Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
I have been at Psychological Counseling Services (PCS) since 2012. One of the most difficult parts of being a therapist is meeting a client in their current crisis and as you join and get to know them better, you realize there is a treasure-trove of historical harms that desperately need attention and may even be exacerbating the issue at hand. In a weekly or bi-weekly therapy model, however, there may be little time to excavate and address the root of the matter.
I’ll give you an example: A client enters therapy for their significant other’s betrayal, and they struggle to find strength and obtain positive traction. Underneath this recent trauma lies the fact they lost a parent in a car accident when they were twelve and maybe they were also severely bullied in high school, or their parents fought constantly and eventually divorced.
It’s not that they cannot heal in weekly therapy, they can; it will just take much longer. Not only because there may be a complex history of trauma, but also because “real life” just has the advantage. We are all familiar with the scientific word “homeostasis”, or as my beloved colleague, Marilyn Murray (PCS Trauma Consultant and author of “The Murray Method”) would say, “the baseline for normal”. It means we have formed a certain muscle memory around how things tend to be, and we become comfortable in that space and often resist change or the unknown. Therefore, it is common for a client to grab important insights within the confines of the one to two hours a week in a therapy office, but then outside the office the pull towards the “old baseline” wins out. They want to make changes but need a space and time to build traction and momentum in a different direction. It is then that intensive therapy becomes an appealing suggestion and opportunity.
The PCS Intensive Program
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
From there, the client begins the weekly process of over 30 individual therapy hours, which include Family Systems, CBT, DBT, Emotionally-Focused Therapy, Art Therapy, EMDR, and other experiential therapies. Additionally, there are 25 group hours, that includes Equine Therapy, Psychodrama, Anger and Forgiveness, Compulsivity, Codependency, Emotional Regulation, Communication, Mindfulness, Boundaries, Courageous Living, and the Power of Positivity and Play.
The days are roughly 7AM to 7:30PM with a few short breaks in the middle, and the individual work ends Friday at 5PM. The intensive then concludes with a follow-up to Marilyn’s Workshop on Saturday morning (9AM to 12PM).
The groups are mixed-gender and incorporate individual and couple’s clients who are dealing with a broad scope of issues, including substance and process addictions, complex trauma, relational trauma and issues, betrayal, divorce, blended family concerns, grief, career concerns, and severe life crises.
No matter what modality is used, all the therapists speak the same language in terms of helping clients grieve what they needed and deserved, but did not receive. Clients are helped to grow a wise-minded, healthy, balanced Adult Self who can “parent” the parts of self that get activated in grief/sadness, over-functioning or over-caretaking, defensiveness, anger, rebellion, or deception.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
The Process
The work I get to do with intensive clients is a unique and fulfilling aspect to my job, because I typically get to help heal deep, difficult life experiences and I get to do that work as part of a therapeutic team. Each intensive has a Case Manager and a team of 4-5 additional therapist who are assigned different areas of focus, such as a genogram, a trauma egg, setting up targets and processing with EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, experiential work, addiction and relapse prevention work, relational processing, understanding offensive behaviors and patterns, healthy intimacy, boundary-work, and health and wellness work.
Typically, clients arrive guarded, unsure and at times, overwhelmed. Still, the process begins very quickly by excavating their history and significant life experiences, in order to understand patterns and themes that have impacted their lives. As clients gradually begin to open-up, they start to positively affect each other and instigate change. The bonding begins early with Equine Therapy on Sunday evening and intensifies as they experience their first Psychodrama Group process, where they help a volunteer from the group put a piece of their story in action with the goal of experiencing catharsis and resolution. By Tuesday morning, they typically are ready to share in a meaningful way in their first processing group. The more clients talk about what is uncomfortable to share, the more they inspire others in the group to do the same. The sharing is spiritually powerful and moving, because clients are allowing themselves to be vulnerable and experience real connection; a connection they are encouraged to replicate with the important and healthy people in their lives.
Many clients will express how much they “get it” in an intellectual way. However, what frustrates them is how much they do not feel it. The most satisfying aspect of my job typically happens closer to the end of the week when I witness a client fundamentally shift what was once intellectual, into a “felt” experience; they no longer know they are lovable, deserving, worthy, good-enough, empowered or trust-worthy, they feel it.
At the end of my first week at PCS, I saw a client from the East Coast who completed a 2-week process, smiling, whistling and practically skipping to his car. He jumped in and was headed to the airport – back home, back to his family. I don’t think his journey ended that day, in fact, he was really at the end of the beginning, but it was awesome to see how good he felt!
Let’s start with the obvious:
It is o.k. to be wowed by another person’s look, be attracted to them. It is o.k. to desire sex; it’s o.k. to be sexual.
It is actually more than o.k.! It is part of healthy development and being human.
Moreover, attraction is at the foundation of our survival as species. A mean to mate, procreate and continuing to exist.
SO WHERE IS THE PROBLEM?
There isn’t, unless we define people solely by their sexuality and what can we get from them. If we reduce them to their looks only and we ignore them as a whole person with feelings and thoughts.
This state of mind narrows them down to a shiny object that’s all about satisfying OUR needs and here to be used. It takes away their agency since they have no say. Do you sense the sexual violence?
Should they be flattered that we find them attractive in this way?
Striping them from their humanity is devaluing, as if all their worth is their body and not the wholeness of mind, body and soul. There’s no respect in that.
Objectifying is association to self-centeredness and entitlement. It is dissociation from empathy. We are drifting away from the ability to be in someone else’s shoes, acknowledging their uniqueness, rights, likes, dislikes, different part of their personality, needs, wants, thoughts, and emotions. We are all about fulfilling our immediate need. We might move on shortly to the next shiny object, which means, we are objectifying ourselves as well. By narrowing down ourselves to lust, the physical need only (leading with our body or maybe with our money) we are depriving ourselves love, intimacy, emotional bond, and emotional safety with another human being.
We deserve the whole package!
Why settle for less?
Do you ever wonder what you can tangibly do to get ahead for
the New Year? As I reflect on 2019, I think back to many moments during the
year that included positive growth, hardship, connection, and loss. I started a
life changing internship (Thank you PCS!), while continuing to take classes and
work on my Master’s program at ASU. I moved to a new state away from my family
and friends. I lost and gained friendships. I felt homesick and leaned on
others. With all of this, I will be the first to tell you that I was not
prepared for much of what 2019 threw at me! While being unprepared might have
served a wonderful purpose (as I grew immensely as a person), I continue to
embrace the importance of being present, grounded and mindful when looking
forward and taking on new challenges and A NEW YEAR!
Here are some tips for starting your New Year on the right
foot:
Reflect (with Self-Compassion): It is
important to begin with self-reflection about how you showed up in the last
year for yourself and for others. What went well? What could be better? If 2019
felt like a hard year, this is especially important. Giving yourself compassion
for the hardships endured or where things fell short allows you to open the
door to change for the coming year.
Compassion for others: As you grow your
compassion for self, extend this to others.
Get Grounded and Set Intentions: What do
you wish to be different for your New Year? This could look like creating a
mental or physical list of what you want to accomplish or change. Even if you
had a spectacular year, we can always push ourselves!
Get Specific: How will you act on these
intentions?
Seek Support and Connection: We are not
meant to do this all alone. There are people who will support you in your efforts
to create change in your life. Seek these people out and watch the team effort unravel
positive growth.
Appreciation and Gratitude: Studies have
shown that showing gratitude positively effects one’s social and psychological
well-being. Showing your gratitude will also allow your connections to grow.
From all of us at PCS, we wish you a joyful and prosperous New
Year!
Article by Kaitlyn Beckham, BA, Intern
Kaitlyn is a Master of Counseling student at Arizona State University graduating in May 2020. She enjoys working with adults who have experienced trauma, as well as those who struggle with anxiety, depression, relationship issues and self-esteem issues.
Everyone struggles in relationships, especially with their intimate partners. Some people struggle a great deal and can see patterns showing up over and over again in relationship after relationship.
Why is this? What makes relationships so difficult and why do we see the same challenges showing up over and over?
Recent research has looked at relationship difficulties through the lens childhood adversity and asked the question “what is the impact of childhood abuse, neglect, and trauma on our relationships?” No one has a perfect childhood. I thought I did… until I started looking deeper and asking myself hard questions. In all my years at PCS, I am yet to meet someone who emerged from childhood entirely unwounded. And do I see my childhood issues playing out in my marriage? You bet I do!
We have learned a lot in the past 20 years about the lasting impact of adverse childhood experiences (ACEs). The ACE Study, conducted in the late 1990s, startled the medical world by showing conclusively that different forms of childhood trauma, alone or in aggregate, increase the risk of many major mental health and physical health problems—by up to 5 or 10 times (or more!). The study called out specifically the risk associated with ten childhood risk factors: physical abuse, emotional abuse, sexual abuse, emotional neglect, physical neglect, and living in a home with domestic violence, alcohol or drug abuse, depression or mental illness, divorce/separation/death of a parent, or incarceration.
Having any of these risk factors in your childhood was found to raise your risk of physical, emotional, and/or psychological problems later in life. And it doesn’t seem to matter how often bad things happened or how bad they were—it simply doesn’t take much to wound a child. Relatively few of us can claim to have none of these risk factors.
Fortunately, many of us are able to adapt to some forms of abuse and bounce back without much consequence—our resilience can offset the risks. However, having four or more of these factors may exceed a child’s ability to adapt and may interfere with the child’s emotional, psychological, neurological, and physical development and may lead to substantial problems in life.
We now understand that childhood adversity multiplies your risk for developing addiction, chronic depression, suicidality, smoking, IV drug use, domestic violence, criminality, and teenage pregnancy. Childhood abuse, neglect, and trauma also dramatically increase the risk of diabetes, obesity, heart disease, cancer, stroke, sexually transmitted diseases, and premature death. And not surprisingly, they also increase the risk of failure in the workplace and failure in relationships.
So, what is it about childhood adversity that messes with our ability to have happy relationships as an adult? Here the research has been very illuminating as well.
Studies have shown that kids who have been traumatized may grow up to be adults who need to be perfectionistic, having learned that anything less than perfect behavior less brings abuse or neglect. They may be prone to anger–anger that may become a personality trait or lead to domestic violence. They may be sensitive to negative emotions and highly reactive when triggered. They may have an anxious attachment to others– worried about losing important relationships or unwilling to get close in the first place. They may not tolerate stress very well, becoming controlling, aggressive, or shutting down altogether. It is not surprising that these traits would make it difficult to be successful in relationship (just ask my husband!).
Interestingly, research has also shown that people who live through aversive childhoods tend to be more resilient—to have more grit, that is, a better ability to bounce back from difficulties. So curiously, while childhood adversity seems to set us up to have difficulty in our intimate relationships, it also makes us more able to weather and overcome the challenges that we create.
Perhaps we can have a bit more compassion for ourselves and our partners if we remember that the lingering effects of childhood adversity and trauma can cast a shadow over our intimate relationships. While it does not give us an excuse to misbehave, the tough parts of childhood (which we likely had no control over) continue to influence our way of looking at the world and the choices we make, day in and day out.
So, what can we do? Fortunately, there is growing evidence that trauma-informed therapy techniques can help to heal the wounding that happened to us when we were children. Treatments such as EMDR, somatic experiencing, and psychodrama (among many others) can effectively address the pain of childhood neglect, abuse, and adversity. This may allow us to become healthier, happier adults, and thereby pave the way for us to have healthier intimate relationships.
“Participating in a PCS Intensive Treatment Program is an opportunity each of us have longed for, yet avoided. In 8 days and 68 hours your story has time to unfold and be received by a team of compassionate professionals whose primary purpose is to create a safe and equally challenging environment. The treatment process involving 35 hours of individual therapy brings an appreciation and understanding for the journey you have lived, including the detours, and offers the discovery of the journey awaiting you.”
– Dr. Marcus Earle, PCS Clinical Director
How it all begins…The Murray Method
Preparatory Workshop
The preparatory workshop begins your PCS Intensive Treatment Program. Each group member shares their reason for participating in the intensive, is introduced to our treatment model, and begins constructing a few key elements of their treatment process. Once the ice is broken, the workshop facilitator presents a framework from Marilyn’s Murray’s work called the Scindo Syndrome. The presentation sets the stage for much of the work to come, offering a way of understanding how the difficult and disturbing experiences in our early life shapes how we think, feel, and behave. It outlines what we strive for at PCS: to become a Healthy Balanced Person intellectually, spiritually, emotionally and physically. The Scindo Syndrome, along with the Circles of Intimacy, Responsibility, and Impact, provide the foundational scaffolding that the coming work can build. Not only does it help a person organize and understand their own story, but it also illustrates how we are similar to the others in the group (and in the world). This preparatory workshop is where the first homework assignments are given. The assignments include exercises such as the Trauma Egg, Genogram and Scindo Syndrome drawings to encourage clients to explore and identify what has shaped their thoughts, their feelings — their lives. These exercises guide clients to discover what is underneath even if they are uncertain what motivates their behaviors that ultimately led them to PCS.
Concluding Group
The Concluding Workshop on Saturday mornings is the final piece of the intensive program; a space to celebrate the integration of the Healthy Balanced Adult with the client’s Original Feeling Child (the “child” they are at the core). Clients share with one another their strongest “ah-hah” moments of the week, along with their Trauma Eggs, and their “Child” drawings. In their final moment, clients reaffirm their gratitude for the group work and the gains they achieved during their time at PCS.
Not Just Mental Health
As
part of the intake process, Dr. Rick Isenberg completes a comprehensive medical
history to identify significant symptoms and illnesses, along with self-care
practices, substance use, and compulsive behaviors which may impact the
treatment process. Our physical well being is entwined with our emotional
and relational health.
Interestingly, for some, the medical history may even identify symptoms, or ailments that point toward an underlying emotional issue that may be unknown to the client. We look for these clues and follow them backwards to see what we find. We also look for medical conditions that may contribute to the client’s emotional issues (like diabetes, sleep apnea, hypothyroidism) that are either not yet diagnosed, or neglected and need to be treated.
As part of the initial assessment, Dr. Isenberg also reviews the ACE Questionnaire with the client. This tool looks at adverse childhood experiences and allows PCS to help the client put psychological and medical problems in a family/historical perspective. Dr. Isenberg also administers a neurocognitive screening assessment that helps to identify brain skills that may be lagging. It is important to have our brains working at their best, so we provide tools to allow our clients to buff up brain performance. When our brains work better, life is better.
How Your Team is Assembled
After the client has filled out the registration materials for the intensive program, they will be required participate in a phone prescreen session with one of our team members. Not only does the prescreen ensure that PCS will be an appropriate fit for the client, but it also assists in selecting the individual and/or couple’s therapists assigned to each program with the background information provided. Every schedule includes at least one EMDR therapist. However, clients who are coming to work on trauma or other related concerns could find two or three therapists that utilize EMDR in their sessions. We also look at the other therapy modalities that would be beneficial for the client such as SE, CBT, DBT & EFT to help in the process of building a schedule for each individual or couple.
Clients who are interested in the intensive program but are on a strict budget can have the opportunity for interns, as well as licensed associate counselors (LAC) to be assigned to reduce the cost of their program. The advantage of having a large team of over 25 therapists allows flexibility in the selection of a client’s team and provides the ability to choose appropriate lower cost therapists while still receiving the full benefits of the process.
EMDR, SE, EFT, ETC. – What is EMDR?
Eye Movement
Desensitization and Reprocessing (EMDR) is a trauma therapy developed by
psychologist Dr. Francine Shapiro. Dr.
Shapiro made the chance observation that eye movements can reduce the intensity
of disturbing thoughts when she noticed her own stress reactions diminished
when her eyes swept back and forth as she walked through a park.
EMDR involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief, while using rapid eye movements to facilitate the process. EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with bilateral eye movements or other forms of rhythmic, left-right stimulation. One of the key elements of EMDR is “dual stimulation.” During treatment, a person is asked to think or talk about memories, triggers, and painful emotions while simultaneously focusing on his/her therapist’s moving finger or another form of bilateral stimuli. Other forms of external stimuli that may be used in EMDR therapy include bilateral tactile sensations and sounds (e.g. alternating hand taps or a chime that pans back and forth from ear to ear).
How Does EDMR Therapy Work?
At the time
of a traumatic event, strong emotions may interfere with our ability to
completely process the experience and the moment becomes “frozen in time.” Recalling the traumatic event may feel as
though the person is reliving the event all over again because the images,
smells, sounds, and feelings still exist and can be triggered in the
present. When activated, these memories
cause a negative impact on our daily functioning and interfere with the way we
see ourselves and our world, and how we relate to others.
EMDR therapy appears to directly affect the brain by “unfreezing” the traumatic memories, allowing them to be resolved. Over time, the disturbing memory and associated beliefs, feelings, sensations become “digested” or processed until the event is able to be thought about without reliving it. The memory is still available, but it is less upsetting.
The exact mechanism for the effectiveness of EMDR is unknown. It appears that using rapid eye movement relieves the anxiety associated with the trauma so that the original event can be examined for a more detached perspective. This is somewhat like watching a movie of what happened. This enables a person to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization). Some experts have noted that the eye movements during EMDR might be similar to what occurs naturally during dreaming or REM (Rapid Eye Movement) sleep. It may be thought of as a physiologically-based therapy that allows a person to see material in a new and less distressing way. Others believe it reactivates parts of the brain that were “shut down” as a coping mechanism. In this way, cognitive reorganizing takes place, allowing the negative, painful emotions to give way to more resolved, empowered feelings.
What is Somatic Experiencing (SE)?
Somatic Experiencing was
developed by Dr. Peter Levine and is practiced all over the world as an
intervention to resolve trauma. Dr. Levine theorized that trauma is not
necessarily about an event, but about what happens after the event, at the
physiological and biological level. How our nervous system responds, how those
around us respond, how we recall the incident and the ultimate meaning we give
to the experience will determine our chance of resolving trauma in the moment
or increase the likelihood of experiencing PTSD in the future.
SE recognizes that
trauma is a natural part of life. Trauma is not a disease or an anomaly. Its
effects do not mean a life sentence or permanent incapacitation. Instead,
trauma can be viewed as an injury to the autonomic nervous system with the
understanding that our bodies have an innate capacity to return to a regulated
state of being.
SE is a short term,
holistic and naturalistic approach that encourages mastery, empowerment,
self-direction and resiliency. SE focuses on “sensate” or “felt sense” of the body by recognizing and
accessing physical sensations, imagery and motor patterns to renegotiate trauma
through physiological channels of the autonomic nervous system – from brain
stem to limbic system. The body remembers everything even if the brain cannot
access certain experiences and unlike traditional therapies, SE brings sensory
experience to the foreground while supporting thought, feeling and emotion in
the background.
How Does Somatic Experiencing Work?
SE is a body oriented
approach to renegotiate trauma. It involves grounding, orienting, noticing the
felt sense of the body and tracking with curiosity how it experiences
activation and then de-activation. With the support of a trained therapist, we
can touch into the nervous system, mind and body and prepare for a reparative
action. This “pendulation” of pleasant, unpleasant and neutral sensations
increases our range of resiliency and facilitates nervous system regulation. We
enter the “here and now” instead of being stuck in the “there and then.” We
become able to recognize and express instinctive responses to threat. Expanding
a person’s tolerance of bodily sensations facilitates their trust in the body’s
wisdom and capacity to heal itself by uncoupling incomplete and undischarged
bio-electric circuits. Symptoms diminish in strength and frequency when the
cycle of discharge that have been fueling the symptoms of unresolved trauma are
released. Discharge my take the form of flushing, muscle contraction/release,
yawning, deep breathing, sweating, tears as well as other somatic responses.
Humans often thwart the natural mammalian instinct for fight, flight, freeze or collapse because we filter our experiences through the frontal cortex, thereby minimizing our “animal” instinct. For example, if a child cries we often attempt to sooth by telling them “Don’t cry, everything is fine.” This shuts down energetic discharge. Patients often experience shaking coming out of surgery. Instead of allowing an individual to discharge energy caused by a traumatic experience (cutting, being tied down, having a mask over one’s face) they are often given warm blankets or medications to dull the sympathetic nervous system. When individuals fidget, we tell them to stop. We manage to stop energetic discharge throughout our day. Our sedentary lifestyles and cultural beliefs disconnect us from the body. If our natural, self-protective responses are not completed, this energy does not discharge and we are at risk of our nervous system getting “stuck on” or “stuck off.” We may not feel safe in our own bodies and so we “numb” with substance addictions (using alcohol or drugs) or with process addictions (gambling, sex, shopping, work, etc.) By bypassing the thinking brain and accessing the nervous system we can reclaim the body’s ability self-regulate.
Mindfulness
Living Without Awareness = Impulsiveness and Mood Dependent Behaviors.
What is Mindfulness? Mindfulness has been described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Mindfulness is the practice of being completely aware of what you are doing in the moment, when you are doing it. It is you being in control of your mind, instead of your mind being in control of you.
Mindfulness is about: learning to maintain awareness of your mind, body, and surroundings. It is about staying in the present moment and noticing when your mind drifts into the past or future. It is learning to enjoy life in the here and now. Finally, it is about finding and connecting with one’s sense of self. When you are aware of what you are experiencing, you can make the choice to change or accept it, thus decreasing your suffering.
Benefits of Mindfulness: Mindfulness increases awareness. It allows us to be completely connected to our environment, reduce stress, and improve our overall well-being. Studies show that practicing mindfulness can reduce blood pressure, increase the immune system function, relax muscles, improve quality of sleep, and increase focus and concentration.
Why Learn Mindfulness?
Mindfulness skills help you to tolerate distress, that is, tolerating emotions and situations that feel intolerable; riding your intense emotions (urge surfing) rather than doing things to shut them off or distract from them, OR from engaging in self-destructive behaviors.
Mindfulness skills help you to regulate your emotions. The more skilled you are at noticing and identifying your emotions, the better chance you have of being able to adjust their intensity. If you are aware of what you are feeling you can change emotions you want to change, OR you can choose to stay with the feelings, knowing you are in control.
Mindfulness skills help you to be more effective in interpersonal situations. Increased awareness helps you decide when and how to make decisions about dealing with people and setting boundaries and limits, i.e. “asking for what you want” and “saying no”. Maintaining healthy relationships (or ending destructive ones!) requires the ability to be able to connect with your emotions and to be able to keep them in check if you want to.
Relapse Prevention: (e.g. relapse to undesirable mood states–depression, anxiety, anger, etc.–or impulsive/unwanted/self-destructive behaviors). Mindfulness teaches you how to recognize and disengage from emotion mind at times of potential relapse. Inability to do so may result in a downward spiral, and eventually, the onset of relapse. To avoid this, you must be able to disengage from emotion mind, bring in reasonable mind, and find wise mind. This will allow you to process mood related information in ways that are less likely to provoke relapse. Awareness of the patterns of thoughts, feelings, and body sensations that characterize relapse-related mind states is an essential first step in recognizing the need for corrective action.
Nutrition Makes A Difference
Taylor
Aasand, MPH, RDN, our registered dietitian (RDN), conducts nutritional
assessments of the complete diet of clients; including foods, beverages,
supplements and medications that could influence medical status. The
dietitian also takes note for any special dietary patterns, food allergies, and
religious beliefs that affect intake.
The RDN
provides education around the link between nutrition and mental health,
emphasizing that the brain and body must be adequately nourished and hydrated
to do intensive therapy. Some clients benefit from additional
dietary services depending on a medical diagnosis or an eating disorder or
disordered eating history. The client and dietitian work together to
develop a more structured dietary plan for their programming that may include
planned meals, grocery lists, challenging food fears and rules, and body
attunement exercises to help clients meet their individual nutrition
goals.
All this allows PCS to help the team assigned to understand the client more comprehensively and provides additional avenues for intervention. The complete Wellness Assessment allows us to recommend changes in bad habits and lifestyle that may lead to a healthier life, better brain performance, and easier recovery from the addiction, depression, trauma (etc.).
Working Together
We enjoy talking about you. The PCS Intensive Treatment Program is a team approach model. During your intensive over 7 professionals focus their attention on how best to facilitate discovering those issues inhibiting personal and relationship growth. The case manager assigned to you communicates with your primary therapist before, during, and after your program while monitoring treatment process. Through notes, emails, and conversations your individual and group therapists continue to update one another of how best to promote change and growth. The Wednesday staffing offers a unique opportunity for reviewing your process, with you present, by our entire team of over 25 therapists.
To learn more about the PCS Intensive Treatment Program, please contact our office at 480-947-5739 where our Intensive Coordinators can supply more information and start you on the journey to discovering a better you.
It’s 2:00 pm on the hottest day of the year and I am watching the men lay brick in the full sun, building a second story on the building next door. As I watch them labor and sweat, I am reminded, in this Pride Month, that the rights and freedoms I enjoy today—being able to marry the man I love and live openly as a gay man—were built on the backs of a generation of men and women who labored and fought for the right to live without discrimination. I owe a lot to those courageous people, many of whom stood in the Stonewall riots of 50 years ago– many of whose names line the walls of AIDS memorials across the country.
Pride Month is a time to honor the victories and sacrifices of the past and to look forward to the challenges of the future. For this is not an easy time to be LGBTQ in our society. Regressive forces are pushing back. This is a time to rally in support of the rights of the next generation.
PCS stands with the LGBTQ community. We acknowledge the enduring spirit of this community that was once considered a mental illness. We stand against bigotry, conversion therapy, and the denial of transgender rights. We support those who remain closeted out of fear of retribution and those who struggle with their faith. We support those living with HIV/AIDS and those who have lost dear ones to the plague. We stand with those who feel alone, different, bullied, abandoned, and afraid. We help them heal.
At PCS, we affirm the value and uniqueness of every individual and strive to help everyone celebrate and live fully in their authentic selves.
Brick by sweaty brick. This is how we have reached this day and this is how, together as advocates and allies, we will build a future for the next proud generation.
“The essence of recovery is embracing and growing from our mistakes and missteps rather than avoiding pain and discomfort.”
My recovery from sex addiction started when I was 28. I was fortunate to participate in a group my father organized consisting of therapists and clergy. It was during one of these meetings a group member divulged his struggle with sex addiction which prompted me to tell my story, one I had hidden until then. This took place just after joining PCS and may have saved my career. The term sex addiction fit. My behavior felt consuming, my efforts to stop failed, real and potential consequences were not a deterrent, marriage and a loving and compassionate wife did not stop the behavior, and no amount of will power could stop the energy which continued to well up inside of me, leading me to “act out.” I am aware as I write this how inadequate words are to express the churning of guilt, shame, and fear I was experiencing.
I moved into recovery and while the support and therapy helped me stop the behavior it is clear to me now the internal struggle continued to percolate. We had children, immersed ourselves in parenting and building relationships with other families. Business grew at a steady pace, but then exploded as our children reached their teen years. This turned out to be terrible timing, and I began to lose myself in work. It took time, but eventually the stress and disconnect from relationships brought back that which had never fully left and I began acting out again. Thankfully, I eventually summoned the courage to disclose to my wife. Individual and couples therapy resumed, and I reached out for support in ways I had not previously done.
Soon after this Doug Braun-Harvey provided an in-service training for our PCS therapists. I found it resonated with me and began questioning whether labeling myself as a sex addict was a way to hide from some erotic conflict I was uncomfortable facing. His six principles of sexual health proved helpful in my journey. They are:
Consent
Nonexploitation
Protected from STI’s and unintended pregnancy
Honesty
Shared Values
Mutual Pleasure.
I found these principles began to shift my perspective on my sex addiction and created a different internal dialogue which in turn influenced how I shared with others. I embraced a gentler and more compassionate view of self. Around this time I stumbled upon Dr. Daniel Sumrok’s phrase, “Ritualized Compulsive Comfort Seeking.” Dr. Sumrok believes what we label as addiction is a normal childhood response to adverse childhood experiences. This perspective generated another question, had I simply developed a distorted, intimacy blocking relationship with my sexuality born from challenges in my childhood? The answer was clearly yes, but where did this leave the “sex addict?”
Would I discard the term sex addiction, no. Currently, I find it helpful to embrace myself as an addict. Not as a way of negatively labeling or pathologizing myself, but to respect and honor that which comforted me through the challenges of growing up. This ongoing change toward increased self-compassion is progressively shifting how I view my past and present-day choices. Integrating my addiction recovery, trauma work, and the six principles of sexual health serve to broaden my recovery and support a gentler approach to self. I desire to continue affirming, as an adult, I now have choices and resources I could not grasp as a child. I am striving to develop a relationship with my wife which is safe, consensual, nonexploitive, and mutually fulfilling. Recovery is a becoming; I hope you agree.
In working with couples where sex addiction has blown up the trust and emotional safety in a relationship, recovery and healing can be an extremely long road. For individuals who discover that the person they love most in the world—and who are likewise supposed to love them back—has betrayed them through sexual acting out, it can feel like their world has been shattered.
The person they thought their husband, or wife, or life partner was…what they thought “was so” about their life and their marriage/relationship…how they knew to trust…what they make this betrayal mean about them and their own worthiness and attractiveness…and what their life will be like in the future…all of this has been dramatically and traumatically altered.
The couples who choose to do the work required to begin the long journey of healing may find their way to PCS and to my office. Most betrayed partners (I’ll say “wife” in this case) experience symptoms of Post-Traumatic Stress Disorder (PTSD) severe enough to meet criteria for this disorder. Those symptoms can last a very long time—meaning many months, even many years—and are influenced by a variety of factors.
One factor that can significantly affect a betrayed partner’s healing process is “discovery.” Discovery means what is says…that the betrayed partner literally discovers that his/her partner has acted out sexually. This can be a one-time event, but more often than not, there are multiple subsequent discoveries over months (even years) that can hurt just as much, if not more, than the first. These subsequent discoveries are like cuts to an open wound, reinjuring the site of the wound, damaging whatever bit of healing that may have begun, and substantially extending the time that healing might occur.
If you are a sex addict and have betrayed your partner, but you are in recovery and doing “your part,” you might feel that that after 6 months, 1 year, or 2 years, etc., “It’s been long enough!” and that your partner should be ready to “Just get over it!” Or, you might say, “Honey, let’s put it behind us and just move on!” If that describes you, please know that there is a part of her that would love nothing more than to be able to do just that! Unfortunately, with sex addiction, the wounding is almost never a one-time discovery, and the pain can continue to get triggered. The last thing she needs is to feel criticized or shamed by her partner for “how long” it’s taking her to heal.
What she needs most from you now is to feel heard, understood, reassured; for there to be concrete evidence that you are faithful and working your recovery; and that you are accessible, responsive, and engaged in the relationship. If you struggle with providing the empathy your partner needs, then reach out to your therapist for help. Seek out a clinician who specializes in Partner Betrayal Trauma to help educate you. Talk with other couples who are further along in their recovery to learn about their journey. Participate in a support group such as Recovering Couples Anonymous (RCA). There is light at the end of tunnel, but whether and how quickly you get there depends on how much of a true and patient partner you can now be to your wife.
Intimacy. When I talk about this concept with clients, the common assumption is that I’m talking about sex. While sex, ideally, will involve intimacy, many of the people I work with have rarely experienced intimacy and sex together. In fact, many people come to realize they haven’t experienced intimacy anywhere in their lives. For the purposes of this very condensed piece on intimacy, let’s define it as a genuine connection between or among people. A connection that might include vulnerability, honesty, closeness, warmth, understanding, safety, and satisfaction. It’s important to note, these connections don’t just occur in the type of intimacy or love that involves romance, sex, and partnership. Expanding our understanding that we can have meaningful experiences of love in other types of relationships will help us to improve the most important one . . . the relationship with ourselves.
We’re taking a page from Aristotle when we talk about The Four Loves (Greek forms of love). Let’s first talk about Eros, the most highly coveted and sought after of all the loves. Movies, stories, songs all suggest that once we get that one special Eros love, we will be all good. Basically, our job is over. We might have the idea that once we find the right romantic partner, we will finally be happy in our lives because this person will fulfill all of our emotional needs, intellectual curiosities, interests, passions, and desire for fun. Unfortunately, it doesn’t work out this way. People get stuck in a cycle of finding “love” when it is really romance they are seeking. Then after the newness wears off, they are left disappointed, dissatisfied, bored, or on the other end of it, feeling rejected. I suppose this could be because some people are “just a bad match” or that “It just wasn’t meant to be.” On the other hand, it may be because some of us weren’t able to show up with intimacy skills. We weren’t able (or willing) to be vulnerable with emotion, tolerate closeness, receive/provide warmth, or be honest about who we are and express it. Consequently, the relationship couldn’t take the next deeper step where romance fades off a bit so that a deeper, more expansive committed love can emerge. So what do we do when we’re caught in a cycle of so desperately wanting love, but continue to either find ourselves in a string of failed relationships, or so fearful of being rejected that we don’t put ourselves out there. Some therapists will say, “Start with the lowest hanging fruit.” Fortunately, Aristotle gave us three additional fruits or loves to explore and they are all within our reach.
To begin, we have Agape — which is mission based or charitable love. Consider, in life, what makes your heart break or motivates you to give your time or resources to a cause without strings attached. Think about how you desire to help people in a genuine way and when you accomplish this are left with a feeling of serenity. Simply put, Agape love helps you develop a positive sense of self-worth and closeness in the world.
Storge — This love speaks to belonging in the family. Immediately, this concept may lose some of us if we feel disconnected from our family, come from a family wrought with issues, or believe family is the reason we struggle with love in the first place. The good news is that the expression of this form of intimacy isn’t limited to the family we are related to. We can find and develop this love in a group or community where we feel a sense of belonging. These groups are defined by shared interests, common goals or values and can involve a little or a lot of investment. Exploration of Storge can be had in many areas including art/creativity, music, academics, sports, hobbies, gaming, crafts, service projects, and recreation. One of the reasons Greek organizations exist in universities/colleges is to offer a transitional family with common academic or cultural characteristics; sororities and fraternities, especially when they include an Agape foundation, provide a sense of belonging, safety, and community for young adults leaving the nest. Notably, in Storge love, the level of talent or role in the group is not what makes this love deeper or more meaningful, it is the person’s genuine participation in the shared interest. If you happen to be a person who has a supportive and loving family, the nudge is still there to intentionally foster Storge. If you overlook this love because “It’s always been there,” you risk losing intimacy in life by becoming too dependent on one or two people. Also, if you have written off family or certain members, you may be selling short your own ability to love with a humble Agape spirit, achieve some healing, and experience more Storge than you once believed was possible.
Philia — This is the reciprocal love of close friends. Intimate friendship involves a commitment to generously invest in one another’s lives with the intent of helping each other to mature in honesty, humility, and discretion. Deep friendship offers comfort through tough times and an expectation that each will challenge the other if one drifts from professed goals and values. Intimate friends don’t criticize character flaws but instead work together to explore healthy alternatives. They stay informed on important issues in each other’s relationships and investments. Simply put, they challenge and encourage each other to be the best they can be. Certainly, this love is not actualized in quantity, but in quality.
Ideally, if it is a personal goal, the aforementioned loves can prepare you for Eros or romantic/sexual love.
Of course, what makes the cultivation of any of the four loves challenging is if we lack love of self. The good news is that we don’t have to acquire one before the other; we actually need to develop them simultaneously. Also, we can’t forget that without knowing and loving self we will continue to repeat intimacy-blocking patterns in all forms of love. Reason being, if we have not defined who we are, we have little chance of becoming ourselves in the world, regardless of the type of love we desire. While all four of these loves challenge and foster personal growth, healthy investment in self-love, and continual maturing of identity, it is Eros that often challenges us most. It is the loving partnership that most clearly strives for a sense of oneness. As such, it requires a clear sense of self along with the intimacy skills of humility, assertiveness, transparency, clear boundary-setting, empathy and compassion. It is not self-sacrificing but rather requires integrating self with another. This cannot be achieved while hiding, disowning or failing to communicate a clear sense of self. If a person invests in Eros love, they must continue to define “me” or risk losing their identity.
Factors such as lifestyle and life stage can negatively impact the growth of oneness if individual goals and cultivating shared goals within the partnership are taken for granted. Therefore, it is really up to each partner to invest in who they are (personal values, interests, strengths, vulnerabilities, passions, and missions) so they can offer more to the relationship and not become helpless or entitled. In Eros love, each partner promotes intimacy by really valuing how the other cares for their own physical, emotional, mental, spiritual, and sexual well-being.
Lastly, self-love can be hard to come by if a person has a long history of self-destructive behaviors that have blocked intimacy in relationships. The good thing is, we all have equal potential in the present to value ourselves and to feel as good about what we have to offer the world. Theoretically, one’s true worth and ability to attract healthy connection with others depends upon who they are being now, not on their possessions, surface appearance, or past. Now, this does not mean we benefit from attempting to forget, minimize, or justify our past harmful actions. Quite the opposite, a greater sense of knowing and loving self can actually come from owning what we have carried out in real life to hurt real people. Accepting that we are more loveable when we are not perfect is a great goal! In this humble space, we can connect with others as our authentic selves and not as actors. We can believe that no person can truly be satisfied in relationships without intimacy.
So ask yourself: What relationships am I neglecting to strengthen or pursue? What is keeping me from experiencing real intimacy? How might I learn to be more authentic and vulnerable with others?
Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
I have been at Psychological Counseling Services (PCS) since 2012. One of the most difficult parts of being a therapist is meeting a client in their current crisis and as you join and get to know them better, you realize there is a treasure-trove of historical harms that desperately need attention and may even be exacerbating the issue at hand. In a weekly or bi-weekly therapy model, however, there may be little time to excavate and address the root of the matter.
I’ll give you an example: A client enters therapy for their significant other’s betrayal, and they struggle to find strength and obtain positive traction. Underneath this recent trauma lies the fact they lost a parent in a car accident when they were twelve and maybe they were also severely bullied in high school, or their parents fought constantly and eventually divorced.
It’s not that they cannot heal in weekly therapy, they can; it will just take much longer. Not only because there may be a complex history of trauma, but also because “real life” just has the advantage. We are all familiar with the scientific word “homeostasis”, or as my beloved colleague, Marilyn Murray (PCS Trauma Consultant and author of “The Murray Method”) would say, “the baseline for normal”. It means we have formed a certain muscle memory around how things tend to be, and we become comfortable in that space and often resist change or the unknown. Therefore, it is common for a client to grab important insights within the confines of the one to two hours a week in a therapy office, but then outside the office the pull towards the “old baseline” wins out. They want to make changes but need a space and time to build traction and momentum in a different direction. It is then that intensive therapy becomes an appealing suggestion and opportunity.
The PCS Intensive Program
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
From there, the client begins the weekly process of over 30 individual therapy hours, which include Family Systems, CBT, DBT, Emotionally-Focused Therapy, Art Therapy, EMDR, and other experiential therapies. Additionally, there are 25 group hours, that includes Equine Therapy, Psychodrama, Anger and Forgiveness, Compulsivity, Codependency, Emotional Regulation, Communication, Mindfulness, Boundaries, Courageous Living, and the Power of Positivity and Play.
The days are roughly 7AM to 7:30PM with a few short breaks in the middle, and the individual work ends Friday at 5PM. The intensive then concludes with a follow-up to Marilyn’s Workshop on Saturday morning (9AM to 12PM).
The groups are mixed-gender and incorporate individual and couple’s clients who are dealing with a broad scope of issues, including substance and process addictions, complex trauma, relational trauma and issues, betrayal, divorce, blended family concerns, grief, career concerns, and severe life crises.
No matter what modality is used, all the therapists speak the same language in terms of helping clients grieve what they needed and deserved, but did not receive. Clients are helped to grow a wise-minded, healthy, balanced Adult Self who can “parent” the parts of self that get activated in grief/sadness, over-functioning or over-caretaking, defensiveness, anger, rebellion, or deception.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
The Process
The work I get to do with intensive clients is a unique and fulfilling aspect to my job, because I typically get to help heal deep, difficult life experiences and I get to do that work as part of a therapeutic team. Each intensive has a Case Manager and a team of 4-5 additional therapist who are assigned different areas of focus, such as a genogram, a trauma egg, setting up targets and processing with EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, experiential work, addiction and relapse prevention work, relational processing, understanding offensive behaviors and patterns, healthy intimacy, boundary-work, and health and wellness work.
Typically, clients arrive guarded, unsure and at times, overwhelmed. Still, the process begins very quickly by excavating their history and significant life experiences, in order to understand patterns and themes that have impacted their lives. As clients gradually begin to open-up, they start to positively affect each other and instigate change. The bonding begins early with Equine Therapy on Sunday evening and intensifies as they experience their first Psychodrama Group process, where they help a volunteer from the group put a piece of their story in action with the goal of experiencing catharsis and resolution. By Tuesday morning, they typically are ready to share in a meaningful way in their first processing group. The more clients talk about what is uncomfortable to share, the more they inspire others in the group to do the same. The sharing is spiritually powerful and moving, because clients are allowing themselves to be vulnerable and experience real connection; a connection they are encouraged to replicate with the important and healthy people in their lives.
Many clients will express how much they “get it” in an intellectual way. However, what frustrates them is how much they do not feel it. The most satisfying aspect of my job typically happens closer to the end of the week when I witness a client fundamentally shift what was once intellectual, into a “felt” experience; they no longer know they are lovable, deserving, worthy, good-enough, empowered or trust-worthy, they feel it.
At the end of my first week at PCS, I saw a client from the East Coast who completed a 2-week process, smiling, whistling and practically skipping to his car. He jumped in and was headed to the airport – back home, back to his family. I don’t think his journey ended that day, in fact, he was really at the end of the beginning, but it was awesome to see how good he felt!
It is o.k. to be wowed by another person’s look, be attracted to them. It is o.k. to desire sex; it’s o.k. to be sexual.
It is actually more than o.k.! It is part of healthy development and being human.
Moreover, attraction is at the foundation of our survival as species. A mean to mate, procreate and continuing to exist.
SO WHERE IS THE PROBLEM?
There isn’t, unless we define people solely by their sexuality and what can we get from them. If we reduce them to their looks only and we ignore them as a whole person with feelings and thoughts.
This state of mind narrows them down to a shiny object that’s all about satisfying OUR needs and here to be used. It takes away their agency since they have no say. Do you sense the sexual violence?
Should they be flattered that we find them attractive in this way?
Striping them from their humanity is devaluing, as if all their worth is their body and not the wholeness of mind, body and soul. There’s no respect in that.
Objectifying is association to self-centeredness and entitlement. It is dissociation from empathy. We are drifting away from the ability to be in someone else’s shoes, acknowledging their uniqueness, rights, likes, dislikes, different part of their personality, needs, wants, thoughts, and emotions. We are all about fulfilling our immediate need. We might move on shortly to the next shiny object, which means, we are objectifying ourselves as well. By narrowing down ourselves to lust, the physical need only (leading with our body or maybe with our money) we are depriving ourselves love, intimacy, emotional bond, and emotional safety with another human being.
Do you ever wonder what you can tangibly do to get ahead for
the New Year? As I reflect on 2019, I think back to many moments during the
year that included positive growth, hardship, connection, and loss. I started a
life changing internship (Thank you PCS!), while continuing to take classes and
work on my Master’s program at ASU. I moved to a new state away from my family
and friends. I lost and gained friendships. I felt homesick and leaned on
others. With all of this, I will be the first to tell you that I was not
prepared for much of what 2019 threw at me! While being unprepared might have
served a wonderful purpose (as I grew immensely as a person), I continue to
embrace the importance of being present, grounded and mindful when looking
forward and taking on new challenges and A NEW YEAR!
Here are some tips for starting your New Year on the right
foot:
Reflect (with Self-Compassion): It is
important to begin with self-reflection about how you showed up in the last
year for yourself and for others. What went well? What could be better? If 2019
felt like a hard year, this is especially important. Giving yourself compassion
for the hardships endured or where things fell short allows you to open the
door to change for the coming year.
Compassion for others: As you grow your
compassion for self, extend this to others.
Get Grounded and Set Intentions: What do
you wish to be different for your New Year? This could look like creating a
mental or physical list of what you want to accomplish or change. Even if you
had a spectacular year, we can always push ourselves!
Get Specific: How will you act on these
intentions?
Seek Support and Connection: We are not
meant to do this all alone. There are people who will support you in your efforts
to create change in your life. Seek these people out and watch the team effort unravel
positive growth.
Appreciation and Gratitude: Studies have
shown that showing gratitude positively effects one’s social and psychological
well-being. Showing your gratitude will also allow your connections to grow.
From all of us at PCS, we wish you a joyful and prosperous New
Year!
Article by Kaitlyn Beckham, BA, Intern
Kaitlyn is a Master of Counseling student at Arizona State University graduating in May 2020. She enjoys working with adults who have experienced trauma, as well as those who struggle with anxiety, depression, relationship issues and self-esteem issues.
Everyone struggles in relationships, especially with their intimate partners. Some people struggle a great deal and can see patterns showing up over and over again in relationship after relationship.
Why is this? What makes relationships so difficult and why do we see the same challenges showing up over and over?
Recent research has looked at relationship difficulties through the lens childhood adversity and asked the question “what is the impact of childhood abuse, neglect, and trauma on our relationships?” No one has a perfect childhood. I thought I did… until I started looking deeper and asking myself hard questions. In all my years at PCS, I am yet to meet someone who emerged from childhood entirely unwounded. And do I see my childhood issues playing out in my marriage? You bet I do!
We have learned a lot in the past 20 years about the lasting impact of adverse childhood experiences (ACEs). The ACE Study, conducted in the late 1990s, startled the medical world by showing conclusively that different forms of childhood trauma, alone or in aggregate, increase the risk of many major mental health and physical health problems—by up to 5 or 10 times (or more!). The study called out specifically the risk associated with ten childhood risk factors: physical abuse, emotional abuse, sexual abuse, emotional neglect, physical neglect, and living in a home with domestic violence, alcohol or drug abuse, depression or mental illness, divorce/separation/death of a parent, or incarceration.
Having any of these risk factors in your childhood was found to raise your risk of physical, emotional, and/or psychological problems later in life. And it doesn’t seem to matter how often bad things happened or how bad they were—it simply doesn’t take much to wound a child. Relatively few of us can claim to have none of these risk factors.
Fortunately, many of us are able to adapt to some forms of abuse and bounce back without much consequence—our resilience can offset the risks. However, having four or more of these factors may exceed a child’s ability to adapt and may interfere with the child’s emotional, psychological, neurological, and physical development and may lead to substantial problems in life.
We now understand that childhood adversity multiplies your risk for developing addiction, chronic depression, suicidality, smoking, IV drug use, domestic violence, criminality, and teenage pregnancy. Childhood abuse, neglect, and trauma also dramatically increase the risk of diabetes, obesity, heart disease, cancer, stroke, sexually transmitted diseases, and premature death. And not surprisingly, they also increase the risk of failure in the workplace and failure in relationships.
So, what is it about childhood adversity that messes with our ability to have happy relationships as an adult? Here the research has been very illuminating as well.
Studies have shown that kids who have been traumatized may grow up to be adults who need to be perfectionistic, having learned that anything less than perfect behavior less brings abuse or neglect. They may be prone to anger–anger that may become a personality trait or lead to domestic violence. They may be sensitive to negative emotions and highly reactive when triggered. They may have an anxious attachment to others– worried about losing important relationships or unwilling to get close in the first place. They may not tolerate stress very well, becoming controlling, aggressive, or shutting down altogether. It is not surprising that these traits would make it difficult to be successful in relationship (just ask my husband!).
Interestingly, research has also shown that people who live through aversive childhoods tend to be more resilient—to have more grit, that is, a better ability to bounce back from difficulties. So curiously, while childhood adversity seems to set us up to have difficulty in our intimate relationships, it also makes us more able to weather and overcome the challenges that we create.
Perhaps we can have a bit more compassion for ourselves and our partners if we remember that the lingering effects of childhood adversity and trauma can cast a shadow over our intimate relationships. While it does not give us an excuse to misbehave, the tough parts of childhood (which we likely had no control over) continue to influence our way of looking at the world and the choices we make, day in and day out.
So, what can we do? Fortunately, there is growing evidence that trauma-informed therapy techniques can help to heal the wounding that happened to us when we were children. Treatments such as EMDR, somatic experiencing, and psychodrama (among many others) can effectively address the pain of childhood neglect, abuse, and adversity. This may allow us to become healthier, happier adults, and thereby pave the way for us to have healthier intimate relationships.
“Participating in a PCS Intensive Treatment Program is an opportunity each of us have longed for, yet avoided. In 8 days and 68 hours your story has time to unfold and be received by a team of compassionate professionals whose primary purpose is to create a safe and equally challenging environment. The treatment process involving 35 hours of individual therapy brings an appreciation and understanding for the journey you have lived, including the detours, and offers the discovery of the journey awaiting you.”
– Dr. Marcus Earle, PCS Clinical Director
How it all begins…The Murray Method
Preparatory Workshop
The preparatory workshop begins your PCS Intensive Treatment Program. Each group member shares their reason for participating in the intensive, is introduced to our treatment model, and begins constructing a few key elements of their treatment process. Once the ice is broken, the workshop facilitator presents a framework from Marilyn’s Murray’s work called the Scindo Syndrome. The presentation sets the stage for much of the work to come, offering a way of understanding how the difficult and disturbing experiences in our early life shapes how we think, feel, and behave. It outlines what we strive for at PCS: to become a Healthy Balanced Person intellectually, spiritually, emotionally and physically. The Scindo Syndrome, along with the Circles of Intimacy, Responsibility, and Impact, provide the foundational scaffolding that the coming work can build. Not only does it help a person organize and understand their own story, but it also illustrates how we are similar to the others in the group (and in the world). This preparatory workshop is where the first homework assignments are given. The assignments include exercises such as the Trauma Egg, Genogram and Scindo Syndrome drawings to encourage clients to explore and identify what has shaped their thoughts, their feelings — their lives. These exercises guide clients to discover what is underneath even if they are uncertain what motivates their behaviors that ultimately led them to PCS.
Concluding Group
The Concluding Workshop on Saturday mornings is the final piece of the intensive program; a space to celebrate the integration of the Healthy Balanced Adult with the client’s Original Feeling Child (the “child” they are at the core). Clients share with one another their strongest “ah-hah” moments of the week, along with their Trauma Eggs, and their “Child” drawings. In their final moment, clients reaffirm their gratitude for the group work and the gains they achieved during their time at PCS.
Not Just Mental Health
As
part of the intake process, Dr. Rick Isenberg completes a comprehensive medical
history to identify significant symptoms and illnesses, along with self-care
practices, substance use, and compulsive behaviors which may impact the
treatment process. Our physical well being is entwined with our emotional
and relational health.
Interestingly, for some, the medical history may even identify symptoms, or ailments that point toward an underlying emotional issue that may be unknown to the client. We look for these clues and follow them backwards to see what we find. We also look for medical conditions that may contribute to the client’s emotional issues (like diabetes, sleep apnea, hypothyroidism) that are either not yet diagnosed, or neglected and need to be treated.
As part of the initial assessment, Dr. Isenberg also reviews the ACE Questionnaire with the client. This tool looks at adverse childhood experiences and allows PCS to help the client put psychological and medical problems in a family/historical perspective. Dr. Isenberg also administers a neurocognitive screening assessment that helps to identify brain skills that may be lagging. It is important to have our brains working at their best, so we provide tools to allow our clients to buff up brain performance. When our brains work better, life is better.
How Your Team is Assembled
After the client has filled out the registration materials for the intensive program, they will be required participate in a phone prescreen session with one of our team members. Not only does the prescreen ensure that PCS will be an appropriate fit for the client, but it also assists in selecting the individual and/or couple’s therapists assigned to each program with the background information provided. Every schedule includes at least one EMDR therapist. However, clients who are coming to work on trauma or other related concerns could find two or three therapists that utilize EMDR in their sessions. We also look at the other therapy modalities that would be beneficial for the client such as SE, CBT, DBT & EFT to help in the process of building a schedule for each individual or couple.
Clients who are interested in the intensive program but are on a strict budget can have the opportunity for interns, as well as licensed associate counselors (LAC) to be assigned to reduce the cost of their program. The advantage of having a large team of over 25 therapists allows flexibility in the selection of a client’s team and provides the ability to choose appropriate lower cost therapists while still receiving the full benefits of the process.
EMDR, SE, EFT, ETC. – What is EMDR?
Eye Movement
Desensitization and Reprocessing (EMDR) is a trauma therapy developed by
psychologist Dr. Francine Shapiro. Dr.
Shapiro made the chance observation that eye movements can reduce the intensity
of disturbing thoughts when she noticed her own stress reactions diminished
when her eyes swept back and forth as she walked through a park.
EMDR involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief, while using rapid eye movements to facilitate the process. EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with bilateral eye movements or other forms of rhythmic, left-right stimulation. One of the key elements of EMDR is “dual stimulation.” During treatment, a person is asked to think or talk about memories, triggers, and painful emotions while simultaneously focusing on his/her therapist’s moving finger or another form of bilateral stimuli. Other forms of external stimuli that may be used in EMDR therapy include bilateral tactile sensations and sounds (e.g. alternating hand taps or a chime that pans back and forth from ear to ear).
How Does EDMR Therapy Work?
At the time
of a traumatic event, strong emotions may interfere with our ability to
completely process the experience and the moment becomes “frozen in time.” Recalling the traumatic event may feel as
though the person is reliving the event all over again because the images,
smells, sounds, and feelings still exist and can be triggered in the
present. When activated, these memories
cause a negative impact on our daily functioning and interfere with the way we
see ourselves and our world, and how we relate to others.
EMDR therapy appears to directly affect the brain by “unfreezing” the traumatic memories, allowing them to be resolved. Over time, the disturbing memory and associated beliefs, feelings, sensations become “digested” or processed until the event is able to be thought about without reliving it. The memory is still available, but it is less upsetting.
The exact mechanism for the effectiveness of EMDR is unknown. It appears that using rapid eye movement relieves the anxiety associated with the trauma so that the original event can be examined for a more detached perspective. This is somewhat like watching a movie of what happened. This enables a person to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization). Some experts have noted that the eye movements during EMDR might be similar to what occurs naturally during dreaming or REM (Rapid Eye Movement) sleep. It may be thought of as a physiologically-based therapy that allows a person to see material in a new and less distressing way. Others believe it reactivates parts of the brain that were “shut down” as a coping mechanism. In this way, cognitive reorganizing takes place, allowing the negative, painful emotions to give way to more resolved, empowered feelings.
What is Somatic Experiencing (SE)?
Somatic Experiencing was
developed by Dr. Peter Levine and is practiced all over the world as an
intervention to resolve trauma. Dr. Levine theorized that trauma is not
necessarily about an event, but about what happens after the event, at the
physiological and biological level. How our nervous system responds, how those
around us respond, how we recall the incident and the ultimate meaning we give
to the experience will determine our chance of resolving trauma in the moment
or increase the likelihood of experiencing PTSD in the future.
SE recognizes that
trauma is a natural part of life. Trauma is not a disease or an anomaly. Its
effects do not mean a life sentence or permanent incapacitation. Instead,
trauma can be viewed as an injury to the autonomic nervous system with the
understanding that our bodies have an innate capacity to return to a regulated
state of being.
SE is a short term,
holistic and naturalistic approach that encourages mastery, empowerment,
self-direction and resiliency. SE focuses on “sensate” or “felt sense” of the body by recognizing and
accessing physical sensations, imagery and motor patterns to renegotiate trauma
through physiological channels of the autonomic nervous system – from brain
stem to limbic system. The body remembers everything even if the brain cannot
access certain experiences and unlike traditional therapies, SE brings sensory
experience to the foreground while supporting thought, feeling and emotion in
the background.
How Does Somatic Experiencing Work?
SE is a body oriented
approach to renegotiate trauma. It involves grounding, orienting, noticing the
felt sense of the body and tracking with curiosity how it experiences
activation and then de-activation. With the support of a trained therapist, we
can touch into the nervous system, mind and body and prepare for a reparative
action. This “pendulation” of pleasant, unpleasant and neutral sensations
increases our range of resiliency and facilitates nervous system regulation. We
enter the “here and now” instead of being stuck in the “there and then.” We
become able to recognize and express instinctive responses to threat. Expanding
a person’s tolerance of bodily sensations facilitates their trust in the body’s
wisdom and capacity to heal itself by uncoupling incomplete and undischarged
bio-electric circuits. Symptoms diminish in strength and frequency when the
cycle of discharge that have been fueling the symptoms of unresolved trauma are
released. Discharge my take the form of flushing, muscle contraction/release,
yawning, deep breathing, sweating, tears as well as other somatic responses.
Humans often thwart the natural mammalian instinct for fight, flight, freeze or collapse because we filter our experiences through the frontal cortex, thereby minimizing our “animal” instinct. For example, if a child cries we often attempt to sooth by telling them “Don’t cry, everything is fine.” This shuts down energetic discharge. Patients often experience shaking coming out of surgery. Instead of allowing an individual to discharge energy caused by a traumatic experience (cutting, being tied down, having a mask over one’s face) they are often given warm blankets or medications to dull the sympathetic nervous system. When individuals fidget, we tell them to stop. We manage to stop energetic discharge throughout our day. Our sedentary lifestyles and cultural beliefs disconnect us from the body. If our natural, self-protective responses are not completed, this energy does not discharge and we are at risk of our nervous system getting “stuck on” or “stuck off.” We may not feel safe in our own bodies and so we “numb” with substance addictions (using alcohol or drugs) or with process addictions (gambling, sex, shopping, work, etc.) By bypassing the thinking brain and accessing the nervous system we can reclaim the body’s ability self-regulate.
Mindfulness
Living Without Awareness = Impulsiveness and Mood Dependent Behaviors.
What is Mindfulness? Mindfulness has been described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Mindfulness is the practice of being completely aware of what you are doing in the moment, when you are doing it. It is you being in control of your mind, instead of your mind being in control of you.
Mindfulness is about: learning to maintain awareness of your mind, body, and surroundings. It is about staying in the present moment and noticing when your mind drifts into the past or future. It is learning to enjoy life in the here and now. Finally, it is about finding and connecting with one’s sense of self. When you are aware of what you are experiencing, you can make the choice to change or accept it, thus decreasing your suffering.
Benefits of Mindfulness: Mindfulness increases awareness. It allows us to be completely connected to our environment, reduce stress, and improve our overall well-being. Studies show that practicing mindfulness can reduce blood pressure, increase the immune system function, relax muscles, improve quality of sleep, and increase focus and concentration.
Why Learn Mindfulness?
Mindfulness skills help you to tolerate distress, that is, tolerating emotions and situations that feel intolerable; riding your intense emotions (urge surfing) rather than doing things to shut them off or distract from them, OR from engaging in self-destructive behaviors.
Mindfulness skills help you to regulate your emotions. The more skilled you are at noticing and identifying your emotions, the better chance you have of being able to adjust their intensity. If you are aware of what you are feeling you can change emotions you want to change, OR you can choose to stay with the feelings, knowing you are in control.
Mindfulness skills help you to be more effective in interpersonal situations. Increased awareness helps you decide when and how to make decisions about dealing with people and setting boundaries and limits, i.e. “asking for what you want” and “saying no”. Maintaining healthy relationships (or ending destructive ones!) requires the ability to be able to connect with your emotions and to be able to keep them in check if you want to.
Relapse Prevention: (e.g. relapse to undesirable mood states–depression, anxiety, anger, etc.–or impulsive/unwanted/self-destructive behaviors). Mindfulness teaches you how to recognize and disengage from emotion mind at times of potential relapse. Inability to do so may result in a downward spiral, and eventually, the onset of relapse. To avoid this, you must be able to disengage from emotion mind, bring in reasonable mind, and find wise mind. This will allow you to process mood related information in ways that are less likely to provoke relapse. Awareness of the patterns of thoughts, feelings, and body sensations that characterize relapse-related mind states is an essential first step in recognizing the need for corrective action.
Nutrition Makes A Difference
Taylor
Aasand, MPH, RDN, our registered dietitian (RDN), conducts nutritional
assessments of the complete diet of clients; including foods, beverages,
supplements and medications that could influence medical status. The
dietitian also takes note for any special dietary patterns, food allergies, and
religious beliefs that affect intake.
The RDN
provides education around the link between nutrition and mental health,
emphasizing that the brain and body must be adequately nourished and hydrated
to do intensive therapy. Some clients benefit from additional
dietary services depending on a medical diagnosis or an eating disorder or
disordered eating history. The client and dietitian work together to
develop a more structured dietary plan for their programming that may include
planned meals, grocery lists, challenging food fears and rules, and body
attunement exercises to help clients meet their individual nutrition
goals.
All this allows PCS to help the team assigned to understand the client more comprehensively and provides additional avenues for intervention. The complete Wellness Assessment allows us to recommend changes in bad habits and lifestyle that may lead to a healthier life, better brain performance, and easier recovery from the addiction, depression, trauma (etc.).
Working Together
We enjoy talking about you. The PCS Intensive Treatment Program is a team approach model. During your intensive over 7 professionals focus their attention on how best to facilitate discovering those issues inhibiting personal and relationship growth. The case manager assigned to you communicates with your primary therapist before, during, and after your program while monitoring treatment process. Through notes, emails, and conversations your individual and group therapists continue to update one another of how best to promote change and growth. The Wednesday staffing offers a unique opportunity for reviewing your process, with you present, by our entire team of over 25 therapists.
To learn more about the PCS Intensive Treatment Program, please contact our office at 480-947-5739 where our Intensive Coordinators can supply more information and start you on the journey to discovering a better you.
It’s 2:00 pm on the hottest day of the year and I am watching the men lay brick in the full sun, building a second story on the building next door. As I watch them labor and sweat, I am reminded, in this Pride Month, that the rights and freedoms I enjoy today—being able to marry the man I love and live openly as a gay man—were built on the backs of a generation of men and women who labored and fought for the right to live without discrimination. I owe a lot to those courageous people, many of whom stood in the Stonewall riots of 50 years ago– many of whose names line the walls of AIDS memorials across the country.
Pride Month is a time to honor the victories and sacrifices of the past and to look forward to the challenges of the future. For this is not an easy time to be LGBTQ in our society. Regressive forces are pushing back. This is a time to rally in support of the rights of the next generation.
PCS stands with the LGBTQ community. We acknowledge the enduring spirit of this community that was once considered a mental illness. We stand against bigotry, conversion therapy, and the denial of transgender rights. We support those who remain closeted out of fear of retribution and those who struggle with their faith. We support those living with HIV/AIDS and those who have lost dear ones to the plague. We stand with those who feel alone, different, bullied, abandoned, and afraid. We help them heal.
At PCS, we affirm the value and uniqueness of every individual and strive to help everyone celebrate and live fully in their authentic selves.
Brick by sweaty brick. This is how we have reached this day and this is how, together as advocates and allies, we will build a future for the next proud generation.
“The essence of recovery is embracing and growing from our mistakes and missteps rather than avoiding pain and discomfort.”
My recovery from sex addiction started when I was 28. I was fortunate to participate in a group my father organized consisting of therapists and clergy. It was during one of these meetings a group member divulged his struggle with sex addiction which prompted me to tell my story, one I had hidden until then. This took place just after joining PCS and may have saved my career. The term sex addiction fit. My behavior felt consuming, my efforts to stop failed, real and potential consequences were not a deterrent, marriage and a loving and compassionate wife did not stop the behavior, and no amount of will power could stop the energy which continued to well up inside of me, leading me to “act out.” I am aware as I write this how inadequate words are to express the churning of guilt, shame, and fear I was experiencing.
I moved into recovery and while the support and therapy helped me stop the behavior it is clear to me now the internal struggle continued to percolate. We had children, immersed ourselves in parenting and building relationships with other families. Business grew at a steady pace, but then exploded as our children reached their teen years. This turned out to be terrible timing, and I began to lose myself in work. It took time, but eventually the stress and disconnect from relationships brought back that which had never fully left and I began acting out again. Thankfully, I eventually summoned the courage to disclose to my wife. Individual and couples therapy resumed, and I reached out for support in ways I had not previously done.
Soon after this Doug Braun-Harvey provided an in-service training for our PCS therapists. I found it resonated with me and began questioning whether labeling myself as a sex addict was a way to hide from some erotic conflict I was uncomfortable facing. His six principles of sexual health proved helpful in my journey. They are:
Consent
Nonexploitation
Protected from STI’s and unintended pregnancy
Honesty
Shared Values
Mutual Pleasure.
I found these principles began to shift my perspective on my sex addiction and created a different internal dialogue which in turn influenced how I shared with others. I embraced a gentler and more compassionate view of self. Around this time I stumbled upon Dr. Daniel Sumrok’s phrase, “Ritualized Compulsive Comfort Seeking.” Dr. Sumrok believes what we label as addiction is a normal childhood response to adverse childhood experiences. This perspective generated another question, had I simply developed a distorted, intimacy blocking relationship with my sexuality born from challenges in my childhood? The answer was clearly yes, but where did this leave the “sex addict?”
Would I discard the term sex addiction, no. Currently, I find it helpful to embrace myself as an addict. Not as a way of negatively labeling or pathologizing myself, but to respect and honor that which comforted me through the challenges of growing up. This ongoing change toward increased self-compassion is progressively shifting how I view my past and present-day choices. Integrating my addiction recovery, trauma work, and the six principles of sexual health serve to broaden my recovery and support a gentler approach to self. I desire to continue affirming, as an adult, I now have choices and resources I could not grasp as a child. I am striving to develop a relationship with my wife which is safe, consensual, nonexploitive, and mutually fulfilling. Recovery is a becoming; I hope you agree.
In working with couples where sex addiction has blown up the trust and emotional safety in a relationship, recovery and healing can be an extremely long road. For individuals who discover that the person they love most in the world—and who are likewise supposed to love them back—has betrayed them through sexual acting out, it can feel like their world has been shattered.
The person they thought their husband, or wife, or life partner was…what they thought “was so” about their life and their marriage/relationship…how they knew to trust…what they make this betrayal mean about them and their own worthiness and attractiveness…and what their life will be like in the future…all of this has been dramatically and traumatically altered.
The couples who choose to do the work required to begin the long journey of healing may find their way to PCS and to my office. Most betrayed partners (I’ll say “wife” in this case) experience symptoms of Post-Traumatic Stress Disorder (PTSD) severe enough to meet criteria for this disorder. Those symptoms can last a very long time—meaning many months, even many years—and are influenced by a variety of factors.
One factor that can significantly affect a betrayed partner’s healing process is “discovery.” Discovery means what is says…that the betrayed partner literally discovers that his/her partner has acted out sexually. This can be a one-time event, but more often than not, there are multiple subsequent discoveries over months (even years) that can hurt just as much, if not more, than the first. These subsequent discoveries are like cuts to an open wound, reinjuring the site of the wound, damaging whatever bit of healing that may have begun, and substantially extending the time that healing might occur.
If you are a sex addict and have betrayed your partner, but you are in recovery and doing “your part,” you might feel that that after 6 months, 1 year, or 2 years, etc., “It’s been long enough!” and that your partner should be ready to “Just get over it!” Or, you might say, “Honey, let’s put it behind us and just move on!” If that describes you, please know that there is a part of her that would love nothing more than to be able to do just that! Unfortunately, with sex addiction, the wounding is almost never a one-time discovery, and the pain can continue to get triggered. The last thing she needs is to feel criticized or shamed by her partner for “how long” it’s taking her to heal.
What she needs most from you now is to feel heard, understood, reassured; for there to be concrete evidence that you are faithful and working your recovery; and that you are accessible, responsive, and engaged in the relationship. If you struggle with providing the empathy your partner needs, then reach out to your therapist for help. Seek out a clinician who specializes in Partner Betrayal Trauma to help educate you. Talk with other couples who are further along in their recovery to learn about their journey. Participate in a support group such as Recovering Couples Anonymous (RCA). There is light at the end of tunnel, but whether and how quickly you get there depends on how much of a true and patient partner you can now be to your wife.
Intimacy. When I talk about this concept with clients, the common assumption is that I’m talking about sex. While sex, ideally, will involve intimacy, many of the people I work with have rarely experienced intimacy and sex together. In fact, many people come to realize they haven’t experienced intimacy anywhere in their lives. For the purposes of this very condensed piece on intimacy, let’s define it as a genuine connection between or among people. A connection that might include vulnerability, honesty, closeness, warmth, understanding, safety, and satisfaction. It’s important to note, these connections don’t just occur in the type of intimacy or love that involves romance, sex, and partnership. Expanding our understanding that we can have meaningful experiences of love in other types of relationships will help us to improve the most important one . . . the relationship with ourselves.
We’re taking a page from Aristotle when we talk about The Four Loves (Greek forms of love). Let’s first talk about Eros, the most highly coveted and sought after of all the loves. Movies, stories, songs all suggest that once we get that one special Eros love, we will be all good. Basically, our job is over. We might have the idea that once we find the right romantic partner, we will finally be happy in our lives because this person will fulfill all of our emotional needs, intellectual curiosities, interests, passions, and desire for fun. Unfortunately, it doesn’t work out this way. People get stuck in a cycle of finding “love” when it is really romance they are seeking. Then after the newness wears off, they are left disappointed, dissatisfied, bored, or on the other end of it, feeling rejected. I suppose this could be because some people are “just a bad match” or that “It just wasn’t meant to be.” On the other hand, it may be because some of us weren’t able to show up with intimacy skills. We weren’t able (or willing) to be vulnerable with emotion, tolerate closeness, receive/provide warmth, or be honest about who we are and express it. Consequently, the relationship couldn’t take the next deeper step where romance fades off a bit so that a deeper, more expansive committed love can emerge. So what do we do when we’re caught in a cycle of so desperately wanting love, but continue to either find ourselves in a string of failed relationships, or so fearful of being rejected that we don’t put ourselves out there. Some therapists will say, “Start with the lowest hanging fruit.” Fortunately, Aristotle gave us three additional fruits or loves to explore and they are all within our reach.
To begin, we have Agape — which is mission based or charitable love. Consider, in life, what makes your heart break or motivates you to give your time or resources to a cause without strings attached. Think about how you desire to help people in a genuine way and when you accomplish this are left with a feeling of serenity. Simply put, Agape love helps you develop a positive sense of self-worth and closeness in the world.
Storge — This love speaks to belonging in the family. Immediately, this concept may lose some of us if we feel disconnected from our family, come from a family wrought with issues, or believe family is the reason we struggle with love in the first place. The good news is that the expression of this form of intimacy isn’t limited to the family we are related to. We can find and develop this love in a group or community where we feel a sense of belonging. These groups are defined by shared interests, common goals or values and can involve a little or a lot of investment. Exploration of Storge can be had in many areas including art/creativity, music, academics, sports, hobbies, gaming, crafts, service projects, and recreation. One of the reasons Greek organizations exist in universities/colleges is to offer a transitional family with common academic or cultural characteristics; sororities and fraternities, especially when they include an Agape foundation, provide a sense of belonging, safety, and community for young adults leaving the nest. Notably, in Storge love, the level of talent or role in the group is not what makes this love deeper or more meaningful, it is the person’s genuine participation in the shared interest. If you happen to be a person who has a supportive and loving family, the nudge is still there to intentionally foster Storge. If you overlook this love because “It’s always been there,” you risk losing intimacy in life by becoming too dependent on one or two people. Also, if you have written off family or certain members, you may be selling short your own ability to love with a humble Agape spirit, achieve some healing, and experience more Storge than you once believed was possible.
Philia — This is the reciprocal love of close friends. Intimate friendship involves a commitment to generously invest in one another’s lives with the intent of helping each other to mature in honesty, humility, and discretion. Deep friendship offers comfort through tough times and an expectation that each will challenge the other if one drifts from professed goals and values. Intimate friends don’t criticize character flaws but instead work together to explore healthy alternatives. They stay informed on important issues in each other’s relationships and investments. Simply put, they challenge and encourage each other to be the best they can be. Certainly, this love is not actualized in quantity, but in quality.
Ideally, if it is a personal goal, the aforementioned loves can prepare you for Eros or romantic/sexual love.
Of course, what makes the cultivation of any of the four loves challenging is if we lack love of self. The good news is that we don’t have to acquire one before the other; we actually need to develop them simultaneously. Also, we can’t forget that without knowing and loving self we will continue to repeat intimacy-blocking patterns in all forms of love. Reason being, if we have not defined who we are, we have little chance of becoming ourselves in the world, regardless of the type of love we desire. While all four of these loves challenge and foster personal growth, healthy investment in self-love, and continual maturing of identity, it is Eros that often challenges us most. It is the loving partnership that most clearly strives for a sense of oneness. As such, it requires a clear sense of self along with the intimacy skills of humility, assertiveness, transparency, clear boundary-setting, empathy and compassion. It is not self-sacrificing but rather requires integrating self with another. This cannot be achieved while hiding, disowning or failing to communicate a clear sense of self. If a person invests in Eros love, they must continue to define “me” or risk losing their identity.
Factors such as lifestyle and life stage can negatively impact the growth of oneness if individual goals and cultivating shared goals within the partnership are taken for granted. Therefore, it is really up to each partner to invest in who they are (personal values, interests, strengths, vulnerabilities, passions, and missions) so they can offer more to the relationship and not become helpless or entitled. In Eros love, each partner promotes intimacy by really valuing how the other cares for their own physical, emotional, mental, spiritual, and sexual well-being.
Lastly, self-love can be hard to come by if a person has a long history of self-destructive behaviors that have blocked intimacy in relationships. The good thing is, we all have equal potential in the present to value ourselves and to feel as good about what we have to offer the world. Theoretically, one’s true worth and ability to attract healthy connection with others depends upon who they are being now, not on their possessions, surface appearance, or past. Now, this does not mean we benefit from attempting to forget, minimize, or justify our past harmful actions. Quite the opposite, a greater sense of knowing and loving self can actually come from owning what we have carried out in real life to hurt real people. Accepting that we are more loveable when we are not perfect is a great goal! In this humble space, we can connect with others as our authentic selves and not as actors. We can believe that no person can truly be satisfied in relationships without intimacy.
So ask yourself: What relationships am I neglecting to strengthen or pursue? What is keeping me from experiencing real intimacy? How might I learn to be more authentic and vulnerable with others?
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