Podcast Series: End Opioid Crisis

Gina Thorne: Hi, everyone. Welcome to the Harmony Foundation podcast series. It’s my pleasure today to be joined with Terri Schreiber, who’s part of the End Opioid Crisis consulting group. Welcome, Terri.

Terri Schreiber: Thank you.

Gina Thorne: It’s really nice to have you here at Harmony. We’re here to learn a little bit about your consulting practice, but before we do that, I’d like to hear a little bit more about you. What got you into learning about the opioid crisis? Why are you so fascinated with this topic, as everyone should be?

Terri Schreiber: Thank you for the opportunity to answer that question. My relationship to the opioid crisis and opioids in general stems from a personal injury. I actually have two spine injuries. I’m a chronic pain sufferer for the last 24 years. The first time I injured my spine, I had a whiplash injury. At that time, opioids were not considered the fifth vital sign. I had two years of treatment, chiropractic, massage, physical therapy, and I went about my life.

The second injury had to do with my labor and delivery of my daughter. I fractured my spine and tore three discs. I didn’t seek medical attention right away, but I did lose a great deal of weight. I lost about 40 pounds within the first weeks of my delivery. When I finally sought medical care, opioids was … They were pervasive. Pain was considered a fifth vital sign. The doctors automatically said, “Here’s some medication. What would you like to do?” 10 years later, I continued taking the medication after having a series of medical interventions that were unsuccessful.
After so many people died, I decided that the medicines that I was taking were similar to ones that they were taking when they died, and I didn’t want to. I had a young daughter. So I decided to stop taking them, and I realized that what was happening to me was not so unique. If I had the capacity to improve my quality of life, maybe other people could, too. So I became very invested in the problem, and I thought I could use my research background and try to help others.

Gina Thorne: That’s fantastic. Tell us how that has moved into this consulting business that you have.

Terri Schreiber: Sure. When I was deciding to reclaim my life, I was a PhD student studying public affairs. I have a background in business administration and public administration. I wasn’t sure I’d ever even be able to write again or do research. But my acuity came back. My capacity to do research and writing and to engage quickly came back, so I reached out to an organization called The Colorado Consortium. I joined various work groups to try to figure out how I could engage with people within Colorado to help solve the problem.

I did a lot of research. I sat in a lot of work group meetings, and I concluded that maybe my research skills could be utilized, so I developed a collaborative organization. Right now it’s a medical doctor with addiction management specialty, a professor in public administration and a grant writer, and myself working together. We have our first presentation in a national audience in March of 2018 to share some of our findings on the prescription drug monitoring program and how to make it more effective and efficient.

Gina Thorne: Wow. Can you share a little bit about what that looks like right now? Are you still in the preliminary stages?

Terri Schreiber: We’re very much in the preliminary stages, because there’s so much opportunity relative to the prescription drug monitoring program, the PDMP as a policy tool. We believe that it can be a policy tool to help us understand when there’s overprescribing, when there’s co-prescribing of lethal dosages. For example, benzodiazepines and opioids together. When there’s doctor shopping. We believe if the right data is in the system, then we can begin to change behaviors on the part of the patient as well as the doctor. Hopefully moving forward that the doctor/patient relationship can change so we can find alternative treatments.

Gina Thorne: That’s a great model that many people learn and use now with behavioral health change and addiction treatment, so it certainly makes sense to take the data and utilize it as a way to change behavior, which I think a lot of us have forgotten how to do. I think we’re always … What is it? They call it aim, fire, shoot, I guess. They wait until after the fact, I guess.
This is your first visit to Harmony.

Terri Schreiber: That’s correct.

Gina Thorne: What are your thoughts?

Terri Schreiber: I love it. I’ve had a wonderful day. I got to meet a number of people. I got to have a tour of the facility. Frankly, it reminds me of an Israeli kibbutz situation, where you have a communal dining area. You have the various houses. It’s a very inviting community. I didn’t personally seek treatment when I stopped taking pain medicine, but if I had, I would certainly want to be at a place like this.

Gina Thorne: Oh, thank you for that feedback. That’s wonderful to hear. If someone wanted to access your services or get in touch with you through the End Opioid Crisis Consulting, how could they get in touch with you?

Terri Schreiber: They could get in touch with me via email or via Twitter. The email address is endopioidcrisis@gmail.com. The Twitter account is @endopioidcrisis.

Gina Thorne: Wonderful. Terri, we look forward to hearing great things with you and your group. Thank you so much for all the hard work you’re doing. We’re all out there in the field trying to battle this opioid crisis. It’s nice to know that we’ve got other soldiers out there doing it, too. So thanks for visiting with us.

Terri Schreiber: Well, thank you for inviting me. Thank you for the partnership.

Podcast Series: Muir Wood Adolescent & Family Services

Gina Thorne: Hi, everyone. Welcome to the Harmony Foundation Podcast series. It’s my pleasure today to be joined with Brad Waldo who is the director of referral relations and alumni services from Muir Woods Teen Treatment. Welcome, Brad.

Brad Waldo: Thanks, Gina.

Gina Thorne: It’s good to have you here.

Brad Waldo: Good to be here.

Gina Thorne: I’m excited to hear more about your program. We don’t do a lot of podcasts around adolescent treatment, but we do know that there’s a huge demand for it. Before we get into talking about Muir Woods, let’s talk a little bit about your background and how you got into the field of addiction treatment.

Brad Waldo: Right. I actually went to treatment when I was 17-years-old. It was a month before my 18th birthday and one difference between adolescent and adult treatment is actually that in most states you can’t sign yourself out until your 18. My parents knew that if I turned 18, I probably wouldn’t agree to go to treatment, so it was a bit earlier intervention than would’ve otherwise happened and I’ve stayed sober since.

Gina Thorne: Where did you go to treatment? What state? California?

Brad Waldo: California.

Gina Thorne: So, California says you have to be 17?

Brad Waldo: 18.

Gina Thorne: 18 to sign out.

Brad Waldo: Yeah.

Gina Thorne: Other states are different.

Brad Waldo: Yeah. Colorado is 15.

Gina Thorne: Colorado is 15.

Brad Waldo: Then, Washington State is 13.

Gina Thorne: Yeah. Wow, that’s so young.

Brad Waldo: Yeah.

Gina Thorne: Your role now is just giving back.

Brad Waldo: Yeah.

Gina Thorne: You’re working in the field to just …

Brad Waldo: Absolutely.

Gina Thorne: … Give back to those adolescents. That’s great.

Brad Waldo: Yeah. I’ve been working with the kids at our center for three years. In January, it will be three years and then another program in Southern California for teens …

Gina Thorne: Wonderful.

Brad Waldo: … For two years before that.

Gina Thorne: Okay. Well, it’s not an easy group to work with.

Brad Waldo: No.

Gina Thorne: Kudos to you guys because that’s not easy. Well, it’s called Muir Woods Trusted Teen Treatment. Correct?

Brad Waldo: Muir Wood Adolescent and Family Services.

Gina Thorne: Okay.

Brad Waldo: Then, Trusted Teen Treatment is the …

Gina Thorne: Is the tagline.

Brad Waldo: Yeah.

Gina Thorne: Nice. You guys are located in Marin County, which most people wouldn’t know that, but that’s close to San Francisco area.

Brad Waldo: Yeah. Just outside of San Francisco.

Gina Thorne: You guys are a gender specific program, so you work with obviously adolescents 13 to 18?

Brad Waldo: Yeah.

Gina Thorne: Can you describe how teen rehab might be different? You might not know the specifics around this, but just curiously is there a big a difference between teen rehab and adult rehab?

Brad Waldo: Right. Yeah. The age at which someone can sign themselves out plays a factor in states like I mentioned. They have to go to … Kids have to go to school. Even the past summer, it’s August and the kid’s in treatment with us and he’s going “No, it’s summer vacation.” We’re going “Legally, you have to go to school a couple hours a day Monday through Friday.”

Gina Thorne: Wow.

Brad Waldo: That’s a difference and we have a school on site, a private school through the state of California. Another thing is we champion earlier intervention, so a lot of the people we see have a genetic predisposition for drug and alcohol abuse. There’s definitely abuse happening, but not chemical dependency yet. But, definitely people where that’s not too far in the future where a lot of boys we see, we’re boys only, might be … They’re definitely going to be in treatment by the time their first year of college rolls around, so coming to us.

Gina Thorne: Catching them early.

Brad Waldo: Yeah. [inaudible 00:03:14].

Gina Thorne: Because when we talked earlier, we talked about this idea of detox. Because you guys focus so much on that early intervention, there’s really not much detox that goes into adolescent treatment.

Brad Waldo: Not typically.

Gina Thorne:Okay.

Brad Waldo: The majority of the boys we see don’t come in actively detoxing from benzos, opiates, and really strong medically urgent type of way. We have a 24 hour LVN nurse practitioner that supervises all our boys when they come in, even if they’re just detoxing from cannabis. Mental detox, all that, they’re seeing a psychiatrist the first day they’re with us. Then, so we have and my story, it’s all going to be intertwined. When I went to treatment at 17, I was a full blown opiate addict, full blown Xanax addict. I did have a medial detox that I had to do prior to coming to treatment.

Gina Thorne: Okay. But, that’s not common typically?

Brad Waldo: Very rare.

Gina Thorne: Okay. You’re working, it’s a little different, not terribly different in some cases between adult and adolescent when you’re dealing with family. Families might be listening to this podcast today and they’re probably thinking to themselves what is it that my role needs to be in helping my teen in this case get into treatment because oftentimes they’re so enmeshed in the situation, there’s so much chaos and pain going around. What is it that you all do to help calm the parents down to help them see that this is a great place for them to come?

Brad Waldo: Great question. The work that we do is long term. We’re not a bandaid. The moment of crisis that family’s in when they’re considering treatment, we sit with them and it is a very fragile time in the child’s life, the family member’s life, and we’re family focused. We’re treating the whole family dynamic. We’re not treating just the kid. Then also, we’re treating what those fractures are within the family, within the loved one in treatment, and then treating substance abuse as the thing that’s on top of those things. It’s a difficult time. There’s no way to minimize that. If you’re seeking out teen treatment from calling me to graduating treatment and going on to continued care and becoming an alumni of the Muir Wood family, from start to finish you’re with people that understand.

Gina Thorne: That’s wonderful. You all obviously have a fairly strong family component I’m sure to really understand what is the family dynamic we’re going to play in this adolescent’s life after they finish treatment with you all.

Brad Waldo: Yeah. We do 90 minutes of family therapy a week in addition to the two individual sessions that the boy in treatment will have. We do a six hour family program every Saturday that includes a presentation by one of six presenters. It’s a six week curriculum and then multifamily process group, lunch, visitation. That’s every Saturday and then before families leave they do what’s called family intensive where they’ll go through all the work that the parents have been doing, the siblings have been doing, the loved one in treatment is doing. Before they leave, going through all that work.

Gina Thorne: That’s wonderful. It’s definitely a family disease, so it sounds like you’re capturing all the right services for them. This is your first visit to Harmony. What are your thoughts?

Brad Waldo: It’s gorgeous. It is. The staff is incredible. Estes Park. I’ve spent a lot of time in Colorado, but Estes Park is beautiful. It’s a little chilly today, which is nice. From growing up in Southern California, it’s welcomed. The program seems incredible. Everyone here from the clients on site to the staff, you can feel energy here.

Gina Thorne: Thank you. We’re excited …

Brad Waldo: You can’t reproduce that.

Gina Thorne: No, you really can’t. You’re right. We’re very excited about having a partnership with Muir Woods because even though we don’t treat adolescents, it is not uncommon for us to receive phone calls from family members who have adolescents that are struggling. I know that there’s a lot of people out there that are listening that are struggling and don’t know what to do with their adolescent son. Certainly, we would be a huge supporter of Muir Woods and want folks to keep you guys in mind. With that said, if someone is listening today and they wanted to access services at Muir Woods, how could they get in touch with you?

Brad Waldo: You can call me directly. My number is 714-318-0955. That’s my direct line. Call anytime for any reason. Then also, you could find us at www.muirwoodteen.com, M-U-I-R-W-O-O-D-T-E-E-N.com. Yeah. Anything we can do to help. The earlier the intervention is, we think the better and help is available.

Gina Thorne: Wonderful. Well, thanks again for taking the time to visit us.

Brad Waldo: Thanks for having me.

Podcast Series: RiverMend Health

Gina Thorne: Hi, everyone. Welcome to the Harmony Foundation podcast series, and I’m pleased today to be joined with Elise DuBois with RiverMend Health.
Welcome, Elise.

Elise DuBois: Thank you.

Gina Thorne: It’s really great-

Elise DuBois: It’s great to be here.

Gina Thorne:It’s so great to have you up on campus here at Harmony, and we want to hear more about RiverMend Health, but before we do, we want to learn a little bit about you. What got you into the field of addiction treatment?

Elise DuBois: I am from Detroit originally, and I was working in automotive marketing for about 13 years there and was looking for a change from the corporate world, so I decided to get my master’s in mental health, so I completed my master’s in mental health in 2010 and then realized that I may not want to be a therapist. I had some personal experience with recovery and some professional interest in the field of recovery, decided to move to Los Angeles and just became more invested in that field professionally.

Gina Thorne: I think it’s quite a big shift to go from Detroit to LA.

Elise DuBois: Yes, it is.

Gina Thorne:You like the sunshine, I guess.

Elise DuBois: I do. I love the sunshine. I hate the traffic.

Gina Thorne: Oh, yeah, there is a lot of that.

Elise DuBois: Yeah. Yeah.

Gina Thorne: I guess it’s like, what do you call it, a way versus … the pros and cons, I guess.

Elise DuBois: Yes, it’s a give and take, definitely.

Gina Thorne: There you go. Yeah.

Elise DuBois: Definitely.

Gina Thorne: You work with RiverMend Health, and what I learned about it when I was doing my research is that RiverMend has a continuum of care model with various treatment programs that addresses residential, IOP, and even eating disorders. Correct?

Elise DuBois: Correct.

Gina Thorne: Can you share a little bit about how RiverMend assesses which program is best for a client when they call into your program.

Elise DuBois: Sure. We do have eating disorders specific treatment programs, substance use disorders specific, and then each of our program also has a niche within it, so Rosewood Centers for Eating Disorders is our eating disorder treatment program. Bluff Plantation is treating substance use disorder primary in Augusta, Georgia, and Positive Sobriety Institute is a professionals program in Chicago.
Our calls are fielded by centralized intake group and, at that point, we do an over-the-phone assessment. We can also run any financial information that a potential patient may be interested in learning more about, where they stand, and then, at that point, we decide which program would be the best fit. If it’s within our family of programs, we also have a really, really large book of resources outside of our programs.
I would say that we probably refer out the majority of the calls because there’s something that is a better fit either geographically, financially or clinically, but we do a pretty thorough assessment over the phone and then, if someone is going to continue on to admit to one of our programs, we’ll then do a deeper-dive clinical assessment and really continue assessing along the way. If a different, say, an eating disorder pops up as a primary at one of our substance use disorder treatment program, we can address that and refer out if necessary and then vice versa. Those two addictions go hand in hand, so we’re always looking to make sure that the patients are in the most appropriate level of care at the most appropriate program.

Gina Thorne: Do you all take insurance?

Elise DuBois: We do take insurance. We’re in network at Rosewood, so eating disorders, and then out of network with our substance use disorder treatment programs.

Gina Thorne: Great. Perfect, so that’s always a big question that people ask, isn’t it?

Elise DuBois: Yes. Yes.

Gina Thorne: My experience working with RiverMend is that you all have a very strong medical model …

Elise DuBois: Yes.

Gina Thorne: … that can really treat some folks that are fairly highly medically acute, because we all know that this disease is not just about the physical addiction and/or the psychological addiction, but it’s also about what’s done to the body, and so can you talk with us a little bit about how you all address the acute medical needs that come up when people admit into your program, and I’m assuming that that would probably be more often at the Bluff’s in Augusta?

Elise DuBois: Yeah, so, for the substance use disorder side of things, definitely Bluff Plantation is equipped to handle a variety of medical issues, so Dr. Jacobs, our medical director there, is also the admitting physician at the hospital, the local hospital, so can really help people get into see neurologists, endocrinologists, work with patients who have diabetes or even chronic pain issues. He is board certified pain management before he was board certified addition and so has a really deep knowledge of just different medical issues that can arise, and we can get those issues addressed pretty quickly.

Our other program that probably deals with that the most is Rosewood, so, with the eating disorders, as you can imagine, there are a myriad of medical complications that come along with that. One thing that Rosewood is able to do is to detox an eating disorder patient, which is a pretty rare resource to have, so, along with that really heavily medically supervised detox with a medically compromised patient, we also look at, I mean, a vast array of medical issues that come along with the eating disorders, and we’re able to treat those safely and have the ability to work with the eating disorder alongside the other medical issues.

Gina Thorne: Usually that just increases the success rate post-treatment when you’re able to take care of those medical issues, which often can be a trigger for relapse with many folks.

Elise DuBois: Exactly, especially for the substance use disorder side and the pain issues that may come along with that, opiate addiction and/or chemical dependency on opiates, definitely, and then for the eating disorder side of it, it’s just a continuum of increased health that keeps somebody in recovery on that side of things.

Gina Thorne: That’s wonderful. This is your first visit to Harmony.

Elise DuBois: Yes.

Gina Thorne: I know that you haven’t really been able to do the full tour yet, but what are your thoughts so far?

Elise DuBois: I mean, it’s beautiful. Again, coming from Los Angeles, it’s a big change, but I really value the seclusion here, I guess, if you will, and just the containment, and I think that, for a lot of people especially in early sobriety, the quiet is really good and really beneficial, and I can see that being a really big draw for people who need to get some space. I mean, I’m a nature lover, so I love the nature aspect of everything, and I also think that that really can be a big plus for someone in early sobriety.

Gina Thorne: We’ve seen that actually be the case is that the natural surroundings do contribute to people, seeing that life in recovery can be less chaotic and crazy, so that’s helpful. If someone were listening today and they wanted to access the services at RiverMend Health, how could they get in touch with you?

Elise DuBois: I mean, I’m always happy to talk with anybody and I can provide you my phone number if needed. I do think though that a really great thing to do to get several things taken care of at one time including the assessment, verification benefits and general program information is to contact our intake department.

Our national director of admissions, Kristen Scheel, is amazing and has put together a really, really good team with a lot of resources, so I always encourage people, even if you don’t know if it’s going to be a good fit or you don’t think it will be, to just give a call anyway because our rule of thumb with our intake group is to never hang up the phone without giving resources whether they’re with us or with another program, so I would say that anyone needing to get in touch with RiverMend Health can call our intake line at 844-464-3876 or always feel free to reach out to me as well. My email address is edubois@rivermendhealth.com.

Gina Thorne: Wonderful. Thank you so much for taking the time.

Elise DuBois: Thanks, Gina. It was my pleasure.

RiverMend Health

Podcast Series: Carol O’ Dowd

Gina: Hi everyone, welcome to the Harmony Foundation podcast series. It’s my pleasure today to be joined by Carol O’Dowd, who is a registered psychotherapist with the Center for Connected Communities. Welcome, Carol.

Carol: Thank you.

Gina: So great to have you here at Harmony.

Carol: It’s a pleasure to be here.

Gina: I’ve been very excited about doing this podcast with you because I’ve had some time to do some research around your background, and it’s just been a delight to be able to learn. And you’ve got an amazing story anyway, which unfortunately, we don’t have a lot of time to talk about. However, I would like to give the listeners an opportunity to hear more about who you are in particular around the practice of what you do in psychotherapy, which is, in my opinion, incredibly unique.

So you have a very interesting approach to clinical care. You’re trained in mindfulness, which is not uncommon in the field of addiction treatment, but you also adopted a Japanese psychology with ordination as a Shin Buddhist priest, which is a blend of eastern and western views. So for those that are new to this whole idea of Shin Buddhism and what you’re doing with the psychology aspect of it, can you talk with us a little bit about how do you do that? I mean, what does that look like?

Carol: It’s a blend of east, which is taking very ancient wisdoms and combining it with the west, which is very practical tools that allow access to body, mind, and spirit. So how I do that in Shin Buddhism, the core practice is what’s called deep listening, but that means that we don’t listen just with our ears. We challenge you to listen with your feet. So it’s the practice of being open and listening to what is as is, not as it is. The minute you say “as it is” that’s solidifying.

So it’s being open to the fact that life is always changing. So similar to addiction, that high gives you this big high and then it goes away. Life is the same way. Okay? What you like, it’s going to change. What you don’t like is going to change. So the real question then is combining, again, [morito 00:02:20] practice, which is where do you want to place your attention? Do you want to place your attention on what you don’t have or do you want to place your attention on what you do have and let in more?

Gina: That’s beautiful, and it sounds so fluid.

Carol: It is.

Gina: I mean, that’s a big part of it, is like you said. It’s not rooting yourself in one thing, which in mindfulness, especially around meditation, it’s always about the concrete of being present in that moment. But I hear what you’re saying is that it’s not just about being concrete in that moment, but recognizing the fluidity of it.

Carol: Well the fluid … What moment lasts?

Gina: Right, right. That’s a great point. There is no such thing is there?

Carol: Right. And so my view of clinical care is more that it is a transformative journey. So to me, it’s a process of working with my client as experts. I’m not the expert. I haven’t lived their life, so I have to find out where are they, what are they doing, and what’s always changing? So I just give tools so I can reach into a eastern bag or a western bag, whatever works for the client because it’s what works for them not what works for me.

Gina: Great. So you have, I guess it’s training also, in …

Carol: Ikebana.

Gina:Ikebana, thank you, which is Japanese flower arranging.

Carol: Correct.

Gina: Which I always think of just the bonsai tree when I think of that, but I’m sure that’s not even close.

Carol: No.

Gina: And then kyudo?

Carol: It’s kyudo, which is the way of the bow.

Gina: Okay, which is an archery, correct?

Carol: Yes.

Gina: Okay. What’s the disciplines that carry into these practices? As you look at that and you’re mentoring and coaching your clients, how do you take these two very unique aspects and bring them into a client’s life where they can adopt it? It seems like there’s a tremendous amount of metaphor work that happens there.

Carol: Yes, a bit. Kyudo is a fascinating exercise because it comes out of Japan and also was practiced intently by the Samurai. What’s fascinating is that the Samurai warriors, before they went into battle carrying the bow, this is before the days of guns and such, it’s strictly arrows, the practice that they engaged in to prepare for battle, ikebana. So these great big tense guys sitting and ikebana is arranging flowers, but the practice of ikebana involves, again, listening to the flowers.

So it’s being aware of body, mind, and spirit when moving the flowers and listening to the flowers. Allow the flowers to show face. Also, what’s a little bit different from ikebana versus just standard flower arranging and lots of just sticking the flowers in the pot is, or the vase I mean, it’s the practice of being aware of space and arranging the space as well as the physical space the flower takes up.

Gina: The space between too.

Carol: Yes.

Gina: Mm-hmm (affirmative).

Carol: Yes. So it’s being aware of that and listening to that. So how that translates into a client’s life is, okay, who are you sitting next to when you go to a particular environment? Do you want to be next to that or are you getting stuck? Are you next to a cactus or are you being a cactus? Right?

Gina: Mm-hmm (affirmative).

Carol: Where are you in space and time? So the practice of ikebana helps with the awareness of space and time. Kyudo, it’s a very intense practice. It involves standing meditation. It also involves being truly aware of body, mind, and spirit, because with kyudo, you have to be aware of totally where you are and how are you connecting with the bow? Different from western archery, in kyudo, you are throwing the arrows because of the way the bow works. It spins around and literally throws the arrow. And when you’re … As I was trained by my sensei, when you look at the target, the target is you.

Gina: Hm.

Carol: So it’s this connection with everything, the bow, the string, the arrow, the target, and realizing you too are part of this great oneness. Be aware of where you are. That is also a practice you can use in daily life because what it is is, again, where do you want to place your attention?

Gina: Which is so much about recovery. Recovery is all about, where do you see your mind being? Where do you see … Because so much of the time they’re in the past and they’re in the future, but they’re not looking at where they want their mind to be in the moment and in the present, and that sounds like a wonderful exercise and helping them with that.

Carol: And from these practices is, okay, the past is fine, but how are you bringing it forward? What are you throwing out there? What, from your past, do you want to bring forward? What future do you wish to create? Where do you want to be? Because the present, you can’t hold onto it. It’s always moving. So where are you going? Where have you been?

Gina: So different. Such a different way to look at it.

Carol: Yeah.

Gina: That’s fantastic.

Carol: Thank you.

Gina: So switching gears a little bit, you’re also the executive director for the Colorado Association of Psychotherapists.

Carol: Yes.

Gina: What is it? Tell us a little bit about this group.

Carol: It’s an exciting group because it’s a place that really promotes diverse practices and diverse therapies for all of Colorado. That’s our venue. What’s wonderful about Colorado is we have numerous indigenous peoples living here as well as those coming from other countries, certainly quite a population from Ethiopia, even Indonesia.

So back to each person, what works for them may not be something that came out of a western college or a single specific academic training. It might be shamanistic practice. Who are we to judge? If that works and it heals, let’s promote it and make it available. Now, we don’t do it in the sense of saying, “Well, whatever you feel like is what you can do.”

We truly encourage anyone who’s been trained because if you, having spent time personally in Indonesia with some of the healers there, the enormous amount of training I’m in awe of. It’s a different form of education, but it’s education training and high standards. Again, focusing on the healing aspects of the client. If you can’t heal the client, you aren’t being allowed to practice. Okay?

Gina: Mm-hmm (affirmative).

Carol: So what we’re doing as an association is promoting legislation that will continue to keep a variety of diverse practices available to all peoples living in Colorado as well as offering our members and even the public education, networking opportunities, and introducing the background behind these many diverse therapies because even some of the Japanese ones that I use, finally science, which is the great god in the west, is verifying what has been used for hundreds of years, and in some cases, thousands of years.

Gina: Right. So it’s a great group of folks where if you wanted to find a therapist that would meet the needs of what you’re looking for, you could easily find someone within that group.

Carol: Yup. You could go to www.coloradopsychotherapists.com.

Gina: Okay.

Carol: And our advisory board, we’ve got the directors of different schools here in Colorado, the Boulder Psychotherapy Institute, Colorado School for Family Therapy, and an academy that is trained, they’re one of the trainers for hypnotherapists. So again, we’ve got folks who are leaders in the development, even, of some new technology. So I guess what I would underscore is not only can you find therapists, you can also look at what’s being tested in the field. So we support and encourage innovation and exploration in ways that serve the needs of residents of Colorado.

Gina: That’s fantastic. It’s great to have that resource here.

Carol: Thank you.

Gina: Thanks for your leadership with that.

Carol: Thank you.

Gina: So if someone wanted to access services for the Center for Connected Communities, how could they get in touch with you?

Carol: They can call me at 720-244-2299 or they can go to www.centerforconnectedcommunities.org.

Gina: Well, it’s been a pleasure talking with you, Carol. I feel like we could spend an hour going through some of the amazing things that you’re doing. But if folks are interested in learning more about you, please have them visit the website. And we thank you for visiting Harmony today.

Carol: Oh, and thank you. It’s an honor to be at Harmony. It’s amazing what you folks are doing.

Gina: Thank you.

Nature and Mental Health at Harmony

Mental Health and Nature

On any given day at Harmony you can witness life’s challenges and know that a compassionate soul is there to help along the path of healing. The mental health professionals are part of a team at Harmony and work with clients in a way that combines the natural beauty of our campus with the intrinsic values of each client.

To further explain how we know being in nature can help heal, I’d like to share a study out of Stanford University which suggests that time spent in natural settings may improve brain health.

“As more and more of us live in cities, we spend less time in natural settings, including parks. Studies also show that people in urban settings without access to green spaces have higher levels of psychological problems than those with access to green spaces. Is there a definitive connection between time spent in green spaces and mental health? The answer is yes. In a series of two studies, Stanford researchers believe there is a connection between time spent in green spaces and a decrease in “morbid rumination,” what is more commonly thought of as brooding over the negative aspects of our lives.”

“This study investigated the impact of nature experience on affect and cognition. We randomly assigned sixty participants to a 50-min walk in either a natural or an urban environment in and around Stanford, California. Before and after their walk, participants completed a series of psychological assessments of affective and cognitive functioning. Compared to the urban walk, the nature walk resulted in affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance). This study extends previous research by demonstrating additional benefits of nature experience on affect and cognition through assessments of anxiety, rumination, and a complex measure of working memory (operation span task). These findings further our understanding of the influence of relatively brief nature experiences on affect and cognition, and help to lay the foundation for future research on the mechanisms underlying these effects.”

The study further asks, what does this mean for everyone?

1. “Spend Time in Natural Settings – What can it hurt to take a daily walk in the park or spend time sitting on your back porch looking at the creek (if you’re lucky enough to have that situation)? Take your lunch to a natural setting and spend vacation time at least partially in the outdoors. Doing so will immediately improve your mental health.
2. Move – Movement is good for us. No doctor in the world says that it’s healthy to sit at home and do nothing. But instead of going to the gym, find a nature trail to hike or bike, golf, or take a stroll in the green belt. Even if you don’t get your heart rate up to aerobic activity levels, you’ll still mentally benefit from the movement.”

The healing journey for a client at Harmony can include a client expressing their emotions in a calmly lit room, moving forward on a walk to the river at Rocky Mountain National Park or learning a really cool coping skill. One of many examples of coping skills taught to clients is called 5,4,3,2,1 where one is taught to evoke all five senses. This is a great coping skill where a client is taught to tap into all 5 senses within as a viable resource. Another experience often happening at Harmony is witnessing clients as well as staff simply spending time with Cooper, our therapy dog.

As a mental health provider at Harmony, I have noticed clients seemingly more calm during sessions when we are taking a walk together in nature. I believe they appreciate the fact we are walking and talking side by side as opposed to sitting across from one another. Clients have stated, “Wow, this is better than sitting in an office, this is a nice place to get treatment.”

Since Harmony offers outings each week at an indoor climbing gym or hike in the park, depending on the weather, clients are able to take advantage of the natural beauty and the healing attributes of moving Harmony has to offer.

Harmony is a special place that helps client’s feel safe, accepted and cared about. For some on their path of healing it is a beginning, for others it is a renewal; for all whose path includes a stay at Harmony, it is a step toward healing in the arms of nature’s embrace.

Kelly Baker, MA, LAC, LPC, NCC
Mental Health Professional, Harmony Foundation, Inc.

References:
http://well.blogs.nytimes.com/2015/07/22/how-nature-changes-the-brain/?mwrsm=Facebook&fb_ref=Default&_r=0
http://www.pnas.org/content/112/28/8567.abstract
http://www.sciencedirect.com/science/article/pii/S0169204615000286
http://www.girlscouts.org/

Does Treatment Work? Why Outcomes Matter…

Does Treatment Work

by Dr. Annie Peters: Harmony Foundation’s Chief Clinical Officer

Harmony has been helping people who are struggling with addiction to find recovery since 1969. While Harmony is well-known in Colorado for providing clients and families with support and quality services for many decades, reputation means little without demonstrating that people do, in fact, get better.

Defining what recovery is, and demonstrating that people who use Harmony’s services begin finding recovery, are essential components to the provision of ethical and effective care. Harmony’s mission is to provide the foundation for recovery from the diseases of drug and alcohol addiction. If clients leave treatment and begin re-developing lives of purpose, satisfaction, and rewarding relationships, we know we have helped to provide the foundation for a journey toward wellness.

Harmony contracts with an external research organization, OMNI Institute, to examine treatment outcomes regarding substance use, psychological well-being, and improvement in life satisfaction.
Data collection for the most recent outcomes study performed by OMNI began in March 2015, and the study was finalized in 2017. One hundred and forty eight (148) Harmony clients were assessed upon admission, at discharge, and at 1, 6, and 12 months post-discharge. The percentage of clients who responded at these time points were, respectively, 100%, 94%, 63%, 61%, and 64%. While results cannot be generalized to clients who were unable to be reached for follow up, a number of statistically significant findings can be reported and provide valuable information about the effectiveness of care provided at Harmony.

DEMOGRAPHICS

Understanding the people we serve helps us provide the highest quality of care by tailoring treatment interventions to the specific needs of our clients. In this study, the average age of clients was 38, with a range from 18-65. Sixty-four percent (64%) of clients identified as male, and 36% identified as female. All clients were asked to identify their “primary drug.” The majority of clients (74%) identified this as alcohol, followed by heroin (10%), methamphetamine (6%), other opiates/painkillers (5%), and marijuana (3%).

Clients under the age of 25 typically used more substances – the average number was four. The primary drug differed by age as well; clients under 25 identified heroin or alcohol (38% for each), followed by marijuana (13%).

REASONS FOR DRUG/ALCOHOL USE

Clients were asked about the reasons they used alcohol and drugs, and their responses help us understand how to help people better. Many clients (30%) said they used substances for “self-medication” or emotional pain/mental illness (28%). Other common answers were using for pleasure (22%), to escape reality (15%), habit (13%), or pain (5%).

PREVIOUS TREATMENT AND REASONS FOR SEEKING TREATMENT
About a third of clients had been to a detox treatment before, and about a third reported a prior treatment for substance use. Another third reported never having any treatment for drug or alcohol use.

About half of clients surveyed reported a prior diagnosis of a mental health disorder, with the most common diagnoses being depression (37%), anxiety (25%), ADHD (11%), PTSD (7%), and bipolar disorder (6%).

Most clients said that coming to treatment was a personal decision (71%). Other common reasons given for seeking treatment were a family situation, health reasons, a legal situation, or a job-related reason.

POST TREATMENT OUTCOMES

After leaving Harmony, clients were asked at 1, 6, and 12 months about their drug and alcohol use. They were asked whether they had been continuously abstinent from drugs/alcohol since discharge, and they were also asked if they had been clean/sober for the previous 30 days. As can be seen in the table below, over half of clients at one year post-discharge had been continuously abstinent since coming to Harmony, and 71% of them had been abstinent for the past 30 days.
Follow-up     %Abstinent for      %Continuously Abstinent
     Time            Past 30 Days                   since Discharge
1-month           77% (n=88)                            68% (n=91)
6-month           64% (n=90)                           57% (n=91)
12-month          71% (n=90)                            54% (n=95)

Abstinence since treatment is not the only outcome that demonstrates that clients are recovering and have improved their lives. In this study, we also wanted to determine how quality of life had improved for people who had come to Harmony. So all those surveyed were asked questions about relationships with family and friends, physical/emotional health, and other factors. Clients reported significant improvements over time in their family relationships, friendships, spiritual connection, physical health, emotional health. They also reported significant positive changes in their ability to handle finances and handling problems or conflicts, as well as improvements in self-respect. There were also significant reductions in arrests and other legal problems post-discharge, as well as improvements in employment status.

Because so many of our clients have co-occurring mental health issues, we also asked questions about symptoms of anxiety and depression. There were statistically significant reductions in symptoms such as hopelessness, fatigue, nervousness, restlessness, sadness, and feelings of worthlessness.

WHAT PREDICTS ABSTINENCE

In order to continuously improve Harmony’s services, we wanted to determine if there were factors that were associated with post-treatment abstinence. For example, do older clients have better abstinence rates than younger clients? Is primary drug related to abstinence rates, such that clients who primarily used alcohol do better than clients who primarily used heroin?

Interestingly, the only variable that predicted abstinence was the reduction in mental health symptoms during treatment. In other words, the more clients’ symptoms of depression and anxiety decreased during their time at Harmony, the more likely they were to remain abstinent after leaving treatment.

WHERE DO WE GO FROM HERE

One of the most compelling and recurrent themes in this study was the importance of mental health care and support. As mentioned above, self-medication of emotional pain and mental health issues were primary reasons clients reported for using drugs and alcohol. Half of our clients had co-occurring mental health diagnoses. And the single best predictor of post-treatment abstinence was the reduction in symptoms of depression and anxiety that clients reported during their treatment at Harmony. For the past few years, Harmony has worked to improve the quantity and quality of support provided for mental health issues. We have added mindfulness groups, a trauma coping skills group, and education groups on a variety of mental health topics. Clients can receive both addiction-specific counseling at Harmony and counseling specific to psychological issues. Given the results of this study, Harmony plans to continue enhancing the services provided to help people recover not just from chemical use, but from underlying emotional issues that can increase risk for relapse.

While the results of this study show that Harmony clients do, overall, have improved lives and decreased drug and alcohol use, we want to help more individuals and more families to recover, with more significant reductions in substance problems and more improvement in life functioning. Harmony is committed to continuous improvement in our services to provide even better care and help more people find their way to recovery. Studies such as this one remind us why this work is so important and why we need to always examine ourselves and find areas for improvement.

CLIENT FEEDBACK

At the end of each survey, clients were asked if they had any feedback about the Harmony experience. Common answers were that they appreciated the support provided by staff as well as the community they built with the other clients. While data can provide us with important feedback on who we serve and how we can continually do better at helping people find recovery, it is these comments that remind us why we do what we do at Harmony:

“I have come to better understand myself, my need to use, and what I am struggling with so that I won’t need to turn to drugs and alcohol to deal with my problems.”

“I’m really grateful to Harmony…it helped me a lot… I was in really bad shape. If I would have went somewhere else, I probably wouldn’t still be clean.”

“The staff here was absolutely amazing and seemed to truly care about me and my recovery. They were instrumental to my time here and truly helped me recognize qualities and worth in myself that make my sobriety worth fighting for.”

 

YMCA of the Rockies

YMCA of the Rockies, located near the town of Estes Park and Rocky Mountain National Park, is an ideal vacation, reunion, wedding and conference destination. Come visit and be inspired by our surroundings!

Gina: Hi everyone, welcome to the Harmony Foundation Podcast Series. I’m pleased today to be joined with Adam Johnson, Greg Bunton and Nick Richardson with the YMCA of the Rockies. Welcome guys.

Adam: Thank you.

Nick: Thank you.

Gina: It’s really great to have you here and we’re excited to hear more about what you all do, but before we do that, let’s talk a little bit about your backgrounds and what you do with the Y, so why don’t we start with you first, Greg.

Greg:  Well, my name’s Greg. I’m an ordained pastor in a Christian church and I’ve been in full time ministry for about 22 years now. I was serving a church in Oklahoma for 17 years prior to coming out to be the chaplain at the YMCA of the Rockies. In my role out there now, basically I oversee all the religious programing that takes place at the Y, from Sunday morning worship to bible studies to adventure ministry, all the different ways in which we can reach out to our staff and to our guests and provide them an opportunity to engage spiritually while they’re at the YMCA of the Rockies.

Gina: That’s great, sounds very robust. How about you, Adam?

Adam: My name’s Adam Johnson, I’m the associate chaplain at the Y so I get to work with Greg all year around, and my main role is what’s called pastoral care, so get to meet with people all throughout the year, normally have five or six clients every week, have a therapy dog named Reverent Hobs who gets to be animal assistant therapy. So we meet with people and then serve with worship in the Rockies Sundays at 10:00 AM, and then all the other wonderful things we get to do at the Y.

Gina: That’s great, thank you.

Nick: My name is Nick Richardson, I main work in the buildings and grounds department. I am also nationally registered emergency medical technician, I run our emergency medical response department at the YMCA, so we maintain the buildings and the grounds and any emergencies that arise, you’ll see me.

Gina: That’s great.

Nick: Alright.

Gina: You got a big campus to work with.

Nick: We do, we have … We can comfortably sleep about 5000 people at any time, usually in the summer we’re pretty close to that, in the winter we’re a little bit lower, but we …

Gina: It’s like a small town.

Nick: It is a small town, and we run it as such.

Gina: That’s great. So YMCA of the Rockies, 110 years that it’s been in existence, which is really impressive. So Greg, when we talk about what you all offer as far as programs and services, if someone wanted to take advantage of the services that you all have there, what would they be looking at?

Greg:  Yeah, so we’re not typically … We’re not your typical swim and gym style YMCA. A lot of times when people hear the word, YMCA, that’s what they think of, but we are a camp and conference center, or a retreat center. We also I guess could consider ourselves like a mountain resort. We can sleep up to 5000 people out there and we have everything from day camp for kids to adventure programing, zip lining, archery, climbing walls, we have a lot of hiking programs out there, a lot of people will come out for vacations as a family and wanna just do some family programing and spend time out there in the mountains. But then we also have a lot of conferences that come out, church groups that come out, family reunions, wedding parties, you name it. People like to come out there, so at any given time, there are multi … It’s like being on a large cruise ship, just not-

Gina: Not on water.

Greg:  Going and just not on water. You’re out there-

Gina: In the mountains.

Greg:  So you can go to a yoga class and then you can go do a hike-

Gina: And make sure the buffet is there.

Greg:  And the buffet, they have-

Gina: You got to have an endless buffet.

Greg:  We have a food service out there, so we have three meals a day served in our cafeteria, plus we have a café on site, and then other meal options as well. We have cabins to stay in, we have lodge rooms to stay in, everything from hotel style to cabins that can hold up to 80-some people if they chose to do that. So there is definitely something for everybody in the family.

Gina: Of course, what I love, the best fun fact for me about your Y is you’re the largest Y in the world.

Greg:  Yes.

Gina: That’s really impressive for Estes Park and for the community surrounding Colorado. It’s fantastic. So you got great programing, so Adam, let’s talk for a few minutes about the issue of what is the Y’s position in working around things. Obviously my experience with Y is that they’re very focused on trying to get people to be healthy.

Adam: Right.

Gina: Healthy and wellness, and obviously good spirituality is important, so when you’re thinking about the issue of addiction or when you’re thinking about wellness, how does the Y play a part in that?

Adam: The Y, I always have thought about spirit, mind and body, in that triangle of having even parts on that and we’re talking about unhealthy behaviors like addiction, want to strive to help combat that, and that’s why we’re having this conversation here at Harmony, we can partner here in town of Estes Park, but also help find healing for those that need that. We’re having this conversation and also I think just addressing that with the Y’s mission and then also the core values of just caring for our staff, our guests, and then for the community at large.

Gina: A lot of great opportunities for parallel work together, that’s fantastic. So Nick, first time here at Harmony.

Nick: Yes.

Gina: So what’s your thoughts?

Nick: It’s beautiful, it’s a beautiful campus, I like the mixture of the physical buildings and my background in maintenance as well. Very well maintained, I like the mixture of the rustic and the new. Looks very nice, it’s very inviting, everyone I’d met here has been fantastic and really helpful and seems to really be invested in what they’re talking about. More so than the physical property itself, I think the people that I’ve encountered and talked with today really seem, yeah I guess invested would be the best word to really do what’s best for the client or the patient or whoever needs help in partnering with us or with the town, just really the bottom line to get help to people who may need it.

Gina: Thank you, that’s great. Great feedback, we look forward to that partnership with you all. So Adam or Greg, either one, if you knew somebody that wanted to access services at the Y, how could they get in touch with you all?

Greg:  Well the best way, we always just direct people to our website, which is YMCARockies.org. You can find everything out about us on that website, and then depending on what it is you’re looking for, if it’s gonna be a group that’s comin’ out or individuals or conference, you’ll be able to find the right link on who you need to get in touch with to start making those arrangements.

Gina: Wonderful, well again, thank you both, all of you for taking the time to come out and visit with us. We really appreciate it, we look forward to the partnership.

Greg: Thank you.[crosstalk 00:07:05].

Are You in a Codependent, Avoidant, or Securely Attached Relationship?

codependency

by Lana Isaacson, LCSW, CAC III, Certificate in Marriage and Family Therapy, PACT Level I

Codependency is one of the most confused and contested words in the couples therapy field today. There could even be a debate between couples therapists and addiction counselors on whether or not codependency (and even the cartoon above!) is healthy or unhealthy.

Addiction counselors would likely say that codependency originates in childhood and manifests as an unhealthy relationship with oneself and a dysfunctional interpersonal pattern in adulthood between the codependent and his/her partner, children, and others that involves controlling, excessive caretaking, and enmeshment. Codependency and enabling are often used synonymously to refer to the dynamic between a partner with an addiction and the codependent who “loves him/her to death” through enabling. Addiction counselors might also contend that any level of dependency or too much “connection” to one’s intimate partner is unhealthy and recommend that individuals in recovery wait at least one year before beginning an intimate relationship.

On the other hand, couples therapists are more likely to conclude that codependency stems from the couples’ current dynamic, which includes one partner displaying an avoidant attachment style, which influences the other partner to feel tremendous anxiety and want to cling to her/his partner, and appear as codependent. These therapists might also underscore how partner’s emotional dependence on one another is a normal human need, and therefore should not be shamed. Or, couples therapists might elevate a codependent relationship as the ideal because they attest that partners are more resilient when they have a “secure base” or emotional anchor and will possibly point to the 2006 MRI study by Dr. James Coan that demonstrated how partners can regulate each other’s psychological and emotional well-being. Finally, some couples therapists, especially those who subscribe to attachment theory, might deny that codependency exists as in Amir Levine, MD and Rachel Heller’s well-respected book, Attached, in which they assert that “codependency is a myth”.

As with couples in therapy, often the truth lies somewhere in the middle. Because I am both an addictions counselor and couples and family therapist, it seems to me that this argument is a semantic one and that codependency means very different things to both professionals. In order to best serve our clients, it is important to distinguish the difference between codependency and interdependency or a secure attachment.

First, what is codependency?

This answer can greatly differ based on the source. I will share a definition by marriage and family therapist, Beverly Berg, PhD who wrote Loving someone in recovery; The answers you need when your partner is recovering from addiction.

“Codependency is an emotional and psychological state in which one is excessively preoccupied with taking care of or controlling another person at the expense of one’s own needs… The codependent’s excessive focus on caretaking does not only occur with his or her primary partner; it can also apply to work relationships, friendships, and relationships with extended family. People with codependency have a hard time leaving relationships that are abusive or depriving, tend to stay in jobs that are stressful, and are prone to ignoring their medical needs. Because of their high tolerance for denying their own needs, codependents tend to wait until they have experienced serious consequences before seeking a path of recovery” (2014).

Internally, codependents tend to struggle with thoughts of not feeling good enough, excessive worry about what other people think of them, and constant waiting for disaster or the other shoe to drop. They may perceive neutral or even positive situations as negative. I know some very “high functioning” codependent people who (similar to some addicts prior to recovery) may look great on the outside, but are internally suffering. Fortunately, treatment/help for codependency addresses both one’s internal and external world.

Lastly, codependency affects people from all walks of life- both men and women, addicts and non-addicts, and should not be assigned to every partner of an addict. To see if you or someone else meets the criteria for codependency, one assessment can be found on The Bridge to Recovery’s website (an outstanding treatment program for codependency)

Second, how does codependency develop & manifest in adult relationships?


Stan Tatkin, PsyD, creator of PACT (Psychobiological Approach to Couples Therapy), which incorporates attachment theory, neuroscience/arousal regulation, and experiential therapy, explains the origins of codependency in the foreword for Berg’s book. Tatkin’s former supervisor was John Bradshaw (the latter was a leader in the addiction and codependency treatment field).

“[…] Codependent men and women tend to bond in love relationships in a way that makes them both angry and resistantbecause during their childhood, at least one of their important caregivers was preoccupied as a result of feeling overwhelmed, unsupported, and unloved by his or her own parents” [or spouse]. Preoccupied caregivers tend to alternately reward their children for depending on and supporting them, and rejecting, punishing, or abandoning them. This inconsistency tends to make the children angry as well as suspicious of and resistant to affectionate approaches from the caregiver [and later spouse] (2014)”.

“[…] Fast forward to adult relationships with a partner preoccupied with addiction [a mental health condition, or something/someone else] and you find a familiar situation. Your partner knows how to feel good without you [or is unaware of your needs], but you need your partner to be present, loving, and caring to feel good. Even though you feel ignored, abandoned, and alone, you STAY in the situation. Why? Because you are insecure and fear abandonment” (2014). And of course, many partners would also say, “because I LOVE him/her.”

Third, what do different attachment styles look like in children and adults?

Tatkin’s (2016) work draws from researchers who discovered that children and adults typically have one of three distinct attachment styles: secure, avoidant, or anxious (codependent). There is also a small portion of adults who have a disorganized attachment style due to severe unresolved trauma. Adult’s attachment (or “relationship”) styles are primarily influenced by the attachment relationship they had with their primary caregivers when they were children and secondarily by one’s intimate relationship history.
In a nutshell:
Children who felt their parents would respond consistently and appropriately when they called out for help or reached out for emotional comfort tended to develop a secure attachment style as adults. As adults, these securely attached folks find it relatively easy to get close to an intimate partner and are comfortable depending on their partner and having the partner depend on them. These relationships are mutually reciprocal. These partners have each others’ backs!
Children who felt their parents minimized, scolded or ignored their emotional needs or did not know how to appropriately emotionally comfort them tended to develop an insecure/avoidant attachment style as adults. As adults, they have disowned their emotional needs and thus struggle to identify what they need from their partner or over rely on themselves for comfort, and do not know how to adequately meet their partner’s emotional intimacy needs.
Children who felt their parents inconsistently responded (sometimes expert soothers and very loving and other times overwhelmed and either ignored the child, got angry, or guilt-tripped the child) when they called out for help or comfort tended to develop an insecure/anxious (codependent) style as adults. As adults, they worry that their partner does not really love them, won’t want to stay with them, or cannot meet their emotional intimacy needs.

The GOAL- A Secure Attachment Style!

Tatkin’s (2013) description of a “secure functioning relationship” is his unique terminology for a secure attachment:
“We have each other’s backs. We soothe each other’s distress and amplify each other’s joy. We protect each other in public and in private. We have each other’s “owner’s manual” and thus are experts on one another. We are as good at our partner as we are at our job! Our relationship is based on true mutuality.” We work on our own recovery and support each other’s recovery.

Fourth, how does an avoidant attachment style affect partners?

Although avoidantly attached partners and relationships are not nearly as vilified as codependents, they are of equal concern because they evoke in their partner a deep loneliness, often feelings of betrayal (when they seem preoccupied with their work, their family of origin, or other people or activities, including their alone time) and emotional deprivation. Perhaps the lack of widespread concern about avoidance is that our American culture places independence and stoicism above collaboration and vulnerability as well.

Yet, what I see as a couples therapist is as many or more relationships suffering when partners balk at mutually making it their sacred responsibility to put their partner’s emotional well-being first. Although this blog focuses more on codependency in intimate relationships, I have included resources at the end that can help folks interested in healing from and transforming their avoidant attachment style into a secure style.

Fifth, how can we integrate the wisdom from the Couples Therapy and Addiction Counseling fields on the topic of codependency?

The couples therapy field, especially attachment theorists, offer us a unique perspective on codependency that doesn’t blame or shame the partner being labeled codependent by explaining that the codependent is behaving in a normal way to an abnormal situation, which is his/her partner disconnecting from the relationship to connect with something else, ex. an addictive substance or behavior. This distancing from the codependent’s partner will likely propel the codependent to take extreme measures in an attempt to reconnect with his/her loved one because it has been found in research that adults, similar to children, experience “primal panic” when they cannot emotionally reach their loved one and/or their loved one stops emotionally responding to them.

Attachment couples therapists also normalize our biological need to attach and bond to others and to be emotionally dependent on significant others from the cradle to the grave. Couples with a secure attachment style and/or an interdependent dynamic have been found to feel the most loved, safe, and secure with their partner, have the happiest and longest relationships, and are more successful in the world because they are launching and landing each day with a partner who serves as their “secure base” or emotional anchor.

Addiction counselors provide a different type of expertise and often more personal and professional experience with codependency, which can bring a level of wisdom that is invaluable. Addiction counselors tend to better understand the gravity of codependency, ex. being the spouse or child of a codependent can be extremely challenging because the codependent limits others’ growth and unconsciously disables them. These counselors are also often aware of the internal pain that codependents experience and feel compassion for the codependent’s inability to stop (cold turkey) his or her codependent behaviors, thoughts, and feelings. Some codependents describe their experience of enabling or helping (anyone with anything) as a “HIGH”, refer to themselves as “self-sacrificing martyrs” or “rescue warriors”, yet by the end of an enabling spree, they need to crash from emotional and physical exhaustion, and later they feel intense hurt and/or resentment from having given too much and sacrificed themselves for others who continually neglect their needs. This cycle repeats until help is attained by a professional who can provide appropriate treatment.

Thus, by acknowledging that codependency is a REAL condition and explaining the research-based recommendations for treatment, addiction counselors can offer validation, empathy, and hope to their clients who previously felt hopeless about their internal suffering and compulsive behaviors. These counselors also go far beyond normalizing the couple’s dynamic to helping the couple navigate out of an insure attachment style into a secure one.

Finally, Moving Forward~ Recovery from Codependency or Avoidance to a Secure Attachment Style and Relationship

Tip #1 Strengthen your individual recovery program (if applicable, ex. CoDA, Al-Anon, AA/NA &/or individual therapy, meditation, etc.) and your ability to know your autonomous self (the ability to be emotionally close to someone while at the same time, not lose yourself). One outstanding book to guide you is Loving someone in recovery by Beverly Berg, PhD, which explains the stages of recovery from codependency, emotional relapse indicators, and teaches missing interpersonal skills. (in addition to a comprehensive overview of how couples in recovery can change a dysfunctional dynamic into a securely attached relationship.)

Tip #2 Learn how to develop a secure attachment with your partner that addresses how to transform both insecure styles (codependent and avoidant) into a “secure functioning” relationship. Three outstanding books to guide you are Wired for love by Stan Tatkin, PsyD, MFT, Attached by Amir Levine, MD and Rachel Heller, MA. & Berg’s book mentioned in Tip #1.

Tip #3 Seek couples therapy, with a counselor who has training in helping couples develop a secure attachment and recovery from addiction and codependency if applicable. And, if you are a couple in recovery, develop a couple recovery program, ex. participate in RCA- Recovering Couples Anonymous and AA/Al-Anon/CoDA speaker meetings).

If you would like help navigating out of an insecure attachment style into a securely attached relationship, Contact Lana Isaacson, LCSW, CAC III, Certificate in Marriage and Family Therapy, PACT Level I Therapist, at 720.432.5262 to schedule your appointment today.

www.lanaisaacson.com