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Understanding Sex Addiction Through an Attachment and Trauma Lens

Understanding Sex Addiction Through an Attachment and Trauma Lens

Presented by Lisa Lackey, LCPC, CSAT, CMAT, EMDR II

Earn 1 free CME credit for this program from the RiverMend Health Institute

Transcript of Presentation:

Dr. Dan Angres: Well, hello everyone! People will be filtering in, I know, but I think most folks are here. I’m Dr. Dan Angres. I’m the medical director of the Positive Sobriety Institute. Also, on faculty at Northwestern. I want to welcome you to what is a monthly combined addiction seminar that’s Lunch and Learn. We provide the lunches as you see can see. This is a combined effort between the addiction component of the Department of Psychiatry at Northwestern along with us here at the Positive Sobriety Institute. We had a bit of a hiatus for a few months so we’re glad to get back into the rhythm of providing these seminars. We are extremely fortunate to have a very sort of important and gifted professional. I’m going to give a presentation today. I’m going to read a better part of the bio because I think that Lisa Lackey has really a fascinating history and provides so much to our patients in the mental health community.

Lisa now holds two master’s degrees. One in education from Garrett-Evangelical Theological Seminary at Northwestern University. The other is in counseling from the National St. Louis University. She has worked as a pastor, leadership development consultant, executive and corporate coach, interventionist and seminar presenter. She further enhanced her skillset by completing the requirements for certification. I think it is very salient for today’s presentation in sex addictions therapy or CSAT certification. Also, in multiple addiction therapy, CMAT. Training in sematic transformation and training as a Level II EMDR therapist.

Her passion combines to make her a dynamic and compassionate therapist, engaging workshop facilitator and speaker who connects as easily with the individual as she does with a large audience. She’s also worked in the field of general addiction since 1994 along with her husband as co-founder of Insideout in 1999. It was incorporated in 2005. This was in response to a desire to create spaces for transformative conversations. She’s also done a number of different series of seminars like conversations of the heart and that sort of thing which has been part of the creative process that Lisa gives us.

Finally, Lisa has this concept of limbic revisioning which is a nice way/effective way of talking about rewiring the neural structure of a person who has suffered trauma or emotional neglect. For this to occur, an external example must be present for the limbic brain to mimic. So, a deep, respectful, contemplative and heart-based listening that’s based on loving acceptance instead of judgment creates an optimum model for the traumatized limbic system to mimic as it is restructuring. I can tell you that both the Positive Sobriety Institute, myself, both personally and professionally have great/high regard for Lisa Lackey. We are so grateful that she and Insideout and her team are available to us and our patients. She has an enormous gift and the ability to not only have this knowledge base but tremendous compassion and investment in her patients. It’s an honor for me to now present you with Lisa Lackey. Thank you.

Dr. Lisa Lackey: Hello! It’s good that we get to meet before three o’clock or after lunch because then I have to do break dancing and all that kind of stuff to get your attention. But I am so glad to be here and to talk about what is passionate for me. Maybe a lot of what you may have anticipated or have an expectation of getting here, maybe some of that you’ll get. The way that I like to look at my work is this tremendous opportunity to keep showing up for people so that I can keep showing up for myself. And so, it really is a mutual exchange.

One of the things that I always start off talks with as it relates to clinicians is — My strong bias is that if we as clinicians aren’t continuing to do our own work, then we kind of put a ceiling on some of the work that we provide for others. A lot of what you’ll hear today is certainly research-based, tried and true. But even more than that, it is personally experienced in my own work of recovery that continues to go on. I wanted to share that.

I want to start off with those people. These people are people I come from. If you can’t read that… That’s me getting my hair pressed. What this says up here I’m going to read it to you. It says “I am more powerful than the combined armies of the world. I have destroyed wars. I have all the nations. I have caused millions of accidents and wrecked more homes than all the floods, tornadoes, and hurricanes put together. I am the world’s slickest thief. I steal billions of dollars. I find my victims among the rich and poor alike. I am relentless, insidious, unpredictable. I cost poverty and death. I give nothing and take off. I am your worst enemy. I am alcohol.”

You could fill in the blank. It could be any type of addiction. That in that form, I have an original copy that was a little article in the newspaper in the early 1900s. The way that I came about knowing about this article was when I was probably about 16 years old, I was looking through my grandmother’s family bible. At that time, family bibles were where you file everything. There was this little wrinkled up piece of paper and it said this. The reason that it said that is because both sides of my family there are all kinds of addictive behaviors. At that time, we didn’t know a whole lot about sex addiction, so we called it womanizing and fast women, and other names that aren’t so nice. But I was surrounded by this from the time I was conceived.
I qualified on all kinds and levels to probably one day become a member of a 12-step program.

And so, when we’re working with clients we often – and everything I share today is also examples that you can use with your clients – often instead of doing a traditional genogram, we’ll have them become very creative and kind of look at what was going on behind the scenes, and what was the thing that kind of passed on through the generations. We do that in pictures. We do that in illustrations. Some people have put together little film clips. All kinds of stuff. And so, then we go here.

I think that a lot of you have heard about the hole in the sidewalk. It’s written by a woman named Portia Nelson who is now deceased but was a recovering person of alcohol at least and so I’m going to hold that up there on this first slide but I’m going to read to you this and I’m going to show you my walk through the five chapters. This is also something that we use whether we’re using it in an outright way or in a way that’s more subtle to really start to get clients to not just tell us they’re a sex addict but who are they, where did they come from, what are some of the holes in their life.

The first chapter says I walk down the street. There’s a deep hole in the sidewalk. I fall in. I am lost. I am helpless. It isn’t my fault. It takes me forever to find a way out. My chapter one is a person that was terrified at even the thought of abandonment. The negative belief for me was somehow I am not lovable. And I would fall in that hole all the time.

Chapter two I walked down the same street. There’s a deep hole in the sidewalk. I pretend I don’t see. He’s pretending he doesn’t see it. I fall in again. I can’t believe I am in the same place, but it isn’t my fault. It still takes a long time to get out. And so, in my family we would dress up our addictions. Pretend that we didn’t see it. It’s better to look good than to acknowledge what’s going on the outside.

Chapter three says I walk down the same street. There’s a deep hole in the sidewalk. I see it’s there. I still fall in. It’s a habit. My eyes are open. I know where I am. It’s my fault; I get out immediately. For me, that chapter was about becoming so lost internally and so disconnected internally that I could no longer play the game that I wasn’t afraid, that I wasn’t insecure, that I wasn’t terrified. And so, where I first began my recovery many years ago, my presenting issue was one thing but really when you narrowed it all down, it had to do with early attachment, unresolved trauma.

Chapter four. I walked down the same street. There’s a deep hole in the side walk. I walked around it. For me that is kind of those places in recovery where I know what to do. I’m on that street; I see the hole, but I have resourced myself with enough tools that I can regulate and come to safety and social engagement a little faster than I used to. It doesn’t mean that I never experience dysregulation. Same thing with our clients in their recovery process. A lot of times what we’re seeing with clients and I’m sure you all do too is not when things are going bad, often when they start to slip or relapse, it’s often when things are going well because, well, it almost feels like a sense of unsafety rather than safety because it’s so unfamiliar.

Chapter five. I walk down another street. For me, my experience has been with that that sometimes something comes up that’s been very, very familiar, I’ve been used to responding one way or doing this or do that and then that thing happens and all of a sudden, I’m responding differently without thought. My autonomic nervous system has been regulated enough that change has occurred a little more easily. So, one of the things that we also do with clients that I want to share here is we try to engage – and when I say we, I mean the staff at Insideout Living – we try to engage more than just one area because some people might respond one way to this and some people might respond one way to that.

When I think about walking down another street, I’m going to play a little bit of something for you. I’ll just ask you to listen.
Without a fault or worry she let go. She let go of the fear. She let go of the judgements. She let go of the conflicts of opinions swarming around her head. She let go of the committee of decision within her. She let go of all the right reasons wholly and completely without hesitation or worry she just let go. She didn’t ask anyone for advice. She didn’t read a book on how to let go. She didn’t search the switches. She just let go. She let go of all the memories that hold her back. She let go of all the anxiety that kept her from moving forward. She let go of the planning and all of the calculations of how to do it just right. She let go.

Sometimes when people come in and they’re in hyperarousal.

It’s one thing to be able to talk about it and it’s another thing to be able to incorporate other tools that not only might help them in the present, but it gives them something that they can do outside of the office. And so, everything that we do as clinicians, we want to make sure that we give people a doggie bag to take with them because they’re not with us as much as they’re in their own lives. And oftentimes with different things like that we will then have them just take a minute or two to maybe write down what it was that they noticed, write down anything that they may perhaps want to talk about later, and allow that to be an experience within the therapy.

So, I’m going to just go through these. And we’ll look at learning objectives. Hopefully, I meet the learning objectives. If I don’t, catch me afterwards and I’ll give you the answer to all of these. We want to be able to identify at least eight criteria for sex addiction. And then, we want to be able to also help clients to see what kind of attachment style may have informed their addictive behavior. We want to be able to list at least three of those. Specify models for treating sex addiction and trauma that increase social engagement and can effectively offer corrective developmental experiences. And to practice at least one way of treating sex addiction through a trauma and attachment lens.

Assessment, I’m pretty passionate about and I have to like to stop myself, like okay, you can only assess so much. But I also realized that a lot of times we’re shooting in the dark and particularly sometimes those of us that have a lot of experience because a lot of things we do know insults a lot of things we sometimes assume if we’re not really taking the time to assess. And so, in our center we want to look at all kinds of information, not just what they’re coming in for. Okay?

We want to look at the background because if you’re acting out, we want to know what is this that you’re acting out. Let’s get behind the scenes. And so, some of the assessments that we use with sex addiction is, and for those of you that are CSATs in the room, sex addiction screening test. Anyone can get that off the internet. You don’t have to be a CSAT. If you’re in your work and you see that there’s something that may look like it’s addictive in terms of sexual behavior or porn or serial affairs, that kind of thing you can use that screening. That is a tool that anyone can use and it kind of helps you and the client understand maybe where things are.

Depending on the outcome of that screening test, then we might move to the sexual dependency inventory and that is a very long online assessment. That assessment is only accessible to certified sex addiction therapist because they want to make sure that not everyone has that in their hands so that it’s not misinterpreted when you’re working with the client. But the good thing is that sometimes people may not be a CSAT, but they need that assessment, and what I do with people that have clients and they’re not CSAT is they may ask me to just do an assessment and then I’ll go over the entire assessment with the clinician. Sometimes I’ve been asked to come and share that with the client because it’s a lot of valuable information. It takes a long time, probably close to two hours to do it, but you can stop. The client can stop and come back to it.

Now, when I give out that assessment, I never give out one. I give out at least three in that area. I’m looking at the post-traumatic stress inventory and the money and work adaptive style index. And again, those three are – you have to be a CSAT to access them, but if you know a CSAT, you have a client and you want to check this stuff out, you can do that as well.

And so, the post-traumatic stress inventory is usually the one that I review with the client first because it gives the client some basis of perhaps the origins of their addictive behavior. It also kind of helps to take some of the shame away in the sense I’m not just this person that’s an addict or I’m a bad person or if people only knew. And so, we spend a lot of time with that. Sometimes that’s when, if they’re going to be a client with us longer term, that’s when we may look at some of those creative ways of looking at the genealogy. Okay? And then you can almost see the light bulbs going off and the connections being made when people are able to see, okay, this is what this is.

We do the money and adaptive work style index. That really shows your pattern of how you handle money, what your relationship is with money, what your strings are that are attached to money, and how you work. And the way I tell people all the time is the way we do one thing is the way we do everything. It’s just true. I hate it sometimes. That is true of me. But if I’m messy with my money, then I’m messy in other areas as well. If I am rigid and operating out of a place of deprivation because nothing was ever given to me and I was a born in a rigid family, I’m going to handle my money like that. And my sexual compulsivity is going to show up very similarly. That’s the fascinating thing to me. It’s like putting these pieces of a puzzle together. We talked again, and I said this a few minutes ago, a lot about acting out but we often don’t show the client right kind of behind the scenes of the play. This is the script that you’re acting out. I tell people that if you had any other disease you want to know everything about that disease, especially if there’s this opportunity to put it into remission. And so, we really look at it from a lot of psychoeducational places.

We also use the ACE questionnaire. You can get that online. Anybody can do that. It’s good and it’s not long but it complements the post-traumatic stress inventory very well. It has very specific questions from this age to this age. And so, we want to know kind of what happened in those early formative years.

And then there’s another questionnaire. Again, you can get this online. I love it because we know that no matter what addiction we’re treating, usually addicts and I put codependency and all that in there, we live from here to here. We have no idea what’s going on below. Okay? And so, if people don’t have an understanding of their body perception and their body awareness, then they will never be able to learn how to stop the trigger here because they’re not going to be aware of it until it comes here. And so, we get to look at that and also see how that body perception has informed their addictive behavior.

For example, you may have someone that their acting out pattern is first they have a negative belief that I’m never going to get the love that I want. And then they go to an irrational response to that negative belief and so maybe I will just go and choose an anonymous sex partner off Craigslist, that’s the answer to that negative belief. And then, as they’re thinking about it and thinking about it and thinking about it, then they might include as their ritualization very detailed grooming. Then by that time they’re way past trigger, not that they can’t stop it there, but it’s harder. Then once they do that, then they haven’t stopped it and they’re doing whatever they need to do to make that connection. What’s sometimes very surprising to people is the connection is anti-climactic. It’s everything that led up to it.

And so, the connection, if we’re talking about sexual, is if we take it out of clinical language, really all it is is this person’s opportunity to move from either hyperregulation or hyporegulation and breath. Like that’s what we do when we have an orgasm. [Deep breath] Wow! Okay? And so, what we’re looking at if we kind of like take this out of sex addiction is this person hasn’t found another way to regulate themselves.

Let’s go back to this body perception thing. So, after you know they’ve acted out, then they feel bad about that, they move into despair. On the way home, they pick up an extra-large pizza and a six pack of beer. Feel not just shame about their acting out behavior, but about their reaction with eating and then how that impacts how they feel and look which informs their body perception. So, the important thing to know here is when addiction walks into your office, there is never one, there is never one addiction.

If we think about alcohol and chemical addictions for anybody that’s familiar with 12-step programs you know there’s a 13th step. The 13th step is all about the old cronies that have been in the program, not necessarily chronologically, but have been in the program for a while just waiting to help someone that happens to be very vulnerable. And so, a lot of times chemical addiction is almost the easiest in the sense you don’t need it. The bottom line is very clear. When you talk about a behavioral process addiction how do I mediate that? What’s normal?

Like what I was saying earlier, my childhood womanizing, that’s what it was called. It was like, yeah. One of my grandmothers would say it often and I never really liked that. Because she was saying it to me way too young. “I never met a man that was converted below his belt line, not even the preacher.” And she just says that, you know, like it was okay. You know like this is okay as long as the preacher or the man brings home the check and takes care of the family. Like this is expected and some of that there is a difference between promiscuity and addiction, but a lot of people were probably in an addictive process and didn’t know it.

And so, we have more information now, so we have to share that. A lot of people suffered as a result of not knowing what this was that was going on. The attachment style task also there’s lots of them on the internet but I like this one by Diane Pool, it is pretty straightforward. And then what we get to do is help the clients understand which we’ll talk about in a few slides how their attachment was formed in the beginning.

The definition of sex addiction is nothing really profound and you could probably find lots of different definitions. This is the one I’m using because it’s pretty simple. Pathological relationship to a mood-altering experience, sex in this case, that the individual continues to engage in despite adverse consequences. Just like any other – you could put any other altering experience in there. Okay?

Then, we’d look at the criteria for sex addiction. And again, these criteria are not very different than any other criteria for another addiction. The way we treat it is a little different than we would a chemical addiction, for example. So, I’d just give you a minute to look through those. I’m not going to read them. That continues it.

And then we go to the making of a sex addict. This has been very helpful for me. Dr. Patrick Connors put this together. It’s really also helpful to show your clients that here’s how again your behavior was informed. It also gives you an opportunity to at least slightly screen for other addictions that might be present.

But what’s really interesting here to me is the family with that red arrow is going down so what we know based on all of the research of Dr. Connors is that most sex addicts have addicts in the family. A lot of times people come in they’re like “No. Nobody else in my family is addicted. Nobody.” I’m like I have never met a first-generation addict. You might be the first one, but I don’t think so. A lot of times because people don’t count addictions that aren’t as obvious. Like work, exercise, food. Okay? And so, as we start to really screen and educate around that, again, more pieces start to come together for the client.

We know that when our clients come in that either they are coming from rigid family systems or disengaged family systems. Whenever you are here, and I hear something that sounds like really, really, really rigid religiosity, we know that there’s something else there because remember the way we do one thing, is the way we do everything. So, if religion is presented legalistically, probably all the things or a lot of those things in that family are either black or white; you’re good, you’re bad. There’s no kind of middle ground.

The other part that we see in families is a combination of rigid and disengaged. But also, what you probably see, and I certainly see a lot, is enmeshment. Like we don’t know where the other begins. Like what is this that you’re opening up the door and going to the bathroom when another family member is in there that’s well past the age. Some of that is not even sexual. We just see that we have families that are either boundary-less or walled, not boundaried but walled. And so, one of the things that we start to see also with sex addiction, I’m sure you’re seeing this in other areas too, is that people almost feel very, very guilty and shameful about talking about their history. And those are often again those clients that come from rigid family systems. That’s almost like a disloyalty. Even if that rigid family system has profoundly impacted the way that they’re living their lives, their addictive behaviors, and that kind of thing.

And so, I think the most important tool that a clinician has is right here. I don’t care how much you know. I don’t care how long you’ve been doing it. If you don’t have heart and love people, you can’t make that connection so that it’s safe enough for them to have you be the first person to witness their story. And so, as we look at that which we are providing as a completely different kind of family system for them than a lot of them have ever experienced. Okay?

I tell people the one place I am not sensitive or feel fear of abandonment ever is with my clients because I am 100% in and probably more. That is not about me. My stuff gets to be taken to other people, my people.

I love this by Susan Johnson, emotionally focused therapy that she uses this kind of therapy for couples, but the therapy can be used for anybody because it’s all what we’re talking about helping people to regulate from the trauma that they’ve experienced because of the ruptured attachment.

How many times do you all have to educate people about trauma? I know I don’t have any trauma. That the little “t” trauma is so much more profound than even the big “t” Trauma because everyone can recognize that. If people grew up with families where they ate every day, they had a nice place to sleep, clothing, things seemed normal, but they were constantly emotionally insulted or those kinds of things, they don’t recognize it and they will compare and say “Well, at least I didn’t have this. What do I have to complain about?”

Have you guys heard of Stephen Porges? I love him. I love him almost as much as Beyoncé. And that’s saying a lot. Stephen Porges. He was a professor at the University of Chicago and he might still have some position there. But for years and years and years he’s been studying the autonomic nervous system as a researcher. And so, he was like “Whoa! This is remarkable. I should be able to share this with the clinical community because there is a way that you don’t just have to go fight-flight, fight-flight.” but you can learn how to shake like all animals shake when they play dead, they shake. You can help people to return back to safety and social engagement.

This is a very slow and deliberate process and sometimes it’s difficult even for clinicians to get used to because we’re so used to talking and listening but what we know also about trauma and you can look up the research yourself is the least effective way to work with trauma is talk therapy. I love this. It gets on the client’s nerves sometimes because I’ll be watching every movement and I’ll say “So, tell me. What do you notice about that?” “Nothing. My eye is itching.” But what we want to do is again this body perception thing coming back to this informs our brain much more than our brain informs this. And so, a lot of times the body is talking to us and we’re missing it because we’re listening to what’s coming out in the mail. If people can slow down enough, they can start to get pieces of their experience that they maybe never would have.

And so, the autonomic nervous system, and if this is repetition for some people, I’m sorry I’ll go through it really quick, it’s like your surveillance. It’s surveilling everything for dangers, the dangers it sees. Is it dangerous? We need it, right? Because if somebody is walking too close behind us at the train station we need that system in place. But for some people that grew up with attachment injuries and unresolved trauma, that surveillance system reacts to a bear behind me getting ready to kill me. The same as that, whatever that may mean for somebody.

And so, some people are stuck oftentimes in a hyperarousal state and they are… Whole thing is slowing him down. Take yoga. Stop running. Just take yoga. Or listen to slow music. Or take a power walk. Take a meditative walk. And so, we’re trying to help them regulate. And then there are some people that we get in there not as often that are more stuck in that hypo-aroused state. And they have so much guilt and shame about it because they always want to know “Why didn’t I do something when I was being abused? Why did I just freeze?” And they don’t know. They didn’t even have a choice about that. That was their automatic nervous system that was so much more brilliant than them that knew that if they had they would have got pummeled.

And so again, lots of education. I don’t have hidden tools. Everything I know I try to teach my clients. A lot of stuff I don’t know, my clients teach me. And so, when you are in either one of those places we want to teach them how to get to social engagement where they can see friendly faces, where they can distinguish that because you looked at me that way, it’s not the same as when someone was going to look at me that way before they beat me. It can slow things down.

Then we look at the attachment styles. I think that there… I always use this person as an example. I have one friend, my good friend Carla. And I think she’s the only person I know that grew up in a secured attachment. Like she just knows boundaries. She would tell me “You know what? Their crises aren’t my emergency.” Oh, that is brilliant Carla. Where did you read that from? She’s like “Duh.”

We don’t usually meet a lot of people that show up with secured attachment in our offices. And if they score a secure attachment, I don’t know anything about the research on this but what I kind of think and you guys can weigh in on this is that they are so compartmentalized that they’re responding to those attachment styles based on who they present. I don’t know if that’s true, but that’s what I am choosing to believe for right now. And then, we look at people that have secure attachment and they experience trauma. It doesn’t mean that they’re not going to be dysregulated, it just means that they come back to self and ground faster.

One of the things that we’ve trying to tell people is that as they learn how to regulate, it’s not going to just help them emotionally but it’s going to help them physically. I like this. Put this lady’s name so you guys can get it because I like sharing information. Deb Danna takes Stephen Porges’ Polyvagal theory and makes it like Polyvagal for Dummies. I love her because I thought I was just reading Stephen’s stuff. I was like, okay. All right. I have been here an hour. I’ve read two pages and I still got to go back over it. She makes it really simple. If you look her up, oftentimes she has workshops. She had one in Chicago maybe a couple of months ago. They’re very inexpensive and she wants to share everything. Okay?

And so, this is just another way of looking at attachment and trauma. That’s all we’re doing here. We are looking at all these different ways. And so, she uses this ladder as an illustration. When we’re at the top of the ladder we’re in safety and social engagement. Sometimes for clients that really resonate with this ladder thing, they’ll come in and they’ll draw a ladder and they’ll say, “Here’s where I am today.”

If we look at that, this is where the secure attachment person is or the person that has returned to safety and social engagement. Then we have the anxious ambivalent or preoccupied attachment. One of the things that we see with sex addicts is this attachment style is usually always substituting fantasy for reality. You can often see it as they start to maybe make an intimate connection with somebody. I’m not just talking about sex. Just getting close and more vulnerable. The fantasy will come in. The fantasy doesn’t always have to be a good fantasy. The fantasy could be imagining that this person is going to take all your money or whatever the thing is. And so, they also tend to have more sexual partners and greater infidelity. Of course, fear of abandonment or loss. We want to have somebody in the back wings.

If we look at that that’s where this person is on that attachment ladder. Fear is whispering. I feel the power of its message. Move. Take action. Escape. No one can be trusted. No place is safe. When we look at that, we also want to take a look at how people tend to show up as avoided. Those people are people that skip appointments or that you had an appointment and the next one they come they don’t share as deeply because they were too exposed the last one. I’m going to skip past more and avoid it and go to what that looks like on the ladder. So, those people are in hypo-arousal at the most… they are isolating at the most avoidant place. They’re already acting out, if you will, the abandonment. And so, what do they do to wake up? We want to help them to wake up in a way that’s more helpful. It doesn’t have to do with an addictive behavior.

And then, when we look at the disorganized attachment style, I think this says this much better is that picture. I love you. I hate you. They’re in a relationship. Everything’s good. I met my soulmate. Two weeks later they met their soulmate again and it’s a different one. So, these people are really finding their way to safety is difficult, but they also are so fearful of going to hypo-arousal. Same thing with the body. You see the breath is short and shallow and the heart rate speeds up.

What I’m going to do because those parts you can look at. This are all the defenses that people use, not all but a lot of them, when they’re in fight-flight so that they don’t have to feel fight-flight. Remember they’re trying to regulate. It’s just regulating in a dysregulated way. And so, on fight-flight you might see lots of controlling behaviors. Okay? So, you try to talk to them about a treatment plan and they’re trying to talk to you about their treatment plan that they think that they should be doing and wanting to monitor things very closely.

Oftentimes what we see is there’s intellectualization. And then the most important is teaching people what the regulating defenses are so that they can use them and when they regulate being able to go back to a chart like this and saying “You know what? Look, how did you do that? Oh, I was self-aware.” Okay?

So, one big way that we teach is affiliation so that’s 12-step groups, that’s group therapy, that’s building a tribe of support. A lot of the treatment modalities – we’ve talked about them, but these are some of the things that we use. We use a lot of EMDR along with the sematic therapy. We also use services that will provide tools where people are not just working by themselves but to reengage.

One of the things that we want to incorporate with all of our clients again is helping to repair and showing them how to repair the past trauma that has not been repaired that has informed their addictive behaviors and to create an opportunity for a different kind of attachment. That’s why it’s so important for the therapist to be attuned to the client and not to be afraid to be wrong. I often say does this feel right? Is this right? Maybe I’m off. But this is what a lot of our clients didn’t get – the seven rights of the child. To be here and welcomed into the world. To have needs and to anticipate that they’ll be met. To be separate and still be loved. To have a voice and to speak their truth. To have autonomy with support. To own their sexuality and to lead a passionate life. To have spirituality and to follow their own spiritual path.

What I am going to do is see if you all have questions. I’m going to… You guys tell me how to do this best. I want to play in the background. It doesn’t even have to have sound because it’s a piece of work that some clients did and said they wanted to show this of how they use their bodies and their emotional calibration to move from fight-flight to regulation. These people are professional dancers, so you can’t have all clients do this, but I’m going to play it in the background because all it is is that you’re watching it. While I’m doing that then maybe you walk and ask any questions that you might have. Does that work? Okay.

Both of them are sex addicts and partners in recovery. I hope I have enough of I don’t raise your hand I’ll get one to you. This is kind of how things were for them when they both were in their addictions and not yet understanding powerlessness. A lot of moving from hyperarousal to hypo-arousal. And the woman spent a lot of time in hypo-arousal even though this is what she does all day every day for her job. She’s a professional dancer. Her hypo-arousal looked like depression. In some cases, it was, but in a lot of it, it was a trauma response for her.

This is as they both started looking at their patterns more closely and understanding that the help that they needed was beyond themselves and they started to talk about it. Not quite yet knowing what to do but at least realizing and becoming aware. They would recognize how much their mirror neurons would feed off of each other that when she was like that then he would become like that and when she would freeze, he would go away.

And this is as they started getting professional support. He was able to keep moving even when she was going back and forth from hypo to hyper. And even though they had trouble staying connected, they realized that the more that they were connecting to themselves, the more they were able to connect with each other and not have to take on what the other person was experiencing internally. This is kind of more where they are now as they’ve moved much more deeply into their personal recovery and in their couple recovery. And so, it’s a support of each other, not one just always having to support the other.
Both of them are again professional hip hop dancers and also professors at Columbia. Their deep desire is to support the recovery community through movement and through sharing the intricate details not only of your past but to celebrate the recovery.

And as you can see, nobody is perfectly regulated and in social engagement in safety all the time but they’re able to return to it much quicker than they had in the past. And they can be together interdependent and move in the same direction if they feel that that’s what’s safe for them. And through that place for them they said their creativity has grown. They have a little talk afterwards where they process what that recovery has been for them incorporating trauma, attachment, and their sexual compulsivity. So, thank you.

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Positive Sobriety: The Book
Daniel H. Angres, MD

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