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Inspiring Success on the Road to Recovery

Thursday, July 5, 2018

Covert Emotional Incest: The Hidden Sexual Abuse

By Adena Bank Lees, LCSW, LISAC, BCETS, CP

"Your dad doesn’t understand me the way you do.” “You’re such a good listener.” “I can’t talk to your mother like this.” “I always feel so much better when I talk to you."

  • Have you ever been hugged too tight or the hug was held too long?
  • Did you grow up feeling responsible to meet your parent(s) needs?
  • Have you ever felt you had to choose between your parent, your spouse or significant other?

If you said yes to any of the above, you may be a victim of Covert Emotional Incest.

What is Covert Emotional Incest (CEI)?

Covert Emotional Incest (CEI) is an elusive, emotional form of sexual abuse that occurs in the family system without there necessarily being direct genital contact. It is incestuous due to the undercurrent of sexual energy between a parent/caregiver and a child. It is characterized by the following: (1) triangulation (2) breach of the intergenerational boundary; (3) surrogate, substitute spouse or confidant role; (4) objectification. *

What do these concepts mean in plain English?

First, it is important to understand that the family operates as a system. This means each person in the family plays an interactive role and all impact one another. A metaphor often used to represent a family system is that of a child’s mobile hanging overhead. When the child reaches up and pulls on one of the parts, it causes the mobile to go out of balance. Stress in a family is like a child pulling on one of the pieces of the mobile; it too creates an imbalance. What we know about systems is that they strive for homeostasis, another word for balance. Marital problems, addiction, serious medical/mental health issues, and being a single parent, are just a few examples of these stressors. Without asking for outside help, the family relies on itself and adapts but its balance is precarious.

Healthy families have what is called an intergenerational boundary in place. This boundary is a flexible, invisible structure or energy field that defines the power differential between the parent/caregiver and child. This structure dictates the natural consequences of behaviors and deter-mines the appropriate interaction with the child on both spoken and unspoken levels. In essence, this means the parent is responsible to meet the child’s needs, not vice versa. The child has a voice in the family, yet does not have the final say regarding decisions that affect the family.

If the intergenerational boundary is rigid, the child has no say in the workings of the family.

If it is diffused or absent, it is often the case the child ends up meeting the parent’s needs as well as making adult decisions. In addition, the child can end up emotionally hijacking the household.

Part of constructing the intergenerational boundary is having parents or caregivers participate as a ‘unified executive committee’ to maintain the framework that ensures the child’s safety and wellbeing. One example is the child not being able to play one parent against the other. When there is only one parent, she/he ideally enlists assistance and support from external sources (peers and professionals) in order to sustain and enforce this boundary.


One adaptation to the imbalance in a family system is a dynamic called triangulation. This is a set up for CEI. Triangulation happens when major caregivers, not possessing the skills necessary to deal directly with each other, use their child as an intermediary and/or confidant. In CEI, this manifests as the child meeting the parent or caregiver’s individual emotional and/or romantic needs, namely, the surrogate spouse role. This role is a sexual role, communicating sexual energy whether there is physical sex happening or not.

It sexualizes the child, creating distorted beliefs and painful behavior in regards to sex and relationships. The system has therefore employed triangulation to ‘balance’ and function, incorporating destructive and abusive behavior patterns. The child often feels “special” and “privileged”, getting lots of attention and being trusted to keep secrets for the parent.


Objectification is another component of CEI. The child is used, not having their feelings or needs considered. Using a person as an instrument for one’s own sexual pleasure (sexual objectification), may occur as well. Again, this may happen in a hug that is too tight or held for too long, bathing with or washing a child with mal intent and/or past the age of appropriateness, comments about the child’s body, voyeuring, watching pornography with the child, and so on.

A Few Client examples

Johnny is an eight-year-old boy who’s father just passed away. His mother calls him “my little man” and starts relying on him to soothe and comfort her. She encourages him to sleep in bed with her because she is lonely. Many adults attending the funeral approach Johnny, giving their condolences telling him, “You are the man of the house now, take care of your mother and your sisters.” Johnny was proud, yet overwhelmed and confused. As a 38 year-old married man, his wife keeps accusing him of “having an affair” with his mother. He finds himself torn between two women.

Who is he really married to? At eight, was he a man? Did he have what it takes to take care of his mother and siblings? What does “take care of mother” mean anyway? Johnny’s childhood was stolen from him. He was a husband long before he was an adult.

Ann is a seasoned professional who describes, “watching myself from the ceiling” while making love with her partner. She longs to be in her body so she can experience the sensations and feelings of connection with her beloved. Ann grew up in a family where her father made peep holes in every room of their house so he could watch his wife and daughters — whenever he wanted to. “But I wasn’t sexually abused by my father. He molested my two sisters, but he never touched me.”

As I was defining and explaining CEI, Ann began to cry, exclaiming, “Oh my goodness! This makes sense! I am not crazy! Being a victim of Covert Emotional Incest is enough for me to have this sexual problem!”

Elana, a 41 year-old woman with 10 years of sobriety and abstinence in 12-Step programs, tells the story of how she was covertly emotionally incested by both of her parents. Since she was a teenager, she felt like she was having an affair with her father. “When Dad and I were out by ourselves, people would come up to us and ask if I was his wife. We laughed. We thought that was cute and funny.”

Upon the return home, Elana experienced the jealousy of her mother. Mother was angry with her, and short and curt with her father. Elana also relayed her mother’s keen focus on her body, consistently commenting on her weight by telling her she would only get a boyfriend if she were thin; that her body was her way to lure a man. Elana received the message that in order for her to have power, worth and be loved, she needed to be sexually attractive to a man. And, of course, in order to do that, she needed to be, what her mother defined as thin. It was not a surprise that Elana had developed anorexia and bulimia and used substances to medicate painful feelings.

Core Symptoms

Those who are victims of CEI often have great difficulty in establishing and maintaining healthy relationships. They are often stuck in the caretaker, fixer, and mediator roles, which do not allow for meaningful intimacy (in-to-me-see) nor a productive sense of self.

Beliefs such as “Who I am and what I do is never enough”, and “I do not have the right to have needs,” combine with the codependent roles above, dictating interaction with others. Faulty boundaries, such as the struggle to say “no” and experiencing extreme guilt when saying “no”, create opportunity for violation and abuse. Sexual difficulties are common, often leading to compulsivity or shut down and denial of desire. Mental health issues such as depression, anxiety, and post traumatic stress symptoms develop, interfering in the ability to have self-esteem and practice good self care.

The abuse of alcohol and other drugs medicate painful feelings as well as foster a false sense of belonging and self-worth. If the only power you believe you have is in determining what goes in and out of your body, doesn’t it make sense that restricting, overeating and the binge-purge cycle take place? Being underweight or overweight are frequently attempts at protection from sexual attention/advances. Disorderd eating may also be means of expressing rage toward caregivers for feeling trapped in the CEI dynamic. Spiritual struggles abound, with emptiness and disconnection, as well as anger and conflict with or about God/Higher Power.

Key Elements of Healing

The most important element of healing is the awareness of Covert Emotional Incest and validation that it is real and hurtful. This includes being cognizant of negative consequences and the fact that it was not your fault. It is parallel to the first step of 12-Step programs; You have to have a name for what you are dealing with (e.g. alcoholism), know it is a legitimate concern (it is a disease), accept your powerlessness over it and the unmanageability it causes in your life (it is not your fault and you have had negative consequences because of it).

Asking for professional help is the next step. You cannot heal from CEI, or addiction for that matter, by yourself. You already know this. Help is out there and there is no shame in asking for it. Asking is actually a strength. Your best bet is the combination of professional and peer support. This is akin to the second and third steps of the program. “I can’t, HP can, I think I’ll let HP.”

The B Word — Boundaries 

Developing healthy boundaries is another key element of healing. What is a boundary? How do you set one? A boundary is a border or limit that is permeable and flexible. You, yourself, are responsible for setting and enforcing a boundary. This includes monitoring you own motives. The motive for a boundary MUST be self-care. Otherwise, it may be an attempt to threaten, control, get revenge, or manipulate the other person. It will thereby disrupt the relationship and cause more problems and pain. A healthy boundary says, “I choose me” versus allowing others to determine who you are and what you need. When beginning to set boundaries, you are at risk to be seen as the ‘bad guy’. Tolerating this role is a must. Get support. Guilt may arise when you set a boundary. Guilt is a withdrawal symptom from the surrogate-spouse, mediator, caretaker, and other codependent roles.

The formula for setting a boundary is as follows:

Tell the person how their behavior impacts you: “When you say/do this (specific thing in this specific way), I feel (emotions).” E.g., “When you complain to me about Dad, I feel angry and sad.”
“If you continue to do/say (specific behavior), I will (take an action), to take care of myself.” E.g., “If you continue to complain to me about Dad, I will hang up the phone and call you back within twenty-four hours.”

NOTE: A feeling is NOT, “I feel like ...” or “I feel that...” 
These are thoughts, not feelings. With a feeling, you say, “I feel angry, sad, hurt, etc.” 
For the best results, make your boundary SMART (Crapuchettes, 2005)
Specific: “I am going to take a time-out and hang up the phone.” 
Measurable: “I am going to hang up the phone for and get back to you within twenty-four hours. 
Attainable: The action is possible and you are willing to follow it through. 
Realistic: Can you do this exactly as you say? 
Timely: The response is as close to the even as possible.

Cultivating your spiritual life relieves you of a core emptiness caused by being objectified and identified with the surrogate spouse role. It allows you to fully experience yourself, as well as be in meaningful relationships with others.

I define forgiveness as “a process of letting go and understanding that is a gift to one’s self,” is the last key element to discuss here. It is necessary to dispel the myths about forgiveness. Forgiveness is NOT a one time event, condoning, forgetting, letting the perpetrator “off the hook”, absolving him/her of sin, nor superficially saying, “I forgive you”, without the emotional work indicated.

Forgiveness IS allowing yourself to feel feelings, acknowledge losses, make the decision to not languish in the past, and gain perspective that CEI has probably been multgenerational. In my view, forgiveness IS the grieving and healing process from CEI. It is a gift to yourself because you have a right to be free of the burdens of victimization.

For Parents in Recovery

Taking responsibility for your own behavior and needs is the best thing you can do for your children. Asking for and receiving the help you need from peers and professionals to stay sober, deal with “outside issues”, and be spiritually fit are essentials for effective parenting. Strive to meet your children’s needs by being aware of your own, checking your motives and listening to their very precious voices. Modeling is the most powerful form of learning. It is what you DO that matters, not so much what you say. Akin to early recovery, looking for those who “have what you want”, and “sticking with the winners”, your children need the same ideal so they can “have what they want” and be “a winner” in their own lives.

Knowing that Covert Emotional Incest is enough to have the struggles you have is of prime importance to your moving from the victim to survivor role and then into really living and enjoying your life. As you have probably heard before, you do not have to just survive any longer. You have the right to and can thrive! Thriving and living “happy, joyous and free” is there for the taking. May you be bold, go and reach for it!

Adena Bank Lees, LCSW, LISAC, BCETS, CP is an internationally recognized speaker, trainer and consultant, providing a fresh and important look at addiction treatment, traumatic stress and recovery. She is the author of the educational memoir, Covert Emotional Incest: The Hidden Sexual Abuse, A Story of Hope and Healing. For more information about CEI and Adena’s work, visit www.adenabanklees.com. Her book is available there and at www.amazon.com

* I have coined the term Covert Emotional Incest. This is an expanded view of Dr. Ken Adams’, term “Covert Incest”, Dr. Pat Love’s,“Emotional Incest,” and Pia Mellody’s “Emotional Sexual Abuse.” It takes into account that the child is treated as an object, their needs and feelings unacknowledged. It happens in many families, yet is relatively unnamed, rarely spoken about or recognized.

Is MAT the Bad Boy of Addiction Treatment?

By Tony Bratko, MSC, LPC, LISAC

“If we only address the physical part of the disorder, other areas
 will be overwhelmed and lead the addict to relapse.”

Is this Deja vu?
There was a time in our history when “Drug Replacement Therapy” was highly encouraged by our government under the guise of “Harm Reduction.” Methadone was supposed to be the answer for heroin addiction.

We were told if heroin addicts could legally get opiates from a clinic, they would stop using heroin and not share needles. This would stop the spread of communicable diseases, thus reducing harm to themselves and society. The only problem? Many addicts continued using heroin intravenously and diverted the methadone (to sell for heroin) or used heroin in addition to the methadone. Methadone only addresses opiates and not other illicit drugs that addicts use such as methamphetamine. This still exists today.

Drive by any methadone clinic at 6:00 a.m. and you’ll see lines of Uber and Lyft cars waiting to take addicts back home — all on the government’s dime and taxpayer’s money. Rarely are the addict’s clean from all illicit substances, yet they stay on methadone maintenance for years, even decades.

There is no incentive for the addict to get off methadone and definitely no incentive for the owners of the clinics to have patients free of methadone. The business is a cash cow for owners. If a patient wants to titrate off methadone, the clinics require it take up to two years, if you can’t pay or lose your Medicaid, they titrate you off in three days. It’s called “Fee-Toxing.”

So here we are again with the government encouraging the use of medication to stop addiction. I suppose they feel it’s the cheaper way than to provide addicts primary treatment in an effort to learn how to change their thoughts and behaviors. Remember, we have Doctors of Medicine dictating public policy and treatment, most of who are not educated or even have a basic understanding of addiction. Maybe it’ll be different this time — I think not. Similar to methadone maintenance programs, only one hour of counseling per month is required for a patient in a MAT program. As a licensed addiction professional, I know more is needed.

Positive Aspects of MAT
I believe there are positive aspects to a MAT program, especially for addicts who constantly relapse. It gives them the ability to stop using illicit substances and create a foundation of recovery. A distinction also needs to be made between maintenance, stabilization with the goal of titration, and eventual termination of use.

As we know, addiction is a physical, psychological, and spiritual disease and all three areas need to be addressed on a daily basis for any addict to be successful.

If we only address the physical part of the disorder, other areas will be overwhelmed and lead the addict to relapse.

Optimally, a MAT program would also consist of at least one hour of individual counseling, a two hour, CBT Based Relapse Prevention group session, and consistent 12-step support meetings. Eventually, the addict will be off the medication but if they are not taught coping skills for triggers and cravings, we are setting them up for failure.

Another consideration needing to be addressed is the misuse regarding Buprenorphine — a narcotic often abused by addicts to get high.

So I ask....

  • What systems will be in place to ensure that diversion is not taking place? 
  • What is the process and/or consequences for addict who consistently test positive for any illicit drugs while in the MAT Program? 

Should an addict who has never attempted primary treatment be admitted into the program or should they be encouraged or referred to a traditional substance use treatment center first?

These are all questions a successful and responsible MAT Program should have answered before a person in active addiction walks into their clinic.

In conclusion, I am an addict in long term-recovery as well as a professional in the substance use and mental health field. I was able to get clean by medical detox and participation in primary treatment. I also have experience working in a methadone clinic. The traditional methadone clinic concept does not work. I only had a few clients who were able to stay clean from opiates and other illicit substances, most tested positive. I had 95 clients I was required to see on a monthly basis for a one hour, individual, counseling session. Most never showed for their appointments and the ones who did were not interested in therapy. They were there to keep getting their drug. I hope our field doesn’t go down this road again.

Medication Assisted Treatment needs to be used as a tool — not the answer to addiction. As we know, the addict is always looking for the softer, gentler way out of their addiction and that is not always the best way. Doing the work required is what is needed for a successful and long-term recovery.

Tony Bratko, MSC, LPC, LISAC is Executive Director of Clinical Services, Continuum Recovery Center, tbratko@continuumrecoverycenter.com. 602-402-4474. 


It's time to talk about alcohol!

By Douglas Edwards, Director, Institute for the
Advancement of Behavioral Healthcare

Perhaps at no time in recent memory have drugs so dominated the headlines. The daily drumbeat about the fight against opioid addiction has even reached the highest levels of government, with former Presidents Obama and Clinton as well as President Trump all agreeing that this is a public health emergency we can ill afford to ignore. Forty-two thousand Americans dying from opioid overdoses in one year (1) is a tragedy that demands a society-wide response.

Yet for those of us who have been associated with substance use treatment for some time, there has been a nagging question: Why aren’t we talking about alcohol, too?

Consider this:

  • 110% more Americans die annually from alcohol-related causes than from opioid overdoses (88,000 vs. 42,000).
  • One-third of substance use treatment admissions are related to opioids — another one-third are related to alcohol. 
  • In the current #MeToo climate, the role of alcohol is particularly relevant: Researchers estimate that 97,000 students between the ages of 18 and 24 annually report experiencing alcohol-related sexual assault or rape.

As the government finds ways to restrict access to opioids, I doubt we will see similar efforts for alcohol, although it is the third leading preventable cause of death in the United States.

Comprehensive discussions about addiction, regardless of substance or behavior, need to be part of national dialogues on health and healthcare, law enforcement, and education.
Yet to ensure alcohol’s importance is not lost in these discussions, as I feel it has been in the past— this year the Institute for the Advancement of Behavioral Healthcare decided to rename our National Conference on Addiction Disorders as the National Conference on Alcohol and Addiction Disorders.

Our programming team has recruited speakers to specifically address alcohol, and we aim to produce resources to ensure alcohol remains part of conversations regarding addiction and behavioral health.
NCAD will continue to address the wide range of addictions and behavioral health disorders—including opioids. The Institute will continue to host national conversations regarding the opioid crisis. But at least once a year we aim to ensure alcohol is part of the country’s dialogue regarding addiction.

Indeed, it’s time to talk about alcohol, too.

Sources:(1) https://www.cdc.gov/drugoverdose/epidemic/index.html(2) https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics(3) https://wwwdasis.samhsa.gov/webt/quicklink/US15.htm

The National Conference on Alcohol and Addiction Disorders is produced in conjunction with IC&RC. Representing more than 50,000 professionals, IC&RC is the global leader in the credentialing of prevention, substance use treatment, and recovery professionals.

August 19 - 22, 2018
Disneyland, CA.
Conference information:

Celebrate the Art of Recovery Expo in Phoenix September 22

Community Bridges, Inc.
Offers Free Recovery Expo to Public on Sept. 22

Celebrate National Recovery Month, Attend Workshops, Find Resources at the Phoenix Convention Center

Community Bridges, Inc. (CBI), the premiere provider of integrated behavioral health programs in Arizona, invites the public, medical professionals, family members and others to the 13th annual Celebrate the Art of Recovery Expo (CARE) to meet leading professionals in addiction treatment and behavioral health on Saturday, Sept. 22 from 9:30 a.m. to 4 p.m. at the Phoenix Convention Center.
Participants will celebrate National Recovery Month by attending workshops, engaging in one-on-one Q and A sessions, and finding the right treatment resources from dozens of on-site providers, including private and public agencies, treatment facilities, outpatient clinics, marriage and family therapists, specialists and more.

Celebrate the Art of Recovery Expo: 
Saturday, Sept. 22, 2018 
9:30 a.m. to 4 p.m.
Phoenix Convention Center, Hall G, South Building
Free event

CARE’s keynote speaker, Justin Luke Riley, is in long-term recovery from substance use disorder. He promotes the fact that people can and do recover each and every day, just like he did at age 19. "Being in recovery is more than abstaining from a behavior,” explains Justin. “It's about resiliency. We want to show people that the things they've gone through can actually be transformed as the building blocks to changing the world."

Visit www.celebratetheartofrecovery.org for details, or contact 877-931-9142 for immediate intervention. Recovery is possible!

About Community Bridges, Inc. (CommunityBridgesAZ.org)
Community Bridges, Inc. (CBI) is the premiere provider of integrated behavioral health programs in Arizona, including prevention, education and treatments using cutting-edge, nationally recognized models. Programs include residential, inpatient, patient-centered medical homes, medication assisted treatment (MAT), crisis units, transition points and outpatient services to individuals who are experiencing crisis, opioid use disorder, homelessness and mental illness. CBI believes in maintaining the dignity of human life, and knows recovery is possible.

Contact: Lauren Jeroski at 480-332-2629 Stacy Lloyd at 602-451-1115

New to the Valley

Cornerstone Healing Center in Scottsdale is a progressive outpatient addiction treatment facility specializing in evidence based, holistic therapies facilitated by doctors, licensed therapists, counselors and addiction specialists.Addiction won't change... without help. 

Cornerstone believes in helping men, broken by addiction, to heal their mind, body and spirit. By treating the underlying causes of addiction and arming our clients with custom-tailored action plans and support networks we can provide a well-rounded approach to long-term recovery.

The vision is to create a safe environment for healing and long-term recovery from drug addiction and alcoholism.Through passion, structure, soul-searching and fun, we seek to change lives from the inside out.

Cornerstone offers a comprehensive approach to treating the individual as a whole and believe the combination of Outpatient care and structured sober living creates a rich and immersive recovery experience.

Visit scottsdalecornerstone.com or call 602-481-1861.

Professionals page

Recognizing Trauma in your Clients

How do I recognize if trauma is playing a part in the behavioral health concerns my patients are experiencing?

First, it is essential to understand the degree to which trauma has permeated our culture.
Consider the following statistics from the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA):

Experts estimate that about 60% of men and 50% of women will experience at least one traumatic event in their lives.

The lifetime prevalence for sexual violence is about 50% for women and 20% for men.

About 25% of women and 14% of men will endure severe physical violence by an intimate partner at least once in their lives.

About 19% of men and 15% of women will survive at least one natural disaster.
Among certain populations, especially those who may need treatment for mental and/or behavioral health issues, the prevalence of trauma is much more common. The National Association of State

Mental Health Program Directors has reported the following:

  • More than 90% of men and women who received publicly funded behavioral healthcare have a history of trauma. Most have endured multiple traumatic events.
  • About 75% of adults who receive treatment for substance abuse and addiction have a history of trauma.
  • Virtually every homeless woman who struggles with mental illness has experienced physical and/or sexual abuse. About 87% of these women report having experienced this type of trauma both during childhood and as adults.

Of course, trauma is hardly limited to individuals who live in the United States. Data collected by the World Health Consortium, which included information on 68,000 adults from 24 countries, revealed that more than 70% of individuals who were studied had experienced at least one type of trauma.
In addition to appreciating the likelihood that your client or patient has experienced trauma, it is also important to understand their risk for suffering long-term negative effects. Most people who experience trauma will not struggle with ongoing impairment as a result. However, for some trauma survivors, the experience can have a catastrophic ongoing impact on their health and well-being.

The CDC reports that the following factors can significantly influence a person’s risk for trauma-related problems:

  • Being in close proximity to the traumatic event. Closer exposure correlates to a greater likelihood of negative effects.
  • Experiencing multiple stressors, or an accumulation of stressors over time.
  • Having prior exposure to trauma.
  • Living with chronic physical illness and/or psychological disorders.

Finally, identifying the role that trauma may be playing is a matter of effective universal screening. SAMHSA recommends the following:

  • Ask all patients about personal history of trauma.
  • Use a valid instrument, such as the Adverse Childhood Experiences (ACEs) questionnaire.
  • Screen all patients with a history of trauma for suicidal thoughts and behaviors.
  • Do not require patients to provide detailed descriptions of past traumatic experiences during the screening process.
  • Address the connection between past trauma and current behavioral/psychological struggles.
  • Discuss with the patient how these trauma-related findings will be incorporated into their treatment.
  • Ensure that the patient is safe, and has necessary social and emotional support, prior to the end of the screening session.

Deciding on the best program to refer patients 

Treating patients whose behavioral healthcare needs are influenced by a history of trauma can be a complex endeavor. SAMHSA advises a trauma-informed treatment environment should accomplish the following objectives:

  • Meeting the patient’s needs in a safe, collaborative, and compassionate manner
  • Ensuring that no treatment practices will re-traumatize the patient
  • Building on the strengths and resilience of the patient in the context of their environments and communities
  • Endorsing trauma-informed principles through support, consultation, and supervision

Depending upon the nature of your practice and the scope of your services, you may determine that a referral is in the best interest of your patient. Once you have made such a decision, the Treatment Placement Specialists (TPS) team can help.

When you contact TPS, we will make sure to ask all the necessary questions to we gain a thorough understanding of your patient’s needs and preferences. Our team will then conduct all necessary research, and will provide you with carefully vetted placement options for your patient.
Treatment Placement Specialists is an Initiative of Acadia Health. (833) 483-6933 or visit http://www.treatmentplacementspecialists.com

Gaming Addiction Classified As A Disorder By The World Health Organization

On June 18th the World Health Organization released the newest edition of the International Classification of Diseases or ICD-11 which included the new diagnosis, Gaming Disorder. The ICD collects research and medical health trends from around the world to compile them into one guide for use in the medical health field as a reference and to standardize treatment. This new disorder’s inclusion could result in more diagnosis and increased treatment options being decided for those that suffer from this affliction.

According to the WHO, they included Gaming Disorder to increase attention to an issue that has grown in the recent years. This should also help provide ways to standardize treatment and create lasting changes in the way that people deal with this disorder.

The WHO created three criteria to focus on when diagnosing this disorder. First is “Impaired control over gaming,” meaning that someone with this disorder has a compulsion to game and remain gaming for long periods of time. Second is “The increasing priority given to gaming, as it would take precedence over other life interests and daily activities,” such as sports, school or even being with friends. Finally, they also focus on “The continuation or escalation of gaming despite negative consequences.”

This last one is key to understanding the disorder. Like other addiction based disorders, the focus is on negative consequences to a person’s life, not just about playing too many games. Treatment methods include therapies based on the Cognitive Behavioral Model. This mostly consists of social support, education of condition and family support. Which is another way that this is similar to addiction based disorders, like how they use AA or other group-based therapy.

Some experts have argued that the presented definition is too broad and too subjective which represents a danger to being over-diagnosed. Experts like Anthony Bean a licensed psychologist who spoke to CNN about the matter. He said, “It’s a little bit premature to label this a diagnosis,” and that people often “use it as a coping mechanism for either anxiety or depression.” Meaning that looking at the gaming is not the right way to go about it. Instead, people should focus on the reasons why these people are looking to video games and trying to understand what life outside isn’t providing for them.

His stance is echoed by the American Psychological Association and their Diagnosis and Statistical Manual or DSM-5. In 2013 when they published the latest edition of the manual on mental health, they concluded that ‘Internet Gaming Disorder,’ as they call it, was a “Condition for Further Study” and that it could be added at a later date. This has remained the APA’s stance, believing that they require more evidence before making for its inclusion into the manual. But the WHO’s inclusion could signal that the APA might follow suit based on similar research findings that lead to the WHO’s conclusion.

It is important to note that the WHO indicated that only a small proportion of people who engage in gaming activities have this disorder. Meaning it is not a widespread issue. The most important thing experts like Daniel Kaufmann, a researcher who spoke with KTAR News, said about how to deal with this is to avoid arguments. Try to find a way to understand what they use video games for and maybe what they aren’t getting from the rest of life.

A Bit of an Obit

By Coach Cary Bayer www.carybayer.com

A major reason so many people put off doing what they want in their lives is because they think they have so much time left to live. The average life span of an American woman is 81.2 years, for men, 76.4. That means just 29,638 days and 27,886 days, respectively. Ladies, chances are good more than half of those days are already gone, even more if you’re a man.

Each day that passes off the calendar means one less day from that total. You’re not here forever; the window of opportunity in life keeps closing, a little with each exhalation of breath. I don’t say this to scare you, but to alert you to the fact time is passing and, if you’re not yet doing what you’re really here to do, what are you waiting for? It’s high time you get on with living the purpose of your life that you came to this planet to live.

You left your mother’s womb naked in body, but you brought with you a genetic code inherited from your parents, and from their parents, too.

You were also born with tendencies, talents, gifts that were intended not so much to amuse yourself on a Saturday afternoon as a hobby to unwind from a rough work week doing something that you wouldn’t do if you didn’t need the money. You were given God-given talents to make the world a better place, to bring the world your very best with these skills you were born with. Doing anything less means depriving the world of your best.

But this is not the case: most people in the industrialized world don’t enjoy what they do for a living. It’s fear, of course, that prevents so many of these people from bringing what they love to the world for a livelihood, or more precisely, a lovelihood.

One powerful way to access what you really want to do in life is to do an exercise I have students do in my “How to Discover & Live Your Purpose” workshop.

It’s called “Write your Obituary.” While the word obituary strikes an even deeper fear into their hearts than doing what they love to pay their bills, the exercise works wonders.
It’s true that most people won’t have obituaries written for them after dying, unless their famous, but writing your own let’s you see the what you really want to do in life, what’s really important to you.

Do you want it to say that you labored for 45 years in a career that means little to you at best, or that you hated at worst? Do you want this obituary to indicate you never did the things that stirred your soul? This exercise forces you to begin thinking about what you want to start doing in life that would make your life one that’s truly worth living, one that gets you up enthusiastically every morning to do what brings you joy and fulfills the meaning of your existence.

The obituary helps you see what you’re doing that’s inconsistent with your true purpose. It inspires you to change what you’re doing so that you can be on purpose. You may need a gradual change in that part of your life: like Rome, a business wasn’t built in a day.

But does your obituary include any mention of your spiritual development? It should. To be truly on purpose you also need to get on with spiritual realization —the primary reason that you came to this planet is for you to realize your oneness with the Creator of this planet. So find something to help you wake up spiritually — be it meditation, Yoga, Tai Chi, or the esoteric inner truths of your religion.

Now that the obituary inspires you, start today by taking steps to make what you wrote what you do. You have a gap between your current reality and the life that you aspire to as recorded in your obituary. If you start closing that gap your life will become so much more exciting, and so much more fulfilling. It’s the life you were truly born to live.

IRS Currently Not Collectible Status

You need a fierce advocate on your side when it comes to any tax issue. Renee Sieradski, EA has received extensive training in the field of IRS Representation, with over 18 years of experience as a practicing Tax Professional, and specializing in Multi-State Taxation and the Real Estate Industry. Her expertise is in resolving tax debt, with a focus on 1040, 941, 6672, and 1120 tax liens. 602-687-9768 www.phoenixtaxhelp.com. Email renee@phoenixtaxhelp.com.

A very powerful tool for getting the IRS off your back is Currently Not Collectible (CNC) status. The IRS recognizes that you maybe in a financial condition that renders you unable to pay anything on your taxes.

When I represent taxpayers who are either insolvent or are having major cash flow issues, the Currently Not Collectible Status is an option that makes the most sense. If you have negligible assets subject to levy enforcement by the IRS and have no income beyond what is absolutely necessary for you to live, the IRS may determine your liability is currently uncollectible. Currently Not Collectible status defers collection action under the undue hardship rule. If you are one of these uncollectible cases, the Revenue Officer assigned to your case will remove your case from active inventory until your financial condition improves. Currently Not Collectible Status is generally maintained for about one year. There are many reasons the IRS may close your case as uncollectible.

These include:

  • The creation of undo hardship for you, leaving you unable to meet necessary living expenses.
  • The inability to locate any of your assets.
  • The inability to contact you.
  • You die with no significant estate left behind.
  • Bankruptcy or suspension of business activities with no remaining assets.
  • Special circumstances such as tax accounts of military personnel serving in a combat zone.

Do keep in mind if you are in Currently Not Collectible Status, penalties and interest will continue to accrue on your tax liabilities.

Before closing your case for the reason of undue hardship, the IRS will require a financial statement from so they can review your finances. The review is similar to the review for an Installment Agreement request — both are similar to a mortgage application. You will be required to provide financial documentation such as bank statements, copies of mortgage statements and car payments, pay stubs, etc. If your assets are negligible and your net disposable income is negligible, you’ll most likely to be able to obtain a CNC status.

The IRS will periodically re-examine your finances to see if your financial condition has improved to the point some payment can be demanded. The review will occur about once a year and you must then complete a new financial statement. The IRS may question you by phone or in person or they may simply send you the form and request that you return it by mail.

As with all information you give the IRS, make sure what you say is absolutely truthful. The IRS may also monitor your financial condition by computerized review of your tax returns. For example, the IRS computers may flag your return if your reported gross income exceeds some pre-established amount. Remember, the IRS only has 10 years from the date of assessment to collect delinquent taxes; once the statute expires, so does your liability.

Millions of Americans have remained in CNC for years and completely avoided having to pay their back taxes. Obviously, these folks could not title assets in their own name or have significant income available for IRS levy. Still, many of these uncollectible cases enjoyed relatively comfortable lifestyles. If you maintain no assets in your own name, you have a small income, and expect your financial situation to continue, then remaining in CNC status may be the most practical remedy.

However, if you do not intend on remaining uncollectible until the statute of limitations expires, or don’t want the tax liability hanging over you, you may want to consider an Offer in Compromise while your financial situation isn't so great.

On to Recovery — Powerlessness

In my personal life, I’m back on Step One in my codependency 12 step group. My sponsor wants me to work on powerlessness. I thought I understood powerlessness, however, as I work through the workbooks and questionnaires, I feel as if I am seeing powerlessness with fresh eyes. No matter what

I do, or say to an addict, my words won’t change their addiction. I’ve realized a part of me still wants to believe I have power over people. I am grateful for my sponsor and the 12 steps. I am grateful for my Higher Power. I understand now why I needed to have denial all these years while I worked through pieces of  past trauma. My brain was protecting me from overload. Now it is time for me to accept my powerlessness. It’s a huge part of my life that I am challenging the work is difficult but the rewards will be even greater.

Last Call?

Dr. Evan specializes in relationships, personal and professional empowerment, compassion and consciousness. 602-997-1200, 602-571-8228, Dina.Evan@gmail.com and

Doesn’t life seem a bit ass backwards as my dad use to say?  As I am sitting here in the end stage of my life, I have begun to wonder would I have done the things I’ve done, if knew then, what I know now? To be really transparent and at the risk of sounding crazier than most of you already know I am... I knew early on that I had a spiritual assignment and some energy that was always with me — that I couldn’t name but knew was there. It was like a whisper in my ear forever saying go deeper.

You have often heard me talking about the master teachers in our lives. Master teacher, sounds so lofty and yet none of my master teachers were renown, rich, or well known. They were the plumber,

Paul and his wife, who lived next door and brought my sister and I over to their house every school night make sure we had a meal before going to bed. Another master teacher was my 87 year old mentor who quietly, under her breath, corrected the men who stood at the church podium teaching incorrect things. I can still hear her saying, “You must teach nothing but the truth, no matter what.”

And then she would say, they’ll learn, and we will just love them through it.” My heart wasn’t quite that open, but she was determined to work on it.

Watching my Mom and Dad showed me who I didn’t want to be — and what I didn’t want in life. How to create what I did want, was still illusive even as I began to have kids and carve out a career. I began to focus on the people I respected and admired, and they all seemed to have some common traits. They were honest and present to everyone, not just those people they perceived were on their economic or educational level. They demonstrated equal respect for everyone.

I also felt a level of trust with them because I never heard them lie or even so much as dress the truth up for their personal advantage. They were honest about everything, even at times when a lie would have been easier. I knew that if they told me something today, it would be the same the next day, and the day after, because the truth never contradicts itself. I never felt I had to watch my words, or hold back my feelings because they were fully present, which made me feel I could be the same.

Over the years, I began to realize there were master teachers in my life and in the world, everywhere, once I began to look for them. They always stood out as being a bit different. They were in alignment with their own character, so telling the truth and standing in their integrity was normal, albeit not always easy, for them.

What I know now is ... the world is asking each of us to be a master teacher. 

It is asking each of us to tell the truth, be fully present and stand in our own integrity because if we don’t, the consequences are not only enormous, they are terrifying. It takes practice, because for years we have been taught to just survive doing whatever it takes, and do it however we can, because survival was primary.

Get enough money, enough stock, enough houses, enough whatever it takes to sprint to the end.

However, somewhere along the line we forgot that the only thing that survives us, is our soul and we have not been feeding that, cherishing that, fine tuning that. And if there ever was a time, that time is right now.

It’s not that we were doing anything wrong, we were simply doing what we were taught to do. But, look around, how is all that partisanship, prejudice and self-serving not so conscious capitalism working for us?

The only companies that are making profits today are those who are putting people before profits. And the only people we trust and respect are putting people before party and prejudices. And you and me? Well it seems to me, the only time we are truly happy and content is when we are being who we came here to be and doing what we came here to do!

So, this is a call to all master teachers...yes that’s you! It’s time to step up, evaluate your priorities and decide to stop playing small. Look around, it’s becoming more obvious that with everything going on, if we don’t step up now...it could be last call.

Monday, July 2, 2018

“The journey into another human being's soul is a far country to travel to.” — Attributed to a medieval mystic

Along with everyone else, I was shocked to learn the news of the deaths of fashion designer Kate Spade, and storyteller, foodie and world traveler, Anthony Bourdain. Within two days, two lives lost.
Because of their enormous talent and success, they became part of our culture, and many of us felt as though we knew them. May they be remembered for their contributions while with us, not for the way they left us.  Barbara

#BeThe1To help someone in crisis.

The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. Committed to improving crisis services and advancing suicide prevention by empowering individuals, advancing professional best practices, and building awareness.
The Lifeline is a national network of local crisis centers across the country. The counselors at these centers answer all Lifeline calls. 1-800-273-8255.

Local Resources:

  • LaFrontera/EmpactCrisis Hotline   (480) 784-1500 or (800) 273-8255
  • Teen Lifeline  ​(602) 248-TEEN (8336) or 1-800-248-TEEN

Arizona Department of Health Services
Suicide/Crisis Hot Lines by County

1-800-631-1214/602-222-9444 (Maricopa)
1-800-796-6762 or 520-622-6000 (Pima)
1-866-495-6735  (Graham, Greenlee, Cochise, and Santa Cruz)
1-800-259-3449  (Gila River and Ak-Chin Indian Communities)
1-866-495-6735 (Yuma, LaPaz, Pinal and Gila)
1-877-756-4090 (Mohave, Coconino, Apache, Navajo and Yavapai)

Tuesday, May 29, 2018

Living Disconnected

The relationship between Eating Disorders, Addiction, and Trauma

By Tanja Haaland, LCPC, Clinical Director, The Meadows Ranch

Eating Disorders are a mental illness that affects an individual’s ability to have a healthy relationship with food and their bodies. Anorexia, Bulimia, Binge Eating Disorder, and Other Specified Feeding and Eating Disorders are prevalent psychiatric diseases that can be life threatening. In fact, eating disorders have the highest mortality rate of any psychiatric illness. About 20% of individuals who struggle with these disorders die from medical complications or by suicide (Hudson, Hiripi, Pope, and Kessler, 2007). 

Prevention and early intervention are critical with these disorders; however, even those who have struggled for decades are able to recover with the help of trained professionals. Effective treatment can be conducted in an outpatient setting, in an inpatient or residential setting with the level of care needed by the patient based on the active symptomology, severity, and duration of the disorder. 

Anorexia Nervosa is categorized by an intense fear of gaining weight, a distorted body image, denial of the severity of the illness, and a weight that is lower than expected for the individual. Persons suffering from Bulimia Nervosa engage in recurrent binge eating (consuming an excessive amount of food in a short time) followed by self-induced vomiting, laxative abuse, excessive exercise, and/or fasting. This disorder also has an extreme focus on weight and shape, but unlike individuals who struggle with Anorexia, those who have Bulimia will often be of average, or even higher weight. 

Binge Eating Disorder exhibits similarities to Bulimia, in that recurrent binge eating episodes take place, but differs because no compensatory behaviors subsequently occur. The binge eating episodes are often when the person is alone, the person eats even when not hungry, and food consumption goes past the point of feeling comfortable.

Some physiological and psychological complications of eating disorders are abnormal sleep patterns, difficulty concentrating, preoccupation with food, weight, and shape, panic attacks, social isolation, mood swings and irritability. Eating disorders are often difficult to assess and are not always readily detected by others. Those who struggle with these illnesses are often very secretive and shameful about their behaviors and will go to great lengths to hide what they are doing. They often function very well in their lives and are frequently successful high achievers. Also, with the normalization of disordered eating patterns in today’s society, eating disorders can go unnoticed and be minimized in severity. 

Who is Affected?

Eating disorders affect all genders, races, socioeconomic classes. They can develop at any age and impact not only the individual who has the diagnosis, but the entire family system. Family therapy is a crucial part of treatment, particularly if the struggling individual resides at home. Eating disorders often place much strain on the family system and support for the family members is not only helpful for them, but in turn also helps the patient receive better support from their loved ones. 

Temperament, genetic predisposition, cultural, and environmental factors, can all contribute to the development of an eating disorder. Those who suffer from an Eating Disorder often have other co-occurring disorders. Anxiety, Depression, Substance Abuse, Obsessive Compulsive Disorder, and PTSD are just a few of the other diagnoses observed in this patient population. Many of those who have an Eating Disorder have also experienced some form of abuse. Sexual, physical, and emotional abuse is rampant in this patient population and is a core issue that needs to be addressed for the individual to fully recover. Studies estimate that 74% of eating disorder patients have experienced abuse (Brewerton, 2008).

The type of trauma and the mediating factors, such as developmental phase, self-image at the time of the trauma, family support, and ability to process the trauma at the time of the event, all contribute to the level of integration or level of dissociation that the individual has with the traumatic event. The higher level of dissociation or the inability to integrate the trauma in a healthy manner, the more likely that the individual will resort to unhealthy coping mechanisms to mitigate the effects of the trauma. 

It’s Not About the Food

Having suffered abuse often creates much emotional turmoil and shame, which if left unresolved can trigger the need to use eating disorder behaviors in an attempt to avoid uncomfortable feelings. It’s inappropriate to just treat the symptoms of an eating disorder, so we often find ourselves saying to patients, “It’s not about the food!” Perfectionism, over-functioning, the avoidance of feelings, unresolved grief, and feeling out of control, are some examples of therapeutic work that must be undertaken to enable the individual to let go of their need for maladaptive behaviors.

It is not uncommon for individuals who have an eating disorder to also struggle with substance abuse. Rates of substance abuse in this population are estimated to be 12-18% for those who struggle with Anorexia and 40-45% for those who struggle with Bulimia and Binge Eating Disorder. Treating both the eating disorder and the substance abuse simultaneously is imperative to a successful recovery. 

Managing symptom substitution and the development of other negative coping behaviors is crucial. 
When starting the treatment process, therapists often talk about the game of Whack-a-Mole, the arcade game where a soft foam bat is used to hit moles that pop up only to have others pop up in different holes. When patients start to address one symptom, the clinician and patient need to remain vigilant to recognize other symptoms that may begin to appear or reappear. Trading symptoms is just another form of avoidance and inhibits the recovery process. 

Substance abuse can also contribute to the adoption of eating disorder behaviors. For example, one of my patients restricted her food intake and over-exercised as a way to counter the calories she was taking in from her alcohol use. Both the use of substances and the eating disorder served as a way for her to disconnect from the grief she was avoiding. 

Just as a therapist must be cognizant of the severity of eating disorder symptomology and the potential medical complications that may arise with these behaviors, the clinician must also be aware of the level of physiological dependence that the patient with substance use disorder may present when starting treatment. It is impossible to begin any meaningful treatment while under the influence of substances and medical attention may be needed to help the individual address any issues of withdrawal. 

Treating Eating Disorders

As mentioned, treatment settings vary based on what the individual will need to be successful in starting their recovery process. The first step is finding a clinician who specializes in treating this specialty population. Once a trusting relationship has begun with the therapist and/or the treatment facility, the initial step in treating trauma in eating disorder patients is to stabilize and manage the maladaptive responses, such as restricting, bingeing, purging, or other compensatory behaviors. 

Psychotherapy is not as effective if an individual is in active addiction, both with an eating disorder and substances. The normalization of brain function through nutritional stabilization is critical to begin the therapeutic work. Refeeding, or normalizing meal patterns, significantly alleviates anxiety and regulates mood. It allows anti-depressants to function properly and allows psychological issues to be fully assessed. Due to the chaos disordered eating can have on the body and brain, it is vital to first nutritionally stabilize an individual before one can fully determine full treatment planning. 

Entering a higher level of care can help a patient stabilize their eating disorder. With the support of trained professionals, they can safely address the underlying reasons for their eating disorder. When an individual has experienced abuse, an adaptive function of the maladaptive eating disorder behavior is to provide a sense of control. Patients often look for ways to hold onto some sense of power in their lives. They create discipline around food and/or exercise, hyper control around their bodies, and the predictability and structure takes them out of the chaos that they internally or externally are experiencing. Managing food intake becomes much easier than managing or processing emotions regarding abuse that occurred. The eating disorder can be used by the individual to feel seen and heard when they feel they have not had a voice. Becoming emaciated or obese are very visible ways that pain can be physically observed. I have frequently heard stories of an individual discharging tension and anger that they have toward their perpetrator through purging. There is an aspect of wanting to feel “clean” or “empty” that individuals who have experienced sexual trauma try to create by restricting their food intake, using laxatives and/or diuretics.

I cannot reiterate enough how the underlying factors of the eating disorder must be addressed to help the patient achieve full and long-lasting recovery. While helping a patient achieve nutritional stability is vital, it is not sufficient to create recovery. 

One patient, Sally, came into treatment having been to multiple other facilities that were fantastic at helping her stabilize her eating disorder behaviors; however they did not process her trauma. Consequently, after treatment, her underlying traumatic memories would resurface making her unable to cope with her emotional distress, thereby triggering her regression back to using her eating disorder behaviors to cope with her unresolved trauma. This left her feeling both increasingly defeated and hopeless, and in a cycle of entering treatment centers where she was unsuccessful at achieving a full and long-lasting recovery. Intensive trauma work, while simultaneously addressing her eating disorder behaviors, was the necessary key to help Sally work through her pain and fully heal. 

Trauma processing through somatic experiencing, narrative story-telling, and other trauma treatment modalities helped her heal the hurt and pain that had burdened her for so long. A pivotal moment came during psychodrama group, where she was able to give voice to her wounded and traumatized child part. Sally was able to say to her perpetrator what she wished she could have said both as a child and now as an adult. She regained her power and was able to unburden feelings of anger, guilt, and shame, which she had held onto for years. Sally’s interpersonal relationships improved once she engaged with a more empowered sense of self. I was able to witness Sally move from operating in the world from a “less than” position to feeling more positively about herself. Once her trauma was processed, she was fully able to connect with herself and with others. Overcoming her apprehension and fear she once again connected with her body, which she had previously avoided since her childhood abuse. Establishing this connection allowed her to learn how to meet her emotional and physical needs. Addressing the underlying factors that contributed towards her need for her eating disorder was the only way Sally was going to be able to maintain recovery and live the life of which she is worthy and deserves to enjoy. 

The Goals of Therapy

The goal of therapy is to take the rejected and disconnected parts of self and work to form an authentic whole. When a person experiences traumatic events they often disconnect, split, and separate from their wounded and hurt parts of self. They avoid feeling the feelings that they deem as being, “too much,” or, “overwhelming.” As clinicians, we help individuals process the emotions that have often been repressed or ignored, allowing them to be fully present and engaged in the world. By addressing underlying issues, they can operate in the world without the need to avoid or distract and subsequently they find their life more meaningful and their relationships improved. 

Post Traumatic Growth

I love the concept of Post Traumatic Growth. The premise of this theory is that through adversity and struggle we can become more connected with ourselves, with others, and with our bodies. If an individual allows themselves to fully engage in the process of working through their struggles, whether they result from trauma, addiction, or attachment issues, the person connects with a level of self-awareness and enlightenment that many others do not make the effort to achieve. I find this to be especially true when applied to those living with eating disorders, addiction, and/or trauma.

Robert Frost says, “The only way out is through.” 

The beauty about having struggle is that if we are willing to muster up the strength to face our adversity, we can come out stronger. To be clear, “stronger” does not mean tougher; in this case, it is the sense that we can face the world in a more connected and meaningful way. Recovery is being mindful and engaged. It is being connected in a way that is impossible when the eating disorder or addiction is taking the lead or the trauma responses are primary. Through recovery, people realize that as they step away from their destructive coping behaviors, they can embrace life with a new view and a new way of relating to others. They make the time to connect more with their feelings in the treatment process, allowing them to fully engage in the world in an emotionally regulated way. When an individual processes the way they are responding to the world and their environment, they automatically become more connected with their sense of self and often deepen their values and belief system.

When a person can let go of the need to hold onto a sense of control, they can begin to blossom in a world where they previously felt out of control. They become more in tune with their thoughts and feelings. With this new perspective, they can thrive. There is a sense of gratitude towards the body that develops; a person recognizes they are a human being not a human doing. The person can often identify feelings of strength and self-resilience that they have never felt before. Patients that leave treatment often find new interests that they had never spent time and energy to consider; they sometimes establish a new life path, they re-evaluate priorities, and true healing occurs. Not only that, but when a person works through a traumatic event, they often find themselves better able to withstand future struggles.

Psychological stress, whether a trauma, addiction, or an eating disorder, is an opportunity for an individual to flourish. It is an opportunity for the individual to take something destructive and negative, and process it so that it can be used to re-establish oneself in the world in a different way, one that is more meaningful and resilient.

Conason AH, Brunstein Klomek A, Sher L. Recognizing alcohol and drug abuse in patients with eating disorders. QJM. 2006 May; 99(5): 335-9. Epub 2006 Feb 23.
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.

Tanja Haaland, MA, LPC, Clinical Director The Meadows Ranch
Tanja received her undergraduate degree in Psychology and her master’s degree in Counseling at the University of South Dakota. Since 2006, she has specialized in the treatment of eating disorders and trauma. Her experience includes working as a trauma therapist in a psychiatric hospital setting, running her own private practice, and program director for an eating disorder partial hospitalization program. Currently, she is the Clinical Director of The Meadows Ranch, an inpatient, residential, and partial hospitalization program for women and girls, who suffer from and Eating Disorders. Tanja has lectured nationally on the topics of eating disorders and trauma and has provided clinical consultation and supervision to clinicians working toward deepening their knowledge of treating this specific population. 866-390-5100. www.meadowsranch.com


“I make choices that evolve me”

By Jolene Baney

I jumped out of a plane  few weeks ago… on purpose. And while many people have skydiving on their bucket list, truth be told, I most certainly did not. A completely different motivation was pulling at me, one that both intrigued and terrified me. How would it feel to confront a significant fear that has gripped me for much of my life with the payback of breaking free of it? How would it change me?

I am the opposite of an adrenaline junkie; I absolutely hate fast cars, roller coasters and high places. I get nauseous on boats and merry-go-rounds. I zip-lined once and hated it. A ropes course challenge at the top of a telephone pole ended in dismal failure. Of the four elements of Earth, Wind, Fire and Water, my spiritual home is Earth. Earth is predictable, solid, nurturing… safe. I’m perfectly and utterly fine with saying no to the things that threaten my safety and peace of mind.

I’ve also learned the hard way about having healthy boundaries, coming from a family history of addiction. Addiction can wreck havoc on relationships within families. If you have loved ones in active addiction or in the critical beginning steps of recovery, creating boundaries restores sanity, moving from enabling the dysfunctional behavior to supporting mutual respect. Boundaries are good.

Boundaries keep us safe. Boundaries help us and others become more self-reliant. Boundaries are personal and empowering.

So, why in the world would I agree to do this thing that threatens to violate my safe and secure boundaries? Of course, when the opportunity first came up to join my husband and a group of friends on this skydiving adventure, my automatic response was “Oh hell no!” But then I stepped back to dig deeper, and the real reason that came through was oh-so-revealing. You see, it wasn’t that I really believed it was dangerous (it’s really not), it’s that I didn’t trust myself. I believed that the fear was bigger than me… that I’d get up in that plane and would be paralyzed by a panic attack of epic proportions, with no way out. But then again, I mused, what if there was a gift in the experience, revealing a self-limiting part of me that really doesn’t serve any purpose, and maybe I just wasn’t ready to see my own ability to transcend fear? What if those false beliefs were at work in other parts of my life, keeping me from stepping into opportunities to live a more connected life?

Choosing Fear or Faith

If the opposite of fear is Faith, why was I not willing to trust in something bigger than my limited human ego? I didn’t want to be on the sidelines and wish I’d been brave enough to push through the fear, never knowing what might be on the other side. I’m brave and adventurous in so many other things — travelling off the beaten path, moving to a new country alone, presenting to groups, starting a new career, pushing my limits.  Why am I so fearful about heights and speed? It’s annoying. It was a jumble of thoughts and emotions, and finally, in a moment of false bravado, I pushed through it all and just said yes to the jump!

In the weeks and days and hours leading up to J-Day, I refused to think about or even entertain any emotional attachment around this looming event. Compartmentalize; that’s a handy, albeit sometimes unhealthy, skill! Even driving to the jump site, signing legal documents (which basically were saying “You fool, you really shouldn’t do this. You know you could die, right?”). Watching others stick their landing ahead of us, suiting up, getting instructions, boarding the plane… all good, high fives, jokes all around.

Don’t look down, don’t think ahead, don’t let the fear take over. I’m good, yay me! I began repeating a mantra, I’m not really sure what part of my reptilian brain it came from… “I am boundless… I am boundless… I am boundless”… as a slight feeling of dread started to creep in.

Then the moment of truth. We had finally climbed two miles up in the sky and others were starting to disappear through that gaping hole in the side of the plane. The rush of cold air was sucking us into the abyss. The noise was deafening. The ground below was now a real “thing” to be reckoned with. I was at the edge and there was no turning back. It was my turn.
“Oh. My. God. I’m doing this.”

We tumbled out (jumping isn’t really accurate, as it turns out). I surrendered and let go. God might have been involved… I certainly spoke his name, along with some other colorful characters who I thought might save me. I was disoriented, every fiber of my being and all five senses were on red alert. We spun, we fell, the force was like a category three hurricane.

But despite being thrust into the most unnatural of circumstances, falling down to earth from 13,000 feet up at 125 mph, it wasn’t terror at all that suddenly flooded my being. I surrendered. I trusted. I focused. I reminded myself to be present. It struck me… I am boundless. I can choose to be open to this experience. And what I noticed was — I was absolutely held in this bubble of safety. Roberto strapped in behind me, guiding every move, and Aaron flying around me, taking a video and reminding me to smile and enjoy the experience. They became metaphors for life. My spiritual training and my deep conviction is that God… Spirit, Divine Source, my Higher Power, the eternal energy of life… ALWAYS has my back and has a plan. And in my journey through life, there’s an inner awareness… my higher self, my observer, my soul… there to remind me to be present to it all and find joy along the way. Thank you, Roberto and Aaron, for being my teachers in those few profound minutes as we glided down and ever so gently landed on solid ground, slightly nauseous and weak in the knees, but completely exhilarated! I was glad it was over, I must admit. Earth never felt so good.

“I make choices that evolve me”… this has been my mantra for the last 15 years. My choice to test my boundaries through this skydiving adventure has evolved me in ways I’m just beginning to understand. I am boundless in a different way now. I still have healthy boundaries, but I think I may move though my limiting fears in a new and more powerful way. Where am I “stuck” and tethered to the ground, preventing me from experiencing more out of life? When can I say “YES” to a new possibility? What am I afraid of… and is it really true? How can I be more present to what is, even when I’m feeling a little out of control? Who can I trust to be there to mentor and guide me through it all, and how can I lovingly release the rest? When is the timing right to “let go and let God”?  These are the big questions, the lessons yet to be learned, the great mysteries of life.

So here’s a challenge for you to consider… what are the ways that YOU can break free and know a greater freedom? Don’t worry, you don’t have to jump out of an airplane to discover your false limiting beliefs, but I challenge you to find your own test, confront your fears, and come along with me to feel the difference it makes to be “boundless”!

Jolene Baney is a Clinical Outreach Representative for Las Vegas Recovery Center.  LVRC is a residential treatment center in the foothills of Las Vegas near the beautiful Spring Mountains, providing a complete continuum of care: inpatient medical managed detox, inpatient treatment, residential and partial hospitalization, and outpatient services.  LVRC’s Pain Recovery Program, lead by the nation's leading authority in pain recovery, Dr. Mel Pohl, has long been considered the best in the country.  LVRC accepts complicated detox treatment, including high levels of methadone and Suboxone withdrawl and have programs for Veterans and First Responders.  Jolene and her husband Rick live in Cave Creek, AZ.  Rick plans to jump out of a plane again, Jolene plans on watching from solid ground. lasvegasrecovery.com

What’s the Under-Employment Index?

LIFE 101 - Coach Cary Bayer

“If you’re not doing God’s work find another employer.”
—Phil Laut, author, “Money is my Friend”

The Bureau of Labor Statistics keeps a monthly tab on the unemployment rate. This number, 4.1 percent in March 2018 — gives a thumbnail look at how many people aren’t working in America.

This index, treating people as statistics, measures their financial cost for not having regular paychecks. What this quantitative measurement fails to measure, however, is the qualitative statistic I call under-employment. There’s no way to measure how 96 percent of the working population suffer for being under-employed.

If a musical composer in Woodstock, New York— and I know plenty of them — works as a handyman or contractor instead of as a composer, he’s under-employed. He’s using circular saws instead of pianos. He’s giving society a wooden bookcase that he makes with his hands instead of the song or the musical he’s writing in his head in the limited spare time that contracting affords him.

The loss is to him and to us. He suffers emotionally, and we suffer for getting less than what he’s here to offer.

Actresses in Hollywood who wait tables aren’t giving the world their best. There may be a Meryl Streep among them. Instead of giving possible Academy Award-winning performances in movies, she’s bringing customers today’s blue plate special in diners or mustard-crusted branzino in bistros.
Writers in New York working as proofreaders in law firms may lack the time or energy to write the next Death of a Salesman or Catcher in the Rye after long days or nights catching typos on lawsuits. I’ve known many of these people in my time.

This isn’t New

Paul Gaugain was a stockbroker. Walt Whitman toiled in the Patent office. Dracula creator Bram Stoker managed a theater. T.S. Eliot worked at Lloyds Bank in London while writing The Wasteland. Wallace Stevens was an insurance attorney for the Hartford.  William Carlos Williams was a medical doctor. Kurt Vonnegut managed a Saab dealership. Philip Glass drove a cab and did plumbing.  Composer Charles Ives co-founded Ives & Myrick Insurance. Jeff Koons was a Wall Street commodities broker. It’s a phenomenon that would be great to retire.

Colleges and universities train people for jobs, often in a terrific manner — at least many do. We need steady streams of new engineers, computer scientists, and medical doctors. The MITs, Stanfords, and Yale Medical Schools of the world are there to train such people for such employment.

What we really need, in addition, are entrepreneurial schools that train composers to make a living as composers, actors to provide for themselves as actors, writers who write successfully for a living so they can also write checks for their mortgages that won’t bounce.

There are institutions like the Juilliard School in New York to train creative people for the arts. There’s the Eastman School of Music in Rochester, and the American Conservatory Theater in San Francisco to train actors, among such reputable centers. But because actors, writers, singers, and dancers are filled with creative ideas they often aren’t very good at marketing these ideas, and so these training centers need to simultaneously train their charges in basic business and marketing skills, as well, so they can work professionally in the arts and not be hyphenates like the actresses-waitresses and composer-carpenters discussed above.

Woodstock, NY, where I have lived for nearly 30 years, is a town filled with hyphenates. It has long attracted artists of all stripes, but because artists—and healers and spiritual folk, as well—are right-brained oriented, they’re not usually strong in the left-brained talents of doing business. What we really need are Entrepreneurial Institutions that focus on creative people. This would enable millions of gifted people to be sharing the talents they’ve been given and be fully supporting themselves in the process. This would lower the Under-Employment Index significantly, make them so much happier, give the society we live in the very best they have to offer, and put a smile on the face of the Great Spirit that has gifted all of these people so lovingly.

Monday, May 28, 2018

Code: Red

Helping others from Summer Heat

In anticipation of what could be its hottest summer ever recorded, the Code: Red Summer Heat Relief has begun. The program, which will run through August 31, and is dedicated to providing food, water, and other heat relief to the elderly and homeless population in the Valley.
Men, women, and children experiencing homelessness are at risk of dying from excessive heat, a fate that 114 individuals fell victim to in 2017 in Phoenix.

Here's how you can help:

Organize a water drive — challenge your co-workers, family, friends, or church to join you in providing life-saving water this summer to those who need it most. Ready to start your drive? Contact Catie Hammann: chammann@phoenixrescuemission.org or 602-346-3347 to get started.

Volunteer — there are plenty of opportunities at the Phoenix Rescue Mission to make a difference in the lives of those we serve. See the latest volunteer opportunities at phoenixrescuemission.org.

Donate — If you live in Arizona, you know costs rise in the summer. From air to energy, man-power and extra equipment, our summer time costs are high. Make your greatest impact by simply donating. Because of a generous donor, your GIFT WILL DOUBLE thanks to a matching grant.

Volunteer drivers will help the Hope Coach Outreach program to deliver needed items to the Valley’s homeless and elderly population. Drop-off sites that accept donations of heat relief items like hats, sunscreen and water are located throughout the city.

If you are interested in helping The Red Summer Heat Relief Campaign, contact Catie Hammann: chammann@phoenixrescuemission.org or 602-346-3347 or learn more phoenixrescuemission.org/

The Brain: A New Frontier

By Dr. Stacey Smith, PhD, CSAT, EMDR

For over a decade I’ve worked in the recovery industry at multiple programs that have used the neuroplasticity of the brain to increase/enhance brain performance. 
These programs have come under a variety of names including: Biofeedback, neurofeedback, and brain optimization. In an environment where research continues to grow and professional conferences continue to focus on these issues (over 50 conferences internationally and 30 this year in the U.S. alone). Whether for personal use, professional referrals, or use in treatment programs, it is important we know what how these programs work.

I have seen these tools assist clients with self-regulation and improved affect tolerance which has allowed them to remain in treatment and develop the needed foundation for recovery Some clients focus better in session, allowing for better development of coping skills. And, many have seemed to be better equipped to deal with anxiety, depression, shame, and anger experienced during the treatment process. Many clients report feeling grounded and become willing to address traumas earlier in treatment. Therapists report their clients have better active listening skills, engage and participate in group. They respond better to difficult feedback and are more aware of thinking processes. AMA (Against Medical Advice)rates decreased as the brain balancing/optimization began. 

Since the 1950’s, biofeedback has been used to measure body signals that are not normally perceptible1. Examples include heartbeats, hand temperature, muscle tension, and galvanic skin response2. Biofeedback programs work with the peripheral nervous system and through an associative learning model where the body mirrors system signals and responds to create ‘normalized’ responses. It does so through shaping (operant/instrumental conditioning), using reinforcement (visual/audio or both) to train the body to increase or decrease functionality of the peripheral nervous system. 

An example: An individual can ‘feel’ the beginnings of a panic attack in the body, based on physical cues, and knows to use coping skills (i.e., breathing, meditation, etc.)3. 
Neurofeedback is a form of biofeedback that works specifically with the central nervous system and brain. This process is neither static or independent. The electroencephalography (EEG) as a measurement tool can be impacted by factors such as sleep, age, caffeine use, etc., so it measures a system in motion (not static). When a ‘push’ is made on any of the systems that are measured by an EEG, other systems also make changes (thus not independent)4. As a tool, the EEG is prognostic and not diagnostic and is used to predict likely outcomes, measured against a database of norms for such areas as speed of processing, interconnectedness, regulation of arousal states and connectivity. 

Neurofeedback does not control system changes, it identifies systems out of balance and through electronic signals, gives a ‘push’ to these weak areas, allowing plasticity of the brain to adjust systems into a more balanced position. It has been suggested that EEG technologies could be used as an adjunctive evaluation method for cerebrovascular disease, dementia, learning and attention disorders, mood disorders and post-concussion syndrome5. In addition it has been suggested that neurofeedback can be beneficial in the treatment of depression6, anxiety disorders7, and ADHD8.

Brain optimization processes typically incorporates aspects of neurofeedback allowing the brain to examine current established neuronal patterns, to recognize those patterns adaptability for our current circumstances, and then to develop a plan that would allow for optimization. The most recent program that I’ve worked with, Vitanya, uses supplements (i.e., enzymes, antioxidants, etc.), support gut health and nutrition delivery, clears toxins from the brain, promotes neuroplasticity, and supports improved focus and stress management. Some of the results for clients included; a better ability to deal with anxiety, depression, shame, and anger, increased ability/willingness to participate in processing of trauma, better sleep, and ability to participate in groups at a higher level. AMA rates declined during this time.

One might wonder about the scarcity of gold standard clinical research studies (double blind, placebo controlled) published to provide validity, efficacy, and specificity for neurofeedback.  This would allow individuals to use insurance for assessment and would facilitate assessment for more individuals. Some practical reasons this research has not been done include the difficulty in doing double blind EEG analysis. EEG signals currently are so sensitive they can be influenced by body movements (coughing, sneezing, and other types of movement) that can create difficulties. Another factor is that brain wave processes are highly individualized and not easily generalizable. It would take a study with tens of thousands of participants with individualized treatments to follow standards needed for FDA approval. Unfortunately, the typical provider of these types of treatment modalities do not have the resources to conduct this size of study5. 

Hopefully, this has helped to give a brief introduction to processes on which books have been written. In short, at this time biofeedback and neurofeedback have been used as a form or treatment or assessment, which can be used in conjunction with other treatment modalities to facilitate clients in making significant changes in their lives. 

1Miller, N. E. (1978). Biofeedback and visceral learning. Annual Review of Psychology, 29, 373-404.
2Miller, L. (1989a). What biofeedback does and doesn't do. Psychology Today, November, 22-23.
3Lehrer, P. & Gevirtz, R (2018). Heart rate variability biofeedback: Current and potential aplications. In Magnavita, J (Ed). Using technology in mental health practice, (p. 123-141). Washington D.C., American Psychological Association.
4Schmachtenberger, D. (2018). Understanding Neurofeedback: Brain Optimization – Dr. Andrew Hill. Retrieved from https://neurohacker.com/understanding-neurofeedback-brain-optimization-dr-andrew-hill
5Hughes J.R. & John, E.R. (1999) Conventional and Quantitative Electroencephalography in Psychiatry. The Journal of Neuropsychiatry and Clinical Neurosciences, 11, 190-208.
6Hammond, D. C. (2001). Neurofeedback treatment of depression with the Roshi. Journal of Neurotherapy, 4, 45-56.
7Moore, N. C. (2000). A review of EEG biofeedback treatment of anxiety disorders. Clinical Electroencephalography, 31, 1-6.
8Masterpasqua, F. & Healey, K.N. (2003). Neurofeedback in Psychological Practice. Professional Psychology: Research and Practice, 34, 652-656.

Dr. Stacey Smith is licensed psychologist in both Arizona and Texas and has been working in the addictions field in residential and IOP settings since 2010. He has a wide variety of experience in the addiction field, including work with individuals who suffer from addictions to alcohol, drugs, intimacy/relationships, sex, and gaming addictions.  Early in his career, Dr. Smith trained in EMDR techniques, knowing the important role that trauma work plays in the recovery process. Most recently, examination of how the brain works and how technology can play a key role in client recovery has been a focus of his work. To reach Dr. Smith email him at ssmith@healthehero.org