Both men and women bring multi-layered issues into treatment, but the genders tend to carry differing perspectives about themselves as they enter the process. While men are more likely to come into treatment with an aggrandized sense of self, says addictions and trauma expert Claudia Black, PhD, women are more apt to demonstrate a diminished view of themselves.
“With a female client, I will ask what she needs and often it’s as if I’m speaking a different language with her,” says Black, who this year has returned to The Meadows in Wickenburg, Ariz., as one of a group of nationally known senior fellows. “She doesn’t know what the word means. This has to do with their primary role having been as caregiver.”
With its focus on addressing trauma and addiction in an integrated fashion, The Meadows serves as an example of a treatment facility that emphasizes the need to address all dimensions of a woman’s life in the process of care. In an interview with Addiction Professional at the start of the year, Black and The Meadows clinical director Nancy Bailey, PhD, touched on a fast pace of hiring and acquisition activity at the organization that they say will result in several program upgrades.
“The Meadows has always been multidisciplinary, in order to address women who present with more complex trauma and addiction issues, and more dual diagnoses,” says Bailey, who became clinical director last September after serving in other capacities in the organization.
Building sense of self
Black, whose work with children of addicts in the 1970s gave rise to an expanded knowledge of the manifestations of trauma and codependency throughout the addiction treatment field, says there continues to be a growing understanding that most women come into treatment with a history of being victimized by some form of abuse.
Still, she sees that many treatment programs continue to focus on one primary issue to the exclusion of a constellation of factors that affect women with addiction issues. Change is not necessarily happening quickly enough, she and Bailey agree. “I’m a bit impatient,” Black says.
One of the key elements in working with women involves initiating trauma work early on. “What we’re realizing is unless we incorporate trauma regulation into treatment, a woman is not going to be able to be in a 12-Step group,” doing the hard work necessary to proceed on a path to recovery, Black says.
Much of the important clinical work inevitably focuses on helping women establish a more healthy identity. “So many women’s identities are connected to something outside of themselves,” says Black. “What we work toward is, ‘How can they take care of themselves in a way that allows them to live out their values?’”
The Meadows describes its clinical goal on its website as “helping trauma victims heal and learn the skills necessary to cope with the devastating, and often hidden, effects of trauma.” As part of this effort, it focuses on cross-training staff in a variety of interventions, as opposed to having an individual specialize in one clinical area only.
In returning to The Meadows, where she had been based for 11 years, Black joins a group of senior fellows that includes Pia Mellody, John Bradshaw, Peter Levine, Bessel van der Kolk, Jerry Boriskin and Shelley Uram. She says that while one should not diminish the complexities involved in treating men effectively, there are some factors that tend to add more layers to working with women. “There is far greater stigma and shame with women,” she says.
Many women’s trauma history sets them up for further victimization, both from without and within. “We look at how their self-talk often takes them to a position of seeing themselves as less valuable,” Black says.
Black explains that building healthier relationships with their female peers also becomes an important aim for women in treatment. “It is important for women, and for men as well, to develop support within their gender group,” she says. The Meadows employs gender-specific talking circles to facilitate this.
Bailey adds that The Meadows seeks to acknowledge the factors around women’s relationships with their children that can also complicate treatment and recovery. “You have to recognize the shame that many of these women feel in having to be away from their children,” she says.
As part of its effort to recognize this, The Meadows allows for more phone contact than the norm between mother and child, in instances where the child is old enough to benefit from that. Also, children over the age of 13 are invited to attend The Meadows’ weeklong family program.
The Meadows announced at the start of the year that it had acquired Remuda Ranch, an Arizona residential facility established in 1990 to treat women and youths with eating disorders and related problems. Black and Bailey see Remuda’s approach as complementary to that of The Meadows, in that it has recognized the interplay of factors such as substance abuse that affect many individuals with eating disorders.
As a byproduct of the acquisition, Remuda intends to incorporate best practices for addressing trauma in its work with patients with eating disorders, according to officials at The Meadows.
Already the two organizations resemble each other in terms of some of the experiential therapies they have traditionally integrated into their respective programs. These therapies include art therapy and equine therapy, and Remuda also has significant experience in working with high and low ropes courses.