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Trauma-informed 12-Step treatment: The last six steps

March 21, 2013
by Jamie Marich, PhD, LPCC-S, LICDC
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Part 2 of 2
Jamie Marich, PhD, LPCC-S, LICDC

This article presents 12 practical ideas on how to strike the proverbial balance between trauma-informed counseling principles and the time-honored offerings of traditional 12-Step recovery structures.  In the first part of this article, the first six ideas were discussed. Below, the six additional steps are listed:

7. Know your local 12-Step “meeting culture.”

Not all 12-Step groups are the same. Some are more rigid, and thus more alienating to trauma survivors. Flexibility and safety are the two hallmarks of what makes a treatment program or a meeting trauma-sensitive. As professionals, it is our duty to learn which meetings in a certain area may be unhealthy for clients struggling with trauma to attend.

Find out which meetings are most likely to respect people’s boundaries (e.g., no forced hugging), and which meetings have less of a tendency to engage in public shaming (e.g., making a big deal if a person identifies as an alcoholic and an addict, or if a person talks about trauma). If you are not a recovering professional, talk to some of your colleagues, or consider attending some open meetings to do your homework.

8. Help your clients with adapting to “meeting culture.”

If a client is new to 12-Step recovery, don’t just throw her into the shark tank. Orient her as best as possible to what she can expect at a meeting. Encourage your clients to bring back to your sessions their concerns about what they might see or hear at 12-Step meetings, especially if you are an outpatient or individual counselor. The observations, even the negative ones, can be valuable grist for the mill in the therapeutic process.

9. Encourage gender-specific meetings while being aware of subtle dynamics.

A piece of 12-Step folk wisdom that is inherently trauma-sensitive is the idea that women need to stick with women and men need to stick with men. Being attuned to gender dynamics within a given area’s meeting culture is key. For instance, steer vulnerable women away from 12-Step meetings that have notorious reputations for “13th steppers.”

Encourage heterosexual men who struggle with intense attraction to women at coed meetings to add a steady men’s meeting where they can more exclusively focus on recovery. Female addicts have a tendency not to trust other women, so seeing a women’s meeting as an opportunity to begin exploring these connective dynamics can be valuable.

Also, be aware that the solution may not be as simple as just sending women to women’s meetings and men to men’s meetings. For example, gay clients may struggle with sexual attraction issues at same-sex meetings, so coed meetings may be more appropriate, or specialized LGBT meetings may be a better fit. For many gay men, seeking out a female sponsor is optimal. Ultimately, the litmus test is whether the meeting and/or the sponsor relationship promotes safety and flexibility.

10. Advise looking for a sponsor who has a basic understanding of trauma.

The relationship quality between a newcomer and a sponsor can make or break someone’s experience with 12-Step recovery. Although the choice of a sponsor is ultimately up to the individual, newcomers with extensive, unresolved trauma histories tend to have more successful experiences with sponsors who acknowledge the reality of traumatic stress and its impact on recovery. As professionals, we can advise as such and be a sounding board for our clients as they search for a sponsor.

11. Take time with the 4th and 5th steps.

Forced 4th and 5th Steps can be damaging to a trauma survivor who does not have adequate coping skills to regulate intense affect, emotion and visceral-level disturbance. For many, the aftereffects of trauma can completely skew any sense of perspective. Many traditionalists see the 4th and 5th Steps as ways to alter these skewed perspectives. Although this may work for some, the risk is very high in the absence of solid coping skills to deal with the body triggers.

Steps 1 through 3 may help in this preparation, but professional help can be a vital adjunct to the process. For many addicted survivors of trauma, extra help for reprocessing traumatic memories and engaging in catharsis may need to come before Steps 4 and 5.

12. Counselors can hear 5th Steps; this is often advised.

The 5th Step says, “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.” Nowhere in that Step does it say the other human being has to be a sponsor or a minister. Some addicted survivors of trauma do not feel optimally safe opening up to a sponsor who, although trustworthy, might not be bound by confidentiality. For other survivors, speaking to a member of the clergy may be triggering, especially depending on the nature of the trauma. Navigating the dynamics of who is best suited to hear the 5th Step is vital and must be evaluated on a case-by-case basis.

These tips may seem overwhelming to addiction counselors trying to wrap their head around this proliferation of trauma knowledge. If this is the case, consider these words from Henri Nouwen, author of The Wounded Healer: “When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

Nouwen’s beautiful words encapsulate the essence of trauma-sensitive addiction counseling. Regardless of the setting in which you work, his words can be embraced as a guiding principle for us all.