IITAP Symposium 2017 .Break Through to Excellence

IITAP Symposium 2017

Break Through to Excellence

When you have a deep experience, language seems to fail to conceptualize paradigm shifts that occur in front of your very eyes. Sometimes the added atmosphere of adventure, the perspective of the tourist, allows you the element of disguise, to move in and around like a ghost. As a voyeur, I got to sink down deep and digest.

The Iitap community has a depth to it that comes from growing up in adversity. Not the adversity you would see in a dysfunctional family system (although I am sure they have had their moments!), but more like a marginalised community, that found its strength and identity from circling the wagons, and within the system, supporting and encouraging, curiosity, eldership, maturing, and allowing exploration to the edges whilst having a defined beating heart of shared integrity. The maturity of the organisation that I am experiencing here now, is one forged then on standing on the foundation of the body of research and sharing their message confidently with the world. As a first-time attendee, from the land downunder, I felt at home in the rhetoric, aligned with the bill of rights that is the glue that holds Iitap together.

Like in a village I felt fear and excitement when the elders moved into view, whether they were presenting or just in the house.

On the day before the opening keynote, I found myself sitting in the front row as enthusiasts do, and then behind me was Stefani Carnes, Alexandra Katehakis and then joining them was Patrick Carnes himself. Patrick then before introducing the mornings keynote, honoured a surprised Vice President, Tami Van Helst for her dedication and service beyond measure. You could feel the love and respect throughout the whole building. In the short time I have known Tami, she is like a schoolmarm/scout master. You get all the help you need, with the encouragement to take responsibility for yourself (Functional Healthy Boundaries). She holds undying belief in the work, in recovery and the gifts this community can contribute to humanity. It was heart-warming to see her tears of gratitude, and to see an eldership in action. Patrick Carnes held a beautiful space. It was mirroring deep functional connection. A healthy family system.

The conference started for me attending a pre-conference workshop by Ken Adams, whom himself is a lifetime member of The Iitap community. The focus was on setting up a successful private practice. Ken brings a wealth of information to this subject. As a Therapist in Private Practice, I was keen and eager to learn everything I could from Ken. It was a clear, concise, active and productive workshop. An opportunity to walk out with a business plan. I was excited to give myself the space to get a clearer vision on how to move forward.

That evening I got to sit in a group hosted by Robert Weiss. It was an intimate circle and I felt privileged. Roberts books, Always, Turned On, Cruise Control, Sex Addiction 101 and its workbook, and the recent Doghouse release have been inspiring meny. In particular Always turned on, and cruise Control. They addrss Porn Addiction and Sex Addiction within the gay community respectively. Great assessments to addicts and professionals. I was disappointed to have to leave early as I have skype sessions to facilitate in my home practice, and I was not to be able to spend any other time with Robert at the Symposium. I will always follow him online and read all his prolific article contributions to the feil.

 

The conference started in full of an opening address by Alexandra Katehakis. The talk was inspired by her new book titled Sex Addiction as an Affect Dysregulation. Building on her work with Dr Allan Schore's, deep learning from Patrick Carnes, and wealth of experience from being the Clinical Director for the Centre for Healthy Sex in Los Angeles, and her Senior Fellowship at the Meadows. The book itself is a comprehensive text on the complexity of sex addiction development, pre-disposition, treatment and recovery. Alex chose to focus the content of the talk on the need for the therapist to have done their own deep integrative work, allowing them to be present in their right brain- mindful state to then be a significant influence of the regulation and healing repair of their client. A journey that was based obviously on personal experience.

The neuroscientific evidence now supporting this has defined what we have known about the power of the therapeutic alliance.

Of course, you cannot do that if you have not done your own work. So, to stay current in your own process is as important as your skill. I will say though it was the depth of conviction, knowledge and personal integrity that made the keynote memorable, which resulted in a standing ovation.

Inspired I then got into the groove of attending workshops. I split my time between workshops focusing addicts, partners and the couple ship work.

Attending the Skinner workshop helped confirm the PTSD correlation that partners feel and experience when the identification of sex addiction is made in their life. The co-dependency model, classic with working with drug and alcohol issues, in the case of sex addiction misses the fundamental systems that derail partner work. It was research driven data that proved beyond doubt that PTSD symptoms, other than Criterion A, were being experienced by partners and needs to be dealt with before we can deal with the possibility of the partners underlying family of origin or relational issues.

Post lunch I attended a refresher by Clinical Director from the Gentle Path Program on the Recovery Starter kit. The Addiction Cycle resource. I have found the Recovery Starter Kit an enormously useful tool in early recovery with addicts, and a clarifying tool for partners to understand addiction, as largely they have been gaslighted up until now.  The cycle tool was defined in the chapters in Facing the Shadow, giving clients/therapists a clear hand rail through the resource. The main opportunity that comes with this tool is it clearly defines the rewards system of the brains role in addiction, and therefore the behaviour itself being only a co-star in a cast of activity which triggers the reward, and brings into focus the damage of objectification fantasy and euphoric recall, that drives ritual that lead to acting out. Many clients think that recovery is about abstinence, and therefore put their focus on just stopping. To make it worse, the symptoms of Craving can disappear altogether giving a false sense of security to an addict that they are FINE now. This addiction cycle model allows a client to prepare for the triggers that are coming, even if the cravings have temporarily disappeared. Don’t get me wrong, when you’re an addict it's an enormous blessing when they go for a while, the message here is that we need to know what leads up to the use, so we can transform those behaviours, creating new neural networks and allowing the old one to lose their champion status. Euphoric recall will always be a danger, but well managed with a transformational Recovery Cycle, these can be weathered.

I have been using the Recovery Starter Kit with clients and personally find it useful. Patrick Carnes in a box with a daily program for the first 130 days. Patrick Carnes, The Gentle Path and The Starter Kit and Facing the Shadow, the whole 30-point competency building plan is a ladder that will lead you out of Hell. You must climb it yourself, but we have never had in the field a more consummate treatment tool, put together by the Master technician of our time. Meyers accounted for the masterful approach with skill and clarity. The Gentle Path Program is in good hands.

My last session for the day was with Tim Stein and Jeanne Vattuone, focusing on the difference of couple work in the early throws of Sex Addiction recovery. The main point raised was that traditional Relationship Modalities, albeit great tools for general relationship difficulties, fall dangerously short with the sex addict and their partner. Most techniques work on trust building, and taking risks with each other by becoming willing to be more vulnerable. With the couple that’s dealing with sex addiction, this can be dangerous, ineffective and at worst, re-traumatising. The focus for these couples needs to be crisis management. Re-building trust must be replaced with boundaries work that allows the couple to talk, and create safety, not trust. That might come, and then eventually when the couple works out a way they can talk, and hear each other, and the trauma of the partner is acknowledged and the healing begins through a process of disclosure, Impact statements and atonement, the relationship can then focus, once it's status is more secure, on building trust. I found the discussion very useful. I have believed this for a while, and it something I think therapists must take heed of.

Friday started with a sobering keynote presentation by Richard Gartner, Founding Director of White Institute Sexual Abuse Service, and the author of Betrayed as Boys-Psychodynamic Treatment of Sexually abuse men.

He presented the research and impact of sexual abuse of boys. The research states that 1 in 4 men have had direct or indirect sexual abuse contact. He commented that male figures are likely to be under reported.

Bessel Van Der Kolk certainly exposed that it’s the way that you ask about abuse that is critical to giving you the best chance of getting an accurate account, mainly due to shame and the impact on memory of trauma.

A masculine template from association with Gender stereo types must be considered when talking to men who were abused as boys, as largely the toxic shame is carried by the abused, haunted by beliefs of weakness, not manly enough, should have done something to stop it. If the boys experienced any pleasure than the damage to their arousal template is catastrophic.

The abuse is more likely to be family or a trusted person by the family and the main impact here is not only is there the damage of the abuse, but more importantly the betrayal of trust. It changes implicit/ explicit brain chemistry. Ruins relationships, because of the abusers braking the vehicle of trust. Incest is a catastrophic form of sexual abuse. When a parent is the offender, the abused grows up chronically trapped relationally due to the damage to inherent value and inability to regulate their state, identify and activate boundaries, and appropriately meet adult needs and wants.

Gartner points out that Abuse is what happens from the abuser - Trauma is what happens to the victim.

Betrayal trauma is endured by Disassociation. Adaptive Association that happens in the moments of trauma leads to Pathological disassociation; the severing of ties with mental contents at the moment of trauma. Global defence mechanisms keep the experience pre-symbolized, experienced somatically, never turning into words.  This stored then in Implicit memory presents in life, fuelling addictions, mental health issues and Physical health issues as outlined by many researchers and clinicians, and brought to the wider arena by the Adverse Childhood Experiences study.

Gartner highlighted the importance of being informed about the impact of Masculine gender socialization. Boys are taught certain ways to Be a Man. This creates in most cases a cone of silence. Boys shut down. When you are shut off from your feelings early on, sad feelings go to activity, caring feelings get sexualized. Gartner outlined that in the masculine constructs of how to be, there is a Confusion of Tongues; as the abuser uses a language of passion however the victim's being a language of caring. This Is highly destructive and is played out in all future relationships.

 It made me think of all the clients and friend's in recovery that have been abused, and how untreated and under identified this issue can be, as we might focus on the addictions and mental health treatment.

I have sat with many men in men's groups and in one on one sessions, on retreat, either peers and in sponsee / sponsor relationships in 12 step fellowships, who have shared their story. I am grateful that I could hold the space for some healing and trust to start to develop, and some shame to be reduced.

This is a must buy book if you work with Men.

The next session was Vicki Tidwell Palmer, presenting material from her book for partners, Moving Beyond Betrayal, focusing the presentation on Boundaries after Betrayal-Helping Partners (of sex addicts) move into Clarity, Power and Connection.

 I have read Vicki's book as was delighted to see her love of Pia Mellody's Model, and her belief like mine in the power of the need to able to identify your own reality, before you can own it and the share it with another. The Process of being able to identify data, know what happens in your body, be conscious of the meaning you are giving it, identify in your own Family of Origin core beliefs that may be triggered (especially if we are feeling Hysterical, because if its Hysterical, its Historical) Then identify what you are feeling and then chose a course of action, as much as clients hate this process at times. This process as Pia Mellody's outlines, requires you to have to "turn up”, and then "grow ourselves up" into our functional adult self. This process, when you have been running from yourself, for your lifetime, avoiding reality due to trauma, to make as Jung said, the Unconscious -Conscious (The examined life is no picnic!) and as Patrick Carnes states, about early recovery, it is like trying to turn the Queen Mary in a harbour, on the spot!

However, when the pain gets to great, we must find another way. This might sound dramatic, but in recovery, once you stop acting out (medicating away your distress) then you are faced with this enormous challenge. The skills outlined here, and in this book, give you the personnel boundaries that allow you to be able to differentiate self from environment and get the space you need to define your reality, identify what is true, not true and questionable, identifying your own needs and wants, and start taking responsibility for the growth needed. It also gives us the safety to grieve.

This is where boundaries are critical. If we do not have them, we will either be an offender of other realities, or a victim of other realities.

When this is translated to the world of the betrayed partners, establishing boundaries will be the only way forward. Not to create trust. That, if it does return, will take a lot of time and effort in therapy and recovery. It will be built on actions and experiences.

Boundaries in the beginning with partners are to build safety, to protect oneself internally, thoughts and feelings, and physically and sexually. A partner being clear on what their boundaries are is essential for them to remain in relationship with the addict, so the disclosure /impact and atonement processes can take place, which could lead to the establishing of trust and deeper relationship in the future. For now, though, knowing your reality, and sharing good healthy boundaries is the first step. This book has a much wider use than the title suggests. It is a great book for partners of any addicts, as well as useful for the addicts themselves. Vicki has a fantastic Blog and website to so look her up. Resources at your fingertips.

After lunch, I attended Debra Kaplan's Sex Shame and Erotized Rage Lecture. Debra is a funny, deep engaging speaker and it comes through in her writing. Her book, For Love and Money, had just been released and at the time of writing this I am halfway through it, purchasing it at the conference. My 13 and 1/2-hour flight back to Australia had an announcement as we boarded that the entertainment system was broken, so no movies. Well I was lucky I had thrown in Debra's book preparing for the flight, so I slept, and read and slept and read, and I loved it! Debra is also influenced by the work of Pia Mellody, and Pia's principles are woven in through Debra's work, as well as her unique views that have come from her career on Wall street before changing careers and becoming a Psychotherapist.

The book and her workshop explored the attachment literature, the impact of abuse through Omission and Commission and the impact that these combined have on the formation of the arousal template. This affected arousal then has direct impact on the quality and type of relationship that we seek in our adult life. Debra then discusses Money, Sex and Power, and how in relationships these can create unique challenges when acted out addictively. I know I run the risk of recommending too many books by the end of this blog, but buy it, you will not be disappointed.

Next Dan Drake and Wendy Conquest led a session based on their fresh off the press Letters from A Sex Addict. A companion book to Wendy's previously released Letters to a Sex Addict, that was a tool for partners of Sex Addicts. The workshop was practical and experiential, and we all got a copy of the book (thank you guys!). Then in triads we went through the book using the letters in role play, that address the different stages of change and addict gets stuck in, due to minimization, denial and delusion. Getting through to an addict can be difficult, and the book as a tool allows addicts to identify the stage that they might be stuck in, through the empathic experience of reading the story of another. This approach can be more of a soft impact then the therapist trying to confront the behaviour. Even so, it might be a rude awakening as your read the story of another, stuck in the same place as yourself.  However, it can lead to change, second order change that will be a necessary paradigm shift for recovery to take place.

The evening was spent watching two documentaries.

First the Courage to Love, directed by Paul Ginocchino.

The film was a case study of four addicts who had the courage over the seven years that the film took to be made. Sex Addiction is the last of the Mohicans when it comes to shame and misunderstanding from the community. I remember seeing Ricky Gervais commenting on the Graham Norton Show. He stated in making comment about a person that was caught acting out sexually who claimed they were a sex addict, " Isn't that what people say when they are caught."

 I found it a strange disturbing comment, as firstly, a person is not likely to put their hand up to claim they are a Sex Addict as a result of the collective shame. I was struck but the ignorance of the comment coming from a man whom I held in regard as an articulate intelligent man. I do believe what he shared is a common position of many in society.

This film had three men and a woman tell their powerful and real stories, of childhood trauma, the onset of addiction and the pain and grief of being lost in the cycle. Paul was a generous and real man, who appeared in the film and told his story. I was encouraged, informed and inspired.

Next, filmmaker Justin Hunt screened, Porn- Chasing the Cardboard Butterfly. Narrated by James Hetfield from Metallica. It was a film of integrity, aimed at the recovery community. It took the addicts need for sobriety seriously by not showing any triggering sexual imagery. In a documentary called Porn, that was an art. The director’s commitment to that level of integrity made the documentary an enormous recovery tool. The film showed new neurochemical evidence and impact regarding Sex Addiction and Pornography, and clear recovery opportunities. Its focus was to create conversation about the subject. In all the years of my work with childhood trauma, I have been stunned at how many parents did not talk age appropriately about sex to their children, generally as a result of never receiving this essential information from their own caregivers. Children need to know about their bodies, about love, their genitals and sexuality. All age appropriate. By puberty, it's way too late. This level of abandonment is acute and leads to difficulty and shame around sexuality, leading to sexualized shame. This film is an opportunity to start the conversation. I look forward to playing this to therapists and clients in Australia.

Saturday, started with Professor Binford. Patrick Carnes introduced her after being impressed with the work she does as an international children rights scholar and advocate. The theme of the talk was highlighting the legislative inefficiencies on a global level in correlation to childhood sexual abuse children, especially when the abuse included having their image captured. The abuse, then is ongoing and lifelong with the infinite access that modern technological allows, as childhood pornography once online is the available for all time, impossible to get taken down. This reality inhibits any real healing, the thought itself retraumatizing the client over and over and over again. Even the comment at a workplace, or a dinner party, of "you look familiar" can trigger the Post Traumatic response in the abused as their mind rushes to imagine when this person might have seen of them. The reality shared by Binford as she went through her research held the room captive, as we imagined the depth of this sort of implication. For many therapists, this is what we see in our daily practice and know the dilemma all too well.

Binford talked to the attempts to change the laws over the years to support clients get control over the rights to the images that have been still copyrighted to the offender, and the research informing clinicians to address the complex and ongoing retraumatizing nature of this Trauma impact was sobering, as most clients stated they did not feel helped by therapists when they reached out for help.

Binford was dynamic, thorough, incredibly bright and tireless in her vocation to create real legislative difference by creating clear and honest discussion about this gut wrenching ongoing element of the sexually addictive work.

After being impressed by her Keynote I chose to attend Professor Binford's Sex, Porn and Manhood talk.  Binford presented research on the impact on young men and woman about phenomenal presence of pornography and how frightenedly available it is to our young people, and how inadequate we are as a society in addressing, containing, limiting and stewarding our children’s environment.

The average age being 11, but with some studies highlighting an average as young as 8 yrs. old, and the reality that still we seem to struggle as a society to talk openly and age appropriately to children, and amongst ourselves, as members of society, and within our educational and spiritual institutions to address this rapidly escalating impact.

The afternoon session, I chose Dr Stefanie Carnes, especially after enjoying the wisdom of Dr Stefanie Carnes recent training in Australia, as she taught us Module Two of the Certified Sexual Addiction Therapist Training. In her presentation, she presented the most current research done with partners of sex addicts about the disclosure process. Bearing about what made a client's experience successful, and what lead to a less than satisfactory outcome was confronting. Every clinician has had times something has gone not as well as you would have liked. As I do disclosure process work with colleagues at home, I appreciated all the feedback clients gave honestly. With sex addiction, as opposed to other addictions, where the impact is created is the bottle, or the poker machine, with sex addiction the enemy is another person, and the pain experienced by the partner reflects the symptoms of Post-Traumatic Stress. Therefore, to move forward addicts and partners need a comprehensive format to work through the complex needs of both addicts and family members. The process that IITAP has developed is world class, but the art of walking through the stress with the client's needs to be facilitated with great skill and competence. Carnes outlined this, and told the stories of when it worked or didn’t work. We must always be able to learn from our growing edges.

To close the conference Patrick Carnes was in the house. The title of his address was The Spiritual Paradox: A Spiritual Matrix for Emotional Intelligence. Patrick is held by this community in the reverence that you would expect an elder to be treated. Just his presence in the building itself, creates excitement.  Everyone in that conference room, has been directly influenced by Patrick Carnes. His personal recovery from Sex Addiction itself lead him to become its greatest recovery advocate. The resources he has written created tools that have saved many lives, while the medical community still argued over their validity. The conference itself was evidence to the influence he has had on the many that have followed in his footsteps. The level of professionalism and elegant intelligence in the way he delivers his research based wisdom, is a labyrinth awareness raising that sometimes sends the listener into another realm. 

Carnes highlighted the recent firing of a major TV personality that was released due to sexual harassment. He interviewed Carnes early on his career, ambushing him at the end of the interview, before heading to a commercial break stating that "he was a nice man, but that he didn’t know what he was talking about." Carnes, certainly standing here in front of us today, could have gloated, but it was not why he referred to the man, or his comment and current workplace issues. He stated it to make the point that back there was a lot to learn. With the hero's journey though, there are times you must press forward with everything you have at your disposal, know all too well there will be moments that will humble you, confuse you, want you to turn back. Carnes refers in his book the Tolkien tale Lord of the Rings, and made the experience even more powerful by showing some of the movie in his presentation. With the amazing presentations over the symposium, and Patricks glorious storytelling of the journey so far, was certainly evidence that he knew not only what he was talking about, but stands in eldership as a craftsman of recovery now. Instead of resting on his laurels, his pursuit of excellence in treatment is relentless.

Carnes, whose early book Out of the Shadows, then research driven book of 1000 addicts, Don’t Call It Love, were game changers. They defined sex addiction, they gave the recovery community a solid tool. Over the many years that have followed, the medical community has started to catch up. When sex addiction is finally added to the DSM-5, and it will, Carnes will be held without peer as the pioneer. The brain imaging and ground breaking work of Professor Voon, and recent Oxford University research, presented by Carnes, brings us ever so close to finally having the medical community identifying sex addiction as the problem that it is.

Carnes paid tribute to John Bradshaw. Peer, colleague, collaborator and fellow recovering person. He showed a film clip of the last Conversation they had, and made the point when he respectfully held Johns hand aloft at its closure, it was the last time he was to see him before he passed away. He then spoke powerfully about us living in mindful awareness about the unpredictable and short time we are here, and to use each moment wisely.

The talk was a spiritual experience. Carnes has a deep presence and palpable passion for the quest of knowledge that is translatable to peer and student. He promotes others work, and is obviously excited by the great literature being published by the authors and clinicians following in his footsteps. He referred and championed the new book by Alexandra Katehakis, Sex Addiction as Affect Dysregulation.

True Eldership is a form of madness, to the listener, they appear floating, nearly disengaged to the rest of us, above us, above society. They have visions from a perspective that to the new person can even seem disconnected from the coalface. Robert Bly went throughs in Mens work. I believe it's when you move from the King archetype to magician. It’s a necessary part of eldership, to keep forging forward, and trusting the legacy that is following behind to continue the work, and stay creating new possibilities. Carnes was weaving magic bear today, surrounded by an inspired legacy.

 For fellow travellers, this challenge you to the edge of your thinking.

In his last lecture series when leaving Pinegrove, Carnes spoke about the pandemical impact of the explosion of technology and its impact due to increased accessibility and autonomy on society in general. The way we relate to each other men and women. In the blindness of this escalation, and the average age of porn being introduced to children as 8, then what we are heading into as a society is frightening. Carnes talk today for me was inviting true maturity for adults to sit with in the spiritual paradox of suffering and hope. The recent election in the USA of a President that on record was gloating about his pursuit of women in a violent, over indulged, deserving way, saying he just kisses them without their permission, referring to grabbing them on the pussy.

Despite the viral effects of the video, he was voted in as the leader of the free world. How could this happen in a free-thinking society? A possible answer to this is the deterioration of our values due to the accessibility of pornography, the sexual revolution has a shadow, cast over all of us currently to the point where even some women just accepted that a comment like the now President, is tolerated, overlooked, minimized as locker room, boys will be boys talk.

The message sent to a generation of young men and women is yet to be gauged, but today, in the presence of Carnes, he proposed the importance of us not resting on our laurels. To continue to be humbled by the complexity of addiction, of the human experience, and of the greater experience as a society. We need to keep talking, to move towards connection.

Closing his talk, Carnes played a scene from Mr Hollands Opus. It’s a powerful film. The first time I ever saw it, I cried deep for the grief I had around the distant relationship with my father. On this occasion, Carnes played the piece at the end when Mr Hollands life's work was not the symphony that he had been slaving over his whole life, but the auditorium of people that had been impacted by his teaching, by their relationships they had with him. As he walks into the room, they stand and applauded him, and he see the relationships that he had with his students was his real symphony. Patrick then asked us all to reflect on all the clients we have influenced and helped along the way. 400 hundred plus therapists, many of us 30 years plus-that’s a lot of people.

He knows by their attendance at the symposium, they are choosing to champion Sex addiction and therefore have come up against the resistance from the medical community and the populace in general. As Alexandra Katehakis stated in her keynote referring to a colleague’s comment about working in sex addiction, that it really isn't sexy at all!  Carnes had used this address to highlight issues regarding humanity, maturity and spirituality. The plight of a mature adult is that you have to sit in the midst of a conundrum. The appearance and experience of Chaos in life, and holding also the vision of hope and the evolution of the spirit of humanity.

By the time Carnes wrapped his speech, his daughter and President of IITAP Dr Stefanie Carnes came forward and kissed her father on the head. It was beautiful. This is a community of great heart, and at its core is love. The love that comes from the spiritual awakening that occurs as a result of working the steps. It's an awakening made all the more powerful because of the ego deflation at depth that occurs as a by-product.

When the conference was over, there was loitering, selfies being taken, lots of hugs, and a reluctance to move of back in normal life.

I slept well that night. I was grateful for the time to digest before heading back to Australia and family life full on Lego and trampolines and sleeplessness that comes with being a parent of three boys under 6.

On my last day, I had the opportunity to hire an Indian Scout Motor Cycle and ride for hours through the desert in the Tonto National Park before flying back to Australia. The Arizona desert is a landscape graphically different from the bush at home. Riding allows you to contemplate, and get lost in the moment all at the same time. I was grateful for the beauty of the nature, the open road, and the promise that it itself brings you.  I belief there is challenges ahead, as this addiction gains a momentum not seen in other addictions. Technology and the sex and porn industry is moving at a rapid pace, and the overall impact on human and relational development and sexual arousal has this community working hard to respond therapeutically, compassionately and spiritually.

 Carnes has stated in previous talks that you can identify the state of human condition by the way we treat each other as people in our relationships. The violence and overt contempt in modern sexology and pornography is impacting generations simultaneously, and the extent of that impact is making itself knows, and the traumatic impact on individuals, families and society is devastating. I cannot not help but think that as the conference closed, the clinicians that made their way back to their private practice's and institutions, at the back of their minds, they are bracing themselves for the work and development on the Horizon, and carrying the inspiration that they do not face the challenge alone.