Category: Gather Information

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Finding Sobriety, Strength, and Hope as an “Alcoholic in Long-Term Recovery”

This week’s podcast episode features one of our Recovery.com cohosts, Cliff McDonald! Cliff is the Chief Growth Officer at Recovery.com and identifies as an alcoholic in long-term recovery. In this episode, Cliff shares his recovery story and details his path as a successful entrepreneur, Wall Street businessman, coach, father, and mentor. 

You can find Cliff’s episode and listen to our past guests here. 

“A Ticking Time Bomb”

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Cliff was raised in a robust Irish Catholic drinking culture. His father, a Boston police officer and professional boxer, along with his grandfather, a decorated World War II veteran, both drank heavily. Alcohol was a staple at family gatherings, where even as a child, Cliff had “sips of beer” and occasionally Jameson whiskey. By 13, Cliff had not gotten used to alcohol but to also anticipate opportunities to drink.

“I had this other life where I was getting severely intoxicated with my friends since I was 13 years old. And that was a secret. And that remained a secret for a long time, until it didn’t. So, I experienced wholeheartedly the progressive nature of this disease.”

Cliff played football in high school and at Dartmouth College, where he sank deeper into the party culture and drinking habits of fraternities. His once-stellar grades dropped. At this point, he started noticing how he drank more than everyone else and seemed more reliant on it, especially during the off-season.

Cliff followed most of his college peers to Wall Street and made a successful career. He married and moved to Madison, WI, where he opened and ran several Irish pubs. Then, his father passed away at just age of 55, which Cliff suspects was because of his drinking. 

The slow-burning fuse became a racing flame. 

Gradual Descent to a Public Rock Bottom

As Cliff navigated the challenges of losing his father, managing a business, and balancing the responsibilities of parenting and marriage, drinking shifted from a habit to a necessity. He expanded his career beyond owning Irish pubs by taking on the role of COO at a company. But during visits to check on the pubs, what started as a routine beer gradually escalated to a beer paired with a shot. About this, Cliff says, 

“So these little changes, right, over time, and then, the next phase, which ended up being this real, real chaos for about 18 months, two years, when I became severely alcoholic.”

After having one too many at a company party, Cliff was let go. In 2018, he went to rehab for the first time but checked himself out after 14 days. His counselor said he’d see him again. Cliff recalls, 

“So I went home here to Madison and I had 90 days of sobriety. Brutal sobriety. Not going to meetings, not having a sponsor, just white knuckling it.”

And then, 

“After 90 days, I decided that it would be okay to have a drink.”

Wading Through The Mire

Life darkened after that drink. Cliff’s wife didn’t want him living in their house if he drank again, and held firm to that. He ended up in his own apartment, unemployed, and drinking around the clock. 

“I think I was drinking to die. And, really, no will to live.”

Cliff also remembers, 

“People were reaching out to me for a while, like, checking in, and I remember I wouldn’t answer the phone a lot, because I didn’t want to talk to people, and I was hiding.” … “Then the phone stopped ringing, and I had never felt alone in my whole life, and I was alone in this apartment without, it’s crazy, with no one near me, no one checking in on me.”

After not hearing from him for a few days, Cliff’s wife made a welfare check and found Cliff needing dire help. He returned to treatment after detoxing in a hospital for 6 days. 

Rising to Recovery

Cliff’s second time at rehab had a much different effect. Remembering what his counselor told him this second time, Cliff quotes, 

“”Some people are alone. You’re not. You have people who still love you and still care for you.” And it hit me. Like it hit me and it hit me hard.”

A spiritual experience and working the 12 Steps of Alcoholics Anonymous set Cliff on the path of long-recovery. After rehab he went to sober living, and then got a sponsor. His therapist at the sober living home told him: 

“She referred to me as a ticking time bomb. She was like, it’s amazing. You held it together as long as you did, and you were just destined to explode. And you did. Now we can do the rebuilding, but let’s dive into why.”

As for what kept him on the path to recovery the second time, Cliff says, 

“So therapy was huge. Prayer and meditation is huge. Fellowship is huge.”

Now, Cliff sponsors other men in recovery and brings his lived experience with addiction and the treatment space to his work as our Chief Growth Officer. He’s also written a book, called Don’t Sell, Generate Revenue. You can buy that here. 


Cliff credits his recovery and his Higher Power with reinstating his creativity, leading him to entrepreneurship and business success again, and being the husband and father he wants to be. Listen to his episode on the Recovery.com Podcast to hear more!

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Unravelling Risk Factors and Strategies for Prevention of Mental Illnesses

Within the global health landscape, the prevalence of Substance Use Disorders (SUDs) and mental illnesses is quite significant. Data reveals that almost 1 in 4 adults have experienced a mental illness in the past year. Approximately 60% of the population1 consumed tobacco products, consumed alcohol, or used illicit drugs in the past month in the US. 

The rising prevalence of substance use is a concerning trend, as it often escalates into Substance Use Disorders (SUDs) and other mental illnesses. Excessive substance use can lead to a range of problems, from deteriorating physical and mental health to strained family relationships. This escalation can result in various challenges, including financial issues, legal troubles, and decreased academic or professional performance.

Prevention refers to strategies and measures aimed at stopping or mitigating the initiation and escalation of substance use. Proactively addressing these concerns is crucial. By implementing prevention efforts, individuals and communities can work together to create environments that deter substance use.

Levels of Prevention

Prevention involves taking action and adopting strategies to avoid or reduce the development of mental health problems. It aims to promote well-being and create conditions that support mental health, ultimately preventing or minimising the occurrence of mental illnesses. 

Prevention can be done at different stages. Primary prevention works before the illness starts, while secondary and tertiary prevention focuses on dealing with the illness after it has begun.

Level 1: Primary Prevention – Stopping Mental Illness Before It Starts

Primary prevention involves actions and strategies that aim to prevent the initial occurrence of a health issue or condition before it develops. In the context of mental health, primary prevention focuses on addressing risk factors and promoting protective factors to stop mental health problems from emerging. 

It includes interventions designed to create supportive environments, enhance resilience, and reduce exposure to factors that may contribute to the development of mental illnesses. Primary prevention is proactive, aiming to build a foundation of mental well-being and resilience in individuals and communities.

Level 2: Secondary Prevention – Early Intervention for Emerging Issues

Secondary prevention involves efforts to detect and address a health issue at an early stage, especially after it has already begun but before it becomes more severe or leads to complications. In the context of mental health, secondary prevention focuses on identifying and intervening with individuals who may show early signs of mental health challenges.

By recognising and addressing problems in their early stages, secondary prevention plays a crucial role in minimising the impact of mental health challenges. It provides an opportunity for timely support, interventions, and resources to enhance overall well-being and prevent the exacerbation of mental health issues.

Level 3: Tertiary Prevention – Rehabilitating and Preventing Relapse

Tertiary prevention involves efforts to manage and minimise the impact of an existing health issue, especially one that has already reached a more advanced or chronic stage. In the context of mental health, tertiary prevention focuses on rehabilitation and preventing the recurrence of mental health problems.

It includes interventions designed to support individuals who have experienced mental health challenges, aiding in their recovery and implementing strategies to prevent further complications or relapses. Tertiary prevention aims to enhance the overall quality of life and well-being of individuals already dealing with mental health issues.

Risk Reduction as a Preventive Measure

The risk reduction approach is a systematic and proactive strategy aimed at minimizing the likelihood or impact of potential harm in various aspects of life. This method involves identifying potential risks, analysing their causes and consequences, and implementing targeted measures to mitigate or eliminate them.

For example, common risk factors of cardiovascular issues include unhealthy eating habits, lack of physical activity, and excessive consumption of processed foods high in saturated fats. To mitigate these risks, individuals can adopt a balanced diet rich in fruits, vegetables, and whole grains, engage in regular physical activity, and limit the intake of processed foods. These proactive measures work to manage weight, regulate cholesterol levels, and improve overall cardiovascular health, reducing the likelihood of heart-related problems.

To understand this in the context of mental health, consider the example of stress management. Chronic stress is a recognised risk factor for mental health issues such as anxiety and depression. To mitigate this risk, individuals can implement stress reduction techniques such as mindfulness, meditation, or engaging in activities that bring relaxation. By proactively managing stress, individuals decrease its potential negative effects on mental well-being, fostering resilience and reducing the risk of developing mental health issues.

Common Risk Factors of Mental Illness and Substance Use Disorders

With an understanding of how risk reduction plays a role in preventing mental illnesses, let’s delve into the common risk factors associated with mental health challenges. In the following section, we will examine how these factors might be effectively addressed both at the community and personal levels.

The Interplay of Genetics

Genetics plays a significant role in shaping an individual’s vulnerability to both mental illness and SUDs. Certain genetic factors may predispose someone to a higher risk of developing conditions such as depression, anxiety, or addiction.

Although we have limited control over genetics, understanding family history can pinpoint a vulnerable population, offering valuable insights for targeted interventions. If substance use disorders or other mental illnesses are prevalent in your family, it may indicate a heightened risk for you.

Environmental Influences

Environmental factors, encompassing early life experiences, trauma, and living conditions, contribute significantly to the risk of mental health challenges and substance use. 

  • Adverse childhood experiences (ACEs): Stressful or traumatic events during childhood such as physical, emotional or sexual abuse, can serve as catalysts2 for both mental illness and SUDs. 
  • Parenting Practices: Harsh parenting and physical punishment during childhood have been shown to undermine child well-being. 
  • Bullying: Bullying stands out as a primary risk factor for mental health issues. 
  • Socio-economic Factors: Lower education, unstable employment, and financial stress were associated with a higher risk of depression.

Coping Mechanisms and Stress

Individuals facing chronic stress or lacking effective coping mechanisms may be at a higher risk of both mental illness and substance use. Substance use can sometimes emerge as a maladaptive coping strategy, further exacerbating mental health challenges.

Substance Use

Excessive alcohol consumption, smoking, and marijuana use were identified as risk factors for depression. In India, 17% of children aged 13 to 15 years reported consuming alcohol3. These figures emphasise the vulnerability of the younger population, demanding a focused approach to prevention and support. 

Children whose parents use substances may face an elevated risk2 of developing a mental illness or substance use disorder. The environment in which children grow plays a critical role in their overall well-being. When parents engage in substance use, it introduces a complex set of factors that can impact their children’s mental health.

Childhood Symptoms of Depression

Childhood mental illness notably predicts adult mental health issues. The onset of many mental illnesses often occurs during adolescence. Timely identification during this crucial stage can significantly improve the prognosis and outcomes for individuals.

This list is not exhaustive, and various other risk factors contribute to mental illnesses. Research indicates that mental illnesses are at least partially preventable4. In the following section, let’s explore strategies to mitigate or manage these risk factors, aiming to decrease the likelihood of adult mental illness and substance use disorders.

Strategies to prevent mental illnesses and substance use disorders

Preventing mental illness necessitates coordinated actions both at the policy level and the individual level. The “Origins of Adult Mental Illness” (OrigAMI) model4 provides a structured approach to crafting a prevention program. The initial step is to identify modifiable risk factors, followed by the identification of vulnerable populations, such as children displaying early signs of mental illness. Subsequent steps entail determining effective intervention techniques and establishing a suitable workforce. 

In low to middle-income countries, task shifting may be essential, involving the collaboration of teachers, counsellors, parents, and volunteers. The final step involves a thorough policy analysis, ensuring that prevention efforts are integrated into broader healthcare policies for comprehensive and sustainable impact.

At the community level, schools and colleges play a pivotal role in fostering mental health awareness. Implementing intervention programs within these settings, where children and parents are easily accessible, can significantly contribute to preventive efforts. Equipping young individuals with healthy coping techniques early on is crucial for enhancing stress management skills. Integrating fundamental mental health education into the school curriculum ensures that children receive essential knowledge from an early age.

Beyond academics, educating children and adolescents about the potential effects of substance use is imperative. Workshops for new parents can serve as valuable platforms for learning about children’s needs and promoting healthy communication and parenting practices. Educational institutes should establish and strictly enforce protocols against bullying, recognizing that both the bullied and the bully may exhibit signs of psychological distress that require appropriate counseling.

Additionally, to curb substance use among adolescents, it is essential to limit advertisements and ensure restricted access to substances like cigarettes and alcohol. By adopting these comprehensive measures within educational institutions, communities can create environments that prioritize mental well-being, resilience, and healthy interpersonal dynamics.

Empowering Yourself for Mental Health And Wellbeing

Empowering yourself with knowledge and practical measures can significantly contribute to overall well-being. Here are a few things you can try to incorporate: 

  • Maintain a healthy lifestyle: Poor overall health is also a risk factor for poor mental health. Prioritize regular physical activity, a balanced diet, and adequate sleep to support overall well-being. 
  • Stress management techniques: Chronic stress is a common trigger to anxiety and depression. Learn and practice stress-reducing activities such as mindfulness, meditation, or deep breathing exercises.
  • Build a support system: Cultivate strong social connections with friends and family, fostering a support network for challenging times.
  • Seek professional help when needed: Don’t hesitate to consult mental health professionals if experiencing persistent emotional challenges. Seeking help early on can reduce the impact on daily functioning and improve prognosis.
  • Limit substance use: Be mindful of alcohol, tobacco, and drug consumption, keeping it within recommended limits to prevent substance use disorders. Substance use can put you and your loved ones mental wellbeing at risk. 
  • Educate yourself: Stay informed about mental health, substance use, and their potential risks to make informed lifestyle choices.
  • Mindful parenting: For parents, focus on creating a supportive and nurturing environment for children, fostering positive mental health from a young age.
  • Educate children on substance use: Initiate open and honest discussions with your children about the harmful effects of substance use. Provide them with accurate information, emphasizing the potential risks and consequences associated with alcohol, tobacco, and drug consumption.
  • Bullying awareness and action: Be vigilant for signs of bullying and engage in open conversations with your children about their experiences. If your child is facing bullying, take proactive steps by communicating with the school, teachers, or relevant authorities to address the issue promptly.
  • Educate others: Share knowledge and awareness about mental health and substance use disorders to contribute to a more informed and supportive community.

In closing, it’s essential to recognize that mental illnesses and substance use disorders are preventable to some extent through proactive measures and informed choices. Education plays a pivotal role in this prevention journey – empowering yourself and your loved ones with knowledge about risk factors, early signs, and effective preventive strategies. Additionally, embracing a culture of seeking professional help when needed fosters a supportive environment for overall well-being. Let’s prioritize mental health, advocate for awareness, and foster a community where wellbeing is a shared priority.

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40 Prayers for Addiction Recovery

Faith and spirituality can serve as a lighthouse during difficult times, like the rewarding but challenging process of addiction recovery. You can write down or memorize a few key prayers to have on hand in moments when you need hope, strength, and comfort in your journey. 

Explore these 40 prayers for addiction recovery and see which ones stand out to you.

Disclaimer: People of any religion, or none at all, can use these prayers. Simply replace ‘God’ with the Higher Power of your choice.

Prayers for Strength and Courage

If you feel that your own strength isn’t enough to overcome what you’re facing, these prayers can help you lift up your concerns and find hope.

Prayer for Inner Strength

“Dear God, grant me the inner strength to face life’s challenges with courage and resilience. Help me find solace in times of difficulty and empower me to overcome any obstacles that come my way.”

Prayer for Courage to Change

“Higher Power, grant me the strength to embrace change with open arms. Fill me with adaptability, resilience, and the belief that through change, I can grow and experience new blessings.”

Prayer for Endurance

“God, you know my heart today and how I am struggling to endure one more moment of this adversity. It feels hard to believe you have good in store for me, but I trust that you are working all things for my good. Strengthen me today.

Grow and mature me so that I lack nothing in my faith. Help me persevere. Bathe me in your love and peace when the suffering, waiting, and lack of control is hard to endure.”

Prayers for Healing and Recovery

Addiction often requires both physical and emotional healing, for yourself and your loved ones. These prayers about healing and recovery can put your desires into words and connect you to spiritual truths. 

Prayer for Physical Healing

“Lord, bless my body with vitality and strength. Grant me the physical endurance to navigate life’s demands and maintain a healthy and vibrant lifestyle.”

Prayer for Mental Clarity

“God, grant me the strength and mental clarity to overcome my addictions. And identify my goals Fill me with the determination and willpower to break free from destructive habits and embrace a life of sobriety.”

Prayer for Emotional Healing

“Heavenly Father, in moments of emotional turmoil, grant me the strength to find peace within myself. Lift the burdens from my heart and guide me towards healing and serenity.”

Prayers for Guidance and Wisdom

As you walk the road of recovery, you’ll likely face difficult decisions with answers that don’t seem very clear. Should you go back to treatment after a relapse? Should you start hanging out with your old friends that drink? Knowing the answer to questions like these might feel overwhelming, so you can pray for wisdom and guidance to center your thoughts and release them. 

Prayer for Guidance

“God, grant me the strength to make difficult choices. Guide my steps, illuminate the right path, and grant me peace in knowing that you are with me in every decision.”

Prayer for Wisdom

“Grant me the strength to seek wisdom and understanding. Open my mind to new perspectives, guide my learning, and help me grow in wisdom and discernment. Lead me to the right path to recovery for me.”

Prayer for Discernment

“Higher Power, help me recognize triggers in my life before they can lead to stress and relapse. Open my eyes to triggers I haven’t yet recognized and strengthen my resolve to avoid triggering places, people, and situations. Grant me strength and peace when I do encounter triggers.”

Prayers for Forgiveness and Grace

Forgiveness can extend to yourself and others. You can forgive yourself for actions done or not done during your struggles with addiction, and you can forgive others for the same. These prayers can help you find the freedom of forgiveness and inner grace. 

Prayer for Self-Forgiveness

“Loving God, grant me the strength to forgive myself for past actions and those who have hurt me. Release me from the chains of resentment and help me extend grace and compassion to myself and others.”

Prayer for Divine Forgiveness

This prayer comes from Psalm 51 and reads, “Because of your great compassion, blot out the stain of my sins. Wash me clean from my guilt. Purify me from my sin.”

Prayer for Grace

“Grant me the compassion and grace to accept past mistakes, change, and things I cannot change. Enable me to hold myself with care and embrace the truths that I am loved, forgiven, and free.”

Prayers for Peace and Serenity

Peace can serve as a solid ship in seas of unknowns and discomforts. You can voice these prayers to ride the ups and downs of recovery with a sense of serenity, trust, and hope. 

Prayer for Inner Peace

“When my inner and outer worlds become chaotic, bring me the inner peace I need to get through these challenges with hope and serenity. Connect me to caring souls and ways to cultivate my peace along my journey.”

Prayer for Serenity

“God, extend an overpowering sense of serenity to soothe my fears and anxieties in my recovery journey. Allow me to trust in my safety and strengthen my sobriety to bolster my confidence and faith.”

Prayer for Acceptance

A classic prayer of acceptance used in the 12-Step fellowship goes as follows: “God, grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” 

Prayers for Gratitude and Hope

Remembering what you’re grateful for can boost your happiness and hope. In recovery, even in the valleys, you can use prayer to voice your gratitude for how far you’ve come.

Prayer of Gratitude

“Thank you for every good thing that’s happened to me in my recovery journey and beyond. Thank you for supportive people, thank you for life-saving treatment, and thank you for giving others the passion and expertise to care for me.” 

Prayer for Hope

“Give me unexplainable, unshakable hope in my recovery, my safety, and my abilities to navigate challenges and enjoy the good times. Let hope be a steady beacon shining in my nights and days.” 

Prayer for Future Success

“I see myself years into the future recovered, healthy, and content in my life. Bring this vision into reality and grant me the skills and wisdom to cultivate success and sustain my sobriety.”

Prayers for Support and Community

Support and a sense of community can bolster your recovery and give you a space of safety and camaraderie. Keep these prayers in mind as you envision your ideal community or nurture the one you already have.

Prayer for Support Systems

“Strengthen my beloved support systems to provide the care I need and encouragement for their spirits as we go through this together. Deepen our love and appreciation for each other during my journey.” 

Prayer for Community

“Lord, help me find a supportive and understanding community to connect to and find support in my recovery. Bless us with compassion and empathy towards each other for a strong and healthy community.”

Prayer for Accountability

“Help me find people in my community, friend group, or family to keep me accountable in my recovery journey. Allow me to accept their feedback and corrections with a humble heart and gratitude, and to grow in holding myself accountable.” 

Prayers for Daily Guidance

A daily spiritual cadence could benefit anyone, whether you’re in recovery or not. Try lifting 3 prayers at key points in your day to reflect, ask for guidance, and express gratitude.

Morning Prayer

“Dear Lord, thank you for this new day. Please guide me and bless me as I go about my day. Help me to be kind and loving to others, and to always remember to be grateful for the blessings in my life.”

Midday Prayer

“Thank you for the morning, for watching over me and walking with me. May I find rest and peace this afternoon in all I do, that I may gather strength to maintain my progress and strengthen my recovery.”

Evening Prayer

“Thank you for getting me through this day, and for each good thing I experienced. Thank you for what I learned through the challenges. Help my sleep to restore my soul, and prepare me for tomorrow.”

Specific Prayers for Different Stages of Recovery

Recovery, like other journeys and stories, often has a start, a middle, and an end: early recovery, maintenance, and long-term recovery. Each stage requires different focuses and strengths, which you can bolster through prayer.

Prayer for Early Recovery

“Heavenly Father, give me the strength to overcome addiction and the challenges that come with it. Guide me in my recovery, help me make wise choices, and grant me the courage to face my struggles. May your light illuminate my path as I navigate recovery every day.”

Prayer for Maintaining Sobriety

“Lord, lift me up today. I pray that you will anoint me with strength and self-care today, tomorrow, and always. I pray that You will grace me with patience and wisdom. I pray that You will encourage me throughout the day to take the correct steps on my recovery journey.”

Prayer for Long-Term Recovery

“Grant me strength and commitment in my recovery. Thank you for each day you’ve given me so far, and please allow me more. Help me grow in resilience and learn how to navigate challenges.”

Find Your Strength in Spirituality

Prayer and spiritual support can strengthen your recovery journey, whether you consider yourself part of a religion or not. For those who do, incorporating your faith into your recovery journey can be integral to the process. Explore your spirituality to find the prayers for addiction recovery that speak to you.

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Therapeutic Takeaways From Psychotherapist Dr. Donald Meichenbaum: Misconceptions And More

In this week’s episode of The Recovery.com Podcast, our hosts were thrilled to speak with psychotherapist, distinguished professor, and advocate Dr. Donald Meichenbaum. Dr. Malasri Chaudhery-Malgeri, Editor-in-Chief, and Cliff McDonald, Chief Growth Officer, led an enlightening conversation on Dr. Meichenbaum’s experiences, advice, and misconceptions about therapy.

Tune into this episode to discover more about the importance of a positive therapeutic relationship, psychological ‘hype,’ and more.

A Successful, Influential Career

Dr. Meichenbaum is an emeritus professor from the University of Waterloo, recipient of the Lifetime Achievement Award from the American Psychological Association’s Clinical Division, honorary President of the Canadian Psychological Association, and acting Research Director at the Melissa Institute for Violence Prevention and Treatment. 

D. Meichenbaum has authored numerous publications and pioneered cognitive behavioral therapy (CBT), which is now a standard practice in most treatment centers and therapeutic settings worldwide. He retired almost three decades ago and continues his work at the Melissa Institute. He’s also involved in training therapists in China.

Critical Qualities For Therapists

Dr. Meichenbaum identified 3 critical qualities therapists need to develop a positive therapeutic relationship between their clients. He stresses the importance of this relationship in the effectiveness of treatment, saying, 

“The research indicates that the quality and nature of the therapeutic alliance is three to four times more important than the specific intervention that’s being used.” 

To create this positive alliance, Dr. Miechenbaum suggests therapists adopt these 3 skills:

  1. Monitor and maintain the quality of their therapeutic relationship and make adjustments as needed. 
  2. Meet the patient where they’re at; vary their approach and protocol on a case-by-case basis.
  3. Collaboratively work towards treatment goals to instill hope.

Empathy as a Tool for Effective Therapy

Empathy serves as a key tool for connection, especially in the therapeutic relationship—where it’s arguably most crucial. Therapists can use empathy to listen actively, show compassionate curiosity, and make clients feel more comfortable with opening up. Regarding the importance of empathy, Dr. Meichenbaum says, 

“No matter what their background…it’s effective insofar as they are able to show accurate empathy. So they [the therapist] may not have a similar exact problem as you did,  but they’re able to identify with the pain, the emotional distress with the past background that you have experienced, and they need to communicate that both verbally and non-verbally during that first session.”

Therapists can build trust with their patients using empathy and by respecting each patient’s experiences and backgrounds. Though they may not know exactly how their patient feels, they can make it clear that they care. 

Misconceptions in Therapy

Dr. Meichenbaum also addressed several misconceptions about therapy that therapists and patients alike may have. First, he says,

“They [therapists] don’t have to have the exact same problems as their clients.”

In the same way a doctor doesn’t need to have a patient’s condition to treat it, a therapist doesn’t need to experience the same issues as their patient to help them. That’s where empathy, respect, and compassion come in. Dr. Meichenbaum particularly highlights compassionate curiosity, which encourages therapists to ask questions that get to the root of an issue and identify how they can help their patient. Secondly, Dr. Meichenbaum points out, 

“Clients come in and have the expectation of the therapist that they’re going to tell him what to do….Often the patient knows what to do, but they’re not doing it. So I have to explore with the patient, what are the potential barriers or obstacles that are getting in the way. What are the nature of the beliefs, emotional feelings that are hijacking their frontal lobe?”

He stresses the importance of teaching patients to become their own therapists, not relying on a therapist’s guidance and advice to make decisions. 

Ongoing Work and Goals

Dr. Meichenbaum stressed the importance of identifying ‘hype’ in the therapeutic space and ensuring patients and therapists can spot exaggerations or unbacked claims. He’s begun training therapists in China, where he found cultural differences and stigma can affect therapeutic relationships. The skills he teaches to improve trust in these relationships–and therapy as a whole–apply globally, not just to China but every culture and subculture. 

Ongoing conversations with each patient regarding their experience in therapy, if they feel heard and understood, and how they would qualify their therapeutic relationship can help therapists in all cultures provide more effective care. 

Tune in for Inspiration and Education

Listen to Dr. Miechenbaum’s episode on The Recovery.com Podcast here! You’ll also find episodes from previous guests. Follow our podcast and subscribe to stay in touch.

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Healing The Workplace: Trailblazing Employee Wellness And Mental Health Literacy

Tune into our recent podcast episode with Laura Kunz, Vice President of Spirence and a woman in long-term recovery. Our hosts Dr. Malasri Chaudhery-Malgeri, Editor-in-Chief, Chief McDonald, Chief Growth Officer, and Amanda Uphoff, Chief of Staff, were delighted to discuss Laura’s experiences and the vision behind Spirence. 

Listen to this eye-opening episode here!

Combining Passion With Business Expertise 

Laura Kunz began her career in business development at behavioral health roles over 15 years ago. She’s gained extensive experience—and walked the path to recovery herself as a woman in long-term recovery. Laura’s current role is as the Vice President of Spirence and Director of External Relations at Futures Recovery Healthcare. 

Her personal journey with recovery has given Laura a unique passion and empathy for other men and women seeking treatment. Her various roles in business development, marketing, and personable authenticity reflect this. Laura’s also a wife and mother to two children, having lived in Ohio before moving to Southern Florida. She’s contributed articles to local news outlets, been recognized for her treatment advocacy, and founded a mental health awareness initiative, Jupiter Recovery Day. 

Finding a Solution for Employee Mental Wellness

The pandemic and the shift to virtual learning, the need for accessible mental health resources, and the ever-present need for mental health literacy prompted the beginning of Spirence. The idea, formed years ago, came into being with Laura’s help and other coworkers at Futures Recovery Healthcare. They combined decades of experience treating addiction and mental health to offer a new, subclinical product geared towards employees and their well-being. 

Laura quotes a study citing the higher-than-expected need for mental health treatment in employees, saying, “25 percent of their team meets the need for clinical care.” One percent of those need residential support. But what about the other 75%, who may need help but not clinical care or crisis intervention? Laura says,

“So for that 75% of the average workforce, they are now saying, what about my mental health? They want the proactive.” … “I might eventually want counseling or need counseling, or identify something through the education that makes me understand that I could benefit from counseling, but I’m not there. So we set out to build products, subclinical, that would reach that 75%.  But also still support the 25%.” 

Education for Mental Health Literacy

Laura’s team connects Spirence members to educational presentations and seminars hosted by experts or those with lived experiences. Employees can attend short, live sessions and ask questions in real-time (anonymously). A “virtual library” contains vital resources and advice employees could normally spend hundreds of dollars on elsewhere, like in therapy. 

Spirence works with small, medium, and large businesses to deliver their content and support to a range of employees and audiences. 

Help for Families

In addition to their other offerings and benefits, Spirence provides weekly family support sessions where family members can anonymously ask questions and learn from the experiences of others in the group. Professionals lead the live sessions, which are recorded and can be accessed anytime after. 

Goals of Spirence And Employee Mental Wellness as a Whole

Laura and her team at Spirence aim to make mental health literacy commonplace at work and home. Debunking myths, reducing stigma, and providing access to care can create a stronger workforce with healthier, happier, and more productive employees. 

Mental health literacy helps employees know what to do and when to do it if they (or a loved one) experience a mental health challenge, or anything else that affects their well-being.
Listen to our recent podcast now to learn more about the importance of employee wellbeing and Laura Kunz’s experience with addiction recovery.

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Does a Good Therapeutic Relationship Matter in Therapy?

Effective therapists possess empathy, compassion, and trustworthiness that make them seem like superhuman healers. Those who find a good therapist often stay with them for years, which can strengthen their overall healing process and improve their resiliency. 

Building a rapport and sense of trust with your therapist can encourage you to share freely and feel safe doing so. This is crucial—if you’re going to therapy but don’t feel comfortable talking to them, you won’t reap the same benefits.

Many therapists encourage you to stay open-minded to the idea of switching therapists, so you can find your best fit. But how do you know what a ‘good fit’ is? And does it really matter?

Defining The Therapeutic Relationship

Therapeutic relationships1 build off mutual engagement, collaboration, and the bond patients and therapists form. Much of therapy’s success comes from this relationship, even more so than the type of therapy used and the therapist’s specific training. This positive effect exists in both medical and psychological treatment, and improves outcomes in both2.

The therapeutic relationship starts to form at your very first session. It can strengthen with each session2 as you and your therapist set goals, collaborate, and form a space you feel safe in. 

Benefits and Examples of a Positive Therapeutic Relationship

Ultimately, positive therapeutic relationships link to treatment success2 and healing. You’re more likely to continue with treatment and feel hopeful for change if your therapist makes you feel understood, safe, and an important part of the treatment process. 

Setting goals together and working to achieve them teaches practical skills for navigating future problems and concerns—without relying on advice from a therapist. This grows your agency and sense of self-efficacy, bolstering your hope and overall well-being. 

Here’s how a positive therapeutic relationship could look in practice:

  • You reach your first therapy appointment, nervous and unsure of how it’ll go. The therapist notes your discomfort and immediately works to reverse it: smiling, welcoming you, and introducing themselves. They ask questions about yourself and what brought you to therapy, listening attentively and engaging in the conversation with their body language and expressions. You feel cared for and safe, and start opening up more. Based on your first or second session, your therapist outlines a few goals you’ll work on together and asks you how they sound. You feel like a collaborative part of your treatment, which makes you want to engage more. 

Effects and Examples of a Negative Therapeutic Relationship

A negative therapeutic relationship can disrupt treatment and reinforce stigma about therapy and mental illness as a whole. You may feel uncomfortable, shamed, and belittled with a therapist that isn’t the right fit for you. But if that happens, don’t worry; you can always switch therapists. A therapist who isn’t the right fit for you could be perfect for someone else, and vice-versa. 

An example of an unhelpful therapeutic relationship could look something like this:

  • You go to your first session with the new therapist. Right away, they don’t exude compassion or much interest in you and your issues. You start to feel uncomfortable, and don’t trust them with your pain. They ask a few questions about yourself and why you’re there, but other than that, you feel pressured to fill the silence. They suggest modifications and changes to your behavior in a way that makes you feel diminished and a little embarrassed. You leave and cancel your next appointment.

How Therapists Can Foster a Good Relationship

Some people come to therapy with past misconceptions, shame, and nervousness. Therapists can alleviate these anxieties through the way they treat their patients and how they treat the act of getting help. 

For example, a kind, empathetic, and patient therapist can soothe initial nerves and validate their patient’s desire for getting help. They can express gratitude for their patient seeking care, and for trusting them with their emotions and struggles. These efforts connect the therapist and patient as humans, which can spark an immediate, positive affect on their relationship.

Aspects like these are key to forming a positive therapeutic relationship: 

  1. Listening without interrupting
  2. Validating fears and emotions
  3. Compassion
  4. Identifying and setting goals together
  5. Communicating regularly about your sessions and how they’re going

How You Can Contribute

A good therapeutic relationship takes effort on both sides, just like other relationships. Here’s what you can do (if and when you feel comfortable):

  1. Recognize your therapist can’t, and shouldn’t, think for you
  2. Engage in the goals you work on and any homework they may give you
  3. Communicate as openly as you feel comfortable
  4. Stay open-minded during your sessions
  5. Let your therapist know what is and isn’t working for you (they want to know!)

Signs You And Your Therapist Are a Good Fit

How you feel towards your therapist and the quality of your sessions can clue you into the nature of your connection. Do you enjoy talking to them? Do they make you feel safe and valued? Do you ever feel silly or foolish for opening up to them?

Reflect on your therapy itself too. Do you know what your treatment goals are, and has defining them been a collaborative process with your therapist? Do you feel like you’re making progress toward them? Do you feel hopeful in your recovery? 

Here are those questions laid out as boxes you can check to know if you’re a good fit:

  • You feel comfortable with your therapist.
  • You feel like they genuinely want to help and understand you.
  • You appreciate them as a person and feel appreciated in return.
  • You set clear goals and collaborate to meet them.
  • You feel hopeful and sense the tangible possibility of healing.

If you find you can’t check any of these boxes, or even feel the opposite, that’s a good sign you and your therapist aren’t the right fit. Remember, that’s okay. View any poor fits as a helpful learning experience that gets you closer to the right one. 

What to Do If Your Therapist Isn’t The Right Fit

First, know it’s acceptable and normal to not click with your therapist. Who you will feel comfortable with won’t be the same as your friends, or people in TV shows and movies. 

Therapists want you to feel comfortable and understood, and trying a new therapist is often one of the best ways to accomplish that. They’re used to it and don’t view it as a personal attack–not at all. People switch therapists for financial reasons, personal reasons, scheduling constraints, and much more.

Before you terminate your sessions, first have a conversation with your current therapist. You can bring up your concerns and what might make you feel more comfortable. For example, you might say you’re not seeing as much progress as you hoped and don’t feel like you’re learning coping strategies. You could also explain the behaviors or attitudes of your therapist that may make you less comfortable engaging in treatment. See what they say, and how they plan on addressing your concerns. 

You may find a solution and feel comfortable continuing services. If you don’t, here’s what you can do:

  1. Cancel any upcoming appointments with your current therapist.
  2. If you’re comfortable with it, explain that you’ll be leaving and looking for another therapist. Your current therapist can help connect you to other options. 
  3. Search for other therapists in your location or ones with online availability.
  4. Vet your new options for the qualities or treatment modalities you’d like to see after your first experience. Here’s 11 tips for finding the right therapist.
  5. Set up your first appointment; you can voice your concerns and preferences right away so your new therapist understands your past experience and treatment goals.

Empathy And Connection to Power Your Healing

In a good therapeutic relationship, you might feel like your therapist has superpowers. They help you see different perspectives, set personal goals, and feel–perhaps most importantly–that you and your experiences matter. You’ll ultimately learn to become your own therapist, navigating challenges and day-to-day life with new skills and coping strategies you learned in therapy.
Listen to our podcast episode to learn more about the therapeutic relationship and insights from renowned expert Dr. Donald Miechenbaum.

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What Is a Digital Detox and Do You Need One?

Many people seek ways to disconnect in an era dominated by screens and constant connectivity. A digital detox is a deliberate and temporary disconnection from devices and online platforms to reduce screen time, promote mindfulness, and restore a sense of balance. 

The movement behind digital detoxes reflects a growing awareness of the potential negative impacts of excessive screen time and constant connectivity on mental health and well-being. Prolonged exposure to digital devices can lead to technostress, digital overload, and decreased productivity1. A digital detox can help alleviate these stressors as you take a break and reevaluate your relationship with technology.

Understanding Digital Detox

The modern dependency on digital technology can lead to digital overload, adversely affecting mental and physical health. Symptoms include fatigue, anxiety, sleep disruption, mental health issues, chronic pain2, and a pervasive sense of being overwhelmed, often exacerbated by the constant influx of information and notifications. Creating a device-free lifestyle, even if it’s just a couple of hours a day, can help you reprioritize other areas of your life. 

Digital detox initiatives come in various forms, from structured programs and retreats to self-imposed breaks from social media and digital communication. These practices often involve offline activities such as nature walks, reading physical books, or spending quality time with loved ones, emphasizing the importance of real-world connections and experiences1. By disconnecting from the digital world, you can reconnect with yourself and your surroundings, fostering a sense of presence and mindfulness. In turn, a digital detox can improve negative physical and mental health symptoms. 

Digital Detox Tourism
The digital detox movement has gained traction in the tourism industry, leading to “Digital Detox Tourism.” This niche encourages travelers to unplug and unwind in tech-free environments, providing a unique opportunity to reconnect with nature and authentic experiences3. Digital detox tourism aligns with the growing demand for wellness-focused travel experiences prioritizing relaxation, mindfulness, and digital disconnection.

Signs You Might Need a Digital Detox

If you’re considering whether you might benefit from a digital detox, here are some signs that it could be time to take a break from digital devices:

  • Constantly checking devices: You compulsively reach for your phone, even without specific alerts or notifications.
  • Difficulty concentrating: There is a noticeable decrease in your ability to focus on tasks at work or home due to frequently checking your devices.
  • Decreased productivity: Your productivity is suffering because you spend too much time on your devices instead of on work or other productive activities, impacting your performance.
  • Neglecting face-to-face interactions: Your device use starts to interfere with personal interactions, and you find yourself distracted during conversations with others, which can negatively affect your relationships.
  • Feeling stressed about social media: You’re stressed about missing out on posts or feeling overwhelmed by the need to keep up with social media updates.
  • Decline in physical activity: You spend so much time on your devices that your physical activity, and therefore your health, suffers.
  • Poor sleep quality: You have trouble falling asleep and staying asleep. The presence of TVs, computers, or cell phones can make it harder to wind down because blue light diminishes sleep quality4.
  • Loss of interest in offline activities: Your devices replace hobbies and activities you used to enjoy.

Benefits of a Digital Detox

As technology’s impact on the world continues to grow, taking purposeful steps to unplug can help alleviate the negative symptoms of excessive device use. Studies show that a digital detox can improve overall well-being2. 

During and after a digital detox, you may experience improved moods, reduced anxiety, and better sleep quality. Without the distraction of devices, your productivity may increase. You’ll have more time and motivation to exercise and spend time outside, which is linked to increased happiness and reduced stress5. A digital detox also fosters meaningful connections with friends and family through in-person meet ups. 

Digital Detox Discussions

Often, digital detox practices are framed as a means to combat technology addiction and promote well-being; however, there are ongoing debates about the effectiveness and sustainability of these interventions. Some argue that digital detoxes may offer temporary relief but fail to address the root causes of technology overuse6 and dependency. Additionally, the social and cultural implications of digital detoxing7, such as the impact on social interactions and work-life balance, warrant further exploration and critical examination. 

How to Start Your Digital Detox

Starting a digital detox can be a rewarding process. You can begin by defining what you want to achieve with your digital detox. Is it to reduce stress, improve sleep, or spend more time with family? Setting clear goals will help guide your actions and keep you motivated.

If suddenly going completely offline seems daunting, start by gradually reducing your screen time. Designate specific device-free times of the day, such as during meals or right before bed. You can also limit distractions by turning off notifications for apps that don’t require immediate attention. This reduces the urge to constantly check your phone. If your job requires you to use your phone and computer, create a device-free zone after work hours.

The most fun part of a digital detox is discovering new activities or picking up old hobbies. Find non-digital activities you enjoy, such as reading a book, meeting friends for dinner, or hiking. This occupies your time and enriches your life outside of the digital world.

You may want to let friends and family know about your digital detox. Their support can make the process easier, and they might even join you, creating a shared experience.

Throughout your digital detox, regularly assess how the detox is affecting your life. Are you feeling less stressed? Sleeping better? More productive? You can make adjustments based on these observations to optimize the benefits. Importantly, plan how you will reintegrate digital devices back into your life in a balanced way. Decide what habits you want to maintain and what boundaries you will set to prevent falling back into old patterns.

Overcoming Challenges in Digital Detox

A digital detox can initially lead to withdrawal symptoms such as restlessness and anxiety, and that’s okay. You can acknowledge that these feelings of discomfort or irritability are normal when reducing screen time. These symptoms typically lessen as your body and mind adjust to the new routine.

New hobbies and activities can help combat the boredom that may lead to these negative feelings. Exercising is a great way to mitigate withdrawal symptoms as physical activity releases endorphins, which improve mood and reduce stress8. You can also try relaxation techniques like meditation, deep breathing, or yoga to manage stress. Journaling can be therapeutic9 as you write about your feelings during the detox,  enhancing self-awareness about your relationship with technology.

The goal throughout this process is to find a balance; it’s not about eliminating digital devices entirely but rather about reducing dependency and being mindful of consumption. The benefits can be extensive, significantly enhancing mental health, productivity, and personal relationships. A digital detox is not just a one-time effort but a lifestyle change towards mindful technology use. So why not take the first step today towards a healthier digital life?

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A Journey to Wholeness: Rebuilding Safety and Trust with Trauma-Informed Care

We were thrilled to speak with Athena Phillips in our recent podcast episode. Athena is an experienced therapist and educator who specializes in trauma and dissociative disorders. Our enlightening conversation was led by our host, Dr. Malasri Chaudrey-Malgeri, Editor-in-Chief, and co-host Cliff McDonald, Chief Growth Officer.

Listen to Athena’s episode and hear from other guests here!

Background, Experience, and Passions

A history in behavioral health treatment inspired Athena Phillips’ pursuits as a therapist and her desire to spread resources, education, and support to address the global issue of trauma. Athena founded the Integrative Trauma Treatment Center (ITTC), created the education-focused Orenda Project, and co-founded a continuing education and community support platform, KALOS, for other mental health professionals. Athena also spent time in Rwanda, learning about their experiences and creating her Multicultural Trauma Training program there.

Her passion for progressive, culturally competent trauma treatment began during an internship at the Sexual Assault Resource Center. Athena worked with people with developmental disabilities for 15 years, then in private practice before opening the ITTC. Her facility meets an ongoing need for trauma-informed care and a progressive understanding of post-traumatic stress disorder (PTSD) and dissociative disorders.

Journey to Trauma Treatment and Findings Along The Way

Athena founded the Integrative Trauma Treatment Center (ITTC) in 2012, filling a large gap in trauma-informed care. She recognized patients with trauma, PTSD, and dissociative disorders weren’t often receiving the sensitive, trauma-informed care that made them feel safe in treatment and trusting of their providers and peers. Their sensitive setting and culturally competent staff create a unique space for healing. ITTC offers a unique array of therapies and services, including individual therapy, group therapy, Reiki, yoga, and more.

Athena and her coworkers traveled to Rwanda to learn more about their experiences with collective trauma and post-traumatic growth. There, Athena created and facilitated a trauma training program catered to their culture and community. Her time in Rwanda emphasized collective and culturally competent healing, which she integrates into her current practice and in continuing education opportunities. Athena says,

“So I really want to emphasize community as part of healing for humans, all humans, but even for clinicians…that was one of the key features that I pulled from Rwanda.”

Normalizing The Human Experience Through Group Work

As a trauma and dissociative disorders specialist, Athena strives to meet each patient where they’re at with their comfort levels, ability to share, and level of trust. Connecting on a human level, letting each patient know what they’ve experienced doesn’t separate them from others, can strengthen their recovery experience. Athena says,

“Even if our experience feels like a departure, we’re still interconnected on a really deep and unknown level….And it helps me continue to normalize the experience of those I’m working with.”

As Athena saw in Rwanda, community and group healing can be powerful tools in healing. They offer group therapy at ITTC to bring patients together, helping them see and hear they aren’t alone. She notes an environment of safety and trust is often required for those with trauma to feel comfortable in a group setting, but once patients feel comfortable, the benefits can go far beyond 1:1 therapy. Here’s another quote from her podcast episode:

“That’s like the foundation of attachment, right? That we need somebody to see us, to attune to us, to understand us and respond appropriately…. Expanding the number of hands and arms that are around us while we go through hard things is obviously going to create a different, a higher level, of support. So I really strongly believe in group work as being foundational to moving forward.”

Addressing Complex Cases with Compassion and Experience

Along with treating symptoms of trauma and complex PTSD, Athena also specializes in dissociative disorders and their relation to trauma. She helps patients navigate complex conditions like dissociative identity disorder (DID), which can develop after childhood trauma and adversity. Athena is almost complete with her education as a Doctor of Psychology, adding to her experience as a Licensed Clinical Social Worker (LCSW)/therapist. She continues to provide training and community for other healthcare professionals with KALOS, an education platform.

Early, accurate diagnoses of conditions like DID, other dissociative disorders, and PTSD can lower costs of treatment, speed up access to care, and improve a patient’s overall quality of life. Athena sees changes like this, and a reuniting to our human connectedness, as important pieces in improving lives and helping those with trauma feel seen in their healing.

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Dissociative Identity Disorder and Trauma: Coping and Healing

Have you ever driven home lost in thought, unaware of what you experienced during your drive? Not even sure if all the lights you passed were green? People often chalk that up as dissociation, which is true. It can feel a little freaky or odd, but it’s been normalized as something that happens to everyone. Someone living with dissociative identity disorder (DID) experiences a much different reality—severe dissociation, gaps in their memory, and new identities that develop.

Trauma can cause DID. Many experts have explored this connection, including Athena Phillips, who we spoke to in our recent podcast episode. You can listen to that here. 

What Is Dissociative Identity Disorder (DID)?

Dissociative identity disorder, once known as multiple personality disorder, describes someone with two or more separate, independent identities1 or ‘alters.’ People can have dozens of alters with their own habits, memories, and even genders. DID is one of several dissociative disorders1 marked by derealization, memory loss, distorted self-identity, and disruptions in consciousness. 

Each identity has their own view of the world and makes their own decisions2. Someone with DID may know about all their alters or just a few, especially ones that come out more often. Patients typically experience memory loss when various identities take over—alters aren’t usually aware of what the others are doing, and memory loss occurs as a result. For example, if an alter brings home a new vase, someone with DID may not recognize it later or know where it came from.

Each alter has their own first-person experience and forms memories based on what they see, feel, and think. Other alters and the true self aren’t usually able to retrieve these memories2, though many clinicians propose they could if they didn’t strongly believe they can’t. Believing they can access an alter’s memories could allow the true self or other alters to retrieve them.

Causes of DID

DID most often occurs as a response to trauma1, typically physical, sexual, or emotional abuse in childhood. The post-traumatic model of DID2 proposes that “​​dissociative identities are the primary results of early trauma and the relational, cognitive, emotional, and neurobiological consequences of it.” Children may unconsciously resort to dissociation and numerous personalities to both avoid and cope with traumatic memories.

Each alter develops as a disconnected, separate, autonomous subset of the self. Picture islands separated by deep waters instead of one town. The true self may travel to different islands depending on what their situation demands and memories that arise, often memories of severe trauma. Once the true self goes to an island, it becomes their whole reality and remains closed off from the other islands.

Clinicians and researchers have found trauma to be the leading and primarily identifiable cause of DID2, though some genetic dispositions, social influences, and personality traits could contribute to dissociation and someone’s inability to cope with stress. Someone who’s more likely to experience dissociation and struggle to deal with stress could be more likely to develop DID.

Diagnosing DID

Most people with DID don’t get an accurate diagnosis until later in life1 because DID has similar symptoms to other personality disorders, including amnesia, dissociation, and losing consciousness. Particularly, borderline personality disorder (BDP) shares similar symptoms, and like DID, patients often present as suicidal and engaging in self-harm. BPD patients also struggle with emotional regulation and dissociation. To meet diagnostic criteria for DID, experts say patients must present with these 4 factors1:

  1. The ability to dissociate
  2. Intense, overwhelming traumatic experiences 
  3. Alters with unique personalities, names, and memories
  4. Homelife instability

Children may cope with unstable homes and overwhelming trauma by self-soothing through dissociation and developing alters. Someone with DID also has altered brain structures3, usually the hippocampus and amygdala, which can affect memory and overall functioning. Looking at the brain can help doctors accurately diagnose DID and rule out other diagnoses. Observing patients also clues doctors into the personality shifts related to DID, as a few key physical signs often occur:

  • Eyes rolling
  • Fading into a trance-like state
  • Blinking or twitching eyes
  • Sudden posture changes

History of DID

Until 1994, DID was known as multiple personality disorder and not well understood3 or sympathized by the medical community. Its strong connection to trauma has recently become better known and understood, helping patients get the diagnosis and help they need.

Before it was recognized as a mental health condition, DID was thought to be the work of demonic possession1. Cultures outside North America were more likely to attribute symptoms to possession, while schizophrenia or psychosis incorrectly explained many symptoms in other cultures. Internal voices from other alters were explained as schizophrenia, which can have similarities.

How Trauma Can Lead to Dissociative Identity Disorder

Children or adults who experience more trauma and stress than they’re capable of dealing with can develop DID as a coping mechanism1. Their experience goes beyond what their mind can process and articulate, leading to dissociation as a way to escape and alternate identities to process a fractured sense of self. 

Certain alters may be more capable of dealing with the traumas experienced and come out when situations mimic the original trauma, or memories of the trauma arise. For example, a tough male alter may take over when a female with a history of assault feels uncomfortable around certain men. He comes out to protect her and deal with a situation she cannot. 

Dissociation as a Predictor of DID

Intense trauma can cause dissociation1, as seen in some cases of post-traumatic stress disorder. An out-of-body experience during an assault can be the brain’s effort at protection. Children who suffer repeated abuse or instability in their homes may regularly dissociate to protect themselves. Alters can eventually present during dissociation and take over general consciousness, leading to amnesia. 

Small Social Cues Can Trigger Shifts in Identity

Social cues can prompt small behavioral changes, triggering an alter to take over2 in someone with DID. As an example, picture a formal event. This requires professionalism and different social etiquette. Someone without DID could adapt to the situation by speaking more formally, standing straighter, and carrying themselves differently. But someone with DID may unknowingly shift to an alter identity that’s more poised and professional. Their true self may not remember the event or what they talked about if the alter takes over.

Treatment for DID and Trauma

Effective treatment addresses the symptoms of DID and its underlying trauma1. Clinicians often use cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR) to treat DID, similar to other personality disorders. For DID patients specifically, hypnosis has been an effective option to reach alters and discuss their memories, views on the world, and life experiences. 

Therapy teaches patients with DID more about their condition, how to regulate their emotions, manage stress, and function in day-to-day life with their unique symptoms. Therapists work with the patient to glean memories from different alters and piece together underlying trauma so the true self and their alters can begin processing. As therapy brings more memories to light, they can become more readily accessed by different alters and the true self. 

Finally, therapy works to reunite the self1 and help patients with DID become more aware of their unified self and its relationship to the world they interact with. Reunifying their sense of self can reduce the number of alters, though therapeutic interventions often can’t merge them all. But with fewer alters, patients are more likely to remain as their true selves throughout various situations and potential triggers. 

EMDR and Hypnosis

Patients with DID respond well to hypnotherapy1 as they’re more receptive to hypnosis. In their hypnotized state, therapists may be able to talk to alters that traditionally stay hidden. These alters can be crucial to the healing process and help the therapist learn more about their patient, giving access to memories and experiences the true self and other alters may not know about.

EMDR uses guided eye movements to help patients process trauma4. Tracking an object back and forth offers a distraction and can make traumatic memories feel less intense, helping patients discuss and process them without shifting to an alter identity or becoming too uncomfortable. Not every patient with DID will feel comfortable accessing memories through EMDR, but for those who are, it can help unify their sense of self and manage symptoms.

Medications

Some medications, like antipsychotics and antidepressants, can manage symptoms of DID like suicidality, mood dysregulation, and improve self-harm behaviors. However, clinicians haven’t yet found a medication or combination of medications to treat DID1. More options may become available as they study and develop new medications. 

Optimized Care for DID Patients

A safe therapeutic environment and collaborative, compassionate care can help DID patients1 find the best treatment outcomes and stay in treatment. Therapists should also recognize and stay aware of alters not communicating what patients learn or discover in sessions. They’ll likely need to bring each alter forward to ensure they talk with them and identify their unique personalities. Building rapport and comfort also encourages alters to come out and speak with their therapist.

Life-Long Care

Patients with DID often stay in treatment their whole lives1 to receive ongoing grounding in their unified self, process trauma, and navigate stressors as they arise. In some cases, it can take years for the therapist to meet and identify each alter. A positive relationship between the patient and their therapist (and treatment team as a whole) is crucial in keeping them in treatment and creating a comfortable environment.

Identifying Alters

Therapists can aim to identify all alters, helping patients become more aware of them, their personalities, and what triggers them to arise. Once patients and their therapist know who’s all there, they can work on identifying their backgrounds and merging alters into one self identity. Therapists can bring alters ‘to the front’ using hypnosis or, if appropriate, mimicking a situation that would bring out a suspected alter. 

Compassionate, Personalized Care

Ultimately, therapists should adapt treatment to their patient by recognizing their comfort levels, assessing their trauma responses, and building a positive therapeutic relationship. Identifying alters and processing trauma shouldn’t come at the patient’s harm. The therapeutic relationship can determine which treatments may be most effective and comfortable for each patient, encouraging them to engage and participate throughout the course of treatment.

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Rural Recovery: Challenges and Hope

Rural areas offer great benefits, like a slower pace of life, open fields, and close-knit communities. But what happens when they can’t provide the resources someone vitally needs, like addiction and mental health treatment? Lacking what many urban dwellers take for granted—access to resources—can endanger the billions of people living in rural communities worldwide. 

Thankfully, technology has opened new doors for rural areas. With just a phone or laptop and internet access, people can attend therapy online and even virtual rehab. Increased mental health awareness in small communities may also create new and improved resources for areas in desperate need.

To learn more about the healthcare challenges in rural areas and how providers navigate them, listen to our recent podcast episode featuring Dr. Jonathan Rosenthal!

Behavioral Health Challenges in Rural Areas

About 1/5th of rural Americans have a diagnosed mental health condition1. Urbanites make up close to the same. However, those in rural areas have more trouble accessing care and finding clinicians, as opposed to urban cities with multiple clinics and practices to choose from. 

Over 60% of rural Americans live in ‘mental health provider shortage’ areas1, with 65% of rural counties without psychiatrists. Waiting lists for therapy or more intensive care can extend for months. Limited mental health knowledge and stigma often prevent rural residents from seeking treatment at all. If they do, low availability often means they must choose the first provider they can get, whether they’re a knowledgeable fit or not. Personalized care can become more of a luxury than a necessity.

Primary care physicians (PCPs) often become the first and only line of defense for mental health conditions and substance use. While PCPs can prescribe medications and recommend next steps, they often don’t have the specialized training in mental health or addiction to educate and support patients properly.

A Top Challenge: Growing Suicide Rates in Rural Communities

Rural residents are twice as likely to die by suicide than urban residents1. Isolation, stigma, poverty, and an inability to access care contribute to the steadily growing rate of rural suicides. Timely access to care, crisis services, and increased awareness of mental health could lower the risk of suicide among rural residents, particularly veterans and young adults. 

Boundaries to Effective Care in Rural Communities

People in rural areas face several prevalent barriers to care, including limited availability of resources, long travel times to get to treatment, and stigma. 

Lack of Access

Here’s a story highlighting a common treatment scenario in rural communities, where the necessary treatment simply isn’t available:

  • Rosie has been struggling with severe depression and loneliness. After months of waiting, she finally got into therapy. Rosie thinks group therapy would help her feel less alone and stigmatized. Her therapist agrees, but tells Rosie they don’t have any groups in town. Rosie keeps going to individual therapy but misses out on an aspect of treatment she feels is crucial.

Not having access to is the biggest bar to effective care1. Often, those in rural communities simply don’t have clear or easy access to treatment (or any access at all) and thus don’t receive it. And when they do seek treatment, overwhelmed medical providers can only refer to whatever resources they have and hope availability opens up.

Rosie’s story is a poignant illustration of the challenges faced by those seeking mental health care in rural areas. After enduring a prolonged wait to receive therapy, she encounters another hurdle: the absence of group therapy options in her area, which she and her therapist agree could be vital for her recovery. This scenario highlights the disparity in mental health resources available in less populated regions and the significant impact it can have on those in need of comprehensive care.

Long Wait Times

Waiting time poses another barrier to care. Here’s a second scenario highlighting this:

  • Darren has a paralyzing fear of socializing and talking in groups. He feels something isn’t right and seeks out therapy, but hears he’ll have to wait at least five months to get in. To manage his symptoms in the meantime, Darren starts bringing alcohol with him to work and getting tipsy to deal with his social anxiety. 

With these long wait times, symptoms can worsen; patients could lose motivation and back out. Being unable to access care could lead to substance use as a way to cope with conditions like depression, trauma, or anxiety. 

Darren’s situation underscores the pressing challenges that arise from the lack of timely access to mental health services. Suffering from a paralyzing fear of socializing and speaking in groups, Darren recognizes the need for professional help and reaches out for therapy. However, he bumps into a discouraging five-month wait. In a desperate attempt to manage his escalating anxiety, Darren resorts to bringing alcohol to work, using it to lessen his discomfort in social situations. This scenario highlights the detrimental effects that can occur when immediate mental health support is unavailable.

Behavioral Health Illiteracy

People in rural communities may not know how to identify behavioral health issues1 or how to get treatment. Bigger cities and communities often have more programs and initiatives highlighting behavioral health treatment and broadening awareness.

Stigma

Without adequate knowledge of behavioral health conditions, stigma can make mental health challenges and addiction seem unimportant or weak, discouraging rural residents from seeking help. Living where everybody knows everybody, they may worry they’ll be judged if they try to get help or admit to a problem. 

Travel Times

Rural residents often have long drives to get to a treatment facility or clinic that meets their needs. Juggling the time spent on the road, work, and other personal obligations can delay care2 or keep them from seeking it altogether. Here’s a predicament a farmer may face when trying to get treatment:

  • Bill seeks out treatment for his alcohol use disorder and needs a psychiatrist to go to once a week. The closest psychiatrist to him practices an hour and a half away, which means he’ll be gone for almost four hours each time. But Bill runs his own cattle farm, and he needs to milk his cows every morning and ensure they’re fed. Leaving for 4 hours feels out of the question; he cancels his appointments and decides to deal with his symptoms alone. 

Solutions for Better Access and Support

Rural areas need more general physicians, therapists, and specialists to meet the rising demand for behavioral health services. Incentive programs in some states encourage new physicians to practice in rural areas1, which could steadily grow their workforce and improve access to care. Other solutions, many already in play, include:

Virtual Care

Virtual care uses the internet3 to connect patients and care providers virtually. Since COVID-19, virtual care has become more commonplace and can serve as a vital connection for rural residents and treatment providers. You only need a phone or laptop and an internet connection to access virtual care. You’ll use a secure online platform to conveniently meet with a doctor, therapist, psychiatrist, or other healthcare provider.

With virtual care, you don’t have to live in a certain city or near a therapist’s office. You can even attend residential rehab online and outpatient levels of care. And with a larger pool of providers and specialists to choose from, you can get into treatment faster and find care specialized to your needs. 

Incentives for Rural Providers

Some state governments have incentivized more healthcare providers1 to practice in rural communities. If they practice for a set number of years, they receive additional financial compensation. If every state had the funding for this initiative, it could repopulate the rural workforce with eager health and mental health providers.

Increased Behavioral Health Training

Additional training would benefit current rural providers1 and help them make better-informed decisions on patient care. Primary care physicians would understand all the available options, including virtual care and local crisis services for mental health and addiction. Some programs have started training non-professionals to provide peer support, which has had success in the rural Native Alaskan community.

Known and Accessible Suicide Prevention Strategies

Death by suicide occurs more commonly in rural populations1, especially in kids, young adults, and older adults. Social isolation and not knowing what support they have can lead to untreated crises. Many programs and crisis services do exist and specifically serve rural populations, like local crisis teams, but residents don’t often know they’re there.

Educating community members on their available crisis services and support programs could save lives. Community leaders could make their crisis services more prominent and accessible by posting them in daily newspapers and highlighting crisis hotlines like 988 (National Suicide Prevention Hotline). Schools, churches, and businesses could also spread the word to destigmatize mental health and inform residents of their resources.

Better Support for Physicians

Physicians and mental health professionals face burnout in all settings, but rural providers can end up shouldering high caseloads and pressure to treat more people than they reasonably can. Compassion fatigue and discouragement can drive providers to areas with better support, so providing support in rural settings could help them stay. Financial incentives could bring more practitioners to rural areas, also lightening the load for current practitioners. 

Psychological care, peer support, and financial benefits can help providers retain their well-being and compassion, essentially helping them help others.  

Future Goals and Ideas

In an ideal world, rural populations would have the same access to and knowledge of mental health and addiction care as urbanites. Virtual health would fill in the gaps, with more better-trained and better-supported providers meeting the high need and demand for behavioral healthcare. Awareness and education on behavioral health would reduce stigma and help people feel more comfortable asking for help. 

Low-Cost Clinics

Low-cost clinics, funded by grants or donations, could offer the affordable care many rural residents in poverty need. Staff at these clinics could educate patients on good mental and physical health, with free resources for improving their diet and creating healthier habits.

Funding Local Resources

Funding for local programs could strengthen community services, too, helping them offer more robust non-clinical services. For example, funds to a local crisis support unit could go towards hiring full-time staff with specific crisis training.

In rural areas and beyond, everyone who needs treatment should have a clear path to it and support along the way, whether from their doctor, family, other community members, or all three. 

Learn more about future goals and ideas in improving rural healthcare by listening to our recent podcast episode here!