by Dr. Johanna O’Flaherty
We can ask anyone in the U.S. where they were on Sept. 11, 2001, and they will be able to recall their exact location, memories of the event and the visceral responses that they experienced when they heard about the terrorist attacks.
Emotional memories like these are imprinted in our psyches. When they emerge, traumatic memories flare up not in the distorted fashion of ordinary recall, but as full moods, physical sensations or vivid visuals. Decreased inhibition opens the door to traumatic memories, and they often surface when our defenses are down, such as when under the influence of drugs and alcohol, during sleep (as nightmares), with aging and after exposure to strong reminders of the traumatic past.
With trauma, an individual experiences an “earthquake of the soul”; therefore, in therapy, it helps to approach the work of recovery in a soulful way. Trauma victims organize much of their lives around their trauma whether they realize it or not. So powerfully ingrained is the memory, that traumatized individuals may repeat patterns of behavior that serve to reenact the traumatic event, or conversely avoid any reminders of the event or its effects. Depth psychology recognizes the deep-seated nature of trauma, as well as the pervasiveness of its effects. This approach is pivotal for therapists in the addiction field because where unaddressed trauma lives, addiction feeds.
The Anatomy of Trauma
Research suggests that there is a strong correlation between trauma and addictions. Addiction is in and of itself a chronic, progressive, fatal illness and correlation does not necessarily mean causation. Even so, I have come to understand that individuals treated for alcoholism and other substance abuse dependency need to be evaluated for trauma at the early stages of treatment. Unresolved trauma will stymie recovery and may lead to relapse. Mood-altering substances are often used to anesthetize the psychic pain of traumatized individuals. When the substance is removed, the trauma is exposed, and, invariably, the individual becomes emotionally flooded.
Trauma is a unique psychological phenomenon. The traumatized patient, by definition, has experienced an event so unusual that their normal coping ability is compromised. The issue is not an internal personality flaw or neurotic defense that can be treated with traditional therapies. Instead, its core lies in an external event and even when the patient’s experience is painful, perplexing, or not well understood by others, it’s important to let them know that they are having a normal reaction to an abnormal situation.
Treating Trauma From All Angles
At the Betty Ford Center, a trauma history is part of the admitting process. When a patient admits to treatment, counselors, nurses and physicians screen for trauma and acknowledge if the patient has a trauma history. Our experience has shown that over 85 percent of patients, both male and female, have experienced some trauma, be it emotional, physical or sexual.
Recovering from trauma is not a quick fix. At Betty Ford, patients are asked to make a commitment to 60 to 90 days of additional treatment beyond their addiction program to participate in a trauma workshop. Combinations of Qigong, art therapy, developing a tapestry of one’s life, as well as a trauma timeline are all utilized in workshops to create an environment where patients feel safe enough to fully explore the vortex of the painful trauma memories.
Of these exercises, a simple timeline can often be the most useful. To complete it, the patient is asked to place their positive memories above the line and grade them from 1 to 10 and their painful memories below the line and also grade them from 1 to 10. It sounds simple, but it is often difficult to complete as the patient can become emotionally flooded by the painful memories.
When a patient presents the timeline, they have an opportunity to evaluate the reenactment phase, e.g. putting oneself in a vulnerable position while under the influence. The patient is reassured that through working a recovery program, they will not put themselves in a self-sabotaging position and therefore will not reenact. This exercise is very empowering, as the demoralization felt by the patient for ‘allowing themselves’ to be re-victimized while under the influence can be overwhelming.
When it comes to treating trauma with addiction, empathy and identification are key. The truth of a traumatic event needs to be witnessed—and in so doing, validated—to help the patient recognize the reality and legitimacy of their suffering and open themselves up to the healing process.
Unfortunately, trauma isn’t always treated as it occurs. Often, an initial experience creates a traumatic memory that is compounded and amplified by subsequent traumatic experiences. Epidemiological estimates suggest the incidence and lifetime prevalence rates of Post Traumatic Stress Disorder (PTSD) in the general population are around 1 percent and 9 percent, respectively. These levels increase markedly for young adults living in inner cities (23 percent) and for wounded combat veterans (20 percent). There is also evidence that early traumatic experiences (during childhood), especially if these are prolonged or repeated, may increase the risk of developing PTSD after traumatic exposure as an adult. And of course the disease of addiction is itself traumatic.
Depth Psychology and Spirituality
Trauma is forever, but suffering from it does not have to be. By working with a specially trained trauma therapist, patients are allowed to guide the pace of their own recovery, choosing when they feel comfortable enough in the safe environment the therapist has created to share their story and in so doing, begin to drain its emotional power. Healing is the patient’s journey, and therapists are well advised not “rush the river.”
While the trauma story must be told, it is not necessary for the patient who has seen several therapists to tell the trauma story in every detail to every clinician. Nor does it meanthat one unemotional synopsis will suffice. As a therapist, my purpose for hearing the details of the trauma story is to revisit the scene of terror and horror so as to enter the vortex of the pain, take the power out of it, and remove the clutch of dreadfulness that the trauma has had on the patient.
My goal is not to teach the patient, so much as to assist the patient on his or her own journey to restore emotional balance. Within an atmosphere of acceptance and caring, the creative potential of the Self finds fruitful earth in which to emerge.
Reviving the Spirit
Frequently, spirituality is conceptualized as an awareness of a “Higher Power’s” love and is often described as a transcendent feeling of harmony and communion with humanity or nature. Spirituality is a state of being fully alive and open to the moment. It includes a sense of belonging and of having a place in the universe.
A sense of belonging is very evident every day in the rooms of Twelve Step programs. Although spiritual growth is a type of healing from which most of us could benefit, a victim’s sense of spirit may be acutely dimmed for a period after traumatic incident(s). Over time, however, as the person heals, the potential for spiritual growth may become greater than before—even greater than those who have not faced the darkness of trauma—and just as when recovering from addiction, the recovery journey after trauma can lead to a lighter, fuller life than we ever imagined.
[bio] For the past 25 years, Dr. Johanna O’Flaherty, Ph.D, CADAC II, CEAP, vice president of treatment services at the Betty Ford Center, has been a catalyst for healing through many traumatic situations. She sees her involvement in the aftermath of disasters such as 9/11 in New York and TWA’s Flight 800 near Long Island as “life-changing experiences – because I have been allowed to be there and help in a small way with people who have experienced an earthquake of the soul.” Dr. O’Flaherty has been featured on ABC, NBC, MSNBC, and CNN and celebrated her 35th year of sobriety on January 1, 2013.