This month we’re pleased to present our interview with Linda Hatch, Ph.D, a clinical psychologist who pens the popular blog “The Impact of Sex Addiction” on Psych Central. Hatch is a certified sex addiction therapist in private practice in Santa Barbara, Calif. There, she specializes in treating sex addicts and sex offenders, along with their partners and families.

Throughout her career, Hatch has worked with both adult and juvenile sex offenders, mentally disordered offenders and sexually violent predators in and outside of the courts and prison system. She also has consulted with the Superior Court, the Probation Department, the Board of Prison Terms, and the State Department of Mental Health, providing forensic assessment and expert testimony.

Hatch is the author of the book Living with a Sex Addict: The Basics from Crisis to Recovery. You can learn more about Linda Hatch at www.sexaddictionscounseling.com, where she also blogs about sex addiction.

1. What’s surprised you the most about being a therapist?

I guess it’s that after the 40 or so years I’ve been a clinical psychologist I continue to find it endlessly interesting. It is as though the work and I have gone through many changes over time and I have evolved along with those changes. I have done so many different things: teaching, research, student counseling, child psychology, crisis intervention and forensic psychology.

In the last five years I have gained a whole new specialty in sex addiction, which has revitalized my professional life yet again. I had wanted to be a therapist from a young age but I did not know how much my work as a therapist, and lately as a writer, would be continuously intertwined with my own emotional growth.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

I recently read Chemical Dependency and Intimacy Dysfunction edited by Eli Coleman PhD. It’s a superb collection of articles about every aspect of the relationship between chemical dependency and human sexuality. What interests me so much about it is that it is, in part, a foundational attempt to look at common roots of chemical dependency and sex as a drug of abuse in terms of family dysfunction.

The book is truly comprehensive and holds up extremely well, dealing with every possible aspect of addiction and relationships including attachment issues, addiction interaction, codependency, boundaries, communication, shame and so on.

3. What’s the biggest myth about therapy?

I think people are sometimes too trusting of clinicians simply because the clinician has the right credentials. Therapy is a craft and not everyone is equally good at it because they had the same training. Also, not every therapist is right for every patient.

Patients need to be empowered to judge for themselves whether a therapist is someone they have confidence in. This is hard because therapy clients are usually grappling with some emotionally difficult problems and often tend to be less critical and more trusting than they would otherwise be.

4. What seems to be the biggest obstacle for clients in therapy?

For addicts it is fear—fear of the therapy relationship itself, of being open and vulnerable with another person. Addicts often have early attachment problems, which make them mistrustful of letting anyone know them. It can be an extremely uncomfortable situation for many clients.

5. What’s the most challenging part about being a therapist?

In treating sex addicts it is the fact that it is often very hard for the client to establish and/or maintain abstinence from their particular addictive acting out behavior. As a sex addiction therapist, I am torn between imposing a task oriented treatment protocol that we know works, while still allowing for the fact that everyone does recovery in their own way and in their own time.

Clients need a lot of support and structure to do what they need to do but also permission to do things in the way that they are capable of doing them given their unique set of strengths and obstacles.

6. What do you love about being a therapist?

I love that therapy has a lot in common with mindfulness practice. It involves being present, being authentic and using all parts of my mind and intuition. I love that therapy is a process that can never be completely duplicated by having the client read a book. In psychology the problems are relational in origin and ultimately relational in the recovery process.

7. What’s the best advice you can offer to readers on leading a meaningful life?

For me meaning comes out of the struggle to overcome suffering and liberate ourselves from obstacles to fulfillment. Meaning comes as we successfully navigate the challenges of each life passage. And ultimately meaning comes from bringing our knowledge and ideas to others. We cannot do everything we dream of doing but we can do the things that we can do; we can use our gifts.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

I feel like I was destined to be a clinical psychologist. I have always been fascinated by the human mind—I think I inherited this from my parents. I was raised on Jung, Freud, Perls and other early therapists. I majored in philosophy as an undergraduate and found out later that I have an uncle who is a philosophy professor.

Much later after becoming a psychologist, I connected with another uncle whom I had never met only to find out he was a clinical psychologist! If I were starting out today I think I would be drawn to neuropsychology to a greater extent, as that seems to be the new frontier at this point in history.

9. If there’s one thing you wished your clients or patients knew about treatment or mental illness, what would it be?

I think clients don’t realize how much change is possible from even the smallest shifts in awareness. Therapy is often in the very subtle changes in perception, which allow for big changes in functioning and self-concept. A little change makes a big difference.

10. What personally do you do to cope with stress in your life?

I am fortunate to have a very low stress life right now. I believe that being in recovery myself has made all the difference, but also luck. I do what I enjoy, I am happily married, live in abundance and have meaningful relationships. Being very mildly cyclothymic myself (it runs in my family), I need to keep my everyday life balanced and grounded. Spiritual reading and meditation helps in this.

I did not read the foreword or the praise-filled blurbs in the front of the book before reading it myself, as I did not want to be swayed one way or another. Instead, I tried to dive in with a somewhat skeptical yet mostly open mind, with the knowledge of my own many failed attempts to adhere to or complete a 12-step program successfully. But when I laid the book down, after soaking up every word and working through every exercise, I thought, Finally! Someone gets it.

Sacco, an adjunct professor of psychology, pulls back all of the recovery/12-step jargon and red tape, and gets down to the bare bones of what is a “must” in order to experience freedom from addictions and habits that control one’s life. He details the core issues that have to be addressed and gives practical, real-life applications that can be implemented immediately. His plan does require an attitude of desire for a better life and a belief in a higher power, whatever or whoever that may be for you. Most important, he gives a real sense of hope, instead of a long list of tasks to complete. He suggests that choosing which aspects of recovery programs work for you, rather than making oneself abide by every single instructed step, can lead to greater success. 

This is crucial when speaking to people who have tried and failed before and want only to be successful in kicking the monster called addiction. Hope is rare in the addict’s world. And sometimes a to-do list of meetings (30 meetings in 30 days for the first month) filled with people one doesn’t know or trust can be overwhelming. It may even be the first step towards another failure if an addict isn’t ready socially or emotionally to jump into a public forum.

I am a recovering addict myself. I spent numerous years living with an overwhelming feeling of failure in regard to my attempts to get substance free. I spun my wheels, so to speak, trying to do what I was told and trying to complete the steps I was advised to complete. Unfortunately, I had neither the maturity nor the appropriate knowledge of a higher power required to make a full recovery. And the failure that occurred time and time again prevented me from realizing that I was capable to succeed in this area.

The author begins his book by explaining the foundation of his plan—the one that can supposedly help one overcome addiction and bad habits in 30 days or less. Sacco posits that three things will need to be addressed in order for true health and recovery to be attained. Together, they form the psycho-social-spiritual. Respectively, they are mental health and well-being (psycho), social well-being (social), and belief in God, a higher power, or the universe (spiritual). He shows how all three work independently, as well as how they become dependent on one another.

He breaks the book into three sections as well. The first contains the components of what an addiction is and why it continues to exist and fester. In the second, he discusses how we, individually, may contribute to the manifestation of an addiction. And third, he presents 30 days of “intentions” to work into one’s daily life. He purposely chooses the word “intentions,” as opposed to “affirmations,” he tells us. His careful choice here is to encourage “active choosing” and “powerfully expecting” outcomes. This is based on his belief that “active choosing” engages the mind to learn on one’s own terms and not be at the whim of whatever garbage flows in. And the act of “powerfully expecting” is believing something will come to pass. It demonstrates our confidence in our own beliefs and abilities, he says.

Sacco, a former private practitioner in the areas of relationships, criminal psychology, addictions and mental health, writes in a no-nonsense, straightforward manner that is easy to understand, even if one is not very fluent in psychology terminology. He acknowledges that everyone is different and that not all types of therapies or treatments work for everyone. Some of the more popular therapies for addiction  are biased, however, requiring a commitment to the so-called full process. For some, this can be a recipe for failure. The message conveyed in this book is that you can take it all or take just the parts you need, depending on where you are psychologically, socially, and spiritually.  It is a buffet of options—and, ultimately, your rate of success begins and ends with you.

After reading the book, I am no longer a skeptic. I believe this is a process that can and does work. Reading it, you will begin to understand how your past and the negatives associated with it can be what keep you stuck in the mud of misery. You will also come to understand and learn about sweet acceptance. And in the middle of all of this, you will find what you have been looking for: peace of mind.

Right Now Enough is Enough!: Overcoming Addictions and Bad Habits for Good in 30 Days or Less!
Booklocker.com, January, 2013
Paperback, 254 pages
$18.95 

The statistics regarding obesity in America are alarming. Currently, 35 percent of American adults are obese (CDC, 2012), and that number is projected to rise to over 50 percent in most states by 2030 (Henry, 2011). We’ve been fighting the so-called “war against obesity” since the 1980s, and yet despite all of our efforts, the problem has only gotten worse. Clearly, what we’ve been doing to try to solve this problem isn’t working and is possibly making it even worse. In my opinion, the reason for this is that the psychological piece hasn’t been addressed yet and until it is, we will have an increasing problem on our hands.

Years ago I was seeing a client who we’ll call Sarah. Sarah was very obese and desperate to lose weight. Her doctor had recently told her that if she didn’t lose a significant amount of weight she would lose her mobility as well as have a host of other medical consequences. Sarah tried numerous diets and exercise programs but nothing worked. She even enrolled in a weight loss clinic but had no success. She actually ended up gaining even more weight during this time. Not knowing what else to do, Sarah’s doctor told her that she needed to talk to a therapist.

When I met Sarah she was quite desperate to lose the weight and very depressed. Much to her surprise, I told her that I didn’t want us to work on her losing weight, but rather I wanted to work on her depression and teach her to accept and love herself unconditionally. This seemed the opposite of what she needed in order to lose weight, but Sarah decided to trust me anyway. You see, like a lot of people, Sarah thought that if she could just hate herself enough, that would motivate her to do whatever it took to lose the weight. As a therapist, I know that that is simply not going to work. We therapists follow something called the “Rogerian hypothesis,” which states that people tend to move in a positive direction only when given unconditional love and acceptance. Well, I’m happy to say that after we had alleviated Sarah’s depression and she had learned to love and accept herself, the weight came right off.

The current methods for helping people lose weight seem to be the opposite of love and acceptance. Much of the efforts seem to involve trying to shame and scare people into losing weight. This simply doesn’t work. The worst thing you can do is give someone more anxiety and depression regarding their weight, and I’m going to explain why that is later on. Also, the ways we go about teaching people to lose weight are much more complicated than they need to be. One should not have to read a book, go to a clinic, or take a class to learn how to lose weight. There is a very successful diet that has been around for thousands of years and all of the big celebrities do it. Can you guess what it is? It’s called “Moving more and eating less.” How you go about accomplishing this is up to you. I believe that losing weight is not complicated and that people intuitively know how best to do it when it comes to themselves. They simply need to stop feeling so anxious and depressed about it.

Obesity and Genetics

Before I talk more about how obesity is linked to depression and anxiety, I first want to briefly address the popular belief that obesity is purely a problem of bad genes. This is the popular belief and I can see why it is so popular. In a society where people are constantly trying to shame you about your weight, it can feel good to be able to say “Hey, you have no right to shame me about my weight! It’s not something I can control! It’s because of these bad genes I have!” But in order for this to be true, it means that our genes would have had to somehow change since the 1960s. Scientists agree that genetics is not responsible for the obesity epidemic, although they do agree it is a factor. Depending on which study you look at, genes only account for between 1 percent and 5 percent of a person’s body mass index (Li et al., 2010). I think that most people would agree that 5 percent of bad genes doesn’t excuse the 95 percent of it that scientists claim is due to bad habits.

When confronted with these facts, people often cite that most of the people in their family are also obese, so it must be genetics. However, the more likely possibility is that families tend to eat the same foods and have similar habits. Genetics also doesn’t explain why obese people also tend to have obese pets (Bounds, 2011). Obviously the dog doesn’t share the same genes as the owner, but they do share the same environment. Of course, we can’t mention genetics without looking at twin studies. Since identical twins have identical genes, researchers often compare twins to examine the effects of genetics and the environment on a person.

Obesity and Depression

Researchers aren’t quite sure if obesity causes depression or if depression causes obesity, but the two are definitely linked. In fact, the two conditions are so intertwined that some are calling obesity and depression a double epidemic. Studies have found that 66 percent of those seeking bariatric, (weight loss) surgery have had a history of at least one mental health disorder. And of course, it doesn’t help that the medications people take for depression and other mental health issues can cause dramatic weight gain.

Consider this: According to the CDC, half of Americans will suffer from some sort of mental illness, and most of them will not receive any treatment for it. 63 percent of Americans are also overweight or obese. There are almost as many Americans taking diet pills as there are taking antidepressants (8 percent and 10 percent). People with mental health issues are twice as likely as those without them to be obese, and that’s even before they start taking psychiatric medication (McElroy, 2009).

So why are people with mental health issues so much more likely than those without them to be obese? We know that depression and bipolar depression slows down your metabolism (Lutter & Elmquist, 2009). Depression also depletes our willpower, making us less likely to avoid eating unhealthy foods. Depression also causes us to crave high-fat foods and sugar. This is where emotional eating comes in. When we’re feeling down, fatty and sugary foods make us feel better, at least temporarily. Of course, you don’t need to have depression or a mental illness in order to engage in emotional eating. It’s something we learn at a very young age. Eating something unhealthy is much easier than fixing the problem or dealing with what’s causing us to feel unhappy. Teaching people how to deal with unpleasant moods other than by eating would certainly cut down on emotional eating and would certainly lead to significant weight loss.

So if depression causes weight gain and antidepressants cause weight gain, then what is the solution? Well, research has shown that talk therapy is just as effective at relieving depression as antidepressant medication (Doheny, 2010), and talk therapy doesn’t have the negative side effects that medication does. Another option is exercise. In a 2005 study on the effects of exercise vs. Zoloft (anti-depressant medication) on the treatment of depression, participants were randomly placed into two groups. On group received 150 mg of Zoloft while the other group engaged in 20 minutes of cardiovascular exercise three to four times a week. After eight weeks, they found that the exercise was just as effective at reducing depression as the Zoloft! Another thing to consider is that Zoloft has negative side effects such as weight gain, sleep problems, and sexual dysfunction. As you can imagine, the side effects of exercising are the opposite of that.

In its latest installment, Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?, primary author J. Welsey Boyd and Eric Metcalf delve into the sensitive time when one’s drug use has become troubling, but has not yet reached the diagnostic criteria for addiction.

Is all drug use bad? How do we know if we need help and when or how to seek it? What can we make of the fact that two states recently legalized marijuana? Boyd sets out to draw a road map for these tough questions for both the substance user and his/her loved ones. A medical doctor and Ph.D., he uses his impressive list of credentials — including faculty psychiatrist at Harvard, staff psychiatrist at Boston Children’s Hospital Adolescent Substance Abuse Program, and co-founder/director of the Human Rights and Asylum Clinic. The end result is a useful guide — but with a few flaws.

Because the “almost” concept may seem foreign to someone who hasn’t read one of the previous books in the series, Boyd spends time going over exactly what this means. He writes that to qualify as an almost addiction, a behavior must fall outside of what is considered normal, but, at the same time, not meet criteria for a DSM diagnosis; that it’s causing identifiable problems; that it might progress to a full-blown condition or, at least, cause substantial suffering; that an intervention should be able to help; and that stopping the behavior will improve quality of life. The benefit of identifying drug-using behavior as “almost addicted,” he writes, is that it offers an opportunity to stop and turn your life around before a problem progresses into full addiction, which is much more difficult to treat. He compares the value of this early intervention to that of spotting glucose intolerance and pre-hypertension before they turn into diabetes, heart attack, or stroke.

There is a case study in each chapter to help reader determine if a drug use is an “almost addiction,” as well as to illustrate the points raised in each section in a relatable, anecdotal way. The book gives an overview of the classes of drugs and their effects, as well as the definition of addiction and how it differs from abuse. Later, it explores possible roots of addiction, including the role of one’s family history, a drug’s effects and initial appeal during a hard time, and self-treatment for a mental health issue.

One section is geared toward family members and friends who are concerned about another’s drug use. Boyd notes that almost addiction is especially hard to see in successful people, as the effects are not nearly as obvious as those of full-blown addiction. Even health professionals miss it a lot between their time constraints and the sensitivity of the issue, he writes. He also stressed that there are things you can and can’t do to help: for instance, you can cease enabling the behavior, but you can’t force a person to seek treatment.

Next, Boyd presents materials and resources aimed directly at the almost-addicted reader, including information on helping oneself and figuring out when it’s time to find professional help (there’s a helpful, if simplistic, chart on page 223). Boyd talks about the non-physical aspects of drug use, such as how it’s woven into a daily routine, and prepares the reader for what the recovery process could look like, and what to do afterward to continue living a drug-free life.

While Almost Addicted is, overall, a valuable addition to the literature on drug use and abuse, it does have a few issues. For starters, it is at once meant for an audience of almost-addicted readers and for an audience of concerned loved ones. Granted, Boyd does try to divide guidelines into separate sections, but it’s still difficult to distinguish the approach he intends for each group.

Boyd also attempts to mention and include all drugs, yet concentrates overwhelmingly on marijuana. Pot is becoming more and more accepted, though, and instead of scapegoating it as the source of all drug problems (which seems simplistic at best), I wondered why Boyd didn’t focus more on prescription drugs—especially since this is the fastest growing area of abuse and addiction.

Finally, there’s a bit of a problem in the last part of the book, where Boyd recommends seeing a primary care doctor to begin the recovery process: The suggestion comes after an entire section on how primary care practitioners don’t have time, motivation, or expertise to notice, let alone care about, the almost-addicted population.

Boyd himself identifies one problem with his “almost addicted” framework: “I wish I could offer some completely black and white advice about using drugs that would be applicable for everyone, but doing so would probably be intellectually dishonest,” he writes. “You’ll have to decide where to draw the line on what kind of presence that drugs — legal or not — can have in your life.”

Regardless of these issues, Almost Addicted is still a well-researched and cited work with information and advice for those who are verging on succumbing to addiction. The emphasis on early intervention, before one experiences traumatic consequences, is not only valid, but an essential concept that will hopefully push our notion of drug treatment forward.

Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
Hazeldon Publishing (Harvard Health Publications), 2012
Paperback, 264 pages
$14.95

Shame involves an internalized feeling of being exposed and humiliated. Shame is different from guilt. Shame is a feeling of badness about the self. Guilt is about behavior — a feeling of “conscience” from having done something wrong or against one’s values.

Shame underlies self-destructive behaviors:

• Hidden shame often drives self-destructive behaviors and other psychological symptoms such as rage, avoidance, or addictions.
• Self-destructive behaviors often are an attempt to regulate overpowering, painful feelings but lead to more shame, propelling the self-destructive cycle.
• Secrecy, silence, and out-of-control behaviors fuel shame.
• Shame makes people want to hide and disappear, reinforcing shame.
• Shame is created in children through scolding, judging, criticizing, abandonment, sexual and physical abuse.

Breaking the Cycle of Shame

Breaking self-destructive habits requires action, not just willpower:

• Changing destructive behaviors requires trying out new, affirming behaviors to replace them.
• New behaviors that generate positive feedback and reward create new connections in the brain, creating the momentum for ongoing growth and change. (Learning on a neurobehavioral level)

Shame can be relieved and healed by:

• taking healthy risks to be seen and known authentically, acting from a positive motive and trying out new behaviors in a safe (nonjudgmental) setting.
• taking actions that generate pride — the antidote to shame.
• breaking secrecy with people who understand.

Enabling is “removing the natural consequences to the addict of his or her behavior.” Professionals warn against enabling because evidence has shown that an addict experiencing the damaging consequences of his addiction on his life has the most powerful incentive to change. Often this is when the addict “hits bottom” – a term commonly referred to in Alcoholics Anonymous.

Codependents often feel compelled to solve other people’s problems. If they’re involved with addicts, particularly drug addicts, they usually end up taking on the irresponsible addict’s responsibilities.

Their behavior starts as a well-intentioned desire to help, but in later stages of addiction, they act out of desperation. The family dynamics become skewed, so that the sober partner increasingly over-functions and the addict increasingly under-functions.

This builds resentment on both sides, along with the addict’s expectation that the over-functioning partner will continue to make things right when the addict doesn’t meet his or her responsibilities.

The Al-Anon program suggests that you don’t do for the alcoholic what he or she is capable of doing. Yet, codependents feel guilty not helping someone, even when the person caused the situation and is capable of finding a solution. It’s even harder for codependents to say no to requests for help. The pressure to enable can be intense, particularly coming from suffering or angry addicts, who generally use manipulation to get their needs met.

Examples of enabling include: giving money to an addict, gambler, or debtor; repairing common property the addict broke; lying to the addict’s employer to cover up absenteeism; fulfilling the addict’s commitments to others; screening phone calls and making excuses for the addict; or bailing him or her out of jail.

How to Stop the Enabling Behavior

Often addicts aren’t aware of their actions when intoxicated. They may have blackouts.

It’s important to leave the evidence intact, so they see how their drug use is affecting their lives. Consequently, you shouldn’t clean up vomit, wash soiled linens, or move a passed-out addict into bed. This might sound cruel, but remember that the addict caused the problem. Because the addict is under the influence of an addiction, accusations, nagging, and blame are not only futile, but unkind. All these inactions should be carried out in a matter-of-fact manner.

Stopping enabling isn’t easy. Nor is it for the faint of heart. Aside from likely pushback and possible retaliation, you may also fear the consequences of doing nothing. For instance, you may fear your husband will lose his job. Yet, losing a job is the greatest incentive to seeking sobriety. You may be afraid the addict may have an auto accident, or worse, die or commit suicide. Knowing a son is in jail is sometimes cold comfort to the mother who worries he may die on the streets. On the other hand, one recovered suicidal alcoholic said he wouldn’t be alive if his wife had rescued him one more time.

You may have to weigh the consequences of experiencing short-term pain vs. long-term misery, which postpones the addict’s reckoning with his or her own behavior. It requires great faith and courage not to enable without knowing the outcome. Although enabling can prolong the addiction, not all addicts recover, even despite counseling and going to many rehabs. This is why the 12 Steps are a spiritual program. They begin with the recognition that you’re powerless over the addict. The desire for sobriety must come from him or her.

To avoid unnecessarily suffering the consequences of an addict’s drug use, it’s vital you begin to reclaim your sense of autonomy and take steps wherever possible not to allow the addict’s drug use to put you in jeopardy. Allowing the addict to drive you or your child while under the influence is life-threatening. On the other hand, taking on the role of designated driver gives the addict free license to use or drink. The spouse might refuse that enabling role by taking a separate car. If the addict is charged with DUI, it might be a wake-up call.

Always have a Plan B to cope with addicts’ unreliability; otherwise, you end up feeling like a victim. Sometimes, Plan B might be going to a 12-Step meeting or just staying home and finishing a novel. The important thing is that it’s a conscious choice, so that you don’t feel manipulated or victimized.

It’s a good idea to follow through with plans, whether it’s keeping counseling appointments or social engagements that the addict refuses to attend at the last minute. This precludes the addict’s attempt to manipulate the family.

Having some recovery under his belt, one husband resolved to remain on vacation with the children when his alcoholic wife suddenly decided she wanted to return home. He later remarked, “It was the first time in years that my mind was free of obsessing about her.”

In another situation, an alcoholic husband picked a fight an hour before guests were arriving for dinner. He threatened to leave unless they were uninvited. When his wife refused, he stormed out and hid in the bushes, while his wife enjoyed herself. Feeling ashamed, he never repeated that ploy.

Enabling has implications for all codependents, because they generally sacrifice themselves to accommodate others’ needs, solve others’ problems, and assume more than their share of responsibility at work and in relationships.

Common examples are a woman looking for a job for her boyfriend, a man paying his girlfriend’s rent, or a parent meeting his child’s responsibilities that the child can do or should be doing. Learning to be assertive and set boundaries are often the first steps in stopping enabling. See my book How to Speak Your Mind – Become Assertive and Set Limits.

Email me if you’d like to hear an interview I gave on enabling.

Verbal abuse takes many forms: from loud rants to quiet comments; from obvious put-downs to not-so-obvious remarks that undermine the partner. What all the methods have in common is the need to control, to be superior, to avoid taking personal responsibility, and to mask or deny failures.

The myth in Hank’s and Mary’s relationship is that he is much, much smarter than she is. She does admire him, but not as much as he admires himself. He trumps anything she says with a stronger, maybe louder opinion. He calls her ideas naïve or ill-informed or even idiotic. Mary thinks he may be right. Since marrying Hank 3 years ago, her self-confidence has plummeted.

Jake, on the other hand, hides his need for control in his relationship with Marilyn under sarcasm, jokes and puns. “Why,” he says, “doesn’t Marilyn understand I’m just joking?” Why? Because she is the object of those sarcastic remarks, “jokes” and puns. He both publicly and privately keeps her off-balance by joking about her insights, her goals, and the things she cares most about. She has come to question her judgment about her ideas and about him. Lots of people think he’s funny. Maybe, she thinks, he doesn’t mean it. Maybe, she tells herself, she needs to have a better sense of humor.

Frank can’t stand to be seen as responsible for any failure. When he makes a mistake, his mantra is “I may be wrong but you are wrong-er.” If his wife says he has hurt her feelings, he claims not to remember having said what he said or having done what he did. He tells her she is “too sensitive.” He whines about being a scapegoat for other people’s problems. He doesn’t seem to get that he is the perpetrator, not the victim.

Al isn’t subtle. His wife and kids never know what to expect when he comes home. Will loving, caring Al be at the door with treats for the kids and something nice for his wife? Or will the Al who flies into rages, who threatens them with physical abuse and swears and calls them names show up? The whole household walks on eggshells. Even when loving-Al is around, things can change in an instant if he is the least bit frustrated. Last week when his 5-year-old spilled milk at the dinner table, he yelled at her for an hour. When his wife tried to intervene, he backhanded her. Everyone got real quiet. Then – the storm blew over and Al left for the rest of the evening.

If you recognize yourself in any of the above scenarios, you are being verbally abused. Make no mistake: Although verbal abuse doesn’t leave visible scars, it does do damage. The victims’ self-esteem is eroded. Children who watch one parent being put down and diminished by the other develop a skewed and sad view of how relationships are supposed to be.

6 Signs You Are Being Verbally Abused

1. Like Mary, you feel you just can’t win. No matter how carefully or kindly you try to work out a problem, your partner says things that make you feel like you’re in the wrong.
2. Your self-esteem and self-confidence are shot. Your partner isn’t your greatest fan but your greatest critic. He often tells you that his comments are “for your own good.”
3. When you say he has hurt your feelings your partner, like Frank in the scene above, tells you that you are too sensitive. When you point out that he has said something inappropriate or hurtful, he accuses you of trying to make him look bad. You notice that he rarely takes responsibility for his part of a problem. Somehow he manages to convince himself and even you that anything that goes wrong is your fault.
4. You often are the brunt of jokes that make you feel bad. The guy who is fun and fun-loving outside the family unleashes a more vicious or undermining humor inside. Other people don’t believe you that the guy they know is so different from what you experience. Like Marilyn, you find yourself constantly questioning yourself.
5. You have to walk on eggshells at home. Your home isn’t a sanctuary for you and your kids. It is the place where you are most afraid and embarrassed. You and the kids stay away as much as you can. When you are there with your partner, you all do everything you can to make sure nothing happens that could set him off.
6. If you’re not very careful, the verbal abuse escalates to physical altercations. Even if you are very careful, what starts with words can end up with physical aggression toward you or destroying things, especially things you value.

Whoever made up that rhyme about “sticks and stones will break my bones but names will never hurt me” was just plain wrong! Words do hurt. They can break a person on the inside just as surely as a whack with a stick bruises the outside. People who are subjected to verbal abuse suffer. People who are subjected to it over time can get so used to it that they lose their sense of themselves as people worth loving. If you see yourself in any of these stories, know you are not alone. There are things you can do. Part II of this article will discuss them.

Codependency underlies all addictions. The core symptom of “dependency” manifests as reliance on a person, substance, or process (i.e, activity, such as gambling or sex addiction). Instead of having a healthy relationship with yourself, you make something or someone else more important. Over time, your thoughts, feelings, and actions revolve around that other person, activity, or substance, and you increasingly abandon your relationship with yourself.

Recovery entails a 180-degree reversal of this pattern in order to reconnect with, honor, and act from your core self. Healing develops the following characteristics:

• Authenticity
• Autonomy
• Capability of being intimate
• Integrated and congruent values, thoughts, feelings, and actions

Change is not easy. It takes time and involves the following four steps:

1. Abstinence. Abstinence or sobriety is necessary to recover from codependency. The goal is to bring your attention back to yourself, to have an internal, rather than external, “locus of control.” This means that your actions are primarily motivated by yourvalues, needs, and feelings, not someone else’s. You learn to meet those needs in healthy ways.Perfect abstinence or sobriety isn’t necessary for progress, and it’s impossible with respect to codependency with people. You need and depend upon others and therefore give and compromise in relationships. Instead of abstinence, you learn to detach and not control, people-please, or obsess about others. You become more self-directed and autonomous.

   If you’re involved with an abuser or addict or grew up as the child of one, you may be afraid to displease your partner, and it can require great courage to break that pattern of conceding our power to someone else.

2. Awareness.It’s said that denial is the hallmark of addiction. This is true whether you’re an alcoholic or in love with one. Not only do codependents deny their own addiction – whether to a drug, activity, or person – they deny their feelings, and especially their needs, particularly emotional needs for nurturing and real intimacy.You may have grown up in a family where you weren’t nurtured, your opinions and feelings weren’t respected, and your emotional needs weren’t adequately met. Over time, rather than risk rejection or criticism, you learned to ignore your needs and feelings and believed that you were wrong. Some decided to become self-sufficient or find comfort in sex, food, drugs, or work.

   All this leads to low self-esteem. To reverse these destructive habits, you first must become aware of them. The most damaging obstacle to self-esteem is negative self-talk. Most people aren’t aware of their internal voices that push and criticize them — their “Pusher,” “Perfectionist,” and “Critic.”¹

3. Acceptance.Healing essentially involves self-acceptance. This is not only a step, but a life-long journey. People come to therapy to change themselves, not realizing that the work is about accepting themselves. Ironically, before you can change, you have to accept the situation. As they say, “What you resist, persists.”In recovery, more about yourself is revealed that requires acceptance, and life itself presents limitations and losses to accept. This is maturity. Accepting reality opens the doors of possibility. Change then happens. New ideas and energy emerge that previously stagnated from self-blame and fighting reality. For example, when you feel sad, lonely, or guilty, instead of making yourself feel worse, you have self-compassion, soothe yourself, and take steps to feel better.

   Self-acceptance means that you don’t have to please everyone for fear that they won’t like you. You honor your needs and unpleasant feelings and are forgiving of yourself and others. This goodwill toward yourself allows you to be self-reflective without being self-critical. Your self-esteem and confidence grow, and consequently, you don’t allow others to abuse you or tell you what to do. Instead of manipulating, you become more authentic and assertive, and are capable of greater intimacy.

4. Action.Insight without action only gets you so far. In order to grow, self-awareness and self-acceptance must be accompanied by new behavior. This involves taking risks and venturing outside your comfort one. It may involve speaking up, trying something new, going somewhere alone, or setting a boundary. It also means setting internal boundaries by keeping commitments to yourself, or saying “no” to your Critic or other old habits you want to change. Instead of expecting others to meet all your needs and make you happy, you learn to take actions to meet them, and do things that give you fulfillment and satisfaction in your life.Each time you try out new behavior or take a risk, you learn something new about yourself and your feelings and needs. You’re creating a stronger sense of yourself, as well as self-confidence and self-esteem. This builds upon itself in a positive feedback loop vs. the downward spiral of codependency, which creates more fear, depression, and low self-esteem.

   Words are actions. They have power and reflect your self-esteem. Becoming assertive is a learning process and is perhaps the most powerful tool in recovery. Assertiveness requires that you know yourself and risk making that public. It entails setting limits. This is respecting and honoring yourself. You get to be the author of your life – what you’ll do and not do and how people will treat you.²

The four A’s are a roadmap. Learn all you can about recovery. Join a 12-step program and begin keeping a journal to know yourself better. Codependency for Dummies lays out a detailed recovery plan with self-discovery exercises, tips, and daily reminders. Your recovery must be your priority. Most important, be gentle with yourself on your journey.

1. To help you, I wrote a handy ebook, 10 Steps to Self-Esteem — The Ultimate Guide to Stop Self-Criticism.
2. Because being assertive is so fundamental to recovery, I wrote How to Speak Your Mind — Become Assertive and Set Limits.

Bill Wilson, the founder of Alcoholics Anonymous, was influenced by Carl Jung. In correspondence, Jung wrote Wilson that the cure for alcoholism would have to be a spiritual one — a power equal to the power of spiritus, or alcohol.

The 12 Steps are that spiritual remedy. They outline a spiritual process of surrender of the ego to the unconscious, or a higher power, and very much resemble the process of transformation in Jungian therapy.

The following is a description of that process. However, the fact that it is described in a linear fashion is misleading, because the Steps are experienced both simultaneously and in a circular manner. Although the same process is applicable to recovery from addiction to a substance (e.g. alcohol, drugs, food) or a compulsion, such as gambling, debting, or caretaking, the focus of this article is on alcohol and drug addiction and the family members in a codependent relationship with the alcoholic or addict.

Facing the Problem

The beginning of recovery is acknowledging that there is a problem involving drugs or alcohol, that there is help outside oneself, and the willingness to utilize it. This also represents the very beginning of trust in something beyond oneself (such as a therapist, sponsor, or the program), and the opening up of a closed family system. Invariably, it takes years to face the problem.

With growing understanding of the problem, denial further thaws. In Step 1: “We admitted we were powerless over alcohol — that our lives have become unmanageable.”¹ The addict begins to understand she or he is powerless over the drugs or alcohol, and the codependent begins to understand that she or he cannot control the substance abuser. The struggle not to drink and the codependent’s vigilant watching the addict begin to slip away. Gradually, attention starts to shift from the substance, and, for the codependent, the substance abuser, to focus on oneself.

There are deeper levels of working the First Step. The first stage of coming out of denial is to acknowledge that there is a problem; second, that it is a life-threatening problem over which one is powerless; and third, that actually the problem lies in one’s own attitudes and behavior.

Surrender

The acknowledgment of powerlessness leaves a void, which formerly was filled with mental and physical activity trying to control and manipulate the addiction or the addict. Feelings of anger, loss, emptiness, boredom, depression, and fear arise. The emptiness that was masked by the addiction is now revealed. It is an awesome realization when you acknowledge that you or your loved one has a life-threatening addiction over which you are powerless, subject only to a daily reprieve. Now, with a modicum of trust, one acquires a willingness to turn to a power beyond oneself. This is Step 2: “Came to believe that a Power greater than ourselves could restore us to sanity.”

In the book Alcoholics Anonymous, it states: “Without help it is too much for us. But there is One who has all power — that One is God.” (p. 59). That power can also be a sponsor, therapist, the group, the therapy process or a spiritual power. Reality itself becomes a teacher, as one is asked to continually “turn over” (to that Power) an addiction, people, and frustrating situations. The ego gradually relinquishes control, as one begins to trust that Power, the growth process, and life as well.

Self-Awareness

What has been happening up until now is an increasing awareness and observation of one’s dysfunctional behavior and addiction(s) – what is referred to as “insanity” in the Second Step. This crucial development signifies the genesis of an observing ego. Now one begins to exercise some restraint over addictive and undesirable habits, words, and deeds. The Program works behaviorally as well as spiritually.

Abstinence and forbearance from old behavior are accompanied by anxiety, anger and a sense of loss of control. New, preferable attitudes and behavior (often called “contrary action”) feel uncomfortable, and arouse other emotions, including fear and guilt. From a Jungian perspective, one’s “complexes” are being challenged:

“Every challenge to our personal habit patterns and accustomed values is felt as nothing less than the threat of death and extinction of our selves. Invariably such challenges evoke reactions of defensive anxiety.” (Whitmont, p. 24)

Group support is important in reinforcing new behavior, because the emotions triggered by these changes are very powerful and can retard and even arrest recovery. Additionally, resistance is experienced from self, family, and friends for the very same reasons. The anxiety and resistance may be so great that the addict or abuser may go back to drinking or using.

There is help in Step 3: “We…turn our lives over to the care of God as we understood God.” This is the practice of “letting go” and “turning it over.” As faith builds, so does the ability to let go and move toward more functional behavior.

1. Other words, such as “food,” “gambling” or “people, places and things” often are substituted for the word alcohol.

• Terminology. When you think about goal setting, you realize that it’s a process and that requires effort to reach your target; a resolution is a decision or intention. It has to be more than a wish, but it’s only the first step in reaching a goal. There’s no implication that planning or effort is involved. It’s as if saying it makes it so. Naturally, it doesn’t. Change isn’t easy. Instead of making several New Year’s “resolutions,” make one you can keep, and it will give you confidence that you can do more.
• Motivation. Change requires work. To be motivated, your heart has to be in it. To realize your goals and resolutions, you must be inspired and really want to make the effort necessary to leave your comfort zone. Inspiration infuses you with energy and power. It stimulates your creativity, promises a better future, or connects you to a larger purpose. It fills you with positive emotions that overcome fear and inertia. Love mobilizes parents to work hard and protect their children, disregarding their own comfort and safety. For change to last, make sure your motive expresses your true self and fosters your highest good. Your goal must be congruent with your core beliefs. Resolutions to make changes for someone else’s approval, for monetary gain, or because you think you “should” are hard to sustain.
• Self-Discipline. In addition to desire and motivation, you need self-discipline. It’s been said that success is 99 percent perspiration and one percent inspiration. Change requires focus and sustained effort before results are noticeable. The process is not a straight path, but a spiral of movement forward, slips, stagnation, and leaps ahead. It’s easy to get discouraged and be swayed by the pull of habit. Expect to feel discomfort. You may feel confused, awkward, or anxious. Studies show that on average that changing habits requires at least two months of vigilant monitoring, and they still sneak up on you. Be patient. Continue to exert your willpower, and over time your persistence will pay off.

For years, every January I’d make resolutions and set goals for the coming year. Twelve months later, I’d see if I’d accomplished them, never considering the “how to” middle part. Of course, “good intentions” didn’t get me very far. Here are five tips that I’ve learned:

1. Create an action plan. I’d get overwhelmed and lose confidence when I thought about a major goal. Break it down into smaller steps by month, week, and daily to-do lists. Actionable steps become manageable and doable.
2. Heighten self-awareness. People often seek therapy to raise their self-esteem or overcome addictions and codependency. If your resolution is to change your habits, self-awareness and vigilance are needed in order to interrupt old patterns. Daily meditation and journaling are potent and helpful tools in monitoring and changing your thoughts, feelings, and behavior.
3. Encourage yourself.Discouragement is normal. Become a positive coach, and continually give yourself positive feedback, praise, and recognition. Look for small signs of progress and celebrate them. If you have low-self-esteem, you may talk yourself out of your desires and think you lack the skill, worth, or ability to achieve them. Underlying depression does the same thing. Self-doubt and negative self-talk paralyze you in a past expression of yourself. They sap energy and motivation, and can easily persuade you to give up.If you aren’t making progress or slip into old habits, don’t dwell on your “mistake.” Rather than stay stuck in self-judgment and guilt, admit what you did or didn’t do, and quickly get back on track. Stay solution-oriented. Ask yourself, “What am I going to do about it?” Self-forgiveness improves both self-esteem and future behavior.
4. Have a vision. To create a powerful motivation for change, picture yourself as you’d like to be and see yourself happy and confident behaving in the new way. Rather than focusing on what you don’t want, focus on what you desire. Here are some suggestions to manifest the new you:
   • Draw the future you.
   • Imagine what it would be like if you were the future you in this moment. See yourself carrying out your New Year’s resolutions. Notice the expression on your face, and experience how you would feel in your body. See the future you as having accomplished your goals. Experience yourself feeling proud, happy, and confident. See people in your life responding favorably to you.
5. Get support. Some changes entail facing the unknown or a perceived danger, such as life after a divorce, moving to a new city, or standing up to intimidation. They require courage, and support can be a great help. Addictions and habits are hard to break, especially if they’re driven by temptation, like drugs, food, and sex. Support and encouragement from friends, family, a mentor, support group, or therapist are vital until new patterns are established as part of your self-definition.

Many people make changes on their own. If it’s been difficult for you, or if you find it hard to muster motivation and self-discipline, it may be that an internal shift is required before anything external can permanently change. Sometimes, unconscious beliefs about yourself and what’s possible hold you back. Consider that therapy can lift depression and move you through the challenges outlined above. It can raise your self-esteem, facilitate insight, and guide you in facing the unknown and maintaining new behavior.

His father, Bill Moyers, is a successful television journalist and former White House press secretary, and the family used these public appearances as an opportunity to speak openly about their struggle and tackle the stigma surrounding the “typical” down-and-out addict.

Following these appearances, the author says, he received thousands of desperate letters, phone calls, and emails from relatives of users around the globe who were experiencing similar struggles. In this new book, Now What? An Insider’s Guide to Addiction and Recovery, Moyers attempts to address the mail and phone calls — and even use some of the stories within them — to explain how recovery worked for him, and how he has managed to stay sober since 1996. He writes: “I hope that in these pages you’ll find practical guidance with straightforward answers to what are often perplexing questions. Those questions and responses come from the experiences of insiders who were once where you are right now.”

It is this down-to-earth style and so-called insider’s perspective that characterize Moyers’s book and set it apart from the rest of the self-help manuals in its field. Moyers talks frankly about his own experiences and describes how he found himself in crack houses before finally deciding that enough was enough and reaching what he terms his moment of “surrender”:

For all of us, recovery begins the moment our inside world matches the outside world, and reality and perception become one. … Mine occurred in 1994, after a cocaine binge drove me to my knees in an Atlanta crack house. I was thirty-five, and the craving was so intense that what I knew I shouldn’t do was exactly what I did. I got high, and then I kept getting high even as my community tried to figure out how to save me from my illness.

This community included his family, and here again Bill and Judith play an important role, furnishing the book with a moving foreword and encouraging others to seek help as they did. It is this sense of community that is central to Moyers’s theory of effective recovery. He writes that because addiction is a “disease of isolation, the antidote is togetherness, other people, community—moving from ‘I’ to ‘we.’” Earlier, he writes, “If only you had honestly shared your thoughts and feelings with somebody in a position to help you—a family member, a recovery coach or sponsor, your counselor, a friend or ‘fellow traveler’ in your circle of recovery, anyone—before the dealer or bartender handed you your drug of choice.” It is the secretive nature of addiction that perpetuates it, he explains, asserting: “Nobody I know has ever relapsed if he first told the right person what he was about to do.”

Moyers now serves as a recovery advocate and ambassador, helping others through the process of recovery, and he is big believer in the Twelve Step approach of organizations such as Alcoholics Anonymous. He suggests that these weekly meetings are a valuable opportunity for users to meet with fellow peers in recovery, and to build up their own “social capital” and support network within the recovery community.

As well as the descriptions of Moyers’s own recovery journey, his book also contains many other users’ stories, gleaned from his years as a journalist in the recovery field. These are all presented in an open and honest fashion, and from the perspective of kindred spirits, rather than experts or advisers. There’s a good wealth of experiential knowledge within these pages, and it is delivered in a way that is far more appealing than just another guide- or textbook. The appendices also contain vital tools such as sobriety plans, screening tests, resource lists, templates for intervention letters, and the 12 Steps.

One of the most over-saturated areas of the psychology literature market is that of addiction and recovery. There’s no shortage of self-help titles penned by experts, professionals, researchers, and ex-users telling their own stories. So any new addition to the field has to have something new to offer, or at least cover the fundamental concepts in an innovative way. Fortunately, this book does both. Indeed, the author states that his goal is to “silence the noise and dilute the confusion.”

Moyers succeeds in doing this by sticking to gritty accounts of his and other users’ own experiences, and by describing simply what has worked for them. There may be more definitive recovery manuals out there, and there are certainly more complex textbooks on the topic, but this is a unique and valuable text that contributes a new perspective to the addiction and recovery field.

Now What? An Insider’s Guide to Addiction and Recovery
Hazelden Publications, October, 2012
Paperback, 208 pages
$14.95

Or maybe you’re a bundle of nerves. You are so anxious you just want to hide. You’re nervous about your job. You’re scared to speak up even when you know you should and could. You are so anxious that you are anxious about being anxious.

Or maybe the issues are about relationships. You don’t have one or the one you have isn’t the one you want. You and your partner are fighting all the time. Every day seems to be “same fight, different day.” Trust has become a huge issue. Neither one of you can relax into your relationship. You each wonder where the love and sweetness and tenderness have gone.

And then there are family issues: The mother you can’t get along with. The father who expects too much or too little of you. Siblings who are mean-spirited, favored, or so self-centered that you feel constantly taken advantage of. Parents who are fighting. Parents who are splitting. Family you are expected to like but who are entirely unlikeable – and here comes another painful family event.

Any of these types of issues can stretch a person beyond his or her ability to cope. Any of them can challenge the most creative, caring, and responsible person, You’ve tried your best. You’ve tried to look at a brighter side, to be rational, to be smart about whatever it is. But you still can’t figure things out. You still feel alone in your troubles and without the inner resources or the outer supports to change things. This is when people often go to therapy. You wish you could. But you have no insurance and you know it can be costly. The situation seems hopeless.

It’s not. Serious, yes. Hopeless, no.

Inexpensive and Alternative Treatment Options

There are many ways to get the help you need, therapist or no. Before you give up on the idea of getting some therapeutic help, consider these alternatives.

Sometimes therapy is free or low-cost.

Depending on your problem, there may be funded or subsidized therapy available to you. Many communities have women’s centers that offer free services to women who are being abused. Many have free services for adolescents. And an increasing number of communities have men’s resource centers to help men with anger management, relationship or vocational problems. Go online and check.

Employee Assistance Programs (EAP).

Many businesses and companies offer a limited counseling benefit. Usually the company provides three to six sessions. If you need further help, the counselor will refer you to a local therapist. Check with your human resources department to see if there is an EAP counselor at your workplace. Often even a couple of focused sessions is enough to offer some relief.

Sliding scales and free slots.

Many mental health clinics and many therapists in private practice have sliding fee scales so that people can pay what they can afford. Ask your doctor if he or she knows who offers this service. Call some of the therapists in your area and ask. Many therapists keep a number of slots at a lower rate as their way of giving to their community.

Support groups.

Often a support group can be very therapeutic. By talking to people with a similar problem, you will feel less alone. Often there are people in the group who are a little ahead in their healing and who can offer you good practical advice as well as emotional support. Local hospitals, libraries, churches, and schools often offer support groups for grief, parenting issues, managing chronic illness, etc.

PFLAG (Parents and Friends of Lesbians and Gays) offers support to those supporting family members and friends who are coming out. There are also support groups online and in the community for gays, lesbians, and transgendered people who need information and advice.

Parent education classes.

Not all problems are mental health issues. Parenting is difficult. Often people new to parenting or new to a stage of parenting could just use some additional information and the reassurance and advice that can come from parents who have been there and done that. Often such groups are offered through the school system or through local parent centers.

12-step Groups.

Alcoholics Anonymous, Al-Anon (for families of problem drinkers) and Alateen (for teenage family members) offer support to people who are struggling with alcoholism and to their families. Other spinoffs include Overeaters Anonymous, Narcotics Anonymous, Clutterers Anonymous and Parents Anonymous. If you think a 12-step program is for you, search your issue and “anonymous” and you are likely to find a group.

The National Alliance on Mental Illness (NAMI) has chapters throughout the U.S. They often offer support groups for those struggling with mental illness as well as for family members.

Online support groups.

Name a problem and there is probably an online support group for it. Here at PsychCentral, there are over 100 such forums and groups. Members are not professionals. They are people who are grappling with the same issue you are. Their compassion and understanding can help you feel less alone. Often members offer experience and wise suggestions.

Are you a veteran? Every branch of the service has a program for military personnel and their families. Call your local Veterans Administration office for information.

Are you a teen? Many high schools have free counseling available through the guidance department. Often the guidance counselors are themselves counselors and can be very helpful with both individual and family problems. Sometimes they know which therapists in town have free or nearly-free services and where you can go for further help.

Are you in college? Check to see whether the health services at your school include a mental health department. Often the health insurance you pay for at school can enable you to see a local therapist for at least a few sessions.

Hotlines and warmlines.

There are important hotlines and warmlines in almost every country. In the U.S., the National Suicide Prevention Lifeline (1-800-273-8255) is available 24/7. The Boys Town National Hotline is also available 24/7 for teens (girls as well as boys). Google “hotline” and your problem and you are likely to find a number to call.

Houses of worship.

Spiritual leaders often have had training in counseling as well as in the practices of their faith. See if your church or synagogue or house of faith offers such help. If your spiritual leader isn’t comfortable dealing with secular problems, he or she may be able to refer you to someone who can.

Journaling or writing letters you will never send can be an important method for self-help. Don’t get put off by having to put something down. You’re the only one who is going to see it. Writing out what troubles us often helps us put our feelings into perspective. Often enough, a solution will come as you work to make your problems clear.

Bibliotherapy is a fancy name for reading a book. Whatever your problem, someone else has probably written about it to share their journey of healing. Sometimes we learn best from reading how someone else did and did not address issues. Search for your issue at one of the major online bookstores and you can find what you are looking for.

Prayer, meditation, chanting.

Anything that helps you relax and get out of yourself for a bit can do wonders for your state of mind. Turning your problems over to God, your higher power or the universe can help relieve the pressure and begin the healing.

Get off the screens and go outside.

Mother Nature is a great therapist. Stop spinning about your problem with online friends who are in the same spin and go for a long walk instead. Open your senses to the outdoors and you may be able to cut your problems down to a more reasonable size.

Talk to a trusted friend or family member.

You know who they are. Many of us have a friend or relative who is wise and loving and supportive. Don’t waste your time on anyone else. People who are critical or judgmental will make you feel worse. Reach for the people in your life who will listen with their hearts and who will validate your strengths.

Take care of yourself.

Getting enough sleep, eating right, and making sure you get a little exercise each day can do wonders for your troubles. You may not feel like doing any of it. But doing it, whether you feel like it or not, can help you start to feel a bit better. You will have taken a step toward self-care and self-love that is the basis for any therapeutic action.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction gives a taste of the Prinsen’s gutsiness at the outset, as she begins by acknowledging that she herself has played a part in her family’s difficulties. In this, her first book, the author tells the searingly honest and remarkably brave story of her family’s battles with mental illness, charting the ongoing chaos they’ve faced following Sean’s service in Bosnia.

After his discharge, Prinsen tells us, her husband returns home to the States and is given a prescription for narcotic pain medication to help him cope with the pain of a neck injury he suffered during military training. It is here that things begin to quickly spiral out of control, as Sean becomes addicted to his pills and begins to self-medicate with additional over-the-counter medications and alcohol. His behavior throws the entire family into disarray.

“Alcoholism is an enigma,” Prinsen writes, “— as complex as it is puzzling. It follows no rules and has no boundaries. Like a giant vacuum, alcoholism goes after everything and everyone in its path. It is a family disease — everyone in the family gets sick.”

Because Sean is reluctant to speak about the trauma he experienced in the military, or to share the truth about his depression with anyone, Prinsen assumes that her husband is simply suffering from addiction. It takes many years for her to understand and recognize the nature of PTSD and to connect the dots between the trauma Sean experienced in Bosnia and his subsequent depression and substance use.

“For so long, in the early stages of Sean’s addiction, I didn’t understand the destructive interplay between Sean’s PTSD, his depression, and his substance abuse,” she writes, explaining:

… Only he understood the desperate need to escape from the crippling flashbacks and the intrusive thoughts that blindsides him without warning, bringing with them the full force of the emotions that he felt in the original traumas. Only he understood the exhausting anxiety that kept him on high alert for ‘danger’ 24/7 and the need for something — anything — to keep that anxiety at bay. Only he understood how the pills helped him get through a night that would otherwise be plagued by the alternating horrors of nightmares or insomnia.

Sean’s PTSD continues to go undiagnosed, until he finally reaches crisis point. One night, in 2007, Sean suffers a complete breakdown and attempts what is known as “police-assisted suicide.” He becomes threatening and aggressive, arms himself with a loaded weapon, and calls the police to the house, almost as a challenge.

Prinsen recalls the horrific events of this evening, as she and her two young children are forced to witness Sean’s breakdown and frightening behavior, fearing not only for his life, but for their own. Sean survives, is arrested, and is subsequently jailed. Then, incredibly, after his release, the same thing happens again exactly a year later, as he suffers a repeat breakdown and once again challenges the police to come and get him, putting his family’s lives at risk in the process. By this point you’d be easily forgiven for wondering why on earth Prinsen doesn’t just leave, but it’s here that the relevance of the book’s title becomes clear. Prinsen adopts the military philosophy of “No One Gets Left Behind” and refuses to abandon Sean, no matter what anyone else tries to convince her, or how tempting it might sometimes seem. Looking back, she realizes that she plays a codependent role in the relationship, too.

But Prinsen doesn’t let her husband off the hook lightly, either, and always holds him fully accountable for his actions. “It took me many more years to fully grasp the reality that abuse isn’t just physical,” she writes. “Sean was a master at manipulating my emotions to get just what he wanted, and as difficult as it is even today to say the words — that is abuse.” Sean also used threats of suicide and self-harm to keep her from leaving or setting healthy boundaries, she tells us, recognizing it as a form of abuse. His “screaming, the holes in the wall, the slammed doors, and the broken objects” are also “definitely abuse.”

Later, Prinsen recounts, with brutal honesty, how she at times longed for her husband’s demise:

Sean stayed in our home, but I was finally starting to understand that Sean would never get help until he hit rock bottom. He needed to fall hard if he was ever going to get up again. I did something then that I’ve since found out is common behavior for the loved ones of addicts: I began to systematically pray for my husband’s downfall. I didn’t want him to get hurt. I didn’t want him to injure someone else and live with the regret. I didn’t want him to suffer lifelong consequences. I just wanted him to suffer enough to want to get help for himself.

It is rare to find these sorts of frank admissions in a personal memoir, let alone a first book, and it is this fearless honesty that makes Prinsen’s story so powerful. One can only imagine how difficult it must have been for her to put all of this into writing, knowing that her husband, friends, and family would all be able to read it. At one point in the story she finds herself wondering, “What will people think when they see this in the newspaper?”

In addition to sharing her own raw experiences, Prinsen also follows every section of the book with a short factsheet, providing the reader with a brief summary of the fundamental topics covered and links to further resources. These factsheets might easily have seemed disruptive or out of place, but Prinsen keeps them concise and informative.

The author also raises some vital ethical and political issues, questioning the morality of a government that puts soldiers in situations that destabilize their mental health, then prosecutes them as criminals. “How can we expect our veterans to come back to their homes and be ‘normal’ again after they have seen humanity at its worst?” Prisen recalls thinking angrily as she and Sean walked out of court one day. She feels sick when considering that Sean, who had never had any trouble with the law before he was deployed to Bosnia, was now a twice-convinced criminal. “What kind of a country is this to condemn and shame its own soul-wounded soldiers in such a way?” she asks. “Why don’t we just help them?”

Blind Devotion lives up to its name as a remarkable testament to the unquestioning power of love against all other odds, including the most destructive forms of mental illness. This is a story of survival, with protagonists who are determined to conquer their personal demons and triumph, no matter what. Prinsen’s writing will appeal to every reader, regardless of whether or not they’ve had to deal with PTSD. For the hundreds of thousands, if not millions, of military families who can relate to her experiences firsthand, hearing Prinsen speak about them so openly and shamelessly will surely be a relief.

Blind Devotion: Survival on the Front Lines of Post-Traumatic Stress Disorder and Addiction
Hazelden, September, 2012
Paperback, 348 pages
$14.95

In Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back, Shannon Cutts attempts to break through the loneliness of eating disorders with the war cry “Relationships Replace Eating Disorders.” Her method focuses on the importance of developing strong relationships with the self, family, friends, and a mentor.

Shannon Cutts is very familiar with living with an eating disorder; her own struggle, she tells us, began at age 11. The weight loss and damage to her bones and ligaments ended her future career as a blues and jazz musician and she dropped out of college.

After finding a mentor and getting on the road to recovery, Cutts founded Key to Life: unlocking the door to hope, an organization that offers events, workshops, concerts, and other activities designed to facilitate with healing from eating and related disorders. She also founded MentorCONNECT, a community that connects potential mentors and mentees. Although Beating Ana is her first book, she brings to it a voice of reason, reassurance, experience, and determination.

The book is structured like an outline. There are four parts, each consisting of several chapters. The chapters begin with an email exchange between Cutts and one of her own eating disorder mentees. Cutts then explains what the chapter will focus on, whether it is the mental argument that takes place at mealtimes or the constant internal stream of insults that may come with an eating disorder. Each chapter has an assignment for the reader and ends with an encouraging “Life Celebrating Affirmation” to be repeated in times of struggle.

The first part of Beating Ana is an introduction to Cutts and the Mentor Method. She shares the story of her struggle with anorexia and bulimia and introduces the reader to the idea that “relationships replace eating disorders. Period. The end.” Her “Mentor Method” is based on the sponsor method used within the Alcoholics Anonymous program; she describes the method as the “voluntary, ongoing, interactive relationship between the mentor and mentee (giver and receiver), for the sole purpose of facilitating progress in recovery.”

Cutts moves on to target the internal conversation that takes place in the mind of a person with an eating disorder. She introduces the “H.O.W. of Recovery (Honesty-Openness-Willingness)” which is another tradition of Alcoholics Anonymous, one that is very important to the recovery process. She also highlights the “F.E.A.R factor: False Evidence Appearing Real.” For example, to someone with an eating disorder, the F.E.A.R. may be “food is a toxic substance that we must avoid at all costs,” whereas the FACT is that “food is a must for our body to survive.”

The bulk of the book is taken up by part three, which focuses on what we can learn from films. However, the movies that Cutts cites and uses for each chapter do not focus on a character with an eating disorder; rather, they provide a lesson for the reader to focus on and an assignment that assists in learning it. The movies that Cutts refers to are varied: from “8 Mile” to “Catch Me If You Can” and “Something’s Gotta Give” to “Girl, Interrupted,” each movie has a lesson about perseverance, freedom, or the finality of death. This section ends on “A Beautiful Mind.” Focusing on the main character’s determination to gain control over his own illness, Cutts encourages the reader to make a list of his or her own “I can’t” scenarios and replace them with “I can” statements.

Finally, Cutts wraps up the book with a section that she says contains “some of the key techniques” from her own recovery work. She encourages readers to take control over their mind; to assert domination over the eating disorder voice; to make life and living the number-one priority; to accept that relapses may happen but to use them as “rocket fuel for recovery;” and to recognize that they are separate individuals from the eating disorders and that the eating disorder does not identify them.

Shannon Cutts makes a powerful impression. Although I do not have any personal experience with an eating disorder, I could feel the author’s words resonating with me and the encouragement and support they conveyed. I was even able to see where some of the lessons may even be applicable to my own life.

That being said, her book is probably not the best source for someone to turn to if they are attempting to understand, from the outside, the mind of someone with an eating disorder (e.g., a parent trying to understand their child). Indeed, the book is not meant for this use. It is specifically geared toward the person with an eating disorder. Although the lessons of each chapter are valuable, the chapters that are inspired by movies may be a bit abstract for some readers. For instance, the lesson from “Something’s Gotta Give” is that putting too much restriction on your life does not allow you to live. Being an adoring fan of said movie, I had to ponder this particular note on the plot for a few moments to begin to see the point that Cutts was attempting to make. Perhaps viewing the movie while working on the assignment that Cutts has paired with it (which is her suggestion) would help a bit more.

Overall, however, Beating Ana seems like a wonderful resource for someone suffering from an eating disorder. Shannon Cutts’s personal experience makes her an experienced ally and mentor to someone who may be lost on the path to recovery. Her cheerful determination and powerful enthusiasm make this book a great tool to keep on hand.

Beating Ana: How to Outsmart your Eating Disorder and Take Your Life Back
HCI, January, 2009
Paperback: 236 pages
$14.95

An estimated 23 million Americans struggle with addiction. Many of these addicts seek AA or NA as part of their road to recovery. A number of rehabilitation centers focus on the 12 steps and urge those in recovery to continue attending meetings on a regular basis to maintain their hard-earned sobriety.

The 12-step program is responsible, in part, for saving many lives. This cannot be debated, but neither can the reality that the program is not effective for everyone. Those recovering from addiction recover in different ways, and the underlying spiritual elements of AA and NA can be confusing and uncomfortable for some.

Deborah’s story is common: Drugs and alcohol, once something she could control, began to define her life after a time. It is also important: It sheds light on the reality that recovery does not necessarily have to be found within “-Anonymous” programs. In fact, some of the principles of the steps can be frightening for people.

Deborah has been sober for over seven years, although she still and will forever describe herself as “a recovering addict.” This is the general consensus in regard to addiction recovery. Similar to chronic mental or physical illness, the nature of addiction requires those living with it to constantly monitor mood changes, life events, and triggers that may spawn relapse. Addiction is, in fact, categorized as a mental illness.

Deborah has two children, both under the age of 15, and she has been married for 23 years. She works part-time as a nurse and spends her spare time hiking and with her family and a close group of friends, many of whom also are in recovery. While this may sound like the stuff of a normal, everyday life, it was not always this way.

Deborah describes the impact of her addiction on her family:

My children were young when I was active in my addiction. I don’t believe they understood what was going on, though my husband worked to be honest with them. He told them I was sick and would become well. When I was an addict, my family, while important, were not as important as drugs. I felt I needed drugs in order to function, and I did function for some time. I managed to complete my nursing degree, but it all fell to pieces. Addiction nearly killed me, and I needed help. I finally realized, after five years of serious addiction, that I could not do it on my own.

During her stay in a rehabilitation center, Deborah was taught that the 12 steps were an important part of her success. However, she struggled with some of the core principles, the spiritual principles in particular. She is not alone.

The basic text of Narcotics Anonymous states as part of its 12 steps:

We admitted to God, to ourselves, and to another human being the exact nature of our wrongs… We were entirely ready to have God remove all these defects of character… We sought, through prayer and meditation, to improve our conscious contact with God as we understood Him, praying only for the knowledge of His will for us and the power to carry that out.

I presented these excerpts to Deborah; she was already well aware of them. In fact, she’d spent a very long time working to understand them and to apply the steps to her recovery journey. While the steps do make a point of mentioning that a person is to understand God “…as we understood Him,” implying that the program does not require a person to be religious nor adhere to any specific principles, the words do still feel stifling to those of other belief systems.

Deborah spent the better part of a year attending the meetings at least three times a week. She obtained a sponsor, a commonly recognized hallmark of the program, in order to work toward completing the 12 steps.

Nevertheless, as hard as she tried to work the program, she felt confused.

My sponsor, an exceptionally kind woman, worked to help me understand the concept of a ‘Higher Power.’ We spent hours over coffee discussing my innate reluctance to approach recovery in this fashion. It became difficult for us, as the months passed and I remained uncomfortable with the ideas, to maintain a healthy relationship with her. I realized then, after I had a year of sobriety under my belt, that the program would not work for me. I had initially assumed that because it has worked for so many people, it would work for me if I tried hard enough. I had to find another approach to my recovery. I had to find my own way.

After deciding to leave the program, Deborah and her family were anxious:

I had spent a long time thinking about what direction I would take. Instinctively, I knew the program would not work for anymore. My husband was understandably nervous. He urged me to stay and give it more time, but I had put enough time into trying to fit the mold. Yes, I was afraid, but not because I thought leaving would cause relapse. I was afraid of recovering alone.

Although she decided the 12 steps were not for her, Deborah recognized the difficulty — if not impossibility — of recovering alone:

It was sort of scary at first, but I was certain I was not the only one who needed to approach recovery in a unconventional way. I was surprised to find support groups that focused on recovery without any of the spiritual elements. I met fantastic people, and while we had meetings, we also took a different approach. We hiked together and found different outlets, doing things we had never done before. I actually skydived this year, something I never would have done otherwise.

Addiction is an isolating disease. While 12-step programs undeniably help many addicts, other options do exist for those who feel they do not fit in. The goal for addicts is ultimately to find a life free of addiction, no matter the route taken to get there.

References

Bill W. (n.d.). In Wikipedia. Retrieved September 14, 2012, from http://en.wikipedia.org/w/index.php?title=Bill_W.&oldid=511410040

Egan, Pamela. (n.d.). 23 million Americans addicted to drugs and alcohol. Pamela Egan: Nurse Practitioner, Diabetes Education and Health Columnist. Retrieved from http://www.pamelaegan.com/articles/addiction/

J., Deborah (surname intentionally withheld). September 14, 2012. Personal interview with author.

Narcotics Anonymous. 2008. Narcotics anonymous. (6th ed.). Chatsworth, CA: Narcotics Anonymous World Services, Inc.