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  1. Healing Shame and Rebuilding Trust after Betrayal M. Deborah Corley, PhD Sante Center for Healing www.santecenter.com deb@santecenter.com

  2. Conference Objectives • Disorders that impact physicians connected to shame & betrayal. Repeated dishonesty = betrayal • Sexual Misconduct/Hypersexual DO/Sex addiction • Sex with patient/subordinate • Other behavior that is against corporate policy or law • Other addictions • Other co-occurring disorders that create disruption • PHP helps rebuilding relationships • PHP as monitor, advocate, educator • Can be another place HCP form support groups • Promoting educational events in collaboration with other to assist couple, family, work

  3. Workshop Objectives • Betrayal & Trust • Impact of attachment • Shame and healing from shame • Rebuilding relationships after betrayal • Everyone being monitored learn more about handling conflict and attunement (attachment style, self-regulation versus dyad/group regulation) • Spouse/family – process should have started at treatment; understanding and supporting the process • Place to discuss the shame; place to acknowledge frustration • Practicing being better friends with self and others • Workplace amends and relationship mending

  4. What is betrayal Perceived violation by a partner of an implicit or explicit relationship relevant norm…when the victim believes that the perpetrator has knowingly departed from the norms that are assumed to govern the relationship, thereby causing harm to the victim. Betrayal is the intentional or unintentional breach of trust. Finkel, et al. (2002)

  5. What is trust? • Define trust as a belief or expectation of reliability or dependability of another. • In specific interactions we can rely on our caretaker - then partner to behave in such a way that our own payoffs are maximized. • Trust & safety are pillars of attachment theory.

  6. How do we evaluate trustworthiness • Honesty – leads no secret life and does not lie to you or others • Ethics/values –has ethical standards and values that you agree with and behaviors are consistent with the ethics/values • Accountability – does what he/she says and you can see proof of it • Alliance – has affinity with you, has set appropriate boundaries with others • Resolution – ongoing processing of shame • Transparent – is forthcoming Gottman, 2011

  7. Impact of attachment styles • Early interaction with Mom (caretakers), genes, other life experiences format the brain • Contributes to how we learn to manage or mismanage emotions • Auto-regulate • Dyadic or interactive regulation • We are only as good at emotional (arousal) regulation as were our best caregivers • Addicts have insecure attachment styles and utilize maladaptive strategies to manage emotions

  8. Avoidant/dismissing insecure attachment • Dismissing: Feels worthy of love with negative disposition towards others. Under trusts. • Learned how to be strong, self sufficient, best is never enough; chronic need for alone time • Report can’t feel/doesn’t know how feels; denies shame. • To cope, auto-regulate to shut down or over-regulate the system; use work to distract from emotions; • Push others away to avoid rejection, vulnerability • Devaluing: finds fault in all others – always the expert • Idealizing: had to falsely idealize parent to meet their needs, so will repeat pattern with you, or group leader • Control: selective attention/inattention ; anger to rage; shaming criticism to control others

  9. Anxious insecure attachment styles • Anxious/Ambivalent/Angry-resistant: Feels unworthy, too willing to please, fearful of asserting true-self. Over trusts. • Overwhelmed by own feelings; hyper-vigilant about distancing from others; fear abandonment – continuously scan for internal and external cues to amply the distress then feel burdened by it • Feel lonely, seek out the untrustworthy • Trouble relying on others because filled w/self-doubt but still long to attach (put self in harm’s way) • High functioning but often are enabling/over functioning in relationships or on-the-job (or in group); are seeking approval of others to verify they are worthy; get angry/resentful if don’t get attention

  10. What is Shame • Shame is not the same as nor simply the product of negative self-appraisals • Innate affect designed to help us • We learn early it is one way to control others without killing them • Shame carries the greatest potential to damage the sense of self and is potentially the most important emotion to examine for addicts and their partners. • Toxic or magnified shame progressively captures and dominates the self • Shame keeps the addict and partner bound pain; it seems to be associated with every schema used to inform their behaviors Nathanson, 1992; Wallin, 2007; Kaufman, 2010

  11. Addicts are not trustworthy • Chronic liars • Break rules • Blame others; cannot be counted on • Operate out of self-interest; live a secret life • Even when caught do not disclose the whole truth • Betray those they fear most will abandon them

  12. Betrayal = Relational Trauma • Because the betrayal is just like an attachment injury, partner is stuck in anger, fear and distress. Often has own shame and takes on addict’s. • Depending on partner’s attachment style and skills in tolerating emotional distress, she/he can become so flooded with emotion cannot process the trauma or regulate emotional state.

  13. Flooding – 3 parts • Discovery happens • Stage 1 – Danger is present! Feel shock. • Stage 2 – Signals the need to fight, flee, or freeze. Stress response system gets in gear, stress hormones amp up heart rate and blood pressure (once pulse is over 90 can’t make sense or easily calm down) so explode in anger and/or tears • Stage 3 – system is overwhelmed, shut down emotionally, extent of betrayal sets in • Next film clip – sexual betrayal is hardest. • Look for the 3 parts of flooding.

  14. Betrayal is proof of breach of trust • When someone has crossed a sexual boundary, the betrayal is experienced as a relational trauma and takes significant time to repair. • Betrayal isn’t a balanced process; partner no longer knows who the addict is.

  15. Restoring Trust After Betrayal • This first stage is long and very painful. 1 – 3 yrs • Addict has to atone; power shifts to partner • After disclosure couple agrees to trial period – • agrees to transparency, verification, not rock the boat • When partner is triggered, addict always expresses genuine remorse • “I am sorry that reminds you of my past behavior & brings you so much pain.” • Agree not to use Four Horsemen when triggered Adapted from Gottman, 2011

  16. Four Horsemen of the Apocalypse 1 • Criticism • A verbal, global description of a flaw in your partner’s personality. Women whose complaints have long been ignored - complaint escalates to criticism • Defensiveness • Countering to protect oneself or defend one’s position or actions. Shame can trigger defensiveness

  17. Four Horsemen of the Apocalypse 2 • Contempt • Any critical statement you make when you feel superior to your partner, to put him/her down or shame him/her • Stonewalling • The listener withdraws from the interaction while staying in the room. Men exceed women in this area

  18. Adaptive Responses • Self management moves from automatic, inflexible non-conscious level of acting out to purposeful, flexible, conscious system of self-regulation. • Important to agree to calling time-out for self repair if become flooded • Developmentally move toward complexity – self play to interactive play; auto-regulation to interactive mutual regulation. • Addict learns to attune, then leads partner in first stage of attunement.

  19. ATTUNE – Addict leads Dyadic regulation • Awareness of emotion - (CYA) exhale, apologize • Turning towards the emotions “I hear that this brings up your fear again – what else do you feel and what do you need right now to help?” • Tolerance of the emotional experience (two valid perceptions of the event, but…) • Understanding the emotion -- seek to understand connection between past and present. “Does this remind you of other times in your life or with me that are making it feel worse?” • Non-defensive listening to impact of the emotion • Empathy (it makes sense to me that you would feel this way)

  20. Restoring Trust After Betrayal 2 • Addict listens repeated expressions of partner’s feeling without defensiveness - ATTUNE • Over time, explore what led to shame, acting out (and acting in) and turning away from each other • ID patterns common to attachment style that are unique to couple history that contribute • Explore how being untrustworthy contributed to shame and excuse to use/moving away • Goals for change; commitment by both for ways to change & maximize cooperation • If partner can’t commit – what does it take, restitution • How much is still about shame?

  21. Restoring Trust After Betrayal 3 • Set up high costs of subsequent betrayals (what happens if addict relapses) • Addict establish sense of responsibility for partner’s welfare (what would it look like, sound like, feel like) (Savings account for taking care of partner). • Role of polygraph and drug testing. • What would consequences of relapse be? What’s a deal breaker (now – in 5 or 10 years?) • If partner can’t commit – what does it take, what is restitution? • How much is still about shame?

  22. Antidotes for Shame • Develop self-compassion and capacity for regret • Shame is internal form of punishment, a walk-up call from the smart part of your brain, self punishing is only a temporary suppressor of the behavior. Talk about shame. • Practice recovery. Responsibility, accountability, seek guidance, +/- inventory, amends, give back. • Self-empathy leads to empathy for others. • Discuss ways for regaining equal power in other relationships

  23. Antidotes for Shame • Develop strategies for dealing with critical or shaming people (especially those in your head) (Practice dialogue/boundary setting) • Become consistently authentic – accept and integrate all parts of self; resist the need to be dependent on external praise or prove your point • Be clear about values and base mindful choices on recovery values; practice humility • Grieve the past circumstance that contributed to the shame. Identify the lessons and practice forgiveness.

  24. Restoring Trust After Betrayal 3 • Why partner/addict did not leave? (especially if partner is stuck) • Reversing Betrayal Processes • Learning constructive conflict and self-disclosure versus conflict avoidance or escalation • Couple agrees to principle of mutually meeting each other’s needs (We have each other’s back.) • Agree to turn towards bids for attachment; increase appreciation & respect (clarify boundaries/triggers) • Ritual of checking in emotionally – processing shame when it comes up • Cherish versus trash; be a safe haven • Establish norms; create the sacred in relationships

  25. Regular conflict in relationships • Happens in all relationships! • To totally avoid issues is dangerous to create resentment and self-loathing (why can’t I say my truth?) • Over responding with negativity and high levels of anger leads to flooding (B/P increases and heart rate exceeds 90 BPM) the opens door for Four Horsemen • No resolution means no repair then distancing, loneliness, parallel lives, more resentment, easier entry to anger • Anger leads to “nasty-nasty” interactions, opening up childhood disappointments and vulnerabilities • Leads to an excuse to use and be untrustworthy

  26. Conflict • Effective repair • Soft-startup (Neutral, Nice) • Positive sentiment – give benefit of doubt, overrides negative • Path to attuning with your partner • Soothing is the antidote to flooding • Or make it worse • Running on emotional empty • Nasty-nasty • Four Horsemen

  27. Attuning exercise for couple • State of the Union Weekly Meeting – 1 hour • ID 5 appreciations for positive things person has done this week (5:1 rule) • ID 1 negative thing want to bring up & how relates to shame • Remember to postpone persuasion until satisfactorily state the partner’s position (summarize, validate feelings, and need) • Speaker use constraint = gentle start up, when get to request say what partner can do to solve it that would work “I feel this, I need this.” • Listener can take notes but keep eye contact, don’t focus on facts, but on speaker’s pain

  28. Workplace Repairs • Re-entry processing when breach of trust impacted people in workplace • Appropriate disclosure • Give staff chance to observe & acknowledge what happened from their perspective • Allow feelings to surface • Get & give support • Reframe experience from crisis to opportunity • Take responsibility • Forgive yourself (and others) • Let go, Move on.

  29. Workplace Repairs Exercise • Activity -- observe & acknowledge • Describe situation on text when trust breaking behaviors spilled over into the workplace • Describe behaviors say and are fearful will reoccur • Express how they and the work environment were impacted • HCP repeats what he/she hears, take responsibility • Establish new policies where appropriate

  30. Earning a secure attachment • Find a few “good enough mothers” (GEMs) to practice dyadic regulation (often early in recovery, one primary “good enough mother” is the therapist, friend in treatment/therapy) GEMS help relearn how to attach and practice regulating emotions in a healthy way • Other places to find GEMS • Mutual Help/12-step groups/sponsor • Therapists • Continuing therapy groups • PHP

  31. Characteristics of Intimate Conversation • Identify in words what feeling • Asking open ended questions • Using statements that follow-up on answers to OE questions for deeper understanding of partners thoughts and feelings • Using statements of compassion & empathy to express understanding

  32. Strategies for repair after the horse • Handouts • Gottman Antidotes for Four Horsemen • Gottman’s Stop Action • Go to safe place – do self repair • Do resolving relationship problem worksheet • Then ask for time for “container” (can call it what ever you like) • Take responsibility for his/her part • Make plan together for how can handle differently in future • Practice, practice, practice

  33. Attuning after regrettable incidents • CYA (calm you amygdala) – long, slow exhale • Feeling – each person takes turns describing how felt during incident • Realities – each person describes his/her reality during the incident – what happened • Accepting responsibility for what might have set up his/her to become hurt, respond defensively, withdraw or escalate the fight • What triggers reflected enduring childhood vulnerabilities • How triggers are associated with past • What person can do to make it better next time; to make it better today

  34. Maladaptive Strategies to Cope w/ Shame Withdrawal (Anxious; Disorganized) • Aware of shaming event as negative and accept the shaming message as true; want to minimize exposure to shame so withdraw from attachment opportunities • Disappear from social or intimate situations • Passivity, underachievement • Attachment style does not allow for seeking support or advice to help deal with the negative emotional state • Become more isolated and depressed (then have to “use” to cope with the depression and shame)

  35. Maladaptive Strategies to Cope w/ Shame “Do unto yourself what you fear others may do to you!” • Attack Self (Anxious; Disorganized) • Self-talk about event is critical, FSLA experiences anger and contempt toward self • Externalize self-criticism • “Nobody likes me, every body hates me, I deserve this bad thing.” • Often results in reassuring comments by others but it is never enough • Thus pushing others away, FLSA experiences more shame, reinforcing belief “I am flawed” • Identifying with the perpetrator/domestic violence

  36. Maladaptive Strategies to Cope w/ Shame • Attack Other (Avoidant; Disorganized) • Use arrogance, demeaning, anger and blaming in attempt to project shame onto others to lessen emotional pain associated with negative message of shaming event • Use aggression, out-of-control raging, physical abuse, and critical verbal assaults used to take focus off self • Carrying a grudge or staying stuck in resentment for past transgressions giving self permission to engage in behaviors that would otherwise cause shame; carrying grudge • Justify actions with righteous sense of anger

  37. Shame – Adaptive Strategies • Secure attachment use it to pay attention to opportunity to use both auto-regulation and interactive regulation • Ground self – feel floor or chair, focus on breath in attempt to regulate • Self talk is about need to pay attention to behavior • Talk responsibility for behavior; attempt to attune with other person

  38. Strategies for TX Shame • Increase emotional competence skills; • Identify where use adaptive and maladaptive behaviors • ID where feel/experience/project shame (or co-occurring emotions/i.e. confusion, fear) in past and present • Safe place imagery & internalized coaches, resources (protective adult self, nurturing adult self, spiritual guide) • Reprocess and reframe shame events • Repair attachment injuries associated with shame (EMDR, somatic/body work, art, brain spotting) • Meeting developmental needs (basic safety, existence/valued as a child, enmeshment, dismissed) • Reframe events of life story or time line

  39. Strategies for TX Shame • Define what earned secure attachment is • Defining what earned secure attachment is • Secure: Feels worthy plus has expectation that others are generally accepting and responsive • Healing work in safe environment (relationships with therapist, group, sponsor, spiritual advisor) • Who is safe to do work with? How do you know? Body work, “I feel, I need” conversations, • Repair when disconnection happens (what inner-child needs/needed) • Practice skill work within therapy, group, friends • Re-engage with Authentic Self • Be Trustworthy at all times

  40. The Sound Recovering Relationship House Creating Shared Meaning and Rituals of Connection Honoring One Another’s Journey Better Resolution of Conflict Talking differently about perpetual problems Effective conflict resolution for solvable problems Adopting a Positive Perspective / Shared Goals Turning Toward Versus Turning Away Increasing Emotional Bank Account Fondness and Admiration Becoming Best Friends Learning to Attune/Use Interactive Regulation Skills Creating Sound Foundation of Recovery

  41. Healing Sexual Shame • Keep identifying the shame and talking about it • Cultural norms and family rules, trauma impact • The partner’s feelings of betrayal and fear of not being good enough; impact of shame – keeping her bound to pain • Create more equity between partners • Saying no to sex – Sexual abstinence contracting • Sexual moratoriums • Replace having sex with learning about attachment & intimacy • Learn more about own and partner sexual desire (Katehakis, Erotic Intelligence, pg 57) • Exploring history of abuse, lovemap crosswiring & arousal damage, and impact of shame on sexuality • Beginning to explore sexual behavior again • Sacred space and time (Spiritual connections) • Keep talking (both shame and celebration)

  42. Returning to Sex After Betrayal • Have to have done the other work before returning to sex • Create personal sex and intimate trust • Knowledge of each other’s personal preferences in sex, love, romance • Reversing processes of impersonal or maintenance sex (objectifying, dissociation due to shame). Don’t have sex if in shame or haven’t resolved an emotional state. • What am I trying to communicate about who I am when having sex? What am I trying to say about our relationship when I am having sex?