How to Use 12 Step Principles to Treat Trauma

How to Use 12 Step Principles to Treat Trauma

By Rivka A. Edery 01/01/15

A creative clinician finds a new application of trusted principles in her work with trauma victims.

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Many clinicians would agree that a mind-body-spirit approach to recovery provides a solid framework for conceptualizing the healing process. In this week's Professional Voices, Rivka Edery describes the innovative approach she has developed for working with trauma survivors. By incorporating 12-step principles in the exploration and treatment of a client's longstanding and intense emotional pain, she argues that healing of the soul is an integral part of the recovery process. - Richard Juman

For many years, I have been working with clients in recovery from addictive and trauma-related disorders. As a therapist who has also personally benefited from the application of 12-step principles, I began to wonder if the spiritual principles of the 12-steps, applied in concert with a variety of evidence-based interventions, could become the foundation of a form of treatment for trauma survivors. Over the past several years I have successfully used this approach in my work with my clients.

Ms. R is a 48-year-old, single, engineering professor with a history of severe physical abuse, multiple accounts of early childhood sexual abuse, family history of chronic alcoholism, and early childhood parental abandonment. She has a history of unstable romantic relationships, multiple marriages and other failed relationships, criminal conduct, interpersonal violence towards others, and debilitating anxiety and depression. Worst of all, Ms. R felt that her life had no meaning at all. By Ms. R’s account, prior to coming to treatment with me, she was in therapy for a number of years, which she described as “mostly me talking, and the therapist listening." Some work was accomplished on gaining emotional detachment from her extremely dysfunctional family, and eventually, she terminated her own treatment. Her symptoms persisted, but she refused to return to treatment until her primary childhood rapist contacted her. At that point, she was flooded and overwhelmed with intense emotional pain, fear and anxiety, and sought immediate help. So, Ms. R was referred to me at the very moment that she became entirely ready to examine her life, pain, and choices to heal.   The process that follows is a true account of one survivor’s spiritual path to healing from complex post-traumatic injury. 

The method and processes involved apply equally to both genders, to all socioeconomic backgrounds, levels of intelligence and emotional maturity. As long as the survivor approaches this process with an honest heart, and appropriate guidance, the outcome will invariably include a restoration of hope and an altered perspective on decades-long buried suffering. The mind, body, and soul of a human being are complex and entirely interwoven; for the person to heal, there must be an inclusion of the soul in the process.

Step One began with building rapport with the client, beginning where the client is emotionally. Ms. R provided a detailed account of her significant adverse early childhood trauma history, and linked it to the cause of her intense emotional and psychic pain. I asked if Ms. R believed there to be any connection between her current troubles, and trauma memories that “got stuck in the memory machine.” Although the question may seem to have an obvious answer, the purpose was to gently support Ms. R in linking her history to her self-report of malignant behaviors. This was how Ms. R “admitted powerlessness” over her history and its consequences, and subsequently ended her own denial of both her pain, and her role in creating and recreating it. Admitting that one was powerless (not weak), at the time, to stop, prevent, or interfere with the trauma, is the beginning of the end of one’s suffering. The consequences of surviving trauma are complex, making it difficult to formulate a recovery and treatment plan. The most common defense mechanism, and the toughest one to work through, is denial. Throughout human history, lack of knowledge and non-acceptance of the perpetrators' misdeeds has placed the suffering of survivors behind an armored wall, perpetuating traumatic effects. No recovery can occur behind this wall of forced silence, ignorance and lack of helpful resources. Denial takes up enormous psychic energy, as there is a non-stop war between The Ego’s desire to protect the person, and the fighting urge for one’s truth to surface. Lying underneath this psychic battleground of maintaining the illusion of power and control is the survivor’s hidden potent rage and vulnerability. Once acknowledging this, Ms. R was ready to move towards a unique, personal solution. 

Step Two is about asking for help, and being receptive to receiving this help. Ms. R, like many survivors, often hides her fundamental lack of trust. Operating in a superficial world, fighting for respect, and lacking in support to pursue a spiritual life, Ms. R continued to press ahead in spite of her collection of battle scars. Such people find themselves greatly challenged to maintain an appearance of having it all together, and are longing to trust and to be fully expressed. Ms. R had been long struggling with courage and determination to make her life work, in spite of this great, gaping wound. Ms. R was introduced to the importance of telling her story, since an untold story of trauma without its language comes with a hefty price. The process of Step Two includes a slow awakening that she is not alone, is loved and worthwhile. Arriving at such a belief can seem impossible at first, depending on the severity of the trauma. However, without such an awakening, moving forward may not make sense, or even be possible. Since she identified her personal spiritual source as a “Higher Power,” we utilized it as her source for safety, love and strength. Trauma recovery especially calls for this. Once the survivor comes to believe that a personal spiritual solution is available for them, they decide that they will allow for their source of safety to guide their process.

Step Three is the next logical step. Ms. R made a decision to turn her will and life over to the care of her current understanding of her personal Higher Power. I call this “The Survivor’s Rock of Recovery.” Prior to reaching this point, Ms. R experienced a lot of crying, mourning the loss of loving, stable parents, and having gone through life feeling chronically alone. She “came to believe” by re-examining her relationships, that she often took on responsibilities that were not hers to shoulder. By allowing herself to be cared for by her own understanding of her Higher Power, she felt like she was putting on an oxygen mask for the first time: “I’m so glad that there’s a Power, greater than myself, that is not capable of abandoning me.” This began her journey from a sense of complete abandonment and helplessness, to the possibility that she is worth being loved and cared for. She also integrated the approach that refusing to allow herself to be cared for kept her connected (in the only way she knew how) to her highly toxic and abusive family.

After significant grief work, and when she felt that she integrated the first three steps, Ms. R began to take a look at her resentments, personal roadblocks, character defects, and how they have impeded on her life. She also came to realize that she was highly gifted and underutilizing her talents. Every survivor has roadblocks, some due to the trauma, some innate. Such a thorough and honest evaluation of strengths and weaknesses requires a dedicated effort from the survivor, described as Step Four. Probably the most significant benefit for Ms. R is that she went from a chronic shaming of others, directing blame and anger towards everyone, to a practice of looking honestly at her role in relationships.  

Step Four is about “cleaning house” on all of the resentments a person has toward others, in a systemic way that brings deepening self-insight onto the person’s own experience and role. It is not about self-blame, deepening shame or guilt, but rather, the beginning of truly letting go of negativity, blame and anger. Ms. R acknowledged that the Fourth Step allowed her to “unlearn the unhealthy ways, and learn new patterns of reacting that help build my self-esteem.”

When the survivor is ready, they move towards a new intimacy. They share their findings with their Higher Power, themselves, and another safe person, holding back nothing. For some, taking Step Five is a first experience of this kind. Ms. R described Step Five as “super scary since I never did such a thing, but I feel like the huge elephant is now off my chest.”  Essentially, Step Five is about not prolonging the pain. Once Ms. R experienced sharing her deepest, darkest “secrets” to a trustworthy Higher Power and another person, she described “the hole in my heart beginning to heal from my suffering.” She realized that there is no anguish that her Higher Power cannot lead her towards healing for. This new experience of intimacy gave her the fortitude to become ready to have her Higher Power assist her in addressing her problems.  

At this juncture, she is emotionally moving away from an isolationist orientation, to a more realistic approach in trauma recovery: asking for, and receiving, help. This is the essence of Step Six:  “becoming entirely ready to have God remove these defects of character.” In Step Six, Ms. R’s preparation, thus far, allowed her to prepare to ask for help, something that can be an enormous roadblock for trauma survivors. Asking for help for personality blocks, problems, or character defects identified in Step Four, was really a request to be distanced from the intensity of the underlying emotions. Often times, the emotional intensity, accompanied with the character defect, causes harm to the self and/or another human being. Ms. R became ready to have some distance, not necessarily a literal “disappearance” of any particular character defect. This also helped her impulse control, and reactivity towards others’ behaviors. This shift in perspective and clarity of this step, brought her forward to the next step. 

In Step Seven, she humbly (without false pride, being realistic and truthful) asks her Higher Power to “remove” her roadblocks. She personally refers to “remove” as being granted a different perspective on the same problem. What also helped Ms. R to “humbly ask for her shortcomings to be removed” was the realization that her shortcomings were learned, and not permanently embedded in her genetic code. Ms. R described this as “pure freedom,” and used her own form of prayer to submit this request. With an improved self-insight and impulse comfort, she was learning to carefully consider her choices, and how they impacted her life.

Ms. R began to prepare for internal peace, with the use of Step Eight by “cleaning up my side of the street.” Since she had committed grievances that caused an imbalance, this is the point where she listed them. Here I encouraged Ms. R to be as specific as possible, and that helped her take an honest look at her own role, as self –identified, in creating an imbalance. For example, as an incest survivor (completely innocent at the time), she went through life seeking revenge at every opportunity. All her subsequent relationships were unstable, with injuries that have not yet been repaired. Step Eight is the time that Ms. R took to itemize those injuries towards self and others, and prepared to make amends.

Once she made her list, prayed for guidance, and reviewed it with me to ensure that it was fair, accurate, and specific to the egregious incidences, she took specific actions to make amends, create peace, and restore the balance (Step Nine). Ms. R’s experience of healing restored connections, forgiving others and ending certain unhealthy connections lifted her up from a lifetime approach of fear of relationships, to a workable set of conditions and an approach to relating to people from a place of integrity, love and compassion. Step Nine is a very specific, sensitive approach to making direct amends to those that the client has hurt: emotionally, physically, psychologically, or sexually.

Step Ten is a daily inventory and personal growth step. Since everything and everyone is either moving towards growth or decline, Ms. R is keeping a close eye on her “strand of diamonds”- her thoughts and behaviors. She remains conscious of her treatment towards herself, and others, and makes amends right away, if necessary. This is extremely important for any survivor, as it prevents the emergence of old, faulty patterns, mistreatment, and imbalance. No longer will the survivor have to create pain needlessly for himself or herself, nor anyone else.

Step Eleven, critical to nurturing her spiritual world, is about setting aside time every day for prayer and meditation. This is in order to improve her conscious contact with her source of strength and safety. This includes asking for spiritual guidance on all matters of her life, and requesting the energy and inspiration to carry it out.  This practice of daily prayer and meditation helps Ms. R to remain connected, grounded, and on a path of healing. And finally, Step Twelve encourages Ms. R to participate in community and humanitarian service in whatever way is meaningful for her. This opened the door for her to have increased moments of serenity, self-love, and a sense of unity of the Universe.

The hurts of the past cannot be undone, the scars cannot be erased, nor the tears that flow from one’s wounds be silenced. But a life rich with meaning and purpose creates the strength and energy needed for healing. In my clinical approach I have found that integrating a spiritual, 12-step approach that includes a core component of client accountability empowers clients to contribute to their own sense of purpose and meaning in life. This includes making amends if necessary, which is often required if the client’s depression also stems from having unresolved guilt for having harmed others. This aspect is often overlooked in the treatment phase, as much of the focus is placed on the client’s feelings, emotions, and dysfunctional behaviors. Theory and practice should embrace a bio-psycho-spiritual approach that addresses the root causes and conditions of unresolved psychic pain.

Rivka A. Edery, L.C.S.W., a licensed clinical social worker who  specializes in trauma recovery and spirituality, has been active in the treatment and recovery field for over seventeen years and is the author of  “Trauma And Transformation: A 12-Step Guide” (2013)

[Professional Voices is designed to provide a forum for clinicians to exchange ideas about good treatment and highlight concepts, techniques and interventions that have proved important in their work with clients. What do you think are the essential elements of effective psychotherapy in addiction treatment?]

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Rivka A. Edery, L.C.S.W., a licensed clinical social worker who specializes in trauma recovery and spirituality, has been active in the treatment and recovery field for over seventeen years and is the author of, Trauma And Transformation: A 12-Step Guide. You can find Rivka on Linkedin.

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