Sanctuary for the Abused
Friday, October 04, 2019
When the Body Says NO
WHEN THE BODY SAYS NO
"Once thought to be in the domain of genes, our health and behavior have recently been revealed to be controlled by our perception of the environment and our beliefs. Gabor Maté, M.D., skillfully blends recent advances in biomedicine with the personal insights of his patients to provide empowering insight into how deeply developmental experiences shape our health, behavior, attitudes, and relationships. A must-read for health professionals and lay readers seeking awareness of how the mind controls health."
–– Bruce Lipton, Ph.D., cellular biologist"The interviewees’ stories are often touching and haunting. . . . Maté carefully explains the biological mechanisms that are activated when stress and trauma exert a powerful influence on the body, and he backs up his claims with compelling evidence from the field. . . . Both the lay and specialist reader will be grateful for the final chapter, ‘The Seven A’s of Healing,’ in which Maté presents an open formula for healing and the prevention of illness from hidden stress."–– Quill & Quire
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Labels: abuse, autoimmune, breakdown, emotional healing, illness, pathological, relationships, stress
Monday, August 27, 2018
Sexual Anorexia
...and A Small Town Private Practice
The following is a conversation between Michael Zahab, a public relations manager at recovery facility, and the husband-wife team of Paul Hartman, M.S., Marriage & Family Therapist, and Ginnie Hartman, M.A., L.P.C. The Hartmans have worked together in private practice since 1991 at the Healing Center in Spring Lake, Michigan. Paul and Ginnie began their counseling careers in 1981 and 1985, respectively. They recently completed training with Patrick Carnes, Ph.D., for the treatment of sexual anorexia.
Michael Zahab (MZ): Please tell me about your professional background and your current practice.
Paul Hartman (PH): I'm a Marriage and Family Therapist in private practice, specializing in addiction issues. In many years of working with recovering alcoholics, I've tried to help those people who are physically dry move on to a higher level of recovery by dealing with family of origin issues as well as doing Twelve Step recovery work. Despite seeing much progress in my clients, I've continued to feel that something was missing in my work.
I've discovered in the last couple years that the issue I've seldom, if ever, addressed is sex addiction. So, after training with Pat Carnes, I began to do groups that specifically focused on this area. Most participants have been people who were already in recovery from another addiction-long-term recovery for some-but all were still having relationship problems and experiencing pain in their life. Once I began to address sex addition issues, once I made it the primary thrust of therapy, I began to see a tremendously positive response among some of my clients. I'm very excited about the outcomes I continue to see.
Ginnie Hartman (GH): My work for many years has focused primarily on individual families that have been affected by addiction. I have done a lot of group work on family of origin issues and have seen remarkable progress. After my training with Patrick Carnes, however, I began to look for and talk about sexual anorexia-and I have been amazed by the number of people-women, primarily-who struggle with this problem. I've long believed that when substance addiction is present in a relationship, sexual function is usually distorted. But I never understood the dynamics involved until I worked with Pat [Carnes]. I am so excited as I watch the participants in women's groups that have been together for quite a while bloom as they discover and explore their sexuality for the first time.
MZ: Do you believe that this is a new problem, or is it something that we've simply overlooked for many years?
PH: Awareness has been building for some years, beginning for us with the model Claudia Black developed in the early 1980's when she published, It Will Never Happen To Me. We've also had Pia Mellody's work to draw from. I was familiar with Pat Carnes' work through his books, but it wasn't until training with him that I set up groups explicitly focused on treating sex addiction.
This is an important point. Previously I put all my clients together in groups; I didn't differentiate. Generally, the clients in such groups became, after several months, became good friends. They felt safe enough with one another to disclose family secrets, but what they didn't do was talk about sexual issues. No matter how safe the environment, these issues never seemed to come out mixed groups.
My first (sex addiction) group was composed of men who had at least two of years of recovery and had done a lot of group work. When they came together in a sex addiction group, experiences came out that they had never before talked about. It's been the missing treatment piece for these men.
Frankly, I'm coming to believe more and more that the so-called primary addictions aren't truly primary addictions. I'm seeing more and more men for whom the primary addiction is sex addiction. The other addictions are secondary to sex addiction.
MZ: Spring Lake, Michigan, is not a large community. Has it been difficult to pull together enough people to conduct groups which address sex addiction?
P.H.: When I came back from the training, I wondered about this same question. As soon as word got out around the community that I was doing this, however, people were calling and asking to get in the group. Now I have two groups running concurrently, and could easily do one every night of the week if I had the time.
MZ: Ginny, what was your experience coming away from the training? Are you finding a similar situation among the women with whom you work?
GH: Although I've always treated some sexual dysfunction, I'm now just much more aware of the problem. After evaluating my clients more carefully, I realized that those who were in a relationship with an addict had invariably shut down sexually in some way and disowned their sexuality. Several women, when first approached about sexual anorexia, responded with such comments as, "I'm not sexual, and I could care less if I ever have sex again. I'm fine without it. I don't feel anything is missing." Other were being sexual with their partner, but only for their partner, not for themselves.
Each of these women had done family of origin work, a lot of recovery work, and were in a Twelve Step program. I had to really help them understand that they would not be fully recovered until they could embrace their sensual and sexual being. After announcing the group and suggesting Pat Carnes' book, Sexual Anorexia, I had a group of ten before I knew it. As word spread in the recovering community, I had another group of ten-and now I have people on a waiting list.
MZ: Do the women in group meet the criteria for sexual anorexia more than the criteria for any of the other sexual disorders?
GH: It seems so. The typical woman who has been in relationship with an addict has totally disowned her sexuality. She's decided she doesn't want or need sex any longer. This represents a shift to an extreme; these women have not had a lifetime of sexual anorexia. There are, of course, women who have been shut down sexually most of their lives, but that doesn't seem to be the norm among those I've seen.
MZ: Do the couples or individuals with whom you've worked have sexual or relationship issues, but no other apparent dysfunction?
PH: We occasionally see people like this, but, they're not our typical couple client. Generally speaking, our typical couple is in their late 30's or 40's and has been in Twelve Step recovery for six, seven, or eight years. The husband is an alcoholic with seven to eight years of sobriety and he's been active in A.A. During this time, his spouse has been working a good Alanon program.
When they come to us, we hear such stories as: "We're doing everything the program tells us to do. We're working the Steps; we've got a sponsor; we're not into our addiction, but our relationship is terrible and we're thinking of getting a divorce." After a deeper assessment of such couples, we quickly get into the issue of sexual satisfaction and dissatisfaction-and there it is.
MZ: Among the dysfunctional behaviors, are the Internet and pornography a factor? Tell me about this.
PH: I'd put this right on the top of the list. I continue to be amazed each week as people come in and disclosing the ways they use sexually explicit materials on the Internet for arousal and masturbation and how they go to chat rooms and how they then go out to meet people from the chat rooms. That's got to be one of the top issues we deal with in our marital therapy work. This is something that, two years ago, I never asked about. Now, I ask routinely.
GH: I can't tell you how many women who have come into therapy saying, "My marriage is falling to pieces, I don't know what's happened, my husband is up all night on the computer, on the Internet." They have no idea what's going on. As a therapist, you simply have to be aware of this problem.
MZ: How has the training affected your clinical approach and work?
GH: Understanding the anorexia cycle (preoccupation, distance strategies, sexual aversion, despair) has been so important for us and for our clients. It's so much easier to identify how sexual addiction has affected individuals and their intimate relationships. Previously, I recognized that some kind of cycle was in place, but I didn't have a term for it. The term "sexual anorexia" fit perfectly. Clients understand it, too. They know immediately what we're talking about. Consequently, it's much easier to then help clients see how that cycle had interrupted their own sexual maturity and growth. It's made all the difference.
PH: Our work in addictions has long had this basic premise: all current dysfunction is tied in to dysfunction in the family of origin-and that dysfunction often took the form of child abuse. One way people survive that kind of experience is to shut down emotionally. The focus of our work has been to help people access those repressed feelings and express them, and the result has been healing.
In contrast, whether it's Ginnie's sexual anorexia group or my sex addiction group, we focus explicitly on the sexual issues and the thoughts, feelings and behaviors that accompany them.
The other difference is that every week, the group is focused on something that is explicitly sexual. We really follow the outline we received at the training, starting with denial and going right through that outline, you have a subject and it just builds-it just provides the program.
We have a large population of clients who have been extensive family of origin work, so not all are starting from square one-but some are. Initially, I was concerned abut how I could take two divergent groups and treat them together. I decided to deal with child abuse early in the process. That piece of it was repetitious for some, but they didn't object. And those who hadn't dealt with these issues found it very revealing and helpful.
MZ: How did you implement what you learned in the training?
GH: I began evaluating my clients to discover those who had sexual disorder issues, and gave those who did some of the literature to read. I also checked with clients who had finished family of origin work and suggested they do some reading on the topic, too. Many more than I expected called back immediately asking to be in the group.
PH: It hasn't worked that well for me on the sex addiction side. I typically recommend Out Of The Shadows or Don't Call It Love. For a person who is in denial of their sex addiction, my experience is that those books don't do a lot to bring them out of denial. When reading about the behaviors that Patrick describes, many men focus on what they don't do.
One-on-one therapy, however, has help enormously. Through it, these men begin to understand that if they're spending an inordinate amount of time fantasizing about sex and/or objectifying women-regardless of what acting out behaviors they have-this alone is enough to make the diagnosis of sex addiction.
I also stress that such a diagnosis is important, not to put a label on them, but to help us know how to help. Some of these guys have been all over the mental health community looking for help, but haven't gotten it. They've been treated for anxiety disorders, depression, obsessive-compulsion disorder, you name it. Many of them have been on medications, especially the SRI's (seratonin reuptake inhibitors) with some improvement. But after all the treatment and all the Twelve Step experiences, they're still coming back saying, "Is that all there is?"
MZ: As a member of the group progresses, what indications or changes do you see?
PH: These male sex addicts have been carrying an enormous level of shame. I believe now that more shame is associated with sex addiction than any other dysfunction. Because of the shame, there's an extra need for secrecy. In treatment, we work to reduce their level of shame, and that alone has an enormous impact on their lines. As their shame decreases, their self-esteem increases. They start to believe, often for the first time in their lives, that they are valuable people. To me that's been the biggest change that I've seen emerge from this group. These men are beginning to really love themselves. They seem themselves as worthwhile, good men. It's so powerful.
GH: I think one of the changes I see is people rediscovering their passion for life. When you shut down any part of your being-particularly your sexuality-you just lose some of the passion and vitality for life. I see life back in their eyes, color in their face. I see a lot of physical changes in female clients. They move differently, they are able to wear feminine clothes again, and they report learning once again to enjoy touching and being touched.
PH: Ginny and I have seen similarities in progress and healing in both our male and female clients, but we have see one significant difference: the progress women make seems to be quite steady and straight ahead. The men in my group, however, initially made good progress breaking through denial. They could identify their dysfunctional sexual behaviors, and, I believe, genuinely wanted recovery. Yet week after week they came to group talking about slipping-going back to their dysfunctional sexual behaviors. I think what Patrick has learned about this in his research is that it's very typical in the first year recovery from sex addiction.
MZ: How is the support community where you practice?
PH: That was another concern I had. We have a very strong A.A. recovery community, but other Twelve Step programs are not widely available. There were no S.A. groups in our area, which meant clients had to drive 45 minutes to less than ideal groups. I'd advise therapists who try this approach to encourage your own clients to start a Twelve Step group-which is what we did. Attendance is typically twelve to sixteen people, and they've just recently expanded to an additional evening night. Both are well-established and well-attended. GH: All of the women I see are in Twelve Step groups, too. Two or three women have sought help for more family of origin issues. And when they finish this group (sexual anorexia) they too will probably go into one of our family of origin groups.
MZ: How critical is to have members of the family of origin geographically close with regard to progress with therapy and recovery?
GH: We have found, since we use experiential and psycho-drama techniques, that it isn't necessary for the family to be physically available.
PH: I agree. Today's treatment techniques enable people to heal whether or not they have direct access to family. A typical dysfunctional response is to cut off relationships-from parents, from siblings, from adult children. I think as long as those severed relationships continue, a certain amount of woundedness lives on inside the person. After they learn how to set boundaries, clients can go back and sustain family relationships-even with a member who has not been through recovery-most, but not all, of the time.
http://www.sexhelp.com/sa_small_town_practice.cfm
Labels: abnormal, abuse, denial, relationships, sexless, sexual anorexia, withholding, woundedness
Friday, July 27, 2018
Top 10 Wreckers of Relationships
Top 10 Relationship Wreckers
1. Neglecting Your Partner (ignoring, workaholism, addictions):
A primary function of a relationship is to provide companionship and to meet each other’s needs. When other activities, interests or preoccupations interfere with our availability, we can wind up short-changing our partner. This can be thought of as absenteeism or being MIA. Taking an inventory and making adjustments in how we spend our time is the first step in correcting this problem. Treat your partner as the important person they are by spending enough quality time together to satisfy each of your requirements in this area and to maintain your connection.
2. Depriving Your Partner (not being attentive, expressive, affectionate, supportive, caring, loving, withholding compliments - affection - intimacy):
Being there physically is not enough. We cannot expect our relationship to thrive if we withdraw emotionally for extended periods of time. In order to be fully present, we must be aware of our partner and be willing to show how we feel both verbally and non-verbally. Expressing love though affection and caring behaviors are crucial to keeping a relationship strong and vibrant. Small regular doses of intimacy will usually suffice, and the most important times of day to communicate positively are upon waking, upon reuniting after a long day, and before going to sleep.
3. Dishonesty & Betrayal (infidelity, lying):
Most people are aware that the foundation of any relationship is T-R-U-S-T. In no relationship is trust more important than in a relationship between mates, except for a parent and dependent child relationship. Cheating and lying breaks down the basis for a relationship, and often results in its demise. A problem of this nature is serious, and resolving it must be a top priority if the relationship is to survive. Couples counseling is highly recommended in order to facilitate the changes that are needed.
4. Attacking Your Partner (blaming, abuse – physical, emotional, sexual):
Aggressive communication is simply unacceptable, especially if the abuse is getting physical. Physical or sexual abuse are deal-breakers in a marriage, and should prompt a permanent separation. The abusive partner needs to get professional help to learn skills in anger management, in order to gain and consistently demonstrate better control over his or her emotions and behavior. Even if the help is sought and progress is made, the risk of recurrence remains high, so in most cases, the abused partner should not return to the relationship. Returning serves to reinforce the abusive behavior, leading to increased severity and frequency of subsequent abuse. Instead, the abused partner should also seek help, and work through issues that have potential to lead one into another abusive relationship. Verbally blaming, accusing, and insulting your partner are less extreme forms of destructiveness, but are not OK either, and assertiveness training can provide the essential skills for healthy communication.
5. Scapegoating (taking your anger or frustration out on you partner):
We all know that it’s not right to kick the dog after a hard day at work, so why do it to your partner? Being held responsible for things that are out of our control is the most stressful of conditions, and that is what we do to our partner when we scapegoat them. Rather than hurt the ones you love, do what it takes to meet the real problem head-on, as effectively as you can. If you are unsure of how to address a problem, the strong and mature thing to do is to ask for help and support from trusted sources (i.e., a friend, relative, or therapist).
6. Negativism (nitpicking, nagging, criticizing):
In order to have a good relationship, the positives must outweigh the negatives by a large percentage. If negativity is creeping into your relationship, it is like water seeping into walls, eventually weakening the structure. People usually feel good around others who are upbeat and positive, as well as those who help them to feel good about themselves. Bringing a negative spirit into your relationship crowds out the positive. However, pushing aside or neglecting to address real problems is not the answer either, and can be just as harmful to relationship health as dwelling on the negative. So pick your battles wisely, strive to communicate effectively, and practice cooperative negotiation.
7. Gossiping (telling family or friends about your problems but not addressing them with your partner):
That’s right, if you are talking about the problems in your relationship with friends or relatives but not working on improving the situation, that amounts to gossip. Gossip is not a productive way to handle problems, and can result in additional problems. For instance, your partner may feel betrayed that you revealed sensitive material to others that cause him or her to be embarrassed or uncomfortable around them. Also, if you promote a negative side of your partner or your relationship, others may get a distorted view, and changes in their attitudes and behavior may follow. Others may remember your conflicts long after you and your partner have gotten past them. Instead, work on improving your communication skills. Turn toward your partner, not away. If you need help, seek out the assistance of an objective third party such as a therapist who works with couples. When it comes to your needs, stop complaining and start asking!
8. Controlling Your Partner (“my way” or else, perfectionism, trying to change your partner, possessiveness):
Wanting things to be a certain way and having preferences are completely natural and even healthy. However, when this tendency becomes extreme and starts to encroach on the rights, needs and desires of others, it can cause major havoc. Freedom of will and self-determination are basic needs, and when these are being threatened, negative reactions may include anger, resentment, and/or rebellion. If the need to control is a problem in your relationship, identify the motivations behind it and work towards dealing with those issues rather than acting them out with your partner.
9. Putting Yourself First (self-centeredness, selfishness, entitlement):
It’s not “all about me,” folks. Letting one’s self interests take priority in an unbalanced way can be toxic to a partnership. The other person usually winds up feeling deprived, resentful, and unimportant. Furthermore, the more self-involved you are, the more you take your relationship for granted, the less you appreciate your partner, and the more alone you actually are. So if your relationship is slanted in this way, you also lose out, because you experience less of the joy that a true connection brings. You and you partner both get more from the relationship through reciprocity in giving and receiving.
10. Putting Yourself Last (self-neglect, passivity, self sacrifice):
Martyrs are seldom happy. More often, they are angry, bitter, resentful, depressed and burned out. This is not to say that you should not consider others and be thoughtful in meeting their needs. But having a healthy relationship involves factoring your own needs and desires into the equation. You teach people how to treat you, and if you act like a doormat, you can’t completely blame someone if they wipe their feet on you. Learn how to stand up for yourself, practice assertive communication, ask and allow others to meet your needs, and take care of yourself as much as you take care of your loved ones.
Labels: abuse, betrayal, infidelity, martyr, narcissism, psychopathy, relationships, selfish, sociopathy, wreckers
Monday, October 30, 2017
Abusive Relationships & Toxic Guilt
I believe that most of us, especially those of us who have mental health disorders, feel guilt in situations where we have no business whatsoever feeling guilt.
It is easy to just look at our behavior, the situation and ourselves and say "I'm guilty! I am ashamed." Now let's back up a bit here.
When I say look at ourselves, it might benefit most of us to look a little deeper. We are complex, complicated creatures and our motivation for doing or not doing something is not just based on our personality, our will, etc.
What do I mean? Let me give you an example of something that may help you see this picture more clearly.
I have been seeing a man who is extremely emotionally and verbally abusive. Now of course I was not aware of his abuse issues at first but I will admit that I saw red flags right from the start.
Mind you, I have trained staff in domestic violence, etc.
The situation I recently faced was a history of ten months seeing this guy, addicted to him, and no matter how much I complained to him about his behavior, I kept going back. I would continue to go back into a little denial that really he is not abusive and that one day we will have a wonderful relationship. I had a very difficult time facing reality because like any addiction, I would occasionally get what I call "adrenalin shots." These "shots" kept me hooked in a situation that I could not get out of. I could not get out of this relationship.
I did notice as I worked harder to get out, he trumped up his abuse. Finally the emotional abuse became so bad that I just could no longer take the abuse he threw at me.
Again I wrote him an email kindly asking him to end this thing between us as it was killing me and that I was having a difficult time getting out. Now imagine an abuser and their personality and their agenda. Would he kindly assist me in this? Of course not.
Of course I knew it was my responsibility to get out I noticed that every time I tried to get out I felt sick. I prayed and prayed to God and asked Him to assist me, started journaling, which did help by the way, but I couldn't get out and if I got close to getting out he knew just how to suck me back in. Wonderful words he would say - tell me just what I needed to hear.
Abuse of any kind decreases your self-esteem and for me I felt like my mind was literally being twisted. His behavior did NOT make sense and the more he did strange stuff, the more twisted I felt.
During this time I felt TREMENDOUS guilt that I could not leave the relationship. It was humiliating to keep enduring his abuse. Every one told me he was playing head games with me, playing with me, etc. This knowledge was very difficult to assimilate and I so needed to believe that he truly loved and cared about me and that I was special to him. I felt I couldn't face any other reality, as it was too painful.
One day I was eating lunch and watching a movie on television in the midst of all the craziness. In the movie the husband was verbally, emotionally and physically abusing his wife. Two times in the movie he said to her, "I own you." The first time it went over my head but the second time he said that to her my jaw dropped and I probably looked shocked, like I had seen a ghost.
My father repeatedly told me he owned me when I was growing up. I never understood that. Once in high school I remember him telling me how he wanted my hair cut. I kindly said I wanted it cut differently and he in no uncertain terms told me I belonged to him, I was his property and he will do with me what he likes.
I had many times questioned whether my dad was verbally and emotionally abusive to me for many years but I never got to the point where I completely came out of denial until now.
I think we are more inclined to unconsciously look for the environment we were raised in, even if it was abusive. We are familiar with that environment and a non-abusive environment is strange.
People that have been abused don't see a lot of the red flags that others see because that way of life for them I normal. Many of us feel that love is pain.
It is vital to remember when you look back on your life or you are currently facing a situation where you are unhappy with your behavior, that you are struggling so much due to your history of abuse. You may appear "weak" and unable to get out of that situation without outside help. It says nothing about your character but everything about your past.
So it is that in my opinion we go to therapy and learn what "normal" is so that we can behave more and more that way and be attracted to healthy people.
Experiencing guilt is not looking at the entire picture and is inappropriate in many cases.
There is "good" guilt that motivates us to do the right thing but in these situations we are experiencing toxic shame. Many of us feel we are bad all the way to the core.
Should we crucify our parents for our issues now? No. They may have done the best they can. Take a look at their family of origin.
We are always responsible for our behavior however and we are responsible to get help if we feel like we are drowning.
Labels: abusive, emotional, humiliation, relationships, toxic guilt, verbal abuse
