My year as a D.A.G.! (Drug, Alcohol and Gambling Counsellor for the Department of Health.)

When I left South Pacific Private in mid-2016, after serving as their Program Director, it was time for a change. First though there was a huge challenge in front of my family, with my wife about to give birth to our third child under the circumstances of Placenta Acreta and Previa. With my sons Marshal being 5 and Maverick being 3, I had to deal with the real prospect of them being without a mother, and me without a wife. When the position came up at the Hornsby Hospital Drug, Alcohol and Gambling Unit, I thought that it could be the job I could do to make my family the focus, and be able to do it if there was a catastrophe.

While Jen was in hospital I went for the interview, took my suit in and got changed at the hospital itself. Trying to appear not being stressed took some effort, but the job I knew I could do. Supporting people with Drug and Alcohol issues had been my bread and butter for 30 years. It was also appealing that after spending the last 15 years in senior management roles of one description or another, to not have anyone underneath me was a relief. Just had to be responsible for myself, to the team, and the manager.

In the interview, I had to ask for the panel forget the management side of the resume. That my focus now was that I could a good job, and then be able to go home for tea, and have weekends free so I could be with my family. I wanted to be there for my boys.

When they called me, and said I had the job I was relieved.

Even better news, was that Jen had made it through emergency surgery, and even though she was in ICU and baby Harland was in NICU, they were alive, and after a time, thriving. That was the longest night of my life, and one I will never forget. The fear, the faith and the celebration. Holding little Harland while they were still working of Jen, was a painful moment, but it was joyful to.

Hospital life dominated the family while Jen and Harland got healthy, and when they came home, I was able to start my year, as a DAG! Thanks to many for their love and support at this time, especially my mother-in -law, Fiona McKinnon. She stayed at home and took care of everything. Always eternally grateful for her love and support.

Walking around Hornsby Hospital in the beginning felt weird. I had gone from being the one that people came to for a solve problems, to get things done, to anonymity. It took some getting used to, but eventually I was able to embrace it.

In my last roles I was writing programs, creating webinars, lecturing and training staff, presenting at Conferences, talking to media, and being part of an Executive Committee. A role more focused on the big picture of treatment. I had been learning new trauma treatment techniques - Radical Exposure Therapy (the tapping therapy) and Brainspotting, as well as studying Sex Addiction treatment procedures produced by Patrick Carnes.

All built off my new-found passion for the Interpersonal Neurobiologists that were inspiring trauma treatment specialists. Dan Siegel, Alan Schore, Stephen Porges, Ed Tronick, and Peter Levine to name a few. My mind was on fire.

To find myself back at the coalface was initially confronting. I was hired to see five people a day, with Drug and Alcohol issues. We had 12 sessions (which I soon learnt could just add another 12, then another 12…) to which to intervene on the crushing realities of Drug and Alcohol addictions.

Life is what happens while you are busy making other plans said Lennon, and this was the case. Life was happening. From day one there was a client load, and as with the nature of a free counselling service, you get a lot of pre-contemplative clients that have to be there, or clients off the street that know somethings wrong, but don’t really want to change much. Harm minimization is the Governments protocol, so I learnt early as an addiction specialist, I needed to just meet everyone that came through my door, right where they are at.

Many had the question of “Am I using, abusing or dependant?” Now this is a question I can deal with. Addiction is an observable, predictably unpredictable process. It creates its own evidence. Measurable by a criteria. The only thing that works against you is the person presenting that evidence -The Addict.

Patrick Carnes states in Facing Addiction that “The degree that an addict can minimize use and consequence is one of the most striking and common manifestations of addiction, as well as the most baffling to others” As an addiction therapist you get desensitized   to hearing some of the most baffling plans that addicts can piece together on how they are going to beat their dilemma. The expertise I have built up is that I know they are going to do what they want, and I need to just be with them, and help them with the research. The only reason I try hard to break the delusion of Addiction, to help prevent a relapse is due to the insanity that can kick in and before you know it five years has past before you return to counselling. Some don’t make it back.

Addictions predictable nature will expose itself. I had a fellow once tell me that he wanted his harm minimization plan to be Get pissed Friday and Saturday. Have 12 beers on Sunday, have Monday off, Then two beers Tuesday, 4 beers Wednesday, 6 beers Thursday and oh, goody it’s Friday again.

Now I did tell they guy that would not be the surgeon general’s advice, but hell, let’s give it a go. I knew that if he was an addict, he would have the phenomenon of craving and that the Monday to Thursday period would give us all the evidence that we needed. In his case that was the case. But if I hadn’t supported him to try it I would have lost him. As it was he never got sober, but he did answer the question whether he was an addict or not.

 I enjoyed the pace at the D.A.G. unit. Being told not to over work, having my clients limited. Given days off to study, to do supervision. I continued my studies in Brainspotting, Sex Addiction and Radical Exposure Therapy, as well as attending and presenting at the Australian Childhood Trauma Conference in Melbourne, The Australian and New Zealand Addiction conference on the Gold Coast and the International Institute for Trauma and Addiction Professionals Symposium in Arizona, USA. All supported by my Manager Barbara Leo.

I think she was grateful to have the experience I brought to the team, and I was grateful to be under some wise leadership. Her style was gentle and direct. The walk warmly up beside you model, non-confrontational. I was delighted. It was a relief. I used to thank her every time she told me her truth and what she needed from me. To hear It clear and straight was a blessing. I have been in Manager roles for many years, and I don’t know If I have ever been that good at it. To self-cantered I suppose. To self-serving. I get interested in what interests me, when a Manager really needs to serve the team. I can say I tried always to be my best. To support people honestly, right where they are at. Always thought my Complex PTSD and resulting Avoidance Addiction made me difficult to work with.

I once went into my CEO when I was a Program Director, and said I should read you this. It was an excerpt from Bessel Van der Kolk’s Forward to Stephen Porges Polyvagal Theory book. A revolutionary text on Trauma Treatment I was studying it at the time. In it Bessel states, “Clinicians and Researchers who deal with people with histories of Chronic trauma are routinely confronted with Fight, Flight Freeze reactions. Our Patients, (and occasionally our colleagues) easily take offense, and they often disorganise their (and our) lives by becoming too angry, to ashamed and too frozen.

 Minor irritations easily turn into catastrophes, small failures of communication are difficult to gloss over and easily turn into dramatic interpersonal conflicts the milk of human kindness, such an essential nutrient in making life bearable, all too often fails to have a significant impact on the despair, rage and terror of people with histories of trauma and abandonment.”

Avoidant addict workaholics can be difficult to work with. I think she got it, and then again, might have just been more evidence of the difficulty.

The other thing I will say is that the training is extensive and very current within the Department of Health. I learnt a lot, and they take safety very seriously.

I was soon to find a rhythm at Hornsby, and I loved that I could go home at the same time every night, and be there for tea with my family. When you work as an Executive, then there is no knock off time really. It was a blessing to be able to leave work at work.

Over the year I got tight working efficiently, using the Facing Addiction text by Carnes as my guide. I also was able to treat many clients underlying issues of childhood trauma, by introducing them to Pia Mellody and her texts Facing Co-dependency and the Work Book Breaking Free. The other must read I shared with clients was Pete Walkers, Complex Ptsd-From Surviving to Thriving. I introduced as many as I could to 12 Step meetings, and practiced Mindfulness and Meditation with as many clients that would let me. That can freak some people out Mindfulness. Hippy stuff that it is!

Would hand out Pete Walkers resources for Identifying your Trauma Type, tips to deal with the Inner and Outer Critic, and especially his 13 Tips for Dealing with Emotional Flashbacks (due to Childhood Trauma). I learnt after being challenged by Dr Roby Abeles, when she told me you cannot bring up peoples Trauma without giving them first skills to regulate their affect. Pete Walkers are some of the most client friendly I know.

 I have always wanted client to walk out of a session having a map to follow. It’s what I love about Pia Mellody. She created a, map for herself, and others to follow. To find your way out of the impact of Developmental Trauma.

Patrick Carnes says in the Gentle Path Through the 12 Steps that there is an 87% chance that if you have one addiction, you have two or more. Now this statement which he wrote of research many years ago has certainly been confirmed by the current Neuroscientific research on the Brains reward system.

 I see it as the reward centre is the hub, and any addiction is the spokes. The hub doesn’t care which spoke feeds it. So many alcoholics get sober, and to kill themselves with Work, Food, Sugar, Sex, Nicotine etc. I know, I have been one of them.

 So, over the year I worked with people around sugar, gambling, food, OCD, cigarettes. The word got out to and I could see Sex Addicts there, even though there was no real way I could write it up. Pornography Addiction is going to be a pandemic within society.  We are in it now, and screening for it is essential for any addiction specialist. The access to it, its availability through smart phones and personal devices make sit the most accessible addiction in the history of mankind. The impact on the brains reward system is only rivalled by Crystal Meth. To be able to assess, treat and help folks with this addiction towards real recovery is challenging, but very rewarding.

Dan Siegel’s Mindful Therapist text had also inspired me as a Clinician to really work on experience of presence when with a client. To move from the traditional Left Brain to Left brain focus on data and information, to the felt sense of the right brain to right brain connection that Dr Allan Schore states starts the repair of the attachment trauma. Alexandra Katehakis gave an inspiring and deeply moving keynote address at the IITAP Symposium on this very subject.

I believe that the core of Addiction is an attachment disorder that effects a client’s ability to affect regulate, so avoiding reality is preferred, to survive not thrive. ICE and Pornography are the only addictions challenging this, as the impact the brains rewards centre is so acute, and so rapid. There is a body of evidence that tells us they are super stimulus, and need seen in a different light.

So, over the year I have had many great therapeutic experiences, in every stage of change. From dis-connection to connection was the goal.  I was part of a team at Hornsby that are hardworking, skilful and diligent.

I would eventually work on my self-care which had been lacking for many years whilst in my work addiction, getting false energy form sugar. I thought leaving SPPP and the stress and starting at Hornsby I would easily let go of the food addiction. But it lingered, it wasn’t till 6 months ago I finally addressed the issue and gave up sugar completely and now it’s been six months and 25 kilo latter, I am truly grateful I stopped killing myself with food. A day at a time I walk forward sugar free. At the start of the year my wife won on Facebook a one year training package with Never Better Fitness., so 5.30 am 4 morning a week I am at the park having Calvin Dauwes run me around silly, nearly kills me every time, but now I have so much more energy for my boys.

The other thing I started at Hornsby was every lunchtime when I could, I darkened my office, laid down a yoga mat, wore and eye mask and listened to Binaural beats and Isotonic tones and had a Drift Session as I started calling them. Deeply resting my Brain. I think my colleagues where intrigued, (probably just thought I as weird!) The level of refreshment I felt was fantastic, and kept me going into the night, it was essential to do this once I gave up the sugar. I have kept the practice going now at home.

In the last six months, I had built up a thriving Private Practice on the side. It eventually rivalled my full time hours. Mainly focusing on Sex Addiction and Developmental Trauma. As I go busy I could see that one would have to go, so decided to build up my practice, and whilst in Arizona in May, I attended a workshop by Kenneth Adams on How to start a successful Private Practice. It was here that I made the decision to go for it, and once I had returned and worked it through with Jen, we agreed it was time.

 I gave a notice of six weeks and it gave me time to get the home office ready, and get my files in as much order as I could, (I am bad with paper work!)

When I rode out of there on the last day, it was confronting. I felt a lot of fear, mainly as I provide for my wife and three boys. I didn’t want to let anyone down. Fear is a great motivator, but Faith, well that is a great alleviator (of fear). So, I prayed, handed my will, my life, my family, and the future of this practice over to God.

When I was recently in Austin, Bestselling author John Lee, whom I see for counsel and supervision, made the offer of becoming my mentor, especially for writing. I have been afraid to write. Afraid to fail at it. So, as part of the private practice. Friday is the writing day. I am excited to see what will come from the venture into creativity.

 More will have revealed.

Indecision and CPTSD

Thank you Lex Mega for sending this through today . Hazeldens Mens reading. I was lost in rigid thinking trying to decide whether to ride the Brass Monkey run or stay focused where my intuition was leading me today. 

Indecision had been a real symptom of my CPTSD . Being disconnection from my centre means the smallest of decisions sometimes become overwhelming and then there is no way out when the implicit feeling state hits and I feel that no matter what do from this point I will not be ok . 

Just for today, the best I can do is nurture the boy within, and trust the man I have become to make the decisions, and if I don't like what I choose, I can always choose again. 

Breathe, hand it over , Carry on.

• MAY 28 •

I sidestep the either/or choices of logic and choose both.

—Ken Feit

Men like us have often had a lifestyle guided by either/or logic. We think we must either conquer the challenge we see before us or we will be failures. We think loved ones must either meet our needs or they do not love us. We think we must either be perfect or we are unacceptable.

Let us now step back from the rigidity of such unhealthy logic. Much of human experience and many answers to our problems don't come in neatly tied packages. As we learn to think and feel in more flexible ways, we find life gets better. Using our intuition at times, rather than always following rigid rules for life, improves the recipe. The arrogance of our thought process has sometimes told us we had the answer, but it closed us to the growth which only comes by trusting our feelings. If we make mistakes, we can learn from them and go on. Many of the most ingenious inventions came not by rigidly following rules, but by following an inner feeling.

Today, I will be open to more possibilities in my thinking.

Dealing with Trauma!

Have been training folks over the last two days about Underlying trauma and addiction. I have shared to all who will listen about the great work of San Francisco Psychotherapist Pete Walker. Here is a blog from his website. Hope it helps those who relate.

Flashbask Management in Treatment of Complex PTSD

The East Bay Therapist, Sept/Oct 2005
A significant percentage of adults who suffered ongoing abuse or neglect in childhood suffer from Complex Post Traumatic Stress Disorder. One of the most difficult features of this type of PTSD is extreme susceptibility to painful emotional flashbacks. Emotional flashbacks are sudden and often prolonged regressions ('amygdala hijackings') to the frightening circumstances of childhood. They are typically experienced as intense and confusing episodes of fear and/or despair - or as sorrowful and/or enraged reactions to this fear and despair. Emotional flashbacks are especially painful because the inner critic typically overlays them with toxic shame, inhibiting the individual from seeking comfort and support, isolating him in an overwhelming and humiliating sense of defectiveness.

Because most emotional flashbacks do not have a visual or memory component to them, the triggered individual rarely realizes that she is re-experiencing a traumatic time from childhood. Psychoeducation is therefore a fundamental first step in the process of helping clients understand and manage their flashbacks. Most of my clients experience noticeable relief when I explain PTSD to them. The diagnosis seems to reverberate deeply with their intuitive understanding of their suffering. When they understand that their sense of overwhelm initially arose as an instinctual response to truly traumatic circumstances, they begin to shed the awful belief that they are crazy, hopelessly oversensitive, and/or incurably defective.

Flashbacks strand clients in the feelings of danger, helplessness and hopelessness of their original abandonment, when there was no safe parental figure to go to for comfort and support. Hence, Complex PTSD is now accurately being identified by many as an attachment disorder. Flashback management therefore needs to be taught in the context of a safe relationship. Clients need to feel safe enough with the therapist to describe their humiliating experiences of a flashback, so that the therapist can help them respond more constructively to their overwhelm in the moment.

Without help in the moment, the client typically remains lost in the flashback and has no recourse but to once again fruitlessly reenact his own particular array of primitive, self-injuring defenses to what feel like unmanageable feelings. I find that most clients can be guided to see the harmfulness of these previously necessary, but now outmoded, defenses as misfirings of their fight, flight, freeze, or fawn responses. These misfirings then, cause dysfunctional warding off of feelings in four different ways:
1. fighting or over-asserting one's self with others in narcissistic and entitled ways such as misusing power or promoting excessive self-interest;
2.fleeing obsessive-compulsively into activities such as workaholism, sex and love addiction, or substance abuse (uppers');
3.freezing in numbing, dissociative ways such as sleeping excessively, over-fantasizing, or tuning out with TV or medications ('downers');
4.fawning in self-abandoning and obsequious codependent relating. (The fawn response to trauma is delineated in my earlier article on "Codependency and Trauma" in The East Bay Therapist, Jan/Feb 03).

As clients learn that their originally helpful defenses now needlessly hinder them, they can begin to replace them with the anxiolytic and therapeutic responses to flashbacks that are outlined and listed at the end of this article. I introduce this phase of the work by giving the client a copy of this list of cognitive, affective, somatic and behavioral techniques to use as a toolbox outside of the session. These tools are also elaborated ongoingly in our sessions. I continually notice that the clients who acquire the most recovery are those who carry the list with them or post it up conspicuously at home until they are thoroughly conversant with it.

As clients begin to derive benefit from responding more functionally to being triggered, there are more opportunities to work with their active flashbacks in session. In fact, it often seems that their unconscious desire for mastery 'schedules' their flashbacks to occur just prior to or during sessions. In helping them to achieve some mastery, my most ubiquitous intervention is helping them to deconstruct the outmoded alarmist tendencies of the inner critic. This is essential, as Donald Kalshed explicates throughout The Inner World of Trauma, because the inner critic grows rampantly in traumatized children and because the inner critic is the primary initiator of most flashbacks. The psychodynamics of this is that continuous abuse and neglect force the child's inner critic [superego] to overdevelop hypervigilance and perfectionism - hypervigilance to recognize and defend against danger, and perfectionism to try to win approval and safe attachment. Unfortunately, safety and attachment are rarely or never experienced. Hypervigilance progressively devolves into intense performance anxiety and perfectionism festers into a virulent inner voice that increasingly manifests self-hate, self-disgust and self-abandonment at every imperfection. Eventually the child grows up, but she is so dominated by feelings of danger, shame and abandonment, that she is unaware that adulthood now offers many new resources for achieving internal and external safety. She is stuck seeing the present as rife with danger as the past.

I sometimes think of this phase of the work as rescuing the client from the hegemony of the critic. Despite the negative connotation rescuing has in many circles, I believe there is an unmet childhood need for rescue that I help meet when I 'save' my client from the critic. like mom didn't save her from abusive dad, or like the neighborhood didn't rescue her from her alcoholic family. This rescue process then, is a gradual emancipation from self-alienation, and a gradual deliverance from the internalized parents who trigger the client with flashback-inducing catastrophizations and perfectionistic invectives. If no one shows the trauma-locked individual that extrication from the self-torturing processes of the critic is possible, he rarely learns to rescue himself. He may live forever without discovering that he now has a variety of helpful responses [detailed in the list below] available to him to resist the triggering and exacerbating dynamics of the critic.

Over the course of therapy, I often reframe flashbacks as messages from the wounded inner child about the denied or minimized traumas of childhood. In this vein I paint flashbacks as the inner child righteously clamoring for validation of past parental abuse and neglect. Flashbacks are the child pleading for unmet developmental needs to be met, none more important than the gradual awakening of a healthy sense of self-compassion and self-protection. This is fundamental to recovery because without self-compassion, clients rarely evolve any substantive self-care habits. Similarly, without reconnecting to the instinct of self-protection, clients rarely develop effective resistance to either internal or external abuse.

When clients get that their emotional storms are messages from an inner child who is still pining for a healthy inner attachment figure, they gradually become more self-accepting and less ashamed of their flashbacks, their imperfections and their overall affective experience. They understand that the lion's share of the energy of their intense emotional reactions in the present are actually appropriate but delayed reactions to various themes of their childhood abuse and neglect. As they learn to effectively assign this emotional energy to those events and perpetrators, they metabolize and work through these feelings in a trauma-resolving way. This in turn leads to a reduction of the emotional energy that fuels their flashbacks, and flashbacks in turn, become less frequent, less intense and less enduring. Eventually flashbacks can even begin to automatically invoke a sense of self-protection as soon as the individual realizes she is triggered. Eventually this can even happen at the moment of triggering, as well as just before encountering known triggers.

Some final words. I have seen so many of my clients respond well to this model, even those who 'only' suffered neglect, I have come to conceptualize Complex PTSD as being on a continuum of severity. In this vein, it seems that with enough neglect, certain children automatically over-identify with the superego and adopt an intense form of perfectionism that, via the critic's "not good enough, not pretty enough, not smart enough, not helpful enough, etc.," triggers them over and over into painful abandonment flashbacks every time they are remotely less than perfect or perfectly pleasing.

MANAGING FLASHBACKS
1. Say to yourself: "I am having a flashback". Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are experiencing are past memories that cannot hurt you now.
2.Remind yourself: "I feel afraid but I am not in danger! I am safe now, here in the present." Remember you are now in the safety of the present, far from the danger of the past.
3.Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat you; you are free to leave dangerous situations and protest unfair behavior.
4.Speak reassuringly to the Inner Child. The child needs to know that you love her unconditionally- that she can come to you for comfort and protection when she feels lost and scared.
5.Deconstruct eternity thinking: in childhood, fear and abandonment felt endless - a safer future was unimaginable. Remember the flashback will pass as it has many times before.
6.Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never had as a child. (Feeling small and little is a sure sign of a flashback)
7.Ease back into your body. Fear launches us into 'heady' worrying, or numbing and spacing out.
[a] Gently ask your body to Relax: feel each of your major muscle groups and softly encourage them to relax. (Tightened musculature sends unnecessary danger signals to the brain)
[b] Breathe deeply and slowly. (Holding the breath also signals danger).
[c] Slow down: rushing presses the psyche's panic button.
[d] Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down in a closet or a bath, take a nap.
[e] Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you if you do not run from it or react self-destructively to it.
8.Resist the Inner Critic's Drasticizing and Catastrophizing:
[a] Use thought-stopping to halt its endless exaggeration of danger and constant planning to control the uncontrollable. Refuse to shame, hate or abandon yourself. Channel the anger of self-attack into saying NO to unfair self-criticism.
[b] Use thought-substitution to replace negative thinking with a memorized list of your qualities and accomplishments
9. Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and abandonment, and to validate - and then soothe - the child's past experience of helplessness and hopelessness. Healthy grieving can turn our tears into self-compassion and our anger into self-protection.
10. Cultivate safe relationships and seek support. Take time alone when you need it, but don't let shame isolate you. Feeling shame doesn't mean you are shameful. Educate your intimates about flashbacks and ask them to help you talk and feel your way through them.
11. Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and triggering mental processes. Practice preventive maintenance with these steps when triggering situations are unavoidable.
12. Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our wounds from past abuse and abandonment. They also point to our still unmet developmental needs and can provide motivation to get them met.
13. Be patient with a slow recovery process: it takes time in the present to become un-adrenalized, and considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real recovery is a gradually progressive process (often two steps forward, one step back), not an attained salvation fantasy. Don't beat yourself up for having a flashback.

http://www.pete-walker.com

Australian Childhood Foundation Trauma Conference 2016-Here I come!

Excited to find this week I am still presenting at the Australian Childhood Foundation Trauma Conference. 2014 was the best conference I have ever attended in my life. Ed Tronick, Cindy Blackstock, Pat Ogden, Allan Schore, Dan Siegel and Stephen Porges to name a few-my brain was on fire.

I got to the front row regularly out of pure passionate enthusiasm with my peers.

I had thought the opportunity was lost due to my changed role, but as I re-registered for the conference in my own right, I was offered to speak as Steve Stokes Counselling Services!

Then when I looked up the website, there is a photo with Dan Siegel presenting and in the front row is Andrea Szasz, Jodi Gale, Roby Abeles, Salene Souza and me! I had so much fun hanging with those guys. I tried to tweet as much as Jodi, but my thumbs just couldn't keep up with the "AHA" moments!

Just across from us is all the international contingent. It was such an honor to here them share their life's work. More information than my poor brain could ever hold. I am in admiration of greatness tonight. 

Thinking of riding to the conference to on the 

Trumpy to get my head centered and mindful to learn, learn , learn, oh, and yes-Present!