Clyde Angel, DMin., BCC, LPCJohn Sullivan, LCSW

PTSD- Families -Addictions and Spirituality: The Common Thread?

Presented to

IN-ARMS Annual ConferenceFriday, March 6, 2015

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Trauma is about wounding The initial wounding is the trauma event

Trauma as defined by patient:

Trauma = earthquake & Flashbacks = aftershocks.

The metaphor of an earthquake is a good one because a trauma event can shake one's very foundation. This is what prompts some to remark, “When x happened, nothing seemed to matter anymore.” While others say, “At my core, I’m NOT the same.”

TRAUMA

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Wounding occurs on many levels:

Initial Wounding (The Trauma Event)Secondary Wounding

Third Level of WoundingFourth Level of Wounding

Trauma = Wounding

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Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.

Spiritual distress arises when one of these relationships that provide meaning is threatened or broken… the individual becomes disconnected from their system of beliefs … there is conflict between a person’s held values and perceived reality.

Spiritual recovery is a journey of establishing, rethinking, and redefining one’s sense of self and relationship to life.

Spirituality

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Signature wound is loss of trust

Compromise of one’s core values or

beliefs

Trauma event is greater than the spiritual

formation formed prior to the traumatic

experience

Need for Spiritual Re-Formation

The shattered soul

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Relationship Road Map IThe Logic of Emotion and Bonding

BIOLOGICALLY BASED NEEDS

Air – Food – Water – Shelter

BONDING(Emotional Openness/Physical Closeness)

SYMPTOMS OF UNHAPPINESS

Illness, FatigueDepression

Rigidity of PersonalityConstriction, Isolation

Closed, Guarded, Wary

Anti-Social BehaviorRange of Addictions:

Drugs, Alcohol Food, Shopping,

Work Gambling, Internet

SIGNS OFHAPPINESS

Health, EnergyWell BeingFlexibilityCreativity

Open, SharingPersonal

ResponsibilityCapacity for

Intimacy

EASEEU-STRESS

TRUSTHAPPINESSPLEASURE

DESIRELOVE

DIS-EASEDISTRESSDISTRUST

UNHAPPINESSPAIN

DANGERFEAR/ANGER

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What exactly is the disorder in PTSD?

While it is true the DSM-IV lists PTSD as an anxiety disorder, it is also a

Disorder of Recovery

D - DISORDER

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The treatment of patients suffering from PTSD is facilitated when they are already successfully working a Recovery Program such as AA or EA. As they discover there are concepts that are interchangeable between recovery programs many gain hope and confidence that they can achieve further success in recovery.

Examples “Stinkin’ thinkin’” (cognitive distortions) “½ Measures” (proper medications w/o therapy or vice

versa) “Sick as your secrets” (denial/repression/avoidance)

RECOVERY

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As people make the subtle move from I FEEL TO I AM…what had been at first a feeling becomes their identity

as they move from:

I feel Incompetent TO I am incompetentI feel inferior TO I am inferiorI feel careless TO I am carelessI feel immoral TO I am immoral

The move from I feel immoral TO I am immoral is an indication of a 4th level of wounding……

Transition from Third Level Wounding to Fourth Level Wounding

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When one moves from: “I feel immoral” to “I am immoral”

….accompanied by debilitating feelings of shame and guilt and a shattered sense of trust….

This is a reflection of fourth-level wounding. That is, wounding at the level of one’s essence as in “My core is NOT the same.”

Fourth Level of Wounding

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In the 12-Step Recovery Model people are the most highly invested in treatment when they “hit bottom”. This in part explains why it is so long before many seek help with PTSD—they eventually hit an “emotional bottom” when various means of avoiding no longer work for them.

“I kept pushing it down, now it is pushing back.”

As with other recovery disorders, those suffering with PTSD may have enablers who attempt to convince the patient and the provider to end treatment in its early stages as they observe the patient getting worse before they get better.

More Parallels - Seeking Help

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A big piece of what needs to be processed relates to certain questions that are forced to the forefront of one’s conscience and consciousness following a trauma.

Answering these questions is basic and fundamental to our peace and well being which is what gives them such urgency.

When such questions are viewed primarily as “profound” this narrow view can actually promote avoidance behavior.

Avoidance is the lifeblood of PTSD

FUNDAMENTAL Not “Profound”

Why did this happen to me? What caused this trauma event? Was this a test from God? If it was a test, is there a way to pass this test? When is this test going to end? If it was a punishment, what did I do to deserve

punishment? Why did I survive when others died? [SE variation on this

question] If God has forgiven me and I have not, can I ever be

forgiven? If God forgives me and I do not, does that place me above

God?

FUNDAMENTAL QUESTIONS

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Recovery entails:Finding MEANING in trauma events and Discovering

ANSWERS to pressing fundamental questions related to these events

The key to recovery via meaning and answers is ACCEPTANCE

Answers and meanings must be those one can literally LIVE with since “recovery” is movement from survival mode to LIVING.

One is better able to move on with life as the impact of memories becomes less disruptive to functioning during the course of treatment.

RECOVERY

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Answers to fundamental questions/beliefs and attaching meaning to events is important.

Acceptance of these answers and meanings is Crucial.

“I saw his reflection in the wall…”

ANSWERS/MEANINGS/ACCEPTANCE

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The only way to get BEYOND traumas is to go THROUGH the traumas…

this is a scary proposition…

You can’t go over, under or around them…Avoidance will not get you BEYOND them

Avoidance is the lifeblood of PTSD

Getting Beyond the Trauma

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http://www.goodsalt.com/details/ebsps0854.html

Anger Management vs. Anger Resolution

Loss and Grief

Shame, Guilt and Forgiveness (to include self)

Spiritual healing

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When patients believe they have betrayed their own values, morals, conscience, their essence/core or what was once referred to as their very SOUL and that they did so because every one of their so-called "choices“ were morally reprehensible and emotionally devastating leaving them feeling coerced into this self-betrayal, we as providers need to ask ourselves:

Can our current approaches to treatment address the gravity and depth of one’s social-psycho-spiritual reaction to this perceived self-betrayal?

Question

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Certainly spiritual wounding involves “moral injury”. However, the cluster of symptoms that make up spiritual wounding is broader than moral injury.

Spiritual Wounding

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Spiritual Wounding Symptom Cluster

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The Shattering of Trust 

Disconnection and alienation from:FamilyFriendsOne’s Higher PowerSELF

Guilt Issues

Shame

Moral Injury

Unresolved grief (so many losses)

Issues related to Conscience

Love Knots are commonly held beliefs that seem to be true. However, they are not true because they are not based on logical, realistic thinking. Love Knots can be very harmful to relationships.

Love Knots

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LOVE KNOTIf you really loved me, you would know what I want, and you would do it. Since you don’t, you obviously don’t

care.

UNTANGLEDI cannot assume that you

know what I want and need. I will ask for what I want and not expect you

to know.

LOVE KNOT #1: You would know …

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LOVE KNOTWhen I tell you how I feel, you

interrupt, disagree, give advice, judge, or dismiss my

feelings. That’s not what I want. I stop telling you. I

distance myself from you.UNTANGLED

If I want you to listen to me and to hear me without

comment, I need to ask for that. Advice is not helpful when

the person does not want it. Learning how to listen

attentively is often more important than giving advice.

LOVE KNOT #2:When I tell you …

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LOVE KNOTIf you are in pain, I believe I

should be able to fix it. I don’t know how to fix it, so I feel

inadequate. I get angry with you for making me feel

inadequate. I withdraw from you and blame you for being in

pain.UNTANGLEDWhen you are in pain, I can be supportive without believing I have to provide a solution. I can listen, empathize, and

acknowledge what you say. I will respect and honor your

feelings as well as your ability to ask for what you want.

LOVE KNOT #3:If you are in pain …

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LOVE KNOT

If I tell you what I want and you do it, it doesn’t count (because I had to tell you). If you try to

guess what I want and you don’t get it right, I get

angry.UNTANGLEDI cannot expect you to

know what I want. Nor can I expect you to do

anything exactly the way I would. I can still

appreciate the gift of whatever you do because you believe I would like it.

LOVE KNOT #4:If I tell you …

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LOVE KNOT

If I let myself get close to you, I will need you. If I am too dependent and

need (love) you too much, I will not be able to

survive without you. I will become weak.UNTANGLED

I can enjoy being close to you yet still survive on my

own if I need to. As an adult, I am not helpless. I can make a new life for

myself if I have to. Meanwhile, the pleasures

of intimacy are among life’s most fulfilling gifts.

LOVE KNOT #5:I will need you …

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LOVE KNOT

If we don’t agree, one of us must be wrong. If it’s me, that means I am bad,

stupid, ignorant, or inadequate. So it can’t be me. I must prove that it’s you so I won’t feel like a

failure.UNTANGLED

We should be able to disagree. We are all

unique, and disagreements are a natural reflection of

our uniqueness.

LOVE KNOT#6:If we don’t agree …

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LOVE KNOT

If I ask what you are thinking or feeling, I

believe I am intruding (as you would tell me if you wanted me to know). If I don’t ask, you believe I’m

not interested, so you never tell me. We live as

strangers.

UNTANGLEDConfiding is the life blood of intimacy. I need to be

able to ask for information, and you need to be able to volunteer it

when I don’t ask, if we are to nurture our

relationship. It is crucial that we speak our truths,

ask our questions, and keep each other informed.

LOVE KNOT #7:If I ask …

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StartHere The Love Knot I

want to work on is…

My assumptionhas been…

I think I have thisbelief because …What I

neededin my past was …The price I have paid

in my life for having this knot is …

The price you havepaid for my knot is…

What I can do for myself to untanglethis knot is…

What you can doto help me is…

I realize …

I hope …

PAIRS Talking TipsUntangling a Love Knot

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EMOTIONAL MEMORY AND ALLERGIES

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My Allergy: (TRIGGER)

Raising yourvoice in anger.

My Belief:Anyone who yells at

me does not love me.

My Behavior:I give you the silent treatment for yelling.

Your Allergy(TRIGGER)Silent Treatment.

Your Belief:Anyone who stopsspeaking to me, does not respect me, will leave me.Your Behavior:

I raise my voice again and you continue not to speak to me.

Dirty Fighting Begins

Dirty Fighting Begins

My Feelings:FearHurt

Anger

Your FeelingsHurtAngerFear

Emotional Allergy Infinity Loop

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Vulnerability:

Allowing another person to see the parts of you that are scared, hurt,

sad, and lonely, etc.

Taking a risk to share your deepest thoughts and feelings with another person even when you are not sure

how they will react.

Empathy:

Imagining what it feels like to be in another person’s shoes

Imagining what that person thinks and feels.

TRANSFORMING THE ALLERGY LOOP INTO A LOOP OF LOVE

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So What is the Common Thread?

Questions?