When people hear about spirituality, they often think of a higher power. While spirituality can include a higher power, it does not always have to. Spirituality, in essence, is seeking a deeper purpose of existing. It expands beyond self-seeking and strives to serve other people. Spirituality is meaning and purpose in one’s life and is centered around core values.

It is a part of human nature to seek meaning and desire to see what is beyond our limited selves. We may strive for many things such as love, connection, beauty, community, the supernatural, and other reasons to live. For healing to occur, we need a holistic approach that addresses all parts of ourselves. This includes taking care of our biological, psychological, social, and spiritual needs.

Addiction can impact all of these areas. When we struggle with an addiction, we may not be aligning with our core values and we may feel disconnected from a higher power or purpose. While substances can mimic spiritual states of consciousness such as feeling euphoric, peaceful, and creative, it often is a temporary relief and does not maintain once the person is no longer using or engaging in the behavior, potentially resulting in feelings of emptiness, disconnection, and shame. While we often do not remember spirituality in well-being, research shows that it is very important in recovery:

The National Institute on Drug Addiction found that those with high levels of spirituality had high levels of remission rates, while those with the lowest levels of spirituality had the highest relapse rates.
There is a positive association between spirituality and increased health with mental health disorders such as depression and anxiety.
Spirituality can help with problem solving capabilities, including finding ways to cope with and manage things that seem unmanageable.
Having a sense of spirituality may help to buffer against self-seeking behaviors, including substance misuse. It may redirect thoughts to have an increase in positivity towards life and have a purpose of helping others.

Struggling with a substance use disorder does not mean that a person is not spiritual. Addiction can be caused or exacerbated by a variety of factors such as biological predispositions, social and environmental concerns, trauma, mental health disorders, a lack of deeper purpose and meaning, and other issues. Regardless of the factors that contributed to addiction issues, it can negatively impact all of these areas.

Finding healing means addressing all aspects of ourselves, including finding a purpose and how to live out our values. What matters to you, and what do you want your life to be represented by? How can I live outside of myself and give back to others? What values do I have and how do I live by them? These are all important questions to ask and consider. As Holocaust survivor and psychotherapist Viktor Frankl said, “He who has a why to live, can bear with almost any how.” What is your “why” that gets you through challenges?

If you are interested in learning ways to manage biological, psychological, social and spiritual needs, Charmed Counseling has several therapists to reach out to. To schedule an appointment or request a consultation, call 509-768-6852.

#recoverythursdays

Written by Taylor Hocking, LMFTA, SUDP, Clinical Therapist at Charmed Counseling

References

Borgen, B. (2019). When need is greatest, help may be closest: Significance of the spiritual dimension in therapy mediated by interviewees. Cogent Psychology, 6(1). doi:10.1080/23311908.2019.1610223

Miller, W. R. (2013). Addiction and spirituality. Substance Use & Misuse, 48(12), 1258-1259. doi:10.10.3109/10826084.2013.799024

NAADAC. (2016). The spirituality of addiction. [Video]. Retrieved from https://www.naadac.org/the-spirituality-of-addiction

When it comes to trauma, no two situations are ever the same. Two people can be standing side-by-side and witness or experience the same traumatic event and maybe exhibit immediate reactions, yet only one of them is later diagnosed with PTSD. It really comes down to the amount of resiliency and development of coping strategies, including social supports, to help them deal with the aftermath and effects of the trauma. Some trauma survivors have difficulty regulating emotions such as anger, anxiety, sadness, and shame—this is more so when the trauma occurred at a young age (van der Kolk, Roth, Pelcovitz, & Mandel, 1993). Those who are older and functioning well before the trauma occurred, usually have more shortened emotional dysregulation responses.

Initial reactions to trauma can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and blunted affect. You could experience a few or all of these symptoms but they don’t usually last for more than 3 months after the traumatic experience. Some people may experience delayed responses to trauma which can include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or activities that are associated with the trauma, even remotely.

The diagnostic criteria for PTSD place emphasis on psychological symptoms, but some people who experience trauma may present with physical symptoms. This is important for primary care physicians to remember because they may be the first and only provider the traumatized patient sees. There is a significant correlation between trauma and chronic health conditions. These could include gastrointestinal issues, sleep disturbances, neurological, cardiovascular, muscle aches/pains, respiratory complaints, dermatological disorders and substance use disorders. Many of these are often found in people with unresolved adverse childhood experiences (ACEs), even when there is no family history of the disorder. As an example, early ACEs and other traumas affect brain development and can increase vulnerability to experience interpersonal violence as an adult which can lead to developing chronic diseases and other physical or mental illnesses (Centers for Disease Control and Prevention, 2012).

Often the psychological effects of trauma are noticed first and can lead to the disruption in the day-to-day life of the individual. This could include depression, anxiety, anger, intense fear, flashbacks, paranoia, dissociation and in some instances cognitive abilities. The traumatic experience could also affect and/or alter cognitions which can lead to the belief that the World or their surroundings are unsafe and people are dangerous, or in extreme cases create altered personalities (DID) to help them cope with the trauma that is happening to them (see the blog on DID for more information).

People cope with their trauma in many different ways and self-medication is one of those methods they use in an attempt to regain control. However, this often leads to further emotional dysregulation. Therapy, and at times medication management, tend to be the best course of action for those with traumatic experiences. If you or someone you love are dealing with recent or past trauma and would like to be evaluated for PTSD or other trauma related disorders and possibly receive further treatment, please reach out to us at Charmed Counseling.

Written by Debra Winter, LMHC, LSWAIC, Clinical Therapist at Charmed Counseling
Debra@charmedcounseling.com, www.charmedcounseling.com

Living alone during the quarantine of Covid can be stressful. We are more restricted by activities in our lives than ever before. With winter beginning to set in and the Holidays on the horizon, one wonders how we will cope with the stress.  We know that our holidays may be very different this year, usually spent with family and friends. This year we might have to think how we can stay healthy and yet still get through it all. It will take a bit more creative thinking to burn off the stress. Try to make sure you create more movement in your daily life. With the cold weather it will be harder to get out to exercise, and gyms are still restricted. This does not mean you need to spend money on some new exercise equipment, there are many free videos on youtube for all kinds of fun ways to create more movement in your life. You will have more energy and improved mood, even if you just get up and stretch for a few minutes every hour.

Reach out to a friend every day, just to see how they are doing. Just a simple text will do, but it helps us to stay connected to people when we don’t see them. Try to have a few conversations each week with close friends or family. 

As for activities, think about cleaning out your closest and donating to an organization that supports homelessness. They could use those warm clothes and blankets we don’t always need. Or think about how you could help out in your community in some small way. Donate food to a food bank if your closet was cleaned out pre covid. The local pet shelters are always looking for dog walkers as well. This will definitely increase your mood if you’re a pet lover, just make sure not to take them all home HAHA. Perhaps a new hobby, learn to knit or crochet, or look online for ideas, Pinterest is a good place to look for ideas. Even a puzzle can be a good way to focus your mind off your stress and not get sucked into the couch with a binge in Netflix. That is sometimes fun but we need to have other mindful activities to take our mind off of things. With the winter and the holidays being so different this year we will have to work a bit harder to stay positive and happy. Making a daily list of the things we are grateful for is always a good way to stay focused on positive things in our life. We can then be grateful for each and every day.

Written by Diane Hopkins, LICSW, Clinical Therapist at Charmed Counseling

Diane@charmedcounseling.com, www.charmedcounseling.com

#TherapyTuesday

The stages of change is a model created in the 1980s by researchers DiClemente and Prochaska. They observed people with addiction issues and discovered different stages they go through, and identified ways to help people move along in their recovery. It is frequently used in a type of counseling called Motivational Interviewing. 

While this model was originally created for people who were trying to quit smoking, it can be used for any behavior that a person wishes to change, such as drinking, drug use, internet addiction, gambling, binge eating, and other issues. Since recovery is not linear and a person’s motivation can frequently change, people can jump to different stages throughout their recovery. Understanding what stage of change you are in can help to identify some of the types of counseling you may need. The stages of change are:

Precontemplation

In the precontemplation stage of change, a person is not interested in making a change. They may be in denial of the problem or believe that the cons of changing the behavior are stronger than the pros. Individuals in the precontemplation stage do not typically see themselves changing within the next six months. Raising awareness of the pros and cons of the behavior or habit may help them start to contemplate reasons to make a change in the future.

Contemplation

In this stage, a person may begin to see pros and cons of their behaviors more equally. They may be ambivalent to change, but want to make healthier decisions some time within the next six months. To help in this stage, a person may need to resolve ambivalence and find reasons to change.

Preparation

In the preparation stage of change, the person is motivated to make a change within the next month. They begin to make preparations for these changes such as making an appointment with a specialist, finding support systems, and making plans to reduce the behavior. The task of this stage is to find resources and strategies to help them put their plans into action.

Action

People in the action stage have begun to change their behavior within the past six months. They may be involved in counseling, self-help groups, and have announced their decision to change their behavior to other people. To help progress through the action stage, people may learn relapse prevention strategies and other coping skills. 

Maintenance

In the maintenance stage, people have maintained their changes over a sustainable period of time of six or more months. They find new patterns to replace previous unhealthy habits. The stresses of relapsing may become less intense over time as people continue to engage in healthier behaviors and learn new skills.

Relapse (optional)

While relapses aren’t inevitable, they are common for people who are striving to make changes. Relapse is a part of the recovery process and can be an opportunity to learn more about oneself and their triggers, and what they need to avoid or change in the future in order to reduce the chance of relapsing again in the future. After a person relapses, they can quickly go back to other stages of change.

Meeting with a counselor, especially one trained in Motivational Interviewing, may help to work through the stages of change by increasing motivation to change, helping you to prepare for changes, finding ways to maintain these changes, and working through any lapses or relapses along the way. 

If you are interested in exploring reasons to make healthier decisions or tools to maintain new behaviors, Charmed Counseling has several therapists who have experience working with both mental health and addictive behaviors. To schedule an appointment or request a consultation, call 509-768-6852.

#recoverythursdays

Written by Taylor Hocking, LMFTA, SUDP, Clinical Therapist at Charmed Counseling

Is it real?  Is this all in my head?  Why can’t I remember?  I can only imagine what it must feel like to have Dissociative Identity Disorder (DID).  There is so much controversy surrounding this disorder, even among professionals.  What it must feel like to be a person living with this day in and day out.  So much misinformation out there on the web and YouTubers who say they have DID and even showing a “switch” happening can definitely add to the confusion. DIssociation is a major part of DID, but just because you dissociate does not mean you have DID.  Today let us focus on the facts, real life experiences and treatments for those with this confusing and controversial disorder. 

FACTS:

First of all, what is DID?  DID was called multiple personality disorder up until 1994, when the name was changed to reflect a better understanding of the condition.  It is a rare condition, generally developed during/after severe childhood trauma as a way for the child to cope and understand what is happening to them. It is characterized by a distinct separation of identity, with at least two distinct personalities or alters as we call them.  These alters have their own identity, personality, and history.  They can be male, female, or non-binary,  any age, and often perform a specific function within their collective community.  Some are children who play which brings peace to the community, others are protectors and come out when the host is upset or triggered in some way, while still others can be very nurturing.  But not all alters are positive.  Some alters can have a very dark and cynical side as well.  

So how is DID diagnosed?  As a clinician, it is not an easy task to diagnose someone with DID and I will not do it without a lot of supportive information from family and friends, and additional research.  I tend to be fairly skeptical if a client comes to me and tells me they have DID, unless they have been diagnosed prior.  It has been my experience, the client (or host) does not even understand what is going on at first outside of the memory lapses, missing gaps of time, and feelings of dissociation.  After gathering supporting information, I can formally diagnose with the use of my diagnostic manual.  Per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),  the following criteria must be met in order to formally diagnose DID:

• The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self). Some cultures describe this as an experience of possession.
• The disruption in identity involves a change in sense of self, sense of agency, and changes in behavior, consciousness, memory, perception, cognition, and motor function.
• Recurrent and frequent gaps in memory, important personal information and events inconsistent with ordinary forgetfulness.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not part of cultural or religious practices and is not attributable to the physiological effects of a substance.

EXPERIENCE:

Now let us hear from a client who has been diagnosed with DID.  Understand, every person’s experiences may be different, but the underlying symptoms are often the same.  

What has it been like living with DID?

That is a very loaded question. I can tell you it isn’t what a lot of people think it is. First of all, it’s a disorder, so it really disrupts your life even after you are diagnosed. Some days I wake up as myself and I’m able to be productive, and other more turbulent days someone else takes the helm and my capabilities as a person completely change. For example, if a small part (or little) is present, my ability to care for myself is significantly reduced. Essentially, you can kiss any sort of productivity or adult responsibilities goodbye until an adult part comes out. Contrary to popular belief, most of the time internal communication is minimal at best so managing this illness takes a lot of discipline and work. 

I think what a lot of people don’t seem to realize is how distressing this mental illness is. The term “alter” conjures up images of quirky helpers whose sole purpose is only to protect the “host” of the system. The reality is a bit more complex than that. Triggers can be unexpected and mundane, and truth be told we have disagreements among ourselves about how things should be done. In addition, we all seem to have situations and emotions that someone else is better suited at handling. So if we must look at it in such simple terms, we protect each other in a sense, just in different ways. However, this mechanism causes distress as well because you lose time, and receive feedback that you behaved a certain way with no recollection of having done so. 

How old were you when you noticed something was different and how did you manage that?

Truthfully, I didn’t even acknowledge that I had anything wrong with me mentally until I was an adult. You see, when you grow up with something being normal to you, it isn’t until you have some outside context that you begin to realize something isn’t right. Once I was out of my abusive household, things began to really come to light for me, as is common with people who have trauma. However, it wasn’t until about eight years later that I would receive the DID diagnosis. Before that point, I think that I managed in the best way that I could at the time. Often I would blame my symptoms of dissociation on other factors, such as blood sugar fluctuations with my type one diabetes, but I think my mind was just trying to make sense of it all so I could function on some level. DID is a covert illness, so my mind would try to find and cling to any excuse except the actuality of the situation. Even now, I struggle with some level of denial, because the brain constantly wants to regress to old habits. 

Many therapists believe you need to integrate the alters with the host’s personality.  As a person with DID, what is your take on that idea?

I think it largely depends on the patient. There are some, such as those who also have bipolar disorder, who may not be able to fully integrate their most prominent alters. Attempting to force that upon them could cause unneeded stress and discourage them from continuing with their therapist. I think the clinician should look at their patients individually and assess what would be in their best interest as a whole. If the patient can live a fully functional and healthy life with alters, then I see no reason as to why integration is absolutely necessary. 

What advice would you give to someone who thinks they may have or has recently been diagnosed with DID?

First and foremost, if you believe you have DID, I highly encourage you to seek a therapist as soon as possible. There is a significant chance you may actually have another disorder entirely, as a key factor in the condition is that it truly is covert. Only a trained professional is going to be able to assess you properly and give you an accurate diagnosis. Self-diagnosing yourself with the wrong illness will severely hinder your healing process, and make it difficult to obtain the help you truly need.

Ironically, my biggest piece of advice for anyone (caretakers included) is to stay away from the internet as much as possible. There is an entire mess of misinformation out there, solely based upon personal experiences and with little scientific backing. If you simply must seek information on the web, NAMI.org is an excellent place to start. There is also a small but highly vetted subreddit that I help moderate called DID Toolbox, which offers information and helpful advice for those living with DID. 

TREATMENT:

Treating DID is about as controversial as the disorder itself.  Do you focus on the symptoms or the trauma that created them?  Do you integrate the personalities or leave them alone?  The answer is…YES!  Ultimately for me, I have my clients take the lead in their treatment.  They are the ones who are living with it day in and day out.  Some want to integrate which means focus on the trauma which created the symptoms and alters in the first place with the use of trauma focused therapies such as EMDR or IFS, while others enjoy the unique personalities each alter has and would rather learn to work with them as a team approach by using therapies like CBT or DBT.  No one way is better than the other and there are a multitude of treatment modalities that can be used; it truly is up to the individual and their counselor to find what works best for them.  Also understand that treatment does not always mean a successful outcome for every person.  Each case is unique and DID is quite complicated within itself.  

Psychotherapy is usually the recommended course of action for treatment, but often with the addition of medication management and case management. In some cases, the need for inpatient treatment may be utilized to help with stabilization then work with an outpatient psychotherapist.  Because DID is based in trauma, treatment is slowly paced and can often last a year or longer.  

If you or someone you love is dealing with dissociation and possible DID feel free to call Debra Winter, LMHC at Charmed Counseling for a consultation.  You can also find reliable and accurate information through the Journal of Trauma and Dissociation at https://www.tandfonline.com/loi/wjtd20  or www.reddit.com/r/DIDtoolbox. 

Written by Debra Winter, LMHC, LSWAIC, Clinical Therapist at Charmed Counseling

Debra@charmedcounseling.com, www.charmedcounseling.com