Essential Workers & COVID: Time and Space for You

By Concentric Psychotherapist Kylie Cherpes, LCSW, MFT-IT, CYT

In times of great stress, such as now with the COVID-19 pandemic, we each find that we have our own unique way of getting through. Some people find comfort by burrowing in at home and disconnecting from constant reminders of their fears. Others juggle between caring for their vulnerable loved ones and carving out time to connect with the support that they themselves need. Some turn their stress into energy towards solving problems or creating something new. While others hit the ground running, called to serve their community. Though we are all under cumulative stress and doing our best to face changes in our day-to-day norms, some, such as Essential Workers, are being impacted exponentially. Essential Workers are being asked to do more and risk more, all while having less access to what would normally help them respond to and recover from their stress.  

Essential Workers continue their work in environments physically underprepared for a pandemic. In a time that feels precarious, Essential Workers are asked both to stay calm and to stay flexible while managing ever-changing recommendations on how to keep their workplace, selves, and families safe. They spend hours reading, learning, and preparing protocols and responses to “what-if” scenarios that breed uncertainty and anxiety. Even after all of the precautions they take, they wonder if it will be enough to keep their work-family safe. When they leave work to go home they find it hard to relax as guilt, worry, and fear about possibly carrying the virus home to their loved ones enters their mind. Though they may have reached for their family and friends for help, love, and reassurance before, it now seems too risky. Where they would go for support and stress relief before, like churches, gyms, bars, and social outings, are no longer options. And even when there is time for it, it is hard to get restful sleep. 

When unable to respond to stress, especially on-going (chronic) or traumatic stress, the body, mind, emotions, and spirit start to show wear and tear. Those under chronic stress may notice that raw feelings such as fear, anger, helplessness, and sadness seem to be lingering, or other common changes such as an increase in irritability, numbness, bitterness, or detachment (that “spaced-out” or “distant” feeling). Chronic stress can also show up as headaches, stomach aches, and muscle pain, or changes in appetite and sleep. Sometimes those under chronic stress may not even be the first to notice the impact it is having, but instead, those closest to them do. For instance, slips in memory or ability to recall information, mistakes at work that used to be uncommon, or shifts in hygiene and self-care regime may be noticed by work colleagues. Family and friends of those under chronic stress may see their loved one’s constant exhaustion, zoning out, adopting an abnormally cynical outlook on life, or lacking the ability to find pleasure in things they had once experienced as enjoyable. 

As therapists, we can close gaps in the care being offered to Essential Workers by providing access to the mental and emotional support they deserve. To support Essential Workers’ day-to-day functioning and healing, we hold space for them to process and release stress and trauma. Just as each Essential Worker has their own unique way of responding to their stress and trauma, each therapist has their own unique approach and is able to tailor care to each individual they work with. Whether it be brief or long-term, therapy is a safe place for self-expression and a secure place to find relief from fears, anxieties, anger, and sadness. Further, therapy is a place of creativity and strategy, used for building coping skills to reduce distress and restore feelings of stability and hope. 

At this time, we know that the Coronavirus is not going away anytime soon and that things may indeed get worse before they get better. We also know Essential Workers will continue to be asked to bear the brunt of this pandemic with limited space (time, resources, and support) to respond to their stress in their own unique ways. It is not an option to wait to address the physical, mental, emotional, and spiritual needs resulting from the chronic and traumatic stress being endured by our Essential Workers. Unaddressed chronic and traumatic stress does not just go away, it accumulates. As therapists, we see the effects of these stressful days mounting on our Essential Workers, and we respond to say, “We are your Allies.”

Special Announcement: During April through May 2020, Concentric Counseling & Consulting is offering short-term telehealth and virtual video counseling to Essential Workers during these challenging times due to Coronavirus (COVID-19). We are all incredibly grateful for all that you do and we want to give back! You can use your health insurance for teletherapy. Also, for those who do not have insurance coverage or have certain insurance plans and have endured financial hardship due to the impact of COVID, we are offering sliding fee and pro bono to a limited number of Essential Workers.

How to Open a Door When Coronavirus is Closing our Doors

By Concentric Owner Jennifer Larson, LCPC, NCC

Originally posted in The Sounds newspaper, Volume 43, Number 15 on April 4, 2020 and later in published in the Illinois Mental Health Counselors Association (IMHCA), a division of Illinois Counseling Association (ICA), News Update. Click here.

You know the saying “When One Door Closes, Another Door Opens”? During this time, we can’t help to notice closed doors everywhere, from schools to restaurants to places of worship to retailers. Even our home doors are closed, keeping others away and containing us inside.  It may seem overly optimistic to think this quote holds true during this extraordinary and challenging time with COVID-19 knocking on everyone’s door.  Alarm bells are sounded within us daily, the threats are real and experienced by so many, and some of us feel our life has been hijacked.  So how can we during this time envision doors opening up or experience something positive from all of this? 

I am by no means suggesting doors are flying wide-open given the sheer number of doors that are literally closed and even locked. But, if you can take a moment to pause, focus and be intentional, you may find that you can open doors to otherwise missed opportunities. 

Psychotherapist and author Esther Perel states when faced with our own existential anxieties it can open the door to fully living.  Some of us may have been living life on auto-pilot depriving ourselves of certain reflections, experiences or opportunities. So, what does living fully exactly mean?

It can mean a lot of things, but to start, it can mean experiencing each moment and each day in the here-and-now noticing and appreciating all of life’s offerings. Perhaps you had been more disconnected from yourself, no longer appreciating your talents, thoughts, feelings and your body’s capabilities -- which you can now fully appreciate.  Or taking a moment to get out of your head to be fully present and connected with another person can offer you an opportunity to be transported, experiencing life through a different lens other than your own.  Also, fully activating your senses can bring about a subtle, yet powerful sense of fully living.  Consider next time you take a walk outside, notice all of your surroundings paying attention to each of your senses. Notice your positive feelings as you attune to your senses.  

Shawn Achor, an educator, researcher, and author, offers a number of research-based ways to live a happier life. One of them is to take a few minutes each day to write down 1 positive experience within the last 24 hours and provide 3 rich details about that experience. Also, write down your gratitudes, giving specific details.  And reach out to someone to fully express why you appreciate them.  We know giving to others not only makes us feel better, but helps the person on the receiving end feel happier too.

And last, what is something you can look forward to when the shelter-at-home Executive Order is lifted and you can bust out the sheltered seams?  Will it be something specific such as dining at your favorite restaurant?  A ritual or practice you will reacquaint with again?  For me, it will be telling myself “I get to go here or I get do this” which represents a door opening into seeing how choice and freedom are true gifts.

Remember The Weatherperson?

By Concentric Counselor Christian Younginer, LPC, NCC

What We Wish Life Were Like

The Curiosity rover landed on Mars August 6th, 2012, the end of a flight that began November 26th, 2011-- 9 months prior. At its traveling speeds, all predetermined by NASA’s Jet Propulsion Laboratory (JPL), scientists had to calculate where an orbiting planet would be 9 months from the moment of launch. In fact, they needed to know where Mars would be years in advance as they began building and programming the rover. They were able to plan for, predict, and pinpoint the location of a planet hurtling through space at 53,600 mph, rotating at 532 mph down to the meter to land a rover on its surface.

This is possible due to the predictability of the celestial bodies. Astronomers from thousands of years ago plotted out eclipses for hundreds of generations into the future, with impressive accuracy. It’s that there just aren’t very many variables in space; bodies in motion stay in motion, unless a force acts on them. And if no force does, they keep on trucking. Thus, their location is predictable. This does not mean that any part of landing a rover on another planet is easy--it’s just possible.

What Life Is Actually Like

Conversely, it is a common occurrence that shuttle launches are cancelled, last minute, tanks fueled, on the pad- due to weather… Earth weather. A shuttle, bound for space, to another planet, is grounded because humans cannot accurately predict the weather more than a couple of days out. And even then it can be a crapshoot. 

The reason for this comes down to something much more akin to living life: variables and information. There are simply too many variables to predict and too much information we’re not able to know. For example, if I knew the direction and velocity of every air particle on Earth, I could give you an accurate weather model. Obviously, this is not possible. So we’re left making educated guesses, working with what we have, and most importantly a social understanding that forecasts are guesses, not gospel. With this understanding comes a grace--sometimes annoyance--but a grace for being wrong. An ‘it’s out of our hands’ amenableness that wonderfully conflicts with the modern American desire for planning, preparation, and predictability. 

What Can We Do?

So often we try to plan for every eventuality, scrutinizing the details, languishing in an anxious mire of a desire for control, only to see our plans crash into a Martian hillside, due to an unforeseen variable. 

Often, the anxious try to view life with such a level of predictability. Hopes that the world will fit into plans and preparations, only to be disappointed when something unaccounted for goes awry. Often times this desire for control flows into our lives as a nagging generalized anxiety, a worry for all things in an effort to be prepared for every outcome. We wish life were as predictable as space travel. As oxymoronic as it sounds, going about our day may be more complicated than rocket science. And we tell ourselves that the stakes are just as high. 

As mentioned in regards to weather, the secret lies in the ability to tolerate the ambiguity of an uncertain system. We can be disappointed with an inaccurate weather report, but continue on to the next day. Yes it can suck when it rains when the news said it wouldn’t, but we don’t hold ourselves responsible for the outcome. In our own lives, we can place an enormous amount of responsibility on ourselves, often for things not in our control. We can assault ourselves with a barrage of ‘should have planned for it’ , ‘should have seen it coming’, or ‘should have done it differently’. All of which are the equivalent of looking at Tuesday’s weather and telling yourself you should’ve known that on Monday. 

Maybe we can have the same grace for the weatherperson, AND with ourselves. If we get it wrong, be disappointed for a bit, be annoyed, but let it go. Tomorrow is another day to try again. If we find ourselves feeling anxious about the ambiguity of life, rather than try to think out the outcomes, what if we gave ourselves permission to feel anxious for a bit? Feeling anxious about the ambiguity of every day is not a failing, but rather an admission to one’s self that we don’t have enough information. And instead of punishing ourselves for trying to know something we can’t, maybe we can have a little grace with ourselves, and remember the weatherperson. 

Where’s My Person? Complexities of Adult Friendships

By Concentric Counselor Kelsey Lamm Rottmuller, LPC, NCC

How do I feel by the end of the day? / Are you sad because you're on your own? / No, I get by with a little help from my friends — With a Little Help from My Friends | The Beatles

There isn't anything I wouldn't do for you / We stick together and can see it through / 'Cause you've got a friend in me — You’ve Got a Friend in Me | Randy Newman

If you wanna be my lover, you gotta get with my friends / (Gotta get with my friends) / Make it last forever, friendship never ends — Wannabe | The Spice Girls

And as our lives change / Come whatever / We will still be / Friends forever — Graduation (Friends Forever) | Vitamin C

Having come of age listening to song lyrics like these, and wistfully witnessing the implausible but admirable portrayal of kinship in the 90s sitcom Friends, I,  like many adults, developed certain ideas and expectations about friendship. For example, I grew up believing one should have a best friend and know how to not only make friends but keep those friendships thriving into adulthood.

But what happens when making friends isn’t as simple as swapping parts of your lunch with a classmate, or performing in the school play together? Even in college, school and extracurricular activities provided fertile ground in which the seeds of friendship could blossom, helped along by common interests and schedules structured around shared classes. Once the structured environment of school is removed and we are left to choose our own adventures, the work of maintaining and definition of friendship seems to dramatically shift for many adults. What perhaps once came relatively easily, now actually takes planning, work, and dedication.

In her Psychology Today article 5 Lies About Adult Friendships, Dr. Miriam Kirmayer unpacks and debunks commonly-held myths about friendships in adulthood. Primarily among these is that “by early adulthood, we should know how to make friends and handle the challenges that come with these relationships; that these are skills we learn early in childhood and adolescence, and that by the time we leave college or even high school, we should have it ‘figured out.’ The problem is, not only is this belief untrue, it can make us feel like we’re the only person who struggles and leaves us feeling disappointed, ashamed, or alone. This, in turn, makes it much less likely that we will reach out for guidance or support if (or when) we do struggle.”

The Struggle is Real

I’ve heard from clients, colleagues and compadres alike how challenging it can be to keep friendships alive, reciprocated, and not feeling like one more thing on a never-ending to-do list. Despite all the best intentions, life as an adult becomes increasingly busy as we fill our time with work, family, continued education, and expanding responsibilities. People move away, start families, follow jobs and hustle hard to build a life. This can leave little time and space for what feels like the luxury of friendship.

A friend from college once told me (before moving away and starting a family) that “being friends as an adult means you take turns texting each other ‘we should get together soon’ repeatedly until you die.” While that statement seemed morbid and pessimistic at the time, it also resonated with me as one of the many struggles faced in adult friendships. Everyone is so busy. Not spending time investing in and invigorating friendships can simultaneously feel like an uphill battle and a source of regret or shame.

Then there are those ‘rites of passage’ in adulthood that can make the lack of a best friend or even close friends acutely apparent. In the 2009 buddy/romance film I Love You Man, we see played out the challenge that can arise when one finds a partner to whom they want to commit but struggles to identify a platonic companion to stand by their side. This film has come up in my work time and again when discussing the loneliness and isolation experienced by clients who struggle similarly to identify close companions outside of family or casual work acquaintances. But why do we feel so driven toward close friendships? Why doesn’t simply having a safe, stable life, perhaps even shared with a romantic partner seem like enough?

The Psychology

In his Psychosocial Development Theory, ego psychologist Erik Erikson posited that young adults (defined by Erikson as ages 19-40 yrs) enter the Intimacy vs. Isolation (Sixth Stage) of development, in which they seek to resolve developmental conflicts related to emotionally intimate relationships. These relationships may be romantic and/or platonic in nature. Erikson believed that failure to resolve said conflicts by establishing close relationships could result in an experience of isolation and loneliness. According to the psychology, this sharing of self with others drives not only our romantic partnering, but also our urge to host a game night, share a multi-hour brunch, or schedule that phone call to dissect the latest Star Wars movie with our World of Warcraft guild buddy.

Psychosocial theory also suggests that a strong sense of self enables us to form intimate interpersonal relationships. Hence, feeling disconnected or unclear about our identity during adolescence - who am I? - can contribute to the struggles faced when striving for friendships as young adults. Sequentially, failure to master the formation of lasting relationships can then additionally hinder us from ‘making our mark on the world’, which is the major task of Erikson’s Generativity vs. Stagnation (Seventh Stage) of development (ages 40-65 yrs).

With each developmental stage building or even hinging upon the completion of its predecessor, it makes sense that we would feel pressure to create and maintain friendships even if we are not sure why or tend to err on the side of introversion. How can I ever Pass Go and Collect $200 – or more so – contribute to the world at large and create greater fulfillment, if I don’t have any close friends?

What Can Be Done?

First and foremost, know that you are not alone. As Dr. Kirmayer notes, it is far from uncommon to struggle with friendship as an adult. Often times, our self-imposed beliefs about how a friendship should look, or roles we are meant to play as friends get in our way more than they motivate growth. If you notice yourself falling prey to the ‘shoulds’ and ‘have-tos’, it can be helpful to challenge and reframe those beliefs, by replacing “I really should call my college roommate back” to “I want to call them, I miss our connection”. Chances are, your friends are equally as busy and will be equally as understanding and appreciative to hear from you – even if just for a quick 10-minute catch-up while you finally fold that pile of clean laundry that’s been staring you down from atop the dresser for the past week. Small steps are ok.

A quick “I’m thinking” about you text – or even better, an actual card via snail mail still tells someone they are thought of and valued. It also goes much further than a “like” on social media or racking yourself with guilt to sustain the friendship. Lean into what brings you together rather than what pulls you apart. Did you first bond over a mutual love of quirky 80’s movies? Maybe it’s time for a movie night. You can debate the most quintessential piece of John Hughes’ filmography or how well or not The Breakfast Club translates to a post-baby-boomer demographic rather than bemoaning how you never see each other anymore despite living less than 30 minutes apart. It doesn’t have to be expensive. If going out for dinner or drinks is not in the budget while you save for a down payment on that first home or even just tickets to that music festival you’ve been pining for – perhaps split the cost of ingredients or encourage BYOB and host a make-your-own-pizza kind of night.

Finally, if you find yourself struggling with emotional intimacy in general or feel paralyzed by social anxiety or depression, consider reaching out to a trained therapist or a support group. There are those that want to help, if we let them and can find the courage to ask. It takes strength to reach out for help and trust someone – friend or otherwise – in which to confide.

Thank you for being a friend
Traveled down a road and back again
Your heart is true, you're a pal and a confidant

—Thank You for Being a Friend | Andrew Gold

The Trap of Anxiety and Trauma

By Concentric Owner Jennifer Larson, LCPC, NCC

Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.

To read the entire blog post on the Anxiety Relief Project’s website, please click here.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Utilizing The Transtheoretical Model or ‘Stages of Change’ to Better Understand Your Addiction

By Concentric Counselor Charles Weiss, LCPC

If the dopaminergic receptors in my brain didn’t make me feel so good when stimulated and weren’t so intertwined as well as interwoven with my serotonin levels and that my GABA receptors didn’t inhibit my nerve transmission leading to my brain activity level to be depressed, I would have never used in the first place.  Do people who suffer from addictions really think like this?  Do they really understand the intricacies on how drugs affect the brain and other physiological aspects of their bodies?  If they had that insight or answers, would they still want to get high, continue rationalizing the reasons in which they use or actually seek out help?

For the change process of the individual to be effective and impactful, it is helpful to better understand how certain drugs affect the brain.  Different drugs when taken affect different aspects of our brain functioning.  For example, alcohol is a depressant, which slows down or depresses our Central Nervous System, which helps reduce anxiety and inhibit relaxation in our body.  It slows down brain activity through binding with GABA receptors to help with minimizing racing thoughts, rapid breathing and quick pulse.  Substances like opioids and stimulants, that target the pleasure center in our brain, which involves the Dopamine neurotransmitter, provide us with that “feel good response” that makes it more difficult for people who are addicted to want to quit.  Let’s not forget the cannabinoid receptors that are naturally occurring neurotransmitters that our brain produces, which Tetrahydrocannabinol (THC) and cannabidiol latches onto.  When this occurs, we often experience a more euphoric feeling and our sensory perceptions are often enhanced, which also increases the level of dopamine that is being produced in our brain.  This list is just to name a few of the more widely used substances individuals can become addicted too. 

Substances have the propensity to be both psychologically and physiologically addicting, meaning either the body and/or our mind needs the drug to avoid potential withdrawal.  Not everyone who tries a substance for the first time will become instantly addicted, however, it can increase their risk of them wanting to try it again because of how it made them feel. 

It is not just the neurochemistry in the brain that makes a person struggling with addiction want to use, but the stages of the change they are in can have an impact and effect into the chronicity of their use.  Prochaska and DiClemente postulated a Transtheoretical Model or what many might know as the “Stages of Changes” that people can experience when it comes to their understanding their addiction and their willingness to cease it. 

This model has 5 stages that an addict can experience, with a sixth called Relapse, which I will discuss later, that indicate the individual’s willingness of wanting to continue or cease the use of the substance(s). This model can also apply to a wide range of other behavioral challenges that individuals are having an arduous time in overcoming, not such substance use, abuse, or dependence. 

Stage 1- Precontemplation

Pre-contemplation is when an individual doesn’t think they have a problem with the drug and/or substance they are using and aren’t willing to change their behavior.  Oftentimes these individuals are in denial that their addiction is a problem, they have not connected the experience of the negative consequences of their addiction or understand the severity of their addiction at this time.  They are currently enjoying and appreciating the positive and pleasurable effected of their addiction, the “high” and positive aspects of the substance they are using due to neurotransmitters that substance targets to cause this affect.  It often isn’t until the individual begins to experience more of the negative aspects of the substance (i.e.: withdrawals, negative consequences from their addiction), will the individual begin to consider they might have a problem and move from pre-contemplation to the contemplation stage.

Stage 2 - Contemplation   

Contemplation stage typically occurs when individuals have the self-talk about the challenges and struggles in wanting to make a behavior change, yet are unable to pull the trigger at this stage and follow through with their thoughts of wanting to change or cut down their use.  Individuals are typically open to listening to advice on how they can change their behavior, to gain a bit more insight into their addiction, understanding the consequences of their addiction, but have not established and/or developed a specific plan on how they would like to change their behavior.  Utilizing a non-judgmental attitude and motivational approaches to encourage change, such as beginning to teach individuals a harm reduction approach, can help propel the individual towards the preparation stage of change.

Stage 3 – Preparation

During this stage of change, individuals are starting to become more committed into wanting to change their behavior and develop plans on how they can begin minimizing the frequency and occurrence in which they are using substances.  Individuals start to gain more insight into the impact and effects the substances have on their level of functioning and the dysregulation of neurochemistry in their brain through collecting and gathering resources either provided to them or investigating these resources for themselves.  They become more cognizant of their triggers and begin learning more effective strategies to minimize the occurrence of them as well as seeking out and developing healthier support systems to aide in their recovery.  Individuals begin to gain more insight into the consequences their addiction is having on their level of functioning.

Stage 4 – Action

As the insight and introspection into their addiction becomes more “front and center”, individuals are able to begin developing plans to implement to aide in their recovery.  Now all the preparation that was exerted and exhibited in the previous stage can be put into motion.  As stressful as this stage can be, it is the best time when interventions such as seeking out a Certified Drug and Alcohol Counselor (CADC), licensed therapist or going to a substance abuse or detox center can be most impactful and continue to move as well as guide the individual towards their recovery.  With a trained and licensed professional, appropriate and realistic goals can be established to be addressed gradually as well as developing more adaptive over maladaptive coping skills that are taught to help move the individual towards the maintenance stage.

Stage 5 & 6 – Maintenance/Relapse

After the strenuous time it takes into in acknowledging, accepting and putting into motion plans that become action, maintenance follows.  This is time in which the individual is able to maintain sobriety for at least 6 months of implementing everything they have learned in treatment and progress on the goals they have developed for themselves.  During this time, individuals might begin to feel complacent or feel like there is some plateau they have reached with their progress, that defaulting into their maladaptive habits might be inevitable.  However, with the continual commitment and support to their recovery, maintenance can be an obtainable long-term goal. 

Part of any recovery can be relapse, although not everyone experiences relapse(s).  When an individual relapses, they don’t necessary default back to Stage 1 - Precontemplation.  If the individual is committed and with ongoing positive support they have created for themselves, they might only fall back a stage to Action and/or potentially Preparation Stage.  It unfortunately might take an individual several relapses before they are fully committed to the change process.  The goal is never to give up and continuing reinforcing yourself of your commitment of wanting to make the behavior change in being able to abstain from one’s substance of choice, such as alcohol or illicit substances.

If you or a loved one is struggling with any addiction, please seek out professional help. There are countless resources available that can help and aide you in your recovery.  Change doesn’t happen overnight, but understanding as well as acknowledging that you might have a problem is the first step in your journey to change and living a healthier and more fulfilling lifestyle.  This Transtheoretical Model or Stages of Change by Prochaska and DiClemente might not be applicable to everyone, but it can be applied broadly to anyone who is willing and wanting make the necessary change to improve their overall lifestyle and to be a better you.