Treating trauma, addiction and shame requires a slower pace

With the high prevalence of addiction disorders today, more private practice therapists are seeing patients who need treatment for addiction as well as mental health conditions. Lynece Benton Stewart has been working with such patients for most of her career. She started her Nashville practice, Benton Counseling and Consulting, in 2012 and works with clients of all ages.

“I was somewhat shocked because I work with individuals presenting with issues such as stress disorders, depression and anxiety, however, when I look at their assessments, I see they’re using pills or cocaine for recreational use,” Benton-Stewart says. “When we talk, they might say they use it to relieve stress.”

In fact, a 2016 survey from the Kaiser Family Foundation found that among long-term opioid users, 34% indicated they use the pills to deal with stress or relieve tension.

Clinical assessment

Benton-Stewart recommends starting with a thorough assessment to be certain that the patient can be treated in an outpatient setting and to discover any possible evidence of withdrawal symptoms, medical conditions or issues related to living environments that could affect patient health. Many individuals attempt to use substances as a coping mechanism to address or avoid the psychological effects of trauma, so a comprehensive assessment is critical in such cases.

“If they have PTSD or past trauma, that determines what type of treatment plan I would use,” she says.

For example, trauma clients benefit from a slower pace of treatment because they often need more time to create rapport and establish a sense of trust with the clinician. But that pace also can cause some impatience, she says.

“They are more of a challenge to treat, and week to week, they get frustrated,” she says. “They still have those messages, cravings and thoughts they can’t stop. I tell them it’s going to take time and it’s going to be slow. As much as possible, I try to help them celebrate the little progress that they’re making because they often don’t trust anyone.”

Past shame messages in particular can continue to surface for trauma clients, which tends to keep individuals cycling back to substance misuse. Treatment often includes cognitive behavioral therapy.

Additional help

Benton-Stewart recommends helping clients find a support system, such as a trusted friend or relative that can act as an accountability partner or a church group or 12-Step fellowship organization. The connections outside of the treatment setting can offer hope.

Many patients do well when they have homework assignments to complete between sessions. For example, Benton-Stewart might have clients practice mindfulness so it becomes more second nature for them when they are in high stress situations. Clients might use guided imagery to create a peaceful comfort space, such as a quiet mountaintop, that might also extend to include people of positive influence, such as:

• The Nurturer—This person, whether real or imagined, can offer comforting hugs during the mindfulness experience.
• The Protector—This person or companion animal can offer protection from harm.
• Person of Wisdom—This person can offer words of encouragement, especially when the patient is discouraged or fearful.

“They set aside time to practice the mindfulness exercise, so whenever they need it on the fly, it will come naturally,” Benton-Stewart says.