant, or inadequate. So it can’t be me. I must prove that it’s you so I won’t feel like a
failure.UNTANGLED
We should be able to disagree. We are all
unique, and disagreements are a natural reflection of
our uniqueness.
LOVE KNOT#6:If we don’t agree …
WB-53
LOVE KNOT
If I ask what you are thinking or feeling, I
believe I am intruding (as you would tell me if you wanted me to know). If I don’t ask, you believe I’m
not interested, so you never tell me. We live as
strangers.
UNTANGLEDConfiding is the life blood of intimacy. I need to be
able to ask for information, and you need to be able to volunteer it
when I don’t ask, if we are to nurture our
relationship. It is crucial that we speak our truths,
ask our questions, and keep each other informed.
LOVE KNOT #7:If I ask …
WB-53
StartHere The Love Knot I
want to work on is…
My assumptionhas been…
I think I have thisbelief because …What I
neededin my past was …The price I have paid
in my life for having this knot is …
The price you havepaid for my knot is…
What I can do for myself to untanglethis knot is…
What you can doto help me is…
I realize …
I hope …
PAIRS Talking TipsUntangling a Love Knot
WB-55
My Allergy: (TRIGGER)
Raising yourvoice in anger.
My Belief:Anyone who yells at
me does not love me.
My Behavior:I give you the silent treatment for yelling.
Your Allergy(TRIGGER)Silent Treatment.
Your Belief:Anyone who stopsspeaking to me, does not respect me, will leave me.Your Behavior:
I raise my voice again and you continue not to speak to me.
Dirty Fighting Begins
Dirty Fighting Begins
My Feelings:FearHurt
Anger
Your FeelingsHurtAngerFear
Emotional Allergy Infinity Loop
WB-59
Vulnerability:
Allowing another person to see the parts of you that are scared, hurt,
sad, and lonely, etc.
Taking a risk to share your deepest thoughts and feelings with another person even when you are not sure
how they will react.
Empathy:
Imagining what it feels like to be in another person’s shoes
Imagining what that person thinks and feels.
TRANSFORMING THE ALLERGY LOOP INTO A LOOP OF LOVE
WB-62