My interest in treating people with childhood trauma/abuse began by noting the histories of the individuals with addictions that I worked with. Studies have shown that a vast majority and as high as 70% of people who develop severe (compulsive) substance dependence have a history of a form of childhood abuse or emotional neglect. My study of this literature and recent completion of the 10-month Certificate Program in Traumatic Stress Studies offered by The Trauma Center at the Justice Resource Institute founded by pioneer trauma expert and researcher, Bessel van der Kolk, M.D., provide overwhelming evidence on how the emotional experiences from childhood abuse and emotional neglect, significant parent-child relational disruptions, are stored neurobiologically, in fragmented form, often inaccessible (without a verbal narrative), dissociated, become embodied and unknowingly acted out via addictions and other compulsive behaviors. These embodied and unprocessed histories predispose individuals to adult depression, anxiety, obsessive-compulsive tendencies, emotional eating, somatization, and relationship (attachment) problems. Treatment and recovery (e.g., from addiction and co-occurring depression) may likely be incomplete until the effects of this developmental history are addressed and resolved. The research also shows that treatment needs to be trauma-informed and phase-oriented, going beyond traditional “talk therapy” by integrating body-mind interventions and neuroscience. Shame also has a chance to be addressed and healed in this process.
Shame also results from childhood relational ruptures such as abuse and emotional neglect, and it also underlies addictions and compulsive enactments. Shame is not a cognition or just an emotion. Shame is physiologically experienced, embodied, without words (no conscious narrative), an experience of the core self being unlovable, unworthy to be connected to. The experience of shame is mostly avoided, defended against or dissociated and remains unprocessed. It becomes embodied and acted out (enacted), expressed in behaviors and relationally (e.g, addictions, emotional eating, and many of the problems presented in psychotherapy). Imagine experiencing Shame, without words or a verbal narrative, having the sensations, a felt sense, of being unlovable, the sensation of “if you get to know me you will not like me”. Imagine this experience without words and not realizing its origination. You, the child, will (without words and awareness) blame yourself (“I must be unlovable”; “I’m toxic”), which originated from the experienced lack of felt connection with and the experienced lack of attunement of your dependency needs (e.g, to feel safe and comforted) by your primary caretakers/parent(s). That is, the parent(s) being out of sync with the needs of the child leads to a felt disconnect, an untethered aloneness, an unworthiness to be connected to that becomes the physiological experience of Shame. Healing of shame becomes an important part of therapy.
I believe it is important to take a a non-pathologizing, developmentally informed approach that integrates trauma-informed and phase-oriented approaches when working with most symptoms presented in therapy, including addictions. It is a way to help someone feel safe and regulated early on in treatment and in our relationship. When working with an addiction to substances of abuse (e.g., alcohol, cocaine, opiates) neuroadaptation (i.e changes in brain chemistry and structures) has occurred and these brain changes play a significant role in maintaining the cycle of use and relapses. Even though there are specific strategies (e.g., cognitive-behavioral, motivational enhancement), even medications, that may be used to break the cycle of use, the person still has an idiosyncratic approach to recovery that is linked to the embodiment of early childhood relational trauma, disruption, and shame. Understanding and being mindful to these dynamics can help with establishing a sense of connection/attachment, safety and stabilization for the individual early on in treatment.
My approach co-creates a safe interpersonal space that fits the person’s need for safety, which is balanced with healthy vulnerability, essential for change. The person learns to trust and put self-experiences into words, bringing more of self into the therapy instead of keeping the experience/affect unknown, embodied and enacted (e.g., compulsively using substances or food, or being symptomatic). This facilitates the resolution of maladaptive coping strategies and disturbing symptoms. This process also assists in the healing of shame, the intense negative experience of self that keeps us hidden.