Skip to content

Posts tagged ‘The Meadows Model’

The Twists and Turns of Recovery Treatment – A Case History

In my third year of medical school, I was mentored by a brilliant surgeon who routinely pontificated about the virtues of his profession, with clear intent to dissuade me from entering psychiatry.  On one such occasion, he disrupted my tense and halting approach at a long abdominal incision with the question: “Do you know what makes a surgeon great?”  I looked up from the patient’s pale, still body – scalpel still poised.  “It’s not the suturing; you can teach any monkey how to sew.”  (That didn’t boost my fledgling surgical confidence.)  He went on to say, “When you open someone up, it rarely looks like the textbook.  It’s messy, unpredictable.  Great surgeons effectively respond to each new situation as it arises… they adapt.”

Although this gifted surgeon didn’t dissuade me from the practice of psychiatry, I was persuaded to believe that effective treatment of the body and the mind requires an ability to adapt to each new situation as it arises.  Most people enter The Meadows with some idea of their underlying problems and what they want to accomplish in treatment.  However, as people give themselves to the recovery process, often the mental and emotional landscape changes in unpredictable ways, presenting new challenges and new opportunities for healing and growth.  The following case history highlights the dynamic unfolding of one patient’s experience at The Meadows and some of the treatment modalities that were adaptively employed on the patient’s behalf. Read more

Attachment Theory and the Developmental Consequences of Relational Trauma

As Humans, we are intensely social creatures.  Close relationships with other people are often the source of our greatest joy in life, but they can also be associated with tremendous pain and suffering.  Early relationships with caregivers, siblings, and extended family are not merely a static backdrop to a mechanistic unfolding of human development – these relational experiences have profound effects on biological and psychological processes, for better or for worse.  We now know that children come into the world with sophisticated neurobiological systems that are keenly attuned to the social environment and in turn these systems are shaped by the social milieu.  This means that the narrative of the early social experience is written into the biology of the developing child, or in other words, nurture actually becomes nature.

Unfortunately, overt forms of childhood abuse and neglect are all too common and can result in serious long-term physical and psychological consequences.  In fact, large research studies have shown that adverse childhood experiences can lead to serious health risks, including many forms of chronic illness and even shortened length of life.  However, it is increasingly recognized that covert forms of relational trauma and emotional abuse can also lead to deleterious outcomes, particularly in the area of social-emotional development.

While the term “relational trauma” often connotes overt forms of maltreatment such as physical and sexual abuse, it can also be used to describe covert forms of maltreatment such as abandonment, enmeshment, parent-child role reversal, verbal abuse, love-withdrawal, and many other forms of emotional abuse.  Relational trauma can be difficult for children, caregivers and outside observers to recognize, which means it can persist throughout much of childhood and even into adulthood.  For this reason, relational trauma can have insidious effects on development through persistent, maladaptive interaction patterns.  These social interaction patterns occur while the brain is developing and can therefore shape the way that individuals think and feel about themselves, others, and the world around them.

Attachment theory is a very useful framework for understanding how differences in the quality of close interpersonal relationships, particularly parent-child bonds and adult romantic bonds, influence health and well-being throughout the lifespan.  In the mid-nineteen hundreds, John Bowlby proposed that an attachment behavioral system evolved in humans (and other animals) because it improved the chances of offspring survival and successful reproduction by fostering proximity to caregivers, protection and safety, and sense of security for the developing child.  Bowlby argued that a secure attachment relationship between a parent and child doesn’t lead to dependency, which was the contention of his psychoanalytic colleagues at the time, but instead creates a secure base for the child.  In fact, he postulated that attachment security, and specifically a secure base, actually facilitates exploration and learning in childhood and ultimately leads to greater autonomy and social competence later in life. Read more