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The Unspoken Rules of the Family We Grew Up In

“Whom we are related to in the complex web of family ties over all generations is unalterable by us.”— Elizabeth A. Carter and Monica McGoldrick—The Family Life Cycle

Decisions, decisions. Have you ever wondered about why you do what you do, when you do it, where you choose to do it, and how you do it, with whomever you choose to do it with? (Hopefully this doesn’t strike too many of you as coming from the department of redundancy department). Me neither. But lets just think about this for a minute. How often do we truly make decisions for ourselves based on our own core beliefs and values? I’d suggest not nearly as often as we’d like to believe we do. So what gets in the way? (Round up the usual suspects). The unspoken rules of the family we grew up in.

This inevitable “stuck togetherness”  Murray Bowen first noted as an “undifferentiated family ego mass.” This concept was subsequently refined and expanded into thoughts about the nuclear family emotional system and projection process, and the multigenerational family transmission process resulting in multiple interlocking triangles.

In the process of fusion, an individual anxiously focuses on relationships and gives up “self,” resulting in physical illness, emotional illness or a problem in social functioning. The question that reflects this process is: What do I give up about myself to be part of the family group?

The flip-side/mirror image of fusion is the process of being emotionally “cut-off,” an equally reactive state wherein the question is “What I DO NOT want to give up about myself and therefore detach from being part of this family.” Unfortunately this is a state of an equally low level of differentiation, which often results in over-investment and fusion in new relationships.

So what are these unspoken rules of family togetherness behavior that we reflexively adhere to or reactively reject without due consideration of what conscious responses would be in our own best interest? Here is my top ten list, reduced to five in the interest of time and space.

  • Rule Number 1: What happens in the house stays in the house.
  • Rule Number 2: Don’t talk politics or religion at the dinner table.
  • Rule Number 3: Do what makes you happy as long as it’s what I want you to do, even if I don’t tell you what it is.
  • Rule Number 4: Don’t ask about the things you’re not supposed to know about.
  • Rule Number 5: Pay no attention to the man behind the curtain.

Whether you are fused and enmeshed, or conflicted, distant, cut-off and non-communicative, you remain undifferentiated and out of control. If your behavior is reactive, whether positively or negatively, you are not self-directed.

The process of self-differentiation consists of partially freeing oneself from the emotional entrapment of one’s family of origin, while developing a unique, personal, authentic one-to-one relationship with each member of your family. It is then possible to be emotionally connected without fusing into emotional oneness. One can be both connected, and sufficiently self-aware to make decisions on one’s own, regardless of the Invisible Psychological Contracts We Make with Our Families.

This post was written by Ronald B Cohen, MD, a Psychiatrist and Marriage and Family Therapist from Great Neck, NY. Dr. Cohen is a Fellow of the American Psychiatric Association and an Affiliate Member of the American Academy of Marital and Family Therapy. As a consultant specialist, Dr. Cohen provides clinical supervision, and confers with individual therapists and other health care professionals and organizations to help them consider how adding family therapy sessions to the treatment program is both restorative and proactive as improvement is long lasting.

Dr. Ronald B. Cohen graduated summa cum laude, from Brandeis University and The Albert Einstein College of Medicine. In addition to his psychiatric residency training, Dr. Cohen was educated at the Psychiatric Epidemiology Program of the Columbia University Joseph L. Mailman School of Public Health. Subsequently Dr. Cohen completed the four-year core postgraduate training program in Family Systems Theory and Therapy at The Family Institute of Westchester

Please feel free to comment, request more information and/or schedule an initial consultation contact Dr Cohen at: http://www.familyfocusedsolutions.com/contact/

Or email him at:

RBCohenMD@FamilyFocusedSolutions.com

 

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Coaching Toward Better Family Relationships

This week’s offering is a guest post by Ronald B Cohen, MD, a Psychiatrist and Marriage and Family Therapist from Great Neck, NY. Dr. Cohen is a Fellow of the American Psychiatric Association and an Affiliate Member of the American Academy of Marital and Family Therapy.

In 2001, Betty Carter & Monica McGoldrick two of the most-respected authors, teachers, and clinicians in the field of family therapy, published Advances in Coaching: Family Therapy with One Person, detailing 25 years of research into the theory and techniques of “coaching” individuals to change themselves in the context of their family of origin. The technical term “coaching” refers to preparing and acting for change in the individual’s natural system of relationships.

In contradistinction to traditional individual therapy, coaching focuses on real world behavior with significant others rather than the in-session therapeutic relationship. It is not the interaction with the therapist but rather the individual’s relationships with their family of origin that is of utmost value. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques are not widely understood nor often implemented effectively. Techniques for helping individuals deal with difficult family relationships are not widely known by most individual therapists.

The goal of coaching is to help individuals proactively define themselves in relationship to others in their families without emotionally cutting off or giving in. The process of change is built upon ownership of one’s emotional reactions to old triggers and interactions. Coaching, or family therapy with one person, offers individuals a process for making change in their relationships even without the participation of other family members.

As a therapeutic coach, I help people plan and strategize. I begin by training individuals to become observers and researchers of their role in their family‘s patterns of behavior, what the anthropologists refer to as being a “participant observer”. The information and interactions are then reviewed and we talk about what kind of responses they got, what worked and what didn’t, and where they got stuck. Then we plan what they might do different next time in order to get a response that is more in line with what they are looking for.

The process then moves to helping individuals bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family “rules.” An important part of the coaching process is to help people develop realistic expectations when moving toward changing their part in the family dance. This includes being prepared to respond productively even if unfortunately the other person reacts unfavorably.

Coaching teaches the possibility of dealing with differences without losing connection, which is one of the primary developmental tasks for a young adult. If you are tied up with all of the stuff and rules and roles of your family of origin, it is really hard to figure out who you are and what you want to do with your life.

Coaching is “differentiation in action,” guiding people through a process of changing their own participation in unsatisfying family relationship patterns. It is a conscientiously thought through approach to establishing a unique one-to-one relationship with every individual in the family system.

This post was written by Ronald B Cohen, MD, a Psychiatrist and Marriage and Family Therapist from Great Neck, NY. Dr. Cohen is a Fellow of the American Psychiatric Association and an Affiliate Member of the American Academy of Marital and Family Therapy. As a consultant specialist, Dr. Cohen provides clinical supervision, and confers with individual therapists and other health care professionals and organizations to help them consider how adding family therapy sessions to the treatment program is both restorative and proactive as improvement is long lasting.

Dr. Ronald B. Cohen graduated summa cum laude, from Brandeis University and The Albert Einstein College of Medicine. In addition to his psychiatric residency training, Dr. Cohen was educated at the Psychiatric Epidemiology Program of the Columbia University Joseph L. Mailman School of Public Health. Subsequently Dr. Cohen completed the four-year core postgraduate training program in Family Systems Theory and Therapy at The Family Institute of Westchester

Please feel free to comment, request more information and/or schedule an initial consultation contact Dr Cohen at: http://www.familyfocusedsolutions.com/contact/

Or email him at:

RBCohenMD@FamilyFocusedSolutions.com

 

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How can I recover from sex and pornography addiction?

Give yourself time to heal

To recover from sex and pornography addiction, Dr Linda Hatch in her blog, states that one must be diligent and motivated. Recovery from sex addiction takes about 3 to 5 years.  Going along with the accepted recovery model used in alcoholism or drug addiction, many believe that sex addiction is a chronic disease requiring diligent treatment for life to prevent relapse. Hatch doesn’t think this is always the case in healing from a pornography addiction. She believes Internet porn addiction may be an exception to this 5 year, life long recovery model.

There are other clinical studies that suggest that pornography addiction is an Internet addiction.  Gary Wilson writes the majority of pornography addicts, even with severe symptoms like porn-induced erectile dysfunction, can recover in a matter of two to four months. The first phase of either sex and pornography addiction recovery is restricting computer or internet access and not using that smart phone to access your acting out partners. Yes, even sex addicts use the computer, internet and cell phones to act out, so the restriction is implemented for them as well.

Robert Weiss author of A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age suggest that addicted users are unable to implement lasting behavior change without the admission that they have a sex or pornography addiction and that the addiction is causing unmanageability in their lives. He suggests admitting this to yourself, to another human being, coupled with a combination of addiction-focused individual and/or group therapy and ongoing attendance at a 12-step (or some other addiction support group) will be the next steps on the road to recovery.

Get as much information as you can

In addition to turning off the computer, Weiss’s advice for addicts, is to educate themselves about what sex or pornography addiction is and how to overcome it. Learn how to be accountable, like handing the computer password over to your wife. Find a friend or sponsor in an addiction support group like SLAA, SA, SCA or SAA, developing an active and empathetic support network is a necessity for long-term sobriety and a healthier, happier life. You can ask your HR department for information on the Employee Assistance Program which can help you with therapeutic treatment. Without this knowledge and outside assistance, addicts have little chance of keeping their goal of sobriety in this addiction.

Fill your bedside table with recovery books. Authors like Weiss, and Hatch are joined by numerous others like Paldrom Collins, a former Buddhist nun and sex addiction counselor, and her husband, George Collins, M.A., a former sex addict and practicing sex addiction counselor for over 20 years. They wrote: A Couple’s Guide to Sexual Addiction: A Step-by-Step Plan to Rebuild Trust and Restore Intimacy. They present a refreshing new approach for couples struggling with the issue of excessive pornography, compulsive masturbation, frequenting prostitutes or strip clubs, serial affairs, and other acting out behaviors. In his book, Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession, and Shame, George Collins shares the techniques he has developed in his practice over the last 20 years that have helped hundreds successfully learn how to confront the negative energy that fuels sex and porn addiction.

Understanding that there are several approaches to recovery for sex and pornography addiction, many therapists and clinicians follow the model developed by Patrick Carnes, author and the former director of Pine Grove Behavioral Health (which treated a well-known golfer) and is currently a senior fellow at the Meadows in Arizona (which treated a well-known X-television star). In a study of recovering sex addicts reported in 2000, Dr. Patrick Carnes identified that during the first year in recovery there was no measurable improvement in areas such as coping with stress, self-image, financial situations, friendships, career status and spirituality, even though the addicts reported that they felt that their life was “definitely better.” The first year of recovery is very tough to cope with, so outside assistance is necessary. During the second and third years of recovery, including a period of sexual celibacy, there begins to be improvement in the areas having to do with functioning at work, communication at home and having a better emotional connection with others. These improvements then continue into the later years of recovery.

Carnes reported in the third year and thereafter, greater healing occurred in the addicts’ relationships with their partner and with their extended family/children. During the fourth and fifth years the addict discovered how to “do” non-sexual intimacy as well as engaging in healthy sexuality. Overall these recovery years are about how to achieve higher self-esteem and more life satisfaction.

Coping with withdrawal

Recovery from sex and pornography addiction is like kicking a drug, or booze. Sex and pornography addicts will go through a withdrawal process. Withdrawal symptoms can be acute, and last a few months. But most addicts develop healthier behaviors during this withdrawal period. This period of withdrawal is usually characterized by:

• Cravings

• Strange sexual dreams and fantasies

• Peculiar physical symptoms

• Restlessness and mood changes

Sex or porn addiction is more than having gotten hooked on a dopamine rush. For most sex and porn addicts, the addictive behavior is entwined in a whole adaptation to life based on self-taught ways of coping with inadequacy and insecurity. Without deeper change, the addict is still at risk for relapse into the old addiction or substitution of a new one.

Accept change, follow the guidelines of recovery

It has long been accepted that the root of a sex or pornography addiction is based on a set of negative core beliefs, such as “I am not good enough”, “no one could love me as I am”, “if I have to depend on someone else to meet my needs they will never get met” and “sex is my most important need”.

These beliefs lead not only to a secret sexual life in which the addict seeks to meet his or her needs, but also leads to a slew of negative consequences that we have discussed in a previous blog. But now it is time to shed the former destructive beliefs and seek recovery. Patrick Carnes outlines his work from a 1980’s study on how recovery can work for a sex or porn addict:

First Two Years

The Developing Stage

    • Admit you have a problem and want to change
    • Seek therapy with a Certified Sex Addiction Counselor (CSAT)
    • Attend a 12-step group
    • Stop acting out (either with porn or other sexually compulsive behaviors)
    • Develop knowledge about this addiction
    • Take appropriate tests for HIV/Aids and STD’s
    • If you slip, or stop going to therapists or meetings, go back

Overcoming the Crisis Stage or Decision Making Stage

    • Coming clean about your addiction to others
    • Realizing that in the face of a crisis (an arrest, a spouse’s discovery, or losing your job) you have to do something and cannot continue doing what you were doing

The Shock Stage

    • Experiencing deep loss, feelings of separation, disbelief or numbness
    • Experiencing withdrawal, also the inability to focus, disorientation, and ambivalence
    • Overcoming the feelings of hopelessness and despair
    • Anger over having a therapist or family member set their limits or handing over the addicts’ decision making power
    • Relief that the double life is finally over

The Grief Stage

    • Grieving over the loss of a job, a spouse, legal involvement and/or the separation from their family
    • Grieving over the loss of the addiction, which was used like a friend, confidant, comforter or emotional high
    • Recognition that they were abused or neglected at some time in their life
    • Grieving over the exposure of early traumas in the addict’s life, such as early sexual trauma, parental neglect or abuse
    • Grieving over the loss of the image of the person that abused them, and acceptance that that person was an abuser, not a friend, mentor, parent or family member

The Repair Stage

    • Moving from pain and loss to forgiveness, repair, restructuring and emergence into a new life
    • Changing long held belief systems
    • Instituting new healthy belief systems
    • Taking responsibility for your actions
    • Deepening new stronger bonds with others, developing empathy and intimacy
    • Making an effort to follow instructions, complete assignments, and responding to requests. Beginning to show up on time for appointments, and/or accepting they may be wrong and promptly admitting it, are hallmarks for acceptance of this stage of repair.

Growth Stage (after two years)

  • Achieve balance
  • Develop a greater sense of self, and non-sexual forms of self-satisfaction
  • Be available to friends, family, partners and business colleagues
  • Have compassion for themselves and others
  • Develop trust in all areas of your life

Carnes said that in addition to accomplishing the above goals, he cited a number of additional factors that stood out as being important parts of the recovery process and should be considered during the five years of recovery:

  • Inpatient or residential treatment experience
  • Group treatment experience, intensive outpatient and outpatient services
  • Long-term individual therapy with a certified sex addiction counselor
  • Participation in 12-step programs
  • An active and knowledgeable sponsor
  • An ongoing spiritual life
  • The support of friends
  • A period of celibacy
  • Regular exercise, medical checkups and balanced nutrition

 

In many ways, the field of sex and pornography addiction treatment lags behind the professional and general population’s awareness of other addictions like alcoholism, drug abuse or even gambling. Resources available to treat compulsive sexual behavior have increased dramatically in the last decade. Physicians and therapists who are new to this type of patient need to be educated. It is slow process for both the health professionals and the people affected with this addiction to learn about recovery from this addiction.

 

Here are some organizations that can help

  • SASH

http://www.sash.net/

  •  Annual International Institute for Trauma and Addiction Professionals (IITAP)

http://www.iitap.com/

  •  The National Council on Sexual Addiction and Compulsion (NCSAC)

www.NCSAC.org

  •  American Foundation for Addiction Research (AFAR)

www.AddictionResearch.com

  •  Sexaholics Anonymous (SA)

(615) 331-6230;

www.SA.org

  •  Sex and Love Addicts Anonymous (SLAA)

www.SLAAFWS.org

  •  Recovering Couples Anonymous (RCA)

(314) 397-0867

www.Recovering-Couples.org

  •  Co SLAA (for spouses/partners of sex addicts)

http://coslaa.org/

  •  Sex Addicts Anonymous

https://saa-recovery.org/

  • Sexual Compulsives Anonymous

http://www.sca-recovery.org/

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 Resources used in this blog:

Patrick Carnes, PhD, (2000) Sexual Addiction and Compulsion: Recognition, Treatment & Recovery, CNS Spectrums 2000; 5(10): 63-72, accessed at: http://www.recoveryonpurpose.com/upload/article_sexualaddictionandcompulsion_pcarnes.pdf

Patrick J. Carnes Ph.D., David L. Delmonico Ph.D., Elizabeth Griffin M.A., (2007) In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior, Hazelden, Center City, Minnesota

Robert Weiss, LCSW, (2013), A Basic Guide to Healing from Sex, Porn, and Love Addiction, Elements Behavioral Health, Los Angeles, CA

Robert Weiss and co-author Dr. Jennifer Schneider, Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age (2006), Alyson Books, New York, NY

Gary Wilson, blogger at: http://yourbrainonporn.com/porn-addiction-not-sex-addiction-and-why-it-matters

Paldrom Collins, and George N. Collins (2011) A Couple’s Guide to Sexual Addiction: A Step-by-Step Plan to Rebuild Trust and Restore Intimacy. Adams Media, Avon, Massachusetts

George Collins MA , Andrew Adleman MA (2010) Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession, and Shame, New Harbinger Publications, Oakland California,

 

 

 

 

 

 

 

 

 

 

 

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