Episode Transcript
[00:00:00] Speaker A: We go back to what is familiar. Right. We see this in trauma as well. Like, people go back to the traumatic relationship, or they go back to the traumatic situation not because it's safe, but because it's familiar. I work with families. I try to keep it as predictable. So if it's predictable, like there's going to be a structure, this is how long it's going to be, that immediately creates the safety.
[00:00:20] Speaker B: I'm Diana Earley, and I've spent most of my life learning firsthand what privilege actually costs.
The legacy control, the family expectations, the guilt of feeling trapped in a life everyone thinks you should be grateful for. If you've ever wondered why having everything still feels like something's missing, you're in the right place.
Welcome to Pressures of Privilege.
My guest today is Dr. Constant Mouthon, an addiction psychiatrist from the Netherlands who is taunting how families understand and support recovery.
His work is rooted in neuroscience, and his message is simple. You can't think your way out of a nervous system in survival mode. For years, families have been told to either confront or detach. Both leave them lost and dysregulated. Constant saw that over and over. People improving in treatment, then falling apart the moment they returned to the same dynamics at home. That's when he realized families aren't on the sidelines of recovery. They're biologically central to it. If you've ever loved someone in addiction, or if you've wondered why smart, motivated people can't seem to change no matter how hard they try, this conversation is for you. Welcome, Constant.
[00:01:38] Speaker A: Thank you.
Yes. Nice being here.
Thanks for inviting me.
[00:01:42] Speaker B: Oh, you're welcome. Well, I just love. I read your book, the Road back to Family Recovery. It was so great.
And I loved the person of concern and how that person is within a system in families.
[00:01:56] Speaker A: Yeah.
[00:01:57] Speaker B: Instead of being the person who is causing all the trouble, person is not the problem.
[00:02:03] Speaker A: That's a core concept in the book. Yeah.
Yeah. So what I always think is, you know, when I work with families, one of the first, first, first things I explain is that if you think of a family system, if they come to do, see me, well, for intervention or even for the first time, whatever the scenario is, they talk about the person with addiction. They call this person the addict, which is a word I don't like to use to talk about people with addiction. You have something you are not your addiction.
And then they talk about what this person has done, and they talk about the lies, and they talk about the. They might talk about manipulation and all the. All the bad Things they talk about and that this must stop.
And then I explained to them, but the person is not the problem. The problem is addiction. And addiction does all of these things. Addiction changes the way we think, the way we feel, the way we act a lot. You know, I always, I'm always not surprised really anymore, but I used to be surprised at the fact how people look back on their addiction and think, oh my God, I did all these things. It's really not who I am. You really see the personality change, right?
And then we draw it out in little, little puppets or little people in the, in, in a, in a ring. And we, we put the person in the, in the middle. And then you see, like one person is hyper focused. That's usually the, the mom or the partner. And that person is completely consumed by the addiction and the, the, the person with addiction. And what we try to do is to put the person back in the circle of the family.
And then everybody can look at the addiction. And you don't have to only focus on the person because the person is part of the problem, but so is the family. You know, like everybody in that circle has work to do to, to have this system heal.
[00:03:49] Speaker B: When I first was introduced to the idea of addiction, even I, I remember thinking what I have to do, work on myself.
This is before I even confronted my own alcoholism. I was in that sort of know, being told by my therapist to go to Al Anon. And for me, I was like, why do I have to do the work? I mean, isn't he the problem?
[00:04:09] Speaker A: Right? Yeah. Yeah. And people get, get angry in therapy as well.
If I give homework, because I'm a therapist, I love homework and a little bit of assignment and people get angry with me. It's like I came here to be fixed. You know, it's like, well, firstly, nothing. You don't need to be fixed.
There's a problem that needs to be fixed and the problem needs to be worked on, but the work needs to be done by you. I'm like on the sideline, unlike your coach and your cheerleader and your, your guide.
But you have to do the work and that, yeah, that's that step to take the responsibility so hard for people.
[00:04:46] Speaker B: So you now are, you know, you started working with individuals, but now you're working more with families. What, what created that shift?
[00:04:55] Speaker A: Yeah, so I've been, I mean, I've been, I've been a psychiatrist now for 20 years. 21 years, I think.
So I mean, for me, kind of, I've always been curious about how Humans work. So I started biologically, you know, doing medicine, and then I got into psychiatry.
And psychiatry is very biological.
Most psychiatrists work more biologically.
And then as you go along, like I did my training in South Africa, you also do therapy work and you work more. So the system kind of grows and you work on your own psychology, your own things, as well as you do psychotherapy. So you become psychotherapist eventually. So I worked more psychotherapeutically.
And then over time, what I saw with families and with communities is that if people do the work, if the individual does the work and they go back to the same system and the environment didn't change, the friends didn't change, and the families didn't change, then people relapse very, very quickly. Well, I did a few trainings and I read a million of books on family dynamics. And every time it comes back that the family should be part of the solution, but then they need to be involved.
And one thing that fascinates me is how we try to keep families away from the person doing the work instead of involving them.
It's really the weirdest thing. Like, we expect people to do the work individually, but we, you know, the families can worry and they can call us, but they should please stay away.
Don't involve yourself in the treatment.
And I think a lot of professionals are also just scared of working with families. I think it's a big thing that I see now. So that's kind of how I got into involving families in the treatment as well, and making them really part of the whole process.
[00:06:38] Speaker B: How are the outcomes?
[00:06:39] Speaker A: There's a few interesting things that happen. So the first thing is if you get the family involved before the person enters treatment. So think of intervention scenario where family calls and they worried, because that happens often. Like the families are worried before the individual.
That might help to get a person into.
Into treatment if the family stays involved. So a lot of the older kind of intervention models were like you kind of the surprise models, where you surprise the person, you know, the Johnson model, and you get the person into the clinic and then everybody thinks the problem solved.
I work more with. With the rise model.
And so what I like to do is to involve the family throughout the process. And then you see the people stay in treatment longer. So they enter treatment, they stay in treatment longer, the chances of completing treatment is higher.
And if you involve the sort of. That first year of. Of recovery is always a complex year. You know, your brain is doing so much of recovery work. There's. So if you Keep the family involved for that first year, then the outcomes in general also just improve. So people really tend to reach long term sobriety and recovery much quicker if you involve them in the whole process.
[00:08:00] Speaker B: And what kind of work does the family do in concurrently?
[00:08:05] Speaker A: Oh yeah, so they do a lot of work.
So in these family meetings we would typically check in on everybody. So how everybody's doing.
So it's not only how the person of concern with the addiction is doing, but everybody's doing how people are dealing with the addiction itself. So if you've had struggles with the addiction, if you've seen some manipulation, if you've been asked for money, if you've encountered some lies about it, you all bring it to the family meeting.
And these family meetings are very safe. You know, like safety for me is I think mentioned in intro as well. Safety, Safety and regulation is super important in these meetings as well because people come in angry, you know.
So we work on regulation, on co regulation and we work on commitments. Everybody has to commit to what they going to do about the situation for the next week or two weeks, depending on how frequently we see each other. So we like to also keep things equal, you know. So if the person of concern with the person with the addiction needs to go to a fellowship meeting, then we also want the family to do that. You know. So if the person with addiction wants to go to the air, then, then other people can go to Coda or Elon or one of those meetings. So if we all going to work on, I don't know, one of the, the, the, the steps. So what, what trust means or what hope means for you, then everybody has to do their homework and come back and report back.
So we really try to have the families also do the work. You know, there's so much overlap really between what families go through and what the individual goes through. You know, like there's so many similarities there.
[00:09:50] Speaker B: What is the overlap like the typical
[00:09:52] Speaker A: symptoms that we see with things that we associate with addiction? Like one that I always think of is the denial in the beginning.
Like I don't have a problem. Why, like you said, why do I have to do the work?
The individual might have that, but the, the family also has that. The families are very fronted with, with why do we have to do the work? Or the problem is not with us or we don't, you know, we're also trying to manipulate the situation, you know, to, to, to get it into direction. The person with addiction might try to go in the direction of addiction and the family's in direction of recovery. But both are manipulating the situation instead of being open about it and saying what you need and saying what you expect and you know, communicating well about it.
The sense of loss, you know, like, I think every person with addiction I've ever spoken to have had some other sense of loss, sense of, or emotion dysregulation.
There's a certain amount of, I don't know, depression immediately, but you know, sad feelings, feelings that need to be numbed. And the family also has this, I think, the guilt and the shame. You know, families don't want colleagues and members from the community to find out about it. So they also keep secrets, just like the person with addiction. So there's so much overlap really.
[00:11:14] Speaker B: It's interesting, the secrets and the denial. But what else do families get wrong? You've said in the past that families are usually told to either confront or detach and both leave them lost and dysregulated. Can you talk more about that?
[00:11:30] Speaker A: There's so much new, so many new things in addiction care these days, you know, like, and some of the older ideas were that it's a, it's a moral failure or you know, there's a choice to stay addicted, you know, you know, all those kind of things. And then the advice that they got was, was to detach. Usually just, just detach. Like no contact, no money, nothing like the tough love kind of situations, you know.
But what happens then is the person with addiction in active addiction then is completely disregulated, right? I mean, because you go through cravings, you go through withdrawals, if you don't get the drugs, you, you have all these different emotions and behaviors that you show that you don't recognize.
Usually your sleep is disturbed, so the nervous system is completely disregulated.
But the families also get disregulated because they still worry, they still anxious about the person. I mean, they still, I think 99% of times still love the person with the addiction.
You know, they might not love the addiction, but the, the person with addiction is, they should, is still love.
And I just think if we can work on the connection rather than the separation of this in, in this group, it's just so much more powerful. It asks for a lot of vulnerability for people to do that. You know, it's not the easy choice, I think.
[00:12:50] Speaker B: So imagine you have like a 25 year old child living at home and they're the person of concern. Should the parents allow this kid to stay at home or should they, what should they do?
[00:13:00] Speaker A: Well, I always think It's, It's. It starts with a conversation, you know, like, be open about.
And this is. This. This always sounds so simple when you tell people and they're like, of course, but it's really hard work. I mean, like, if you're in this situation to have that first conversation. I think there's.
I think there's a whole chapter in my book about having that first conversation. It's just good to kind of open the door and express your concerns, you know, like, just start with what you're concerned about and tell the person what you need. You know, we tend to. Or family thing in general, to be accusatory in the way they have these conversations.
[00:13:34] Speaker B: Like, you always do this and you do this and you hurt me here.
[00:13:37] Speaker A: And you need to change and you need to go to treatment and you need to stop using. And I always think that's the. That's the serious thing to tell somebody with addiction. Like, you have to stop using. Like, duh. Of course they also know that, but if it was easy, then they would be treatment centers. And. Yeah, so I always think, like, let them stay at home, but have the conversation.
What I also like about these family meetings is if we organize them, we invite everybody, so everybody gets the same invitation.
Also the person in addiction, like, we're going to have a family meeting, and we're all concerned about you, and you're invited.
And then you might think that the person will not pitch up, but they always come because the meeting is about them. So of course you're going to go and defend yourself in that meeting.
And then in these meetings, we really, really focus on safety and trying to regulate everybody's emotions so that you can have a constructive conversation about the addiction. I just think there's no. There's no quick fix in this. You know, there's no. These conversations take some time as well.
[00:14:37] Speaker B: I was curious about. You said you keep it safe. How do you do that?
[00:14:40] Speaker A: Oh, so I'm the strict one in the. In the meetings on rules.
So we have. Yeah, we have very strict rules. Like, there's no shaming. There's no blaming.
There's no name calling.
You talk. You use the I statements, which I think most people know.
Like, I feel this and this and this, or I see that in that pattern.
And you express your needs. So you say, like, what you need. You never tell people what they have to do. You say what you need, and it's up to the other person to give it or not, you know, so that's how we try to keep the structure.
And I think one of the. One of the. Of course, we started to talk about regulation already. Like, one of the co. Regulation things is repetition. You know, like if things are familiar and it's repetitive, that also feels safe. So getting into these meetings are a bit tough at the beginning because people have so much to say and they have so much emotions and things. But after, I think the third or fourth meeting, usually people know how it works and it's always the same structure. And that really gives a sense of safety as well.
To introduce the regulation as well.
[00:15:45] Speaker B: What do you do when somebody starts to ruminate and ruminate, meaning, like they are talking about the past and, you know, maybe they're depressed and they're just going on and on and on about the past and how sad they are. Do you let them go on or do you give them their time out?
[00:15:59] Speaker A: I'd like people to have their authentic feelings and express that so that. That could be okay. If it tends to become.
And people are allowed to say what they. They are going through. So if. As long as it's still in relation to the addiction, that's okay for me. But like in any group setting, really, Because I also see it as almost like a group therapy.
In any group setting, you will also have to like, structure it a little bit. So sometimes I will cut people short and say, listen, like, so in summary, that's what I hear.
Is this correct to kind of lightly cut the story short a little bit just so that everybody also gets a turn to say what they need to say?
[00:16:39] Speaker B: The regulation you're talking about is that, Constance. That constancy that they feel, that it's familiar.
[00:16:47] Speaker A: Yeah. Yeah. So. So, I mean, humans. Humans are strange. Like. Like we. That's. That's why it's hard to break patterns as well. We go back to what is familiar. Right.
We see this in. In trauma as well. Like, people go back to the traumatic relationship or they go back to the traumatic situation not because it's safe, but because it's familiar. And we. We kind of. That familiar familiarity and safeties is kind of intertwined.
So in the meetings and I work with families, I try to keep it as predictable. I think it's predictability, really, that's giving the safety in it.
So if it's predictable, like, this is going to be the structure, this is how long it's going to be, that immediately creates the safety.
[00:17:28] Speaker B: What if you have a family member who's maybe critical?
[00:17:32] Speaker A: That's right.
Yeah. I mean, that's also an opinion and a Feeling that goes with that.
[00:17:38] Speaker B: As long as it's not shaming and blaming. What's the difference between criticism and shaming and blaming?
[00:17:43] Speaker A: Yeah, so I mean you can be critical on the process. You can be critical about treatment centers.
On me, that's okay. You know, like that's, that's okay. So you could be skeptical, I guess about it, but I, I do a lot of psychoeducation as well. You know, often when people are just critical, they just don't know, you know, they have a different opinion or something that's maybe not based on neuroscience or so I always try to bring it back to that. And then I think with shaming is more telling the person that the person is a bad person. You know, like I always with shame in. When I work with individuals, if they, if they feel ashamed for what they did in, in active addiction, that's okay. That's. That's a feeling we can work through with the steps and with, with therapy.
But people don't need to feel ashamed of who they are, you know, so I think that's the, that's the dangerous part. If you start blaming somebody or shaming them for who they are as a person, that's a problem because nobody chooses to be, to be addicted. You know, like nobody thinks when they small, like, you know what I want to be when I'm grow up? Addicted. That sounds great. Never heard anybody say that.
[00:18:51] Speaker B: No, they just think that, oh, it's not going to happen to me.
[00:18:53] Speaker A: Exactly. Everybody thinks that.
[00:18:55] Speaker B: So what else do you do for the co regulation aspect in order to get into what you call that. That window.
[00:19:02] Speaker A: The window of tolerance. Yes. The window of tolerance was developed by Dan Siegel. He talks a lot about connection as well.
But the window of tolerance is where your nervous system is well regulated. It's like a middle ground where your, your nervous system is regulated and you feel calm and you feel confident and you can connect to people and you can listen and process.
That's your window of tolerance.
We can be hyperaroused, so be above the level. So kind of go to the peaks and that's when we feel anxious and angry and aggressive and. Or you can feel irritable or annoyed or. So that's if you overstimulated. Hyper. Hyperaroused he calls it. Or you can even be hyperaroused where you kind of like not connected, checked out, not interested, naturally tired. And then you also not in your window of tolerance. I think the original work was done on individuals of how to get yourself.
So there's two things you can do. The one thing with regulation is have daily practices to regulate. And that's good to broaden your window of tolerance, to make sure that most of your day you're in your window of tolerance.
And this also like emergency tools that you can use to get back into the window of tolerance when you are detaching or you are anxious or so those are two different aspects of, of the window of tolerance. But you can also use it in families and in groups, you know, because humans always kind of copy the energy of others around them.
[00:20:34] Speaker B: So if they see their parent being calm, then it helps them to be calm.
[00:20:38] Speaker A: Yeah, so. So yeah, there's. There was old concept, I don't know if they still use it, called mirror neurons. So you have mirroring of what the other person does and feel. Some people are more sensitive to that than others, but maybe you've noticed it as well. If you was a very energetic person and they talk and they have also. You also feel kind of like more excited. And if you were a very calm, settled person, then you also get calmed down. So that's the co regulation.
And I mean this, this thing happens on the fly the whole day actually, when we, when we. With people.
And I mean, as therapists use that in therapy sessions as well to co regulate with. With a client. If the client is dysregulated, then we should be very regulated and calm and in the moment and connected.
And we use that on purpose. So. But you can teach families as well to do that.
[00:21:28] Speaker B: So. Yeah, so I can imagine in some families, if there's addiction, there's probably hyperactivity, you know, like, like anxiety and stress.
[00:21:36] Speaker A: Absolutely.
[00:21:37] Speaker B: And how does that stress and anxiety impact the person of concern?
[00:21:41] Speaker A: Like I say, like all emotions are welcome, but not all behaviors are welcome in these music meetings.
So it's okay to express that you have anger. And this, by the way, the first co regulation thing that I teach people is to name the emotion. If we feel emotion, we feel overwhelmed.
One of the big things within a therapy is to give it a name. So you could say like, I'm feeling overwhelmed or I'm feeling anxious or I'm starting to get angry.
So as soon as, what your brain does, as soon as you give it a name, then you go from the emotional part of your brain to your cortical side to the outside of your brain where you can think and process and, and work on things. So by naming something that you activate that part of your brain and that's, that's already calming, you know, then you also Already not as, not as much in the emotion. We teach people grounding techniques, just things like literally putting your feet on the ground, things like box breathing. You can think of taking a pause before you speak.
Sounds very obvious, but people don't know how to do that.
[00:22:44] Speaker B: Well, how can you do that?
[00:22:46] Speaker A: Well, you have to, you have to be conscious about it. You have to be conscious about what you do and what you, about your actions and where you're at, you know, so. And also if people feel too overwhelmed to talk, we take a break. You know, there's, they said the typical 90 seconds. I like to just do five minute break and everybody gets some fresh air, ground yourself, do some breathing, and then we come back and then we talk further. So if it gets too much and people are too anxious or too aggressive, then we take a short break. Sometimes I will go sit with somebody and just help them ground and calm, you know, find their, their place of their window of tolerance, I guess.
And then you can continue the conversation.
[00:23:23] Speaker B: Do you have to protect family members from each other? Like if they start fighting, how do you handle that?
[00:23:28] Speaker A: Yeah, so physical aggression is of course not allowed. So we just stop the meeting, you know, and if it's really violent, I will call the police.
[00:23:35] Speaker B: You know, you do them only online in person.
[00:23:38] Speaker A: I do online as well. So I mean, online, online, it's quite interesting. Online people tend to be more calm than in the room. But online you could also do things like, you know, mute the whole group, close the meeting. And it's also a lot got a lot to do with my own way that I'm in the meeting, you know, like I need to be calm and I need to be centered when I do these meetings, you know, like, I will never go into a meeting like this when I'm not in my own window of time.
[00:24:04] Speaker B: It's, let's say you had a parent who was maybe shaming and blaming. How would you handle that in a meeting?
[00:24:12] Speaker A: So it wasn't to reframe it, I guess to say like, okay, you're shaming the person. And also I would give it a name like this is what you're doing, because the behavior of shaming somebody else has a name. So, okay, so I see that you're shaming the person because that really brings you back already, like, oh, that's not what I meant. Or sometimes they do mean it.
And then I would say, like, okay, if we go back to the rules, like what is it that you see and what is it that you need from the person? So what would make this better or what?
And it really takes a while for people to. To get into that language of doing these meetings.
It really takes a minute.
[00:24:51] Speaker B: I'm thinking of an example. Let's say the person of concern is always 20, 30 minutes late to the meeting. Always.
[00:24:57] Speaker A: I'm always quite strict on time as well. The meeting starts when the meeting starts and the meeting ends when it ends. So it's from this time to that time and that's it. So if you're late for your own meeting, then it means that we're going to talk 20 minutes about you or about the problem or about the addiction. And you would miss the first 20 minutes. And you can read back in the notes because somebody takes notes and send it in that around.
But we. That's it. Yeah. So what. I mean, part of it is also like, you know, people need to. Or people start to feel the responsibility for their own actions. You know, that's for the. That's such an important, integral part of recovery, I think, from addiction.
Like what you said, like, I have to do the work in my own therapy. That's really taking responsibility for your own actions and your own work that you're doing.
And families also do that. You know, families also need to start what they need to. They. They do stop. Take responsibility for their. Their actions and their words in these meetings. But people need to. To learn that.
[00:26:01] Speaker B: So that's interesting. So you continue that. You don't say, well, if you're not here in 10 minutes, we don't do the meeting.
[00:26:06] Speaker A: Oh, no, no, the meeting goes on. Yeah. And that goes for everybody in the family system.
If dad can't make it, then dad misses out on the meeting. But we're still going to ask dad, has anybody heard from him and is he doing okay? And any points for him?
[00:26:19] Speaker B: Who takes the notes? Do you take notes or is it somebody else in the family?
[00:26:22] Speaker A: Somebody in the family?
[00:26:24] Speaker B: Yeah, something family takes notes and then they kind of send it copy. Everybody in the family.
[00:26:29] Speaker A: Yeah, yeah. So the idea of these meetings is also like, I typically work like six months to a year with a family, and then in the end I hope that they never need me again. But in the end, I can really, you know, sit back and just see it all happen. And they kind of take care of the whole meeting themselves. So that's where you want to be. Because then they have that skill in the family to solve any problem really, in future as well.
[00:26:54] Speaker B: Oh, that's wonderful. Yeah. I'm thinking of all the families who don't have addiction who probably would. Could use something like this.
[00:27:00] Speaker A: This works for so many things. I mean, like, usually it's kind of like addiction is the thing that introduces all these skills, I think with recovery as well. You know, one of the things I always tell people is addiction runs in families, but so does recovery.
And this is what we mean with it. If we do the recovery skills within the whole family, everybody benefits from this. And you can solve somebody's depression later in life or maybe somebody has, I don't know, struggles in school or cancer or anything really.
[00:27:33] Speaker B: But I think what's important is that you're a trained doctor and a psychotherapist. Right. Which is kind of rare in the United States. Here we have psychiatrists and they just do the pill prescribing and they don't do much of the talk therapy. And then you have the, the psychologist who then does the talk therapy. And ideally you want them to have both, but you're able to do both. So you understand those dynamics in the family and the psych psychology behind it.
[00:27:59] Speaker A: Absolutely, yeah. Yes, yes. And with my work with individual clients, I do a lot of trauma therapy.
So I'm also trained as a trauma therapist.
So with a lot of trauma.
And I do a lot of parts work with schema therapy as well. So. So I use different things, which I guess you can use with families or individuals. But I think it is, I think it is important, you know, to have knowledge of the biology of things, but also the, the psychology and the systems theories, I think it's important to combine them.
[00:28:30] Speaker B: Plus you understand all the personality disorders. So when somebody's trying to hide back the meeting or they're, there's some narcissism. I mean, how do you handle that?
[00:28:40] Speaker A: So these meetings are not therapy meetings in the sense of solving those kind of problems. These meetings are more about identifying things that you should work on in your own therapy.
So sometimes if we do see a pattern, I mean like with narcissism or personality disorder, our case, you can point out things, you know, that I notice in these meetings you tend to do. And I try to keep it on behaviors.
So maybe that's something you would like to work on.
So once again, I was, I would suggest it, I would never tell people what they, what they need to do, but I could suggest what they could do.
And that usually, it usually works quite well. You know, as long as you bring it in a non threatening, non accusatory, non shaming, blaming way, people tend to react pretty good to it.
[00:29:31] Speaker B: Wow, these meetings sound Fantastic.
[00:29:33] Speaker A: I mean, they really help and they really, they really add something, you know, and you can do different variations on it, I guess.
You know, some people do it only during treatment. Some people tend to be in it for the long run instead for a year, or want to do a year and a half of these meetings. But they really help the families to develop this sense of recovery in the family as well.
[00:29:56] Speaker B: In terms of dysregulation, a typical dysregulated person would be somebody who flies into a rage instantly or they're, they go into maybe the freeze, flight and fight and fight fawn maybe.
[00:30:07] Speaker A: Yeah, absolutely. Yeah.
[00:30:09] Speaker B: How can that person get out of that?
[00:30:11] Speaker A: Once again, the first step, I think is by naming it, by recognizing what's going on.
And that's very difficult to do.
One thing that I try to teach people is like, if you look at your brain, like, like a first, I don't know, listen to this, but I'm showing you now. But then the, the, the middle part of your brain is the survival part of your brain, right? So that's what keeps your heart beating and breathing and all of your autonomic things. That just happens automatically.
Then this part around is the emotional part and in the outer part is your cognitive part that you can think.
So if you are in the emotional part and the emotions are just unregulated, you struggle to get to the cognitive part where you can think of things. You can think rationally for solutions and problem solving.
If you are triggered and you are, you go into this fight, flight, freeze or fall mode. You often go, you stay in the, in the bottom two parts. You also. Your autonomic nervous system is also dysregulated. So you will feel your heart racing or your breathing being shallow. And in your chest, it feels like somebody's clinging your, your, your throat and your blood pressure will rise. All these things happen.
So literally all your blood in your brain goes here to the. These parts and it doesn't get to the part that can problem solve.
So by naming the what's happening. So, you know, like in internal family systems, they talk about parts work.
So by naming the part that is happening or just, just naming, like I feel I'm being triggered right now, that already makes you go more to the cognitive side and more to the outer side of your brain, which, which helps you to, to problem solve and get back.
So if you can do that, that's great.
If people shut down completely, that's of course, you know, if people dissociate, that's, That's a different scenario completely. I mean, then you won't be able to name anything.
So then I teach people that if that happens to them, to just literally put their feet on the ground, close their eyes, concentrate on the breathing. The breath is super important to have a little bit longer outbreaths than in breaths. You might go four breaths in and then six breaths out. It kind of calms the nervous system.
And then when you're ready and that part, your breathing is more regulated to slowly open your eyes and just look around. Just observe the room around you and just name five things that you see.
And it can be simple, like lamp, plant, carpets, shoes.
Just start naming things. Because that also brings you back into the.
Out of the emotional and autonomic disregulation part of it.
So that's. And you can do other things. Like you can do tapping people, tapping their shoulders or just tapping on the side of their legs. You know, it's soft tapping that they can do themselves. Yeah, there's many, many breathing things that you can do.
Also focus on your senses, smelling things.
I think what you smell in the room, some people carry. Some, like patients like to carry around something that smells nice, like aromatherapy, something that they can open, just smell it when they start to dissociate.
So those are kind of things to bring people back.
And in the beginning, you. In the beginning, you have to do it as a therapist. Right. So in the beginning, people will do it on their own.
[00:33:31] Speaker B: How do you get somebody who's out of control to actually do any of that? Because maybe anger is even an addiction, maybe for some of them.
[00:33:39] Speaker A: Absolutely. Yeah. These are patterns. I mean, these are patterns that.
So becoming angry would be in the schema therapy. We call it the angry child mode, you know, the raging child mode. And. And people learn to behave like that, and they learn that that's protecting them for something.
And that takes very long in therapy, you know, to. To unlearn and to think like, okay, so my.
My raging child mode is activated, but how do I get back into healthy adult mode? Yeah, because we want to be in schema therapy terms, you want to be back in your adult, healthy adult mode mode where you're in that window of tolerance where you're regulated and you calm. You can have autonomy and agency over your life, you know, and your day. That's where you want to go back to.
So a lot of the trauma work that we do is to teach people to recognize this, name it, explore where it comes from.
[00:34:32] Speaker B: But sometimes I hear that people aren't Stable enough to do that trauma work. Do you agree with that? Sometimes?
[00:34:39] Speaker A: Well, it depends. I mean, to, to do that trauma work. If, If I start trauma treatment, I usually start with the basics, you know, like what we spoke about, the grounding techniques. I work a lot with connection.
So we have to build that safe therapeutic connection, you know, like, I will never go into the deep, ugly stuff, you know, right from the get go. Never. I would never go there because people need to start trusting me as well, with the therapy, with the traumas, you know, so work on the therapeutic connection.
Teach people the basics of stabilizing themselves so they have a little bit of sense of agency over it.
Like I do indr with a lot of clients and, And EMDR is very daunting in the beginning. You know, it's. It's a scary place because you have to really experience. Re. Experience the emotions and the bodily sensations and everything of the trauma. So before you get there, you have to do all the basics first. You know, teach the breathing techniques, you know, make them feel safe. Know how to regulate a little bit before you jump into those things. Absolutely.
[00:35:42] Speaker B: So it's a long process. They have to learn to trust you. They need to trust the process. They, they. Before you can even do something like emdr. For ours, it's eye movement desensitization and reprogramming. What is that? I mean, I've never actually done that.
[00:35:58] Speaker A: I mean, you have different, different things. The typical one is the. Is the light that goes from left to right.
So like I, I have a lamp here. You can also do it with moving your hand. But I'm too lazy to do that. I like to work with a lamp and I can't multitask, so I don't do that.
But I have a lamp. But you could also have like, I have a pulsatrus that goes from left to right. Somebody's hand. You could do tapping. Anything that goes from left to right.
[00:36:21] Speaker B: It mimics the walking. I think when you're walking, your eye does that anyway.
[00:36:25] Speaker A: Yeah. So great link to co regulation as well. Or regulation is walking. You know, if you feel dysregulated, going for a walk is very, very. It really brings the, the emotions and the things down because of that left, right, left, right action of it. Absolutely.
[00:36:46] Speaker B: And how does that tap into memories?
[00:36:49] Speaker A: Yeah. So how we think EMDR works is. So what you do with EMDR is you let the person go back to the day well, that you like a visualization of what happened in trauma and then you ask them to picture it and describe what they see on the picture. So you kind of search with the person for a picture in their brain that they have of the day. Doesn't have to be exactly what happened. It just what is in their mind at the moment.
And then you ask them to feel the emotions when they look at it and talk about the thought. They have the negative thoughts about themselves usually or about the situation, you know, this is not safe, or, you know, this is not fair, or.
And then feel the bodily sensations and in the beginning, and this is why it feels, you know, it's, it's.
You need the safety. You, you try to make everything as bad as you can for the. Before you can start the, the desensitization. So you, you really try to, to get all the emotions, all the bodily panic symptoms into the body.
And then you start with the desensitization.
So we say you get the train on the mountain, and then as soon as it's at the top, then you can start the desensitization.
And in the desensitization, we work in sets of 30 to 40 seconds. Typically after each set you just check in so what's happening? And then it's very interesting. Like sometimes thought which thoughts would shift, do something different, sometimes bodily sensations would shift.
You know, like when I did the training, we practice on each other.
So for me, I, I felt, I felt more stress in my neck area and on my chest in the beginning. And then it, it moved to my stomach and then moved to my lower back and then it kind of left my body. So each set that I did, something shifted to a different place which was, which is kind of magical how it works. So when the, when all the tension is out of the body, then we round up with a safe exercise. Like I like deep red relaxation exercises or progressive relaxation body scan, those kind of things to just create the safety. And then we discuss afterwards what happened in the session.
So it takes about an hour. But what's amazing about it is we used to use it for once off traumas so typical like war traumas, hormones, or sexual abuse, those kind of traumas. But what we see is you can also use them for personality disorders and kind of things that comes from patterns in your life. You know, things that kind of originated in childhood. You can also go back to those situations with the mdr and then the patterns tend to change and the triggers and this feeling of being triggered, you know, like getting into the angry child mode or those things also decrease with emdr, which is quite fascinating. It's like new New, New research here from the Netherlands.
[00:39:46] Speaker B: That's really interesting.
Yeah, I've looked at sort of like research on borderline and all that. I've never seen EMDR as like a treatment for that.
[00:39:54] Speaker A: Yeah, yeah. So it's, it's, it's actually a friend of mine that's, that's doing the research. He's the professor of psychiatry here in Rotterdam.
And they. Looking at, I think they do five to 10 sessions of EMDR and their findings are really interesting. Like, I think, I think she said after 10 sessions, 40% of people with borderline personality disorder does not meet the criteria anymore after just 10 sessions. It's incredible.
[00:40:22] Speaker B: So for pathology, that's like deemed incurable.
[00:40:26] Speaker A: Exactly, exactly.
[00:40:27] Speaker B: I'm curious, I'm sure you work with wealthy families.
[00:40:32] Speaker A: I would. With everybody.
[00:40:33] Speaker B: With everybody. How would you find working with that population in comparison with the general population?
[00:40:39] Speaker A: People tend to think if you're wealthy, you can, can buy away.
When you can buy the best therapist, you can buy the best things, you know, like.
And people see that as a, as a pro. And of course it is, I mean, it is, it is, it is beneficial to be able to afford good therapies. I mean, I also work with very poor communities.
And then you see completely different struggles.
But what I do see is, is with wealthy families, for example, or even wealthy individuals. I think maybe because, because these people get used to buying the best therapist or the best personal trainer or the, you know, like, and fixing the problem quickly.
They tend to struggle with the idea that you need. Need time to heal from these things.
I think we spoke a lot about how long this takes, but for addiction, for example, this research done, to look at your reward center, which is the part of your brain that's affected in addiction.
And after one month of sobriety, your reward center still doesn't react in a reg. In a normal way to normal stimulus. So if you think of something that's usually enjoyable, like good plate food or something like that, nothing happens after a month. So you kind of feel flat in that first phase of recovery, like the raw phase people talk about.
Only after 14 months, that reward center is recovered. And you will feel motivation in the same way as you did before. You will feel rewarded in the same ways. Motivation, reward, all those things.
So it takes a year.
Even behavioral addictions takes a year.
And that year is, is full of ups and downs. You know, like in the beginning you, you have the detox phase and, you know, people go through physical withdrawals and then you get the honey honeymoon phase or the rosy cloud phase. People are like feeling better and they look better and they get compliments. They have life, life skills and like, you know, high fiving themselves about how great it is.
And then you get to the war phase, which is typically month three to nine, sometimes the first 12 months.
And then you think like, why am I doing this? This is hard. I don't want to go to meetings, I don't want to go to therapy. I don't want to do the work.
I struggle to get out of bed. I'm tired. You know, that's the war phase.
[00:43:02] Speaker B: Or, or that's when I went into another addiction, which was the love and sex addiction.
[00:43:07] Speaker A: Exactly, exactly. Spot on. That's where the, the co addiction with the co, co addictions comes. The relapses happen in that phase as well, you know, and what I see in wealthy, wealthy families and wealthy individuals as well is one of the skills that we teach people is to sit with feelings and sit with the discomfort and let the discomfort exist, you know, And I mean, I think it's logical if you have money to, to buy something to fix the feeling. Why not? That's the, the first thought, you know, like, so if you don't have money, you don't have the opportunity to do that.
But I do think that in wealthy families, I see that quite a lot. The struggle of. But can't I get another coach? Or can't I go to the treatment center or can't I instead of learning how to regulate your, your own nervous system, you know, do the regulation work.
And some days are hard, you know, some, some days are just unbearable. But to get through those days, I think, you know, wealthy individuals and families
[00:44:06] Speaker B: struggle with, plus they're moving around a lot, so it's very difficult to continue their treatment because I mean, I know in the United States you can't continue with your therapist if you're out of state.
[00:44:17] Speaker A: Oh really? Oh yeah. So in Europe we don't have that problem, luckily.
But people do move around, I mean at these family meetings, usually with wealthy families as well. We end up working online because everybody's everywhere.
[00:44:29] Speaker B: Well, at least they can do that. Right? But those.
[00:44:31] Speaker A: Yeah, yeah, you can, you can do a lot of things online as well. That's true.
[00:44:35] Speaker B: So what, what are some examples of things that, you know, maybe wealthy families pay for? I mean, I, I mentioned it in my article a few weeks ago. You know, the ketamine treatments, the go go to go to the Amazon, get, do an ayahuasca ceremony. I have a friend who Two weeks later ended up on the, on the, on the cliffs of Dover wanting to kill himself.
[00:44:54] Speaker A: Yeah. Goodness him.
[00:44:56] Speaker B: The ayahuasca brought back, you know, some child abuse from his childhood that he
[00:45:00] Speaker A: had repressed memories and stuff. Yeah, yeah, yeah.
[00:45:03] Speaker B: But there was no sort of follow up. There was no integration of that memory into his body or into his.
Like the adult part of him couldn't take care of him. Yet.
[00:45:14] Speaker A: Those are perfect examples of what, what wealthy people might run into. You know, like these are kind of like experiential experimental things often or things like the ketamine. I also have a lot of examples of other people going for ketamine treatment and paying a lot for it, but they're not getting the best care.
Like the, the most expensive thing is not always the best thing. By going, going kind of like around the, the known systems, you also lose the protective factor of these systems. You know, like things like in the Netherlands, things for ketamine of very, very regulated and it needs to be in a specific treatment center and you need to have all the checks in and the department of health comes and checks in on it. And you know, I think if you're wealthy you can just fly to another country and get it done there, but then you don't get the aftercare and you don't get the right complete recovery package. If you want, you know, how long
[00:46:08] Speaker B: would it take to integrate? I mean maybe the ketamine is okay, but it's gotta be coupled with a lot of things.
[00:46:14] Speaker A: The therapy, psychotherapy. Yeah. And controls. And it has to be regulated how much you get. And like in the Netherlands, you can't get it with. You can't take the ketamine home with you. So you go to the treatment center, you get it there, you do the psychotherapy according to the, the, the protocols that Basel just published. Not it was a year ago.
And it's very, very regulated.
[00:46:37] Speaker B: Yeah. I think in this case, I think that the treatment center sent them some psilocybin in the medicine male, which is a total felony in America.
[00:46:45] Speaker A: Right. Yeah. There's also. That was interesting. We can't remember the name now. Exactly. I think it's called Fragile Power by Paul.
Yeah, Paul. Yeah, you know, Paul as well. And he writes about the sense of agency of wealthy people. That is a different sense of agency to people who are middle income, for example.
And that sense of agency also make them struggle to take responsibility for their behavior and their recovery and what needs to happen and that it's uncomfortable, you know. So I think that sense of agency also plays into it.
[00:47:18] Speaker B: This is too uncomfortable.
[00:47:19] Speaker A: Yeah, yeah, I'm going to get the psilocybin over the mail, you know, instead of getting, getting really the best person for the job, which might not be the most expensive thing, but it's, it's regulated and the safer, the safer option that's also going to have the long, long term effects. You know, like we always teach that. I always teach people like the, the, the best short term solution is not always the best long term solution.
[00:47:44] Speaker B: There's a top neurologist in my karate class in, in New York City and I've asked him, I'm like, you know, I'm like, nick, would you ever do psilocybin or something like that? He's like, no, I'm too afraid. I, I'd rather do the work exactly. Of intense meditation and just do the work and get to that same spot of enlightenment, but doing my own work, not, not taking a shortcut. I kind of like his philosophy on that. Afraid to do psychedelics even though we fund psychedelic research.
[00:48:10] Speaker A: Yeah, no, me too. I'm not taking any of those things yet.
[00:48:13] Speaker B: Well, speaking of tools though, you're developing some tools for families who can't access emotional therapy, right? What's your dream there?
[00:48:22] Speaker A: Yeah, so that's kind of exciting. That's my next phase, I guess, after the book. So I've been working with a lot of families, but I mean the method also, you know, not accessible to everybody. So you know that the book is one way of making it more accessible. I'm working on something that should launch this year still that has a lot of notable digital solutions for this.
[00:48:43] Speaker B: Sorry, what kind of solutions?
[00:48:44] Speaker A: More digital solutions, more online solutions, more things that fits into daily life, you know, modern life.
So things that are educational but also things that works on your regulation of your nervous system.
Recovery tools. I think everybody should be in recovery whether you've had a past with addiction or not. Because I think recovery has so much to give in terms of physical health, mental health, community, purpose, all those kind of things.
[00:49:14] Speaker B: I've seen some therapists argue about the word recovery online. Recovery to you means 12 step, right?
[00:49:20] Speaker A: 12 step plus. So we, I mean, I always like people say sobriety is recovery. That's not true. Sobriety is a prerequisite for recovery.
But the way I see recovery is, is I think SAMHSA has a nice framework that they talk about health, home, community and purpose.
So for me it's really health in the broad sense. Physical health and mental health. You know, people also tend to just go for therapy and think that's okay. But you also, you know, like, do your karate, go to your personal training, go for your runs, you know, eat healthy, those kind of things. Also recovery, have a safe place, have a safe home to recover from. Right. That's also part of the family work that we do.
Overlap to community, to surround yourself with people that will uplift you and create the environment for you to thrive in.
And purpose, like, do purposeful things with your life, you know, whether you find it in work or in community or in volunteering, whatever you might find it in, to have a life that's purposeful. And if you build on all those things, it's all those building blocks together that for me is recovery.
And of course, the 12 steps absolutely help with that, with getting there.
[00:50:35] Speaker B: Although some people would say recovery starts even before, when it's abstinent, because you can still go to a meeting and be using as long as you're willing to stop.
[00:50:45] Speaker A: Yeah, I always think it's a bit like a maslow triangle, you know, like it's little building blocks, and hopefully you end up in a version of yourself that you can think in the morning. Like, you know what this is? Okay.
[00:50:55] Speaker B: Are you creating an app? Is that it?
[00:50:57] Speaker A: Yeah, it's an app and an online environment. The online environment would be educational, but also there will be a community online.
There will be a lot of resources, things that you can read, things that you can practice. It should be for everybody, you know, so I wanted to be out there because I think all these things, you know, like remain behind closed doors in therapy rooms or in meeting rooms. And I think it should be available for everybody, actually. So.
[00:51:23] Speaker B: Fantastic. So if a family listening today, one thing away from our conversation, what would you want that to be for families?
[00:51:32] Speaker A: Yeah, be part of the road to recovery.
You know, like, you can. You can.
You can be part of the whole process, and you can also benefit from all the recovery things that are out there. You know, like, we always think it's the individual that needs to change and needs to improve and benefit from recovery, but families can absolutely benefit from that as well.
And every individual can benefit from. From recovery tools and that whole process. So be part of the. Be part of the process.
The most, most important thing to stay connected in.
Into the. In the. In the whole process.
[00:52:13] Speaker B: I mean, there's a way of being separated from the person of concern, the person suffering, without getting drowning with them.
[00:52:22] Speaker A: Absolutely. I mean, you have to work. That's one of the most important things. You have to work. On is your own boundaries.
[00:52:27] Speaker B: I think boundaries is the hardest thing and recovery. I wish there was like a manual, like a boundaries manual where you would just go, okay, how to deal with that? And then you've got your list of boundaries. I think that would be a great adventure.
[00:52:39] Speaker A: Okay, okay, maybe, maybe if I get to do that, then I'll put it on the website and let you know. I think the hardest thing about boundaries is the fact that you have to repeat them so often. Like people don't just hear them the first time. If you need to set a boundary, it actually per definition means the person receiving the boundary or hearing the boundary will not hear it the first time because it was a blind spot to them. You know, and people don't just recognize a blind spot and then change the behavior. You have to go back to and repeat and repeat and repeat until the person knows, oh, this is actually what, what I'm going to do.
[00:53:13] Speaker B: What would be a perfect, an exact boundary. Like, you will not speak to me so disrespectfully.
[00:53:18] Speaker A: Well, not that you will not speak to me like that. I would, I would appreciate if you can use a respectful tone when you talk to me. And then somebody will probably not hear it the first time and still be rude or whatever. And then you can say like, okay, like I said before, this is what I expect of you. And sometimes you have to take a little bit of distance. Like I think, you know, some, some people also not ready to accept your boundaries. And then it's good to take a bit of distance. And sometimes it's even good to say goodbye to people who are not respecting your boundaries at all. Boundaries are there for me to preserve and to improve the relationship.
That's why they're there.
But if the other party does not accept them in the end, then, you know, what's the point of the, of the connection. So there's also grades in that. I think there's the. You can create a little bit of distance between the person. You can limit the time you spend with the person.
You don't have to kind of say goodbye immediately.
[00:54:13] Speaker B: You know, what would you say are the biggest differences between, you know, the Netherlands and the US in terms of mental health treatment and recovery?
[00:54:23] Speaker A: Oh dear, that's a good question. I can speak based about the Netherlands. I think what's, what's interesting here is there's a great deal of treatment centers that are 12 step based and total abstinence based. And you know, then there's also the other part is the, the. So the social Psychiatry or the people with social problems. What is well organized here is I think a lot of things and speak from us are always kind of jealous about it.
Almost all these treatments are paid for by the health insurances here.
So we can, we can do really, really long intensive treatments and it's covered by the health insurance.
So like my clients, I like to, you know, because that first year is with so many ups and downs with the war phase and this and that happens and the family tries to keep up with space and I like to keep people in treatment for a year or two before, before they're ready to go, and that's all covered.
[00:55:23] Speaker B: You keep them in treatment in a treatment center or at home.
[00:55:26] Speaker A: At home. No, at home. At home.
[00:55:27] Speaker B: Okay. It's intensive outpatient kind of stuff.
[00:55:29] Speaker A: I always think that's better, you know, if you can, if you can avoid a, an admission to a treatment center, that's, that's better. I think treatment centers are great for when it's not. When you're not able to recover at home. That's, I mean, it kind of helps with the part reset.
It's great for that. But I think in the end it's better to, to do the work at home where the family can participate and everybody can participate together in, you know, and experience things and work on it as it happens.
Otherwise you kind of go through that growth in the clinic and then you get home and then everything's exactly the same.
[00:56:02] Speaker B: You know what I was thinking? Constant. Those families that outsource their childcare to nannies and boarding schools, how are these types of families going to deal with the recovery at home? They didn't deal with recovery at home. So how the hell are they going through.
[00:56:16] Speaker A: I know. And the, and the, and the connection. I mean, there's also like the connection between the parents and the child is so different than if you had these nannies, you know, like I would say if the nannies are around, make them part of the family meetings.
[00:56:28] Speaker B: Oh, good idea. Yeah. Because that's another part of the arise this model that you're talking about, which is to bring in like even non family members into the meeting, whoever can help him. And you can bring in therapists, you can bring coaches, you can bring friends,
[00:56:43] Speaker A: your best friend, colleagues, if they're very involved, anybody. Yeah.
[00:56:46] Speaker B: When I've spoken to people I know about this array rise method, I feel a lot of like, oh no, we're not going to bring people into our family drama. We don't want them to know our dirty secrets.
[00:56:59] Speaker A: The family Fame. Yeah, there it is.
[00:57:01] Speaker B: And then I have to say, no, no, no. We've got to get. The more people we get in, the better.
[00:57:04] Speaker A: Yeah, yeah. Because, I mean, addiction thrives on secrets. That's part of what we have to do, is we have to break the cycle of the secrets and talk about the messy bits and talk about the hard parts and talk about the tough days.
[00:57:18] Speaker B: I think this is huge. Addiction thrives in secrets or in the darkness, right?
[00:57:23] Speaker A: Absolutely.
[00:57:24] Speaker B: Yeah. I've heard shame doesn't tolerate light.
[00:57:27] Speaker A: Now, the best thing you can do with. With shame is to speak it out. If you, if you. As long as you don't speak about the shame, you're going to talk about the shame, your shame will thrive.
Just stay in your head where it is actually. I mean, the shame is just inside your head. And then usually when you start to speak about your shame, you know, other people don't see it like that.
Usually.
[00:57:49] Speaker B: It's amazing. It just, it dissolves into talk about it. Well, it's been so lovely. I love our conversation, huh?
[00:57:56] Speaker A: Yeah, me too.
[00:57:57] Speaker B: I think there's a lot here for our listeners.
If this episode landed for you, share it with someone who might need to hear it. And if you haven't already, subscribe so you don't miss what's coming. But here's the real thing. I want you to know if you're carrying something you can't talk about, if you have every resource except accept someone who actually understands what wealth costs. I work one on one with people like you navigating exactly that. You can reach me at Diana oehrli.
[00:58:30] Speaker A: Com.
[00:58:30] Speaker B: Thanks for listening.
