In the late 1990’s I begin attending workshops on trauma therapy because I realized many of those who struggle with addiction also wrestled with untreated underlying trauma – sexual, physical, and emotional. It was at one of the workshops that I first heard the name Stanley Greenspan.
Today he is known as one of the foremost experts on autism having published over 35 books and many scientific publications since graduating from medical school in 1966. But for me, he has become an instrumental figure in understanding the foundation of long-term successful addiction management – which in a nutshell is healthy relationships.
In an earlier post I described how addictions are about relationships, and that long-term success in dealing with addiction necessitates replacing unhealthy relationships with objects with healthy relationships with people. The key to doing this is realizing that to initiate, develop, and maintain healthy relationships requires developmental skills that become constricted, or in some cases, never develop due to trauma or time spent in addictions.
These skills are critical to relating to others in many contexts: intimate relationships, child rearing, work environments, marriage. Yet most treatment programs and self-help groups are unaware of the critical need to assess and treat emotional developmental problems. When they go unaddressed, many continue to relapse and struggle in life without the benefit of knowing what is missing in recovery.
Stanley Greenspan’s developmental framework
Based on his extensive clinical and research experience, Stanley Greenspan created a developmental framework that I believe is among the very best at helping us understand the essence of what it takes to succeed in relationships, but even more, how to optimize our mental health.
Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root. In all fairness, I spent plenty of time hacking at the leaves with patients because assessing emotional development and knowing how to do developmentally based psychotherapy is not so easy.
In fact, it requires a therapist to be attuned to their own emotional development and have some fairly advanced therapuetic skills. But therapy is not the only way to increase developmental capacities. By doing things out of your comfort zone, joining diverse types of groups, engaging with people in many contexts, and journaling about your emotional world can help. In future posts I will be more explicit about specific things that lead to developmental growth.
Autistic-like: Graham’s story
To get a flavor of the genius of Dr. Greenspan, here is a very short clip from the documentary film Autistic-Like: Graham’s Story. Although he is talking about the early development of his Developmental Individual-difference Relationship (DIR) model of intervention for autism, such insights are very applicable to those who struggle with addiction.
Emotions serve as the orchestra leader for getting the mind and brain working together
It is absolutely critical to long-term successful addiction management that significant energy is invested in understanding, managing, expressing, and acting on the vast array of emotions we experience every day.
The following statement struck me: “Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root.” Getting to the root of addiction rests in working with the underlying trauma and problematic relationship patterns that clients have experienced throughout their lives. Getting to the root of these deeply rooted problems inside clients with addictions seems like an extremely difficult task that requires many therapeutic skills and techniques. Using DBT is very complex and takes extensive training, and I imagine that many addictions counselors are not trained in DBT, because many do not a have a graduate-level education. If professionals are not thoroughly trained and educated to treat people struggling with addictions, then how do clients receive the most effective therapy from these professionals?
I also think we must be constantly thinking back to prevention and education. We can’t expect to exclusively treat addictions effectively after the roots have sprouted into dysfunctional and diseased branches and leaves, especially if we do not have the training to do so effectively. We already know that the acute based treatment system is ineffective in many ways. Therefore, we have to prevent the unealthy roots from growing unhealthily to begin with. The very first and most crucial step is to ensure that the “soil” is healthy. Child development is very much dependent upon their environment. As teachers, counselors, community members, and parents, we must ensure that we identify children in these unhealthy environments and do everything we can to help them when they are young. Children must also have the proper prevention services available so that they can learn how to be healthy before their problems get too deeply rooted. It is much easier to uproot a sapling than it is an old-growth tree.
I appreciate the importance being placed on emotional development. This is often the root of the problem. I think that counselors spend too much time “hacking at the leaves” because they don’t know any better. Real change necessitates going deeper and helping clients increase their emotional development. At this stage in my education I do not know much about how to do this, but I know that I will be looking to learn more as it is so important; not just for addiction treatment, but for the treatment for all clients.
I think I’m a Greenspan fan, this guy is great! Hearing him in this interview (albeit brief) really makes me want to see him in action. I understand that he values “meeting the client where he’s at” but honestly I’m not sure what that looks like. For example, I would love to see Greenspan do a session with a typical 10 year-old, and then do a session with an adult who possessed developmental constraints and restrictions that would make him similar to a 10 year-old. I wonder what differences and similarities there would be in his tone and technique?
What I hear in this blog is the importance of replacing unhealthy objects with healthy behaviors. I really appreciated what you had to say about the various ways that this can be achieved, such as doing new behaviors, joining groups, or participating in things previously uncharted. In a class I have on interpersonal neurobiology, we talk about creating new “pathways” by trudging through this uncharted territory. Research shows that the plasticity in the brain is high, and that there are many ways that growth can occur for individuals not only struggling with addiction, but struggling with social relationships of any kind. Trauma can stunt areas of the brain, causing development to halt for a period of time or in some areas of relational functioning. This post brought to mind the importance not only of psychotherapy, but also of relating openly and honestly in social relationships in new, uncharted ways.
Television gave me autism. It was the babysitter for me as well as thousands of other American children who plan to major in online video making and entertainment arts. The average American spends 40,000 hours watching television before age 18, and only 2,000 hours with parents. We know that television causes the brain to release endorphins, which makes an opiate-like effect combined with pathos appeals. In line with Harry Harlow’s monkey experiment, I am suggesting that the lack of tactile engagement(also related to healthy brain development) combined with the pleasure of television may be related to feelings of abandonment by the figures on television, predominantly females, because the mother is important during early childhood. The more dependent the males look, the more they will be rejected by both females and non-affected males in the future. Further, if society sought deficiency and achievement in females as much as males, more females would be diagnosed with autism.
I am sorry to say it, but I believe our entire society is becoming autistic; treating the symptoms with psychiatric medications has not been effective; churches, of all places, invite the largest television screens into their worship services. I urge you and other experts to strongly declare war on visual electronic media, so that more children will have a future in productive fields and productive relationships. I am certain of one thing if no other: television gave me autism.
Journal of Autism and Developmental Disorders
Volume 17, Number 2, 201-216, DOI: 10.1007/BF01495056
Brain opioids and autism: An updated analysis of possible linkages
Tony L. Sahley and Jaak Panksepp
Journal of Autism and Developmental Disorders
Volume 8, Number 4, 477-479, DOI: 10.1007/BF01538051
Letter to the Editor
Speculations on similarities between autism and opiate addiction
James W. Kalat
Appreciate your feedback and I fully support your opinion that our society consumes way too much screen time. We ditched all televisions in our house earlier this year and have not missed them a bit. The challenge now is to limit our screen time on computers as well. I am not an expert on the links between television and autism, but you make some very insightful points and I agree that an over-reliance on medications is not helping our society. At the same time, in my last blog post I wrote how video is the number one consumed commodity online, and as a result, I have uploaded numerous videos to get my messages across. In the end, perhaps “all things in moderation” is a necessary evil. One last point. I believe it is important we take a critical look at the root causes behind why screen time has dramatically increased in the past couple of decades while close ties with others have diminished. My post on social isolation speaks to this issues. Thanks again for following the blog!
J
The secondary addictions were more difficult to overcome. It was hanging out with friends just to drink alcohol and have someone to talk to. We shared our feelings of not being loved; we worried our lives away. But most recently, I’ve been able to maintain steady work, and have learned from most lay people that I don’t really have any inherent problem per se, but more of a worry of not being loved or cared about that just snowballs into more and more worries. So in the end, I learned to just go about my business and not care about what others thought of me. I now find that most people are happy with someone who can just communicate their feelings well and hold a job. I will never believe in movie fairytales again. You know, they never tell how the prince actually gets to where he is. The girl just marries him at the end each time. They make it look like he’s wealthy instantly, so she’s wealthy instantly, but nobody gets anywhere in life without effort. I can live alone, and I can live with myself, because God made me the way I am. I’m going to look even more ridiculous if I worry about the way I look in front of others. I have a supportive family and a good chance of leaving all the bad things behind by fulfilling my duties to society, getting ahead, getting the next degree, and trusting in God’s grace if I follow his rules.
But I do agree with you about the moderation thing. Maybe a beer a month; I can’t stand much more. Maybe five to ten Facebook messages a month; I’d guess most people can’t do less than twenty. Maybe meet up with friends twice a month; we used to meet every day, but it’s really impractical. They say that this generation is made for spending long hours on technology and not being social in person. But either way, I don’t feel deprived of anything anymore. In fact, it’s said I have a lot to be grateful for. I’m not dead–I could have been gone when I was drinking before. I don’t have mental retardation, or any obvious flaws, just sort of a…blindness, which I’m certain I can overcome over several decades with assistance.
Actually, God would have it that you helped me to realize my blindness. I took a look at your Social Isolation page, and found out what my brain does. I realized that if you had not told me that the page was different, I would have seen a “dark” picture on top, and a “light” area for text on the bottom, just like all the other pages, an undifferentiated mass of electron fuzz. And unfortunately that is how I viewed the world for a very long time. I could remember that I went into a particular building with certain architecture, went through two tall, skinny doors, went into a room with a big table and five people, profiled each one’s attire and demeanor; but for the life of me, I could not remember their names. They were simply part of the fuzz, simply part of the cartoon act, which was always moving very quickly. And I was trapped because I had no time to think; every word that came from my mouth condemned me–I would realize the consequences of that meeting a day to a week later.
But there was also a second mechanism at work. I respect my parents and what they did, because it demonstrated love. They passed on to me “immigrant syndrome,” by never being satisfied with anything less than the best, because in their experience, if they didn’t exceed everyone else, they would be ignored. And then you have to generalize in that mindset. That one experience when one person finds one little thing wrong with you, is the point when their entire group and the whole community is going to buzz subconsciously with the idea of not trusting you. You’ll always be welcome to a friendly group of people, but will not be sought out for the most intimate parts of ordinary friendship.
I’m not talking dating, marriage, and sex. I’m talking about the time when several people always repeatedly said they’d wait for me before driving to the restaurant, and because I was a minute slow, they all left without me. I’m talking about the time when two or three friends somehow met “randomly” for lunch four times a week, never called me at that time, and always had to leave when I wanted to talk with them. Not one minute! I’m talking about the times when a strong alpha or a “better” best friend comes up to the table, and suddenly the person who you were talking with pretends that you’re not there, with the rest of the table. If this person totally changes the topic, the whole table changes with him every five seconds. If he leaves, half the table tosses their food and goes with him. The real issue was that nobody *really* knew me, because I was doing a tough major and couldn’t go to all of the major activities.
And now, I reflect–nobody really knows anybody in particular. There’s no world out to “get me” or “deprive me” anymore. Why would someone go out of their way to cause me trouble if they didn’t know me? It’s really rare; it’s on a certain profile at a certain time, with a minute twitch of the eye or jaw, a slight jostle of the hand. But I don’t take it personally: that person is not angry at me, just angry, and life is getting to them, just like it got me. Dying to the flesh in times of stress is difficult, but it can bring you to new life. People still call me names on the street because I don’t have a celebrity presence; people really are afraid of each other because they don’t know anybody, or how anybody works. But I’m not that different, and neither are they.
“stuck at early developmental levels and require developmentally based therapy to catch-up. Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root.”
I have, unfortunately, had to experience the pain of watching one son go through addiction (alcohol) and also a nephew (Heroin). I can accurately say that we read, researched, committed, cried, yelled, etc…anything to try to get them to stop. I often felt that they were stuck at an age emotionally that was preventing them from progressing to the next level. I often felt that I was screaming into the wind and there was no one out there to hear me scream.
This article and Dr. Greenspan helped me to put into words my gut reaction to much of the addiction problem we were going through. With any addiction there is emotional baggage that must be looked at and when an adult has the reasoning skills of a child in some cases it is impossible to get them to make more adult decisions especially regarding their addiction choices. I don’t believe anyone wants to be addicted. It is a solution to an ongoing problem that isn’t being addressed. Address the underlying problem that led to the addiction and then you will see some success and positive movement forward. Thank you for this blog. So much to read and all of it very informative!
I completely agree with this article. I believe that emotions are the key to human beings. As this article put it, “many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root.”
This is true. I’ve also talked some of my family members who are therapists or psychologists. A lot of the times they seem to always try and fix the problem that is at the surface versus helping to dig down and find out what the origin of this issue. Most likely it probably has to do with ones emotional state. However this “hacking at the leaves” or scratching of the surface is usually the extent of what gets done.
Thanks for the feedback! sorry to hear about your own pain and frustration with the treatment system, it is definitely in need of an overhaul. I do believe helping those who struggle catch-up developmentally is one of the most important leverage points for achieving positive outcomes.
J