Behaviors become clinical if they negatively impact work, social, or personal functioning. Empowerment in therapy begins by knowing what therapy options are available to you. This list is not exhaustive:
TRAUMA THERAPY:
Integration is difficult business. It requires here-and-now contact with the most difficult pain, knowledge, or experience of a person’s lifetime.
The Body Keeps the Score by Besel van der Kolk is a treasure chest of therapeutic techniques, and you owe it to yourself to investigate it thoroughly. It focuses primarily on major and unfortunately common life traumas—the kind of thing that ends up in court or on the news.
The techniques described there should all be provided by a trauma expert, no exceptions. The therapist you are looking for should be “trauma-informed” and preferably have experience with your particular issue. If they cannot comfortably discuss their “integration strategy”, at least after the initial surprise of you asking about it, then keep looking.
You can familiarize yourself with the expected trauma competencies of American Psychologists with the American Psychological Association’s Guidelines on trauma competencies for education and training, which you can find here: https://www.apa.org/ed/resources/trauma-competencies-training.pdf.
COGNITIVE BEHAVIORAL THERAPY (CBT):
This is the modern gold standard. There is a ton of easily accessible information about this online. The cognitive distortion worksheet is one such example. This therapy assumes that thoughts create our actions.
Thought → Emotion → Behavior. By examining thoughts, the beliefs that the thoughts create, and the emotions they generate, we can change maladaptive or dysfunctional behavior.
Challenging cognitive distortions, or toxic beliefs, is the core of CBT, however this practice was first developed and formalized by the Stoics of Ancient Greece. CBT is effective for all ages and can be applied in individual therapy, group therapy, and family therapy.
COGNITIVE PROCESSING THERAPY (CPT):
Traditional CPT is a 12-week program, however, research has shown that an extended protocol is equally effective.
The structured program implements a new step in the process, which includes talking about your traumatic experience and what to expect (weeks 1-3), writing down every detail you can remember about the experience (week 4), then reading it with your therapist and processing the minutia of your emotional and cognitive reactions (Weeks 5-11).
Week 4 is when most people drop out, but those who make it to the end enjoy an 80% reduction in their symptoms, including a cessation of nightmares. If you are suffering from nightmares related to trauma, this is the treatment for you.
DIALECTICAL BEHAVIORAL THERAPY (DBT):
Prolific research has long shown DBT to be an effective treatment against Borderline Personality Disorder. It trains clients in in-the-moment non-judgmental awareness and the ability to accept reality without huge emotional reactions.
EYE MOVEMENT and DESENSITIZATION REPROCESSING (EMDR):
EMDR was Developed in the 1980s to treat Post-Traumatic Stress Disorder (PTSD).
Francine Shapiro was walking in a park, tortured by a traumatic experience, and found that rapid eye movement from right to left had a stabilizing effect on her uncomfortable memories.
She developed EMDR to include repetitive “movements, sounds, or taps”, and has been expanded to treat other conditions like anxiety and stress-related mental illness.
It changes the way memories are held and valued in the brain, though has a much larger effect on trauma experienced after childhood.
EMOTION-FOCUSED THERAPY (EFT):
This therapy is exactly what it sounds like.
When an emotion arises, focus on it. This may sound silly, or oversimplified, but it is an invaluable approach to reconnecting with our natural intelligence after a lifetime of being conditioned to value our thoughts and ignore our feelings.
Even Crack Your Codependency places a huge emphasis on tempering passions, which can be easily misunderstood as ignoring one’s feelings. EFT succeeds when it pulls people away from their ruminations and facilitates a here-and-now assessment of present emotions, gives them names, and explores them. It trains emotional intelligence. The Deep Dive is an exploration of exactly this.
EFT is appropriate for every age group and can help young people develop critical emotional awareness. It is so useful in groups that it spawned a subtype of EFT called “Emotion-Focused Family Therapy” (EFFT), in which parents and children can develop a unique, personalized emotional language.
EFT for couples boasts an 80% success rate in preserving marriages on the brink of divorce.
SCHEMA THERAPY:
This is a good option for less obvious attachment traumas—the purely emotional kind that provokes codependent tendencies.
It involves analyzing your current worldview, the events where they originated, and renegotiating the fundamental way we interact with people and within situations.
This is a kind of rebirth of classical psychoanalysis with a narrower focus on process and less focus on dreams. Jeffrey Young published a book about it that you can read online.
NARRATIVE THERAPY:
This is one you can easily engage on your own.
Write down who you are, how you got that way, and where you want to see yourself in the future. There are many free options available online, and most consist of appropriate writing prompts and thoughtful questions about what you have written.
The Deep Dive explores some of this. If something comes up that you find intolerable, refer yourself to a therapist and try to arrive at treatment with a few filled-out CBT forms.
A free education on Narrative Therapy can be found online.
If you wish to pay for a “self-authoring” program, you can do so.
PSYCHOTHERAPY:
Psychoanalysts can help you talk openly about who you are, why you believe others deserve better than you, and why you never got your cake when everyone else did.
If you are an active dreamer, this is definitely a welcome environment for you. While Sigmund Freud’s focus on the exclusive sexual nature of dreams hasn’t aged particularly well, Carl Jung maintains an avid following.
A Jungian therapist will not be covered by insurance. It will not be cheap, but it will probably be worth it.
If you can find a reputable psychotherapist of the original tradition, act fast. They are among the most targeted by insurance companies because psychotherapy is mostly effective when administered long-term, and is therefore more expensive.
This is in spite of the fact that studies show psychotherapy to be highly effective against some of the most difficult conditions (schizophrenia and Borderline Personality Disorder), and it proves to be a cost-effective treatment provided red tape is removed from receiving it.
Insurance companies continue to suppress this therapeutic modality even after the American Psychiatric Association published the “Resolution on the Recognition of Psychotherapy Effectiveness” which states that the effects of psychotherapy are “significant and large” and “constant across most diagnostic conditions”, including those which are notoriously hard to treat.
It is worth considering whether some psychologists consider Borderline Personality Disorder untreatable because they would never get paid to provide the appropriate treatment.
The current mental health educational system also rejects it specifically because it was created by white men, and because it does not conform to the ideological demands of postmodernism.
John Sommers-Flanagan and his wife authored the most widely used personality theories textbook in American counseling education, which teaches students about “male inferiority” and presents feminism and postmodernism as representative of “higher-consciousness.” Here is their website:
https://johnsommersflanagan.com/.
POSTMODERN THERAPY:
You will want to ask your new mental healthcare provider if postmodernism describes their therapeutic approach. It may serve you to make this your first question.
It does not allow you to talk about the past. It denies that objective truth exists and is the least researched of all the therapeutic modalities. Postmodernism, by its own admission, makes no sense, yet is insisted upon as the morally superior therapeutic approach.
Basically, if you can get a client to agree with postmodern ideology, you have made them more mentally healthy.
INTERNAL FAMILY SYSTEMS THERAPY:
Remember the part of you that you abandoned when you encountered unbearable pain? Probably not.
This is the direct, systematic process of discovering and recovering your exiled parts. It is excellent for shame regulation, PTSD, and improving self-governance.
This therapy allows you to confront your codependent self and ask what exactly it is trying to protect you from. When you find the answer, you will find your abandoned self.
Meadow DeVor wrote a great book on the subject called The Worthy Mind. She was partly inspired by another author, Debbie Ford, who wrote The Dark Side of the Light Chasers. DeVor and Ford were both heavily influenced by Carl Jung.
GROUP THERAPY:
Human beings are social creatures, and society is medicine.
We belong in groups. The fact that the nuclear family is small and high levels of development have shrunk our social circles does not change our biological reality.
Being a part of social groups improves mental health and makes us less likely to develop Alzheimer’s disease. Being around other people allows our brains to breathe in a way that they do not when we isolate ourselves.
There are group therapy options for every diagnosis and therapeutic approach in Crack Your Codependency, you only need to get on Google and call your local university health center. If you want to start with a codependency support group, you can easily find online meetings.
12 STEPS:
Codependents Anonymous (CODA) is a 12-step recovery program.
It is the 12-step recovery program adapted from the original Alcoholics Anonymous (AA) model that focuses exclusively on addiction and addictive behaviors.
Bill Wilson was an amazing individual who gave hope to millions of people without any escape from their alcoholic minds. While surrendering to a higher power isn’t for everyone, at least take a moment to flip through “The Big Book”, especially to review “Step 4”, which calls on you to perform a rigorous inventory of all your life’s resentments.
CBT and Deep Dive are great tools for this step since they seek to investigate your thoughts and emotions and find out what lies beneath them. Finding that bitter core, the resentment, is the only way to give yourself the power to let it go.
If it is helpful, consider virtue to be your higher power, and anything that takes away from it to be your addiction. For what it’s worth, the opposite of virtue is vice, and vice is where we get the word for “vicious.”
If you find the 12-steps frustrating or unhelpful, you are not alone. There are plenty of alternatives.
MEDICATION:
If you are offered medication from a prescribing professional, research everything you can before taking it.
Know all the risks and benefits and read about the experience of coming off of it. The goal is not to rebuff your prescriber, but to make an informed choice. Did you know that 5mg/day of Prozac has been shown to have almost the same effectiveness against depression as 20mg/day?
You owe it to yourself not to fall prey to the culture of overprescribing in the Western medical community. That said, don’t let hubris prevent you from choosing to accept medicinal help. It can work miracles.
A person reeling from trauma is in a mental space of total disorganization, and every day they experience the mental and emotional aftershocks of the initial event or events that destroyed their sense of equilibrium. This is where medications excel in their ability to help.
It takes some time, but once an antidepressant has built up in your system, in a process called “titration”, it can give you the ability to breathe with calm. Your brain is being given a bit of a holiday, which may be exactly what it needs.
Continue working with your therapist and practicing with your CBT, mindfulness, and self-care. When you have stabilized, only under the guidance of your prescribing professional, start shaving a little piece of that pill away.
Get a cheap milligram scale from Amazon and shave off the exact same amount every day. When the intolerable feelings start to return, you can face them a little piece at a time, instead of drowning under them like before. Stabilize again, and then start shaving off more.
It may take longer than you like, but the slow titration down can be far preferable to the living hell that you initially sought treatment to resolve.
THERAPEUTIC PSYCHEDELICS:
The 1960s were an amazing time for the study of psychedelic drugs.
The invention of LSD by Albert Hofman and the introduction of psilocybin mushrooms to the modern world resulted in an artistic and cultural revolution so well-known that it has become cliché.
What most people do not remember were the revelations in psychiatric medicine that showed psilocybin and LSD to have remarkable potential for addiction cessation. We knew 60 years ago that LSD was effective in the treatment of alcoholism. Bill Wilson, the AA founder, is known to have tried it. Some long-term, hardcore alcoholics were able to quit drinking after a single dose.
After a research Dark Age brought about by the colossal political, social, and economic failure known as the “War on Drugs,” psychedelics are once again being explored in the clinic.
Currently, MDMA (Ecstasy) and psilocybin (Magic Mushrooms) are showing excellent results in treatment-resistant depression, PTSD, anxiety (psilocybin outperformed escitalopram (Lexapro) for lasting symptom remission), and addiction.
At print, several clinics around America will either facilitate or observe a psychedelic session with MDMA and psilocybin, and fees average about $3,500. (Ketamine is an option in many states. The experience is a little more expensive $4500+, with mixed results.)
MICRODOSING PSYCHEDELICS:
You may be surprised to find that your therapist or medical doctor—the qualified person who will oversee your use of psilocybin—is surprisingly open to your use of microdosing.
That is because they have only heard good things about it, like how it is safe, improves mood and mental health, lowers anxiety and depression, improves symptoms of migraines, Pre-Menstrual Syndrome, and traumatic brain injury, reduces cigarette and alcohol intake, and can reduce the use of antidepressants.