Tag Archives: Family Therapy

Understanding Trauma

Trauma. It’s the latest trend in therapy, right? Yes, yet it’s more than a trend. If we look at how trauma has been perceived historically, it’s easy to see how this focus on trauma could be considered a trend. However, when we look at what recent research has to say about trauma, it changes our understanding of why we need to focus on trauma. When all of this comes together, then we can better understand what we need to do to address the trauma in our lives and in the lives of our loved ones who may be continuing to use substances to cope.

Brief History of Trauma

Historically, people think about trauma as something that happens to veterans in war. Shell shock, battle fatigue, soldier’s heart, and combat stress reaction are all names that have, over the years, been employed in attempts to describe what we now call Post Traumatic Stress Disorder. Experts did recognize trauma as a possibility outside of a wartime scenario but believed these incidents to be limited. Therefore, these instances outside of wartime trauma exposure were not looked at much. So, when you look at trauma from this lens, it’s easy to see how limiting our understanding of trauma can be.

Current Understanding of Trauma


Image by John Hain from Pixabay 

Now days, though, researchers have done quite a bit of work around trauma in other settings. We understand PTSD can stem from things like abusive situations, bad car accidents, witnessing things that can be seen as life threatening, and more. And, thanks to researchers in the last few years, we also know how challenges and difficulties in the home environment that disrupt attachment can affect development. In fact, many researchers, therapists, and specialists are advocating for a new DSM-5 diagnosis of Developmental Trauma Disorder as a result. This is because research has found that symptoms of PTSD and symptoms of trauma stemming from developmental trauma are distinct, even though they do have some overlap.

In sum, this shift to focus on trauma is not just a trend. It’s a broadening of our understanding of what symptoms of trauma look like and what trauma means. In fact, for most clients who struggle to maintain recovery and who struggle with mental health symptoms, underlying trauma is likely part of the problem.

Supporting Someone with Trauma

So, then, what do we do about it? How do we support someone with underlying trauma in their lives? There are a few key things to remember. First, we must keep in mind, people with a history of trauma are living their lives hyperalert to everything around them. They are constantly keyed into anything that could be conceived of as a threat. This hyperarousal is also exhausting. Which means not only is the person scanning for danger all the time, they are exhausted on top of it. Put those two things together and it’s clear they’re not going to be thinking things through as clearly as someone not in this position would be.


Image by John Hain from Pixabay 

Also, keep in mind they cannot control this. Just because the rational brain can understand the threat is not there, doesn’t mean the emotional part of the brain believes it. A classic example is the idea of walking through a parking ramp late at night all alone. Men tend not to be as alert in this scenario when compared to women. Why? Because most women have been taught situations like this are dangerous. In general, men have not had this same lesson. It doesn’t matter if it’s a parking ramp a woman knows like the back of her hand, she’ll still most likely be on high alert for any danger if she’s there late at night and all alone regardless of what ration and reason may tell her.

Once we establish this understanding that the part of the brain controlling the traumatic stress reactions doesn’t respond to ration and logic, it becomes clearer we need to tap into the emotional part of the brain to calm that stress reaction. That’s mainly a role for therapists and specialists. As a support person for someone with trauma challenges, we can remember to honor as many of their requests as possible while still ensuring we are caring for ourselves. For example, if your loved one feels like they need to sit in a specific place and there’s no obvious reason not to honor it, let them. Also remember their anger is not about you despite what it may feel like. Accompany them to therapy appointments when appropriate and when possible. Learn what you can from the experts to help you support your loved one. And keep those healthy boundaries we’ve talked about in the previous articles here and here.

Trauma and Yoga

A final thought for you on how to support a loved one who’s struggling with trauma. Encourage yoga. Research from The Trauma Center, a leading training and research institute on trauma, shows the use of yoga in people with trauma can be a very effective tool in being able to rebuild the mind-body connection that can be broken with trauma. But go slow and be prepared for it to trigger trauma reactions. Make sure if you choose to offer this as a support to your loved one, you’re working with their therapist.


Image by Mary Pahlke from Pixabay 

Trauma is not just a trend in the therapy world. It’s a very real part of what clients in substance abuse treatment programs, mental health programs, jails, prisons, and more deal with. It can be an underlying reason why they struggle to remain stable in the community for long. Caring for a loved one requires lots of understanding, patience, and insight. And healthy boundaries.

Stacy Overby, MS, LADC, CCTP is the program director. She has been a licensed drug and alcohol counselor since 2010 and a certified clinical trauma professional since 2017.

Support System Roles in Recovery

Over the last couple months, we’ve talked about what relapse means in recovery and how to set healthy boundaries with loved ones to support their ongoing recovery. The next piece of this puzzle of supporting loved ones in recovery is to understand how their behaviors and substance use has affected the people around them.

The Pond

Imagine for a moment a clear, still pond. The surface is just like a mirror it is so smooth and still. Now imagine someone comes along and throws a rock into that pond. What happens? That’s right. Ripples and waves spread out across that pond. When they get to the edges of the pond, those ripples affect the grass, the mud, and more at the edges. Then they bounce back across the pond in another direction. Those ripples continue until enough time has passed to return that pond to its still state. But that pond has been changed by those ripples. It can’t go back to what it was before the rock was thrown.

This image is what happens in a support system when a loved one uses. The rock is the loved one’s behaviors around their substance use. The pond is the support system. Those behaviors create disturbances in how people in the support system behave. The good news is that those ripples will subside, and things can find a new normal with time and support.

The Enabling Role

In order to find that new normal, though, it is important to understand what those ripples are and how they are working in your life. One of the more common ways a loved one is affected by substance use behaviors is to become enabling. It doesn’t happen overnight, but it can happen. Most often people we’ve worked with who have ended up enabling their loved one’s using talk about doing it because they’re scared of what could happen if they don’t. For example, with teens, parents and family have said they have allowed substance use in the home because that way they know their teen is safe while they’re using. They’re afraid if they set a limit preventing use in the home, the teen will leave and find somewhere else to use and potentially engage in even more dangerous behavior. That’s why someone who is enabling can be referred to as a caretaker—they see their role as taking care of the person using rather than enabling the use.

The Family Hero Role

Another common way these ripples affect loved ones is to become the family hero. Shame, fear, and guilt over the loved one’s using behaviors drive this person to become overly positive. They work to make everything look good and give the support system the illusion that everything is fine. Perfectionism is a common trait seen with people reacting to substance use behaviors in this way.

The Mascot Role

A third way these ripples can affect a support system is to create the role of a mascot for the support system. This role holds someone from the support system up as a clown and joker. The person uses humor to deflect and divert attention away from the person using and the dysfunction developing in the support system.

The Lost Child Role

Another role that can develop in a support system affected by substance use behaviors is where people in the support system disappear. They may still physically be present in the support system, but they are quiet and careful not to make problems. This means people in this role can be easily overlooked in the activity being generated elsewhere in the support system. It also means people in this role end up sacrificing their needs to the perceived need to keep a low profile with everything else going on in the support system.

The Scapegoat Role

The last role to be discussed here is a critical one to understand when it comes to understanding adolescents in a support system affected by substance use behaviors, as teenagers are often cast in this role. The role is called the scapegoat. The person or people in this role will often act out, rebel, use substances themselves, engage in illegal behavior, and more to divert attention away from the secrets the support system is holding. In essence, they take the blame and consequences for what the loved one using is doing.

Teens in Treatment

This last role is vital to understand when discussing teenagers in treatment programs, because often there are much bigger issues in their support systems than their own use and behaviors. And it is for this reason that substance use treatment should always include interventions and supports for the loved one’s support system. These interventions often include family groups and individual family therapy. But it doesn’t have to be limited to that. Sometimes it may be getting someone else in the support system their own substance use treatment or mental health therapy. It could be addressing legal, educational, and/or economic disparity issues.

The Connections

Now, to bring these roles back to the original discussion on boundaries and supporting loved ones in recovery. In order to best support and help a loved one in recovery, people in that loved one’s support system need to understand how the behaviors have affected how the rest of the support system thinks and behaves. Only when we understand how we have been affected by that rock thrown in our pond can we make the changes needed to set healthy boundaries and truly support a loved one in recovery.