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2003 July/August (2)

Friday, 02 January 2009 11:16

Our Businesses, Our Selves

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Our Businesses, Our Selves

Learning to Love the Entrepreneurial Side of Therapy

by Lynn Godzki

One hot summer afternoon John, a psychotherapist in private practice for 17 years, came into my office looking frustrated, complaining that his practice was going nowhere. Not that he didn't like doing therapy--he still loved it--but he felt stuck and frustrated in the practice itself. His income had barely inched upward over the past few years, he wasn't getting his name and practice out in the world as he wanted, and he felt increasingly overwhelmed by paperwork, as if the business part of his practice were running him, not the other way around. When I asked him to explain what he meant, he sighed and described the chaos of his office: journals, newsletters, papers, insurance forms, notes, bills, and whatnot were stacked on the desk, the table, the chairs, the floor, to such an extent that it was difficult to get around. "I know I'm really good at what I do, and I have dreams of expanding my practice and developing more of a reputation in my field," he said despondently, "but I can't seem to get organized to do anything about it. I thought I'd feel more settled and directed by this age, but I don't."

John's experience wasn't at all unusual. Psychotherapists don't go into clinical practice because they're such great businesspeople. They want to be helpers and healers, not entrepreneurs. Although most of them recognize the advantages, in terms of autonomy and income, that working within a private practice brings, the business world and terms associated with it--such as profit, expansion, competition, even "success" itself--tend to make many of them uneasy. In short, therapists tend to regard business as alien to their practice.

I find that, with business coaching, therapists can learn to become very smart businesspeople. Far from being a struggle against their own better instincts or a betrayal of their own best principles, becoming more entrepreneurial can be deeply liberating. I can actually allow therapists to be more effective, less anxious, and less psychically split between their "good" clinical practice and their "bad" business.

After John finished describing his frustrations and the rat's nest of paper that was his office, I asked him to mentally take a step back, so he could better examine not only the state of his practice, but his relationship to it. Therapists tend to overidentify with their practices. As sole proprietors, they frequently do everything and take every role in the business--clinician, CEO, administrator, bookkeeper, secretary, janitor. With so much of themselves wrapped up in their practices, it isn't surprising that they tend to think they are their practices. This overidentification is one key reason why therapists feel unhappy in business. When the business is up, their mood goes up; when the business falls off, they crash, too. In their fused state, they often can't recognize the difference between what they want and what the business needs.

 

One way to help clients differentiate themselves from their practices is to ask them to imagine the practice as a distinct entity from themselves--another person, so to speak. True, they created the business, but no more than their own child is it an undifferentiated extension of themselves. "If your daughter needs braces," I sometimes say, "you don't refuse her orthodontics because your own teeth are perfectly straight." I asked John if he could talk to me about his practice as if it were a separate being, with its own individuality, personality, needs, and behavior.

He laughed nervously, but agreed to give it a try. "Should I make it a male or a female?" he asked.

"Your call," I replied.

He thought for a moment. "Well, my practice is definitely a she, " he said. "She's timid and boring. She's also pretty rigid--she only knows how to do things one way, and she sticks to it, even when it's illogical. We've gotten along okay, so far; she's a familiar, safe presence in my life. But I've known her for more than 20 years and she never changes. I'm bored with her." John paused, looking ruminative. "It wasn't always this way. When we first met, I was thrilled by her--she got all my attention and energy. But now, my attention is drifting. I want something more."

John suddenly reddened, looked at me open eyed, and barked out a laugh. "I sound like the world's biggest cliche´! I get it now. I'm having a mid-life crisis," he said. "I want to have an affair, but it's not my wife I want to leave, . . . it's my private practice!"

The great thing about working with therapists is that they frequently get the picture very quickly. John looked out the window for a minute. "This is ironic," he said, a little sheepishly. "I specialize in working with couples, and here you're reminding me that when you're in a relationship for two decades, even a relationship with your business, things change. The question for me, I guess, is what the changes mean and how they'll play out. Will I need to leave this timid, messy lady--and all that we've built up together over the years--in order to get what I want now?"

We looked at each other and smiled. "Welcome to business ownership at mid-life," I said.

 

Finding a Road Map

When seeing therapists who are struggling with their relationship to their own practices, it's crucial to have a broader developmental framework to help break up the logjam keeping them stuck. Certain similar themes consistently emerge in the early, mid-life, and mature stages of a small business. As a business goes through the early stages, its owner is consumed by survival, competition, and stabilization. During the mid-life stages of a business, issues such as organization, expansion, and achievement take center stage. Later, during more mature stages, the "successful" businessperson focuses on renewing personal values, finding more affiliation with others, and incorporating a greater sense of integrity.

The developmental model I use in my business coaching with practitioners like John is adapted from Spiral Dynamics, Don Beck and Christopher Cowan's work on social and organizational evolution. I focus on the specific objectives and tasks suggested by their model, actions that small proprietors need to take at each of the eight, color-coded developmental stages of business development. Working in this way, I recognize the stage a business is in by the themes my clients reveal as they talk to me about their private practices.

Any beginning entrepreneur, including a therapist, in the first (beige) developmental stage, is primarily concerned with survival. Clients in this  stage typically complain of feeling insecure, panicky, and clueless about what to do next to keep the business viable. Inexperienced and driven by anxiety, they operate mostly on instinct, and the best way to help them is by teaching them to replace instinct with intention and planning. I usually begin by helping them devise a business plan that leaves as little as possible to chance. This might mean writing down their short-term goals and long-term vision for the practice, deciding on specific networking steps to take and how many hours each week to network, scheduling time to consult a financial advisor or a computer expert, if needed, and creating a circle of professional support, such as meeting regularly with other therapists, who can be a source of guidance and encouragement. These suggestions are often met with surprise and resistance--"It'll cost too much money!"; "I don't want to get all these other people involved!"; "I should be able to do this stuff myself." It always amazes me that clinicians invest freely and generously in their own clinical growth--paying for clinical supervision, taking advanced training courses, attending workshops, buying textbooks--but consider investing in their businesses a kind of unnecessary extravagance.

The second (purple) stage often reflects a superstitious, even magical, way of thinking, and parallels cultural eras when people feel dependent on rituals and traditions, often without practical or rational basis. At this point, a business may be surviving, but the entrepreneur has no idea why--no idea what he or she's actually doing that makes the thing "go." Not knowing how to keep on being successful, they tend to cling to comfortable rituals and habits, almost from a sense of dread that if they change anything, the success will go away. For example, one therapist told me he had four different bank accounts in three different banks and randomly deposited his clients' checks each week into all of them. "Why?" I asked him, suggesting that consolidating them would make better financial sense. He shook his head and repeated doggedly that this system had just "worked" for him up until then, and things might not "work" if he changed it. Several therapists have told me that when they lose clients, they believe that if they don't allow themselves to worry and just visualize abundance, new clients will show up. They insist that if they think about their situation too carefully, it stops the flow of clients. Many clinicians have no idea how clients discover them, where the referrals come from; the appearance of new clients remains a vast mystery to them--a gift from heaven. Not knowing what they've done to get clients in the first place, they don't know how to keep doing it.

 

Helping these therapists unravel the myths and mystery of business and implement practical, concrete strategies, while they learn the laws of cause and effect, empowers them. They feel less anxious as they see that can take steps to create their own business destiny. Writing business plans and setting goals; determining how much they want to earn and how to set and raise their fees; deciding what their policies are (about cancellations, for example) and what factors determine client retention; knowing how to effectively market, network, and generate referrals--all this information can help them understand how a therapy business works. Such steps normalize business operation, make it less confusing, and help them become savvier entrepreneurs.

Finally, in the early stages of a business's growth, there's the red stage--what Beck and Cowan call the egocentric phase--when a strong sense of individualism and selfhood comes to the fore. With survival secure, clinicians begin to have some practical sense of what they need to do to keep their businesses afloat and start concentrating more on staking out their own professional identity in the world. At this stage, a proprietor knows she's developed something substantial, worth protecting and preserving, and begins to look around at all the potential rivals she has--how many others in her area also specialize in addictions, or adolescence, or couples' counseling? How's the clinician going to stand out from the throng?

Therapists often have a hard time with competition. While it seems perfectly normal for a car salesman to be competitive, it feels perverse to therapists, who aren't happy to find themselves thinking envious thoughts about colleagues and obsessing about how they can get ahead of the pack. It sounds so narcissistic and unbecoming in a mature, selfless healer!

In contrast, because clinicians often don't understand the normal mind-  set of an entrepreneur or how to accept themselves as competitive beings, they may overreact to the  presence of perceived rivals. One  therapist I saw had identified a colleague in her area--with similar credentials, professional history, and specialty--as someone she needed to match and keep up with, step for step, as if her own career somehow  depended upon how her colleague did. She found herself trying to second-guess the colleague--angling to present at workshops where she thought the other therapist would  also present, for example. What helped her negotiate this particular stage was refocusing on her own personal vision for her professional life, reconnecting with what it was about the work that she loved, what she  wanted for her own career. Getting back in touch with her original vocational foundations helped her stay on course with the goals that were    important for her professional development and act to determine her own identity as a therapist, rather than react with one eye always on somebody else's progress.

 

Mid-Career Issues

When John described the chaos of his office--journals, papers, insurance forms, and whatnot stacked on the desk and the floor--and showed me his old-fashioned calendar with a jumble of scrawled names and appointments, I knew he was having trouble negotiating the fourth (blue) developmental phase, which focuses on organization. People at this mid-life stage need to create stronger, more functional, business structures to support their dreams of enlarging their business and becoming more profitable. John's frustration came about because he wanted to branch out and pursue greater opportunities, but he hadn't completed the tasks required by the blue phase of his business. He had ideas and dreams, but didn't have the structures in place to make them happen.

Although people have to learn that their businesses stand alone as separate entities, it's also true that because people's businesses are their own creations, they necessarily reflect key strengths and weaknesses within them. However distinct your children are from you, undoubtedly they also reflect your genes, your values, your capacities as a parent. At times, the easiest way to help a therapist change a problem in his business, is to see whether he can make a similar change first, in himself.

I told John that he needed to think of his business as a mirror of himself. What was it in his life or in his childhood that might contribute to the mess of his office and the paperwork that was essentially drowning him? John said he'd never been a well-organized person. As a young child, his parents had moved many times. Again and again, he'd been uprooted from familiar surroundings, friends, and schools, leaving him feeling that nothing ever really belonged to him. Nothing, that is, except what he could physically carry with him from house to house, state to state. Rather than teaching him to pare down his belongings and travel light, the constant moves made him ferociously attached to his "stuff." Once John understood the connection between the origins of his pack-rat mentality and their effects on his business, he could begin, with difficulty, to take steps to change his business practices. Reluctantly, he admitted that this problem was more entrenched than he thought; he needed to bring in someone to help him fix it and agreed to hire a "clutter consultant," a professional he found in his local paper, who came to his office and completely banished the clutter and reorganized it.

John focused on other "blue" issues of organization, including how to use what I call a Practice Upgrade Plan--which I developed to help a small-business owner bring more stability and substance to the business and enhance its reputation in the community. Through the Practice Upgrade Plan, I encourage proprietors to build into their daily schedules time for planning and actions that will strengthen the long-term prospects of their practices. For example, this is the stage for a therapist to decide his top five business goals for the next year and to take one action every day toward these goals.

 

After several months, John found, to his delight, that his business was easier to operate: his billing was done on time each month, he'd collected past-due receivables, and his clean office and new, computerized calendar made his weekly administrative tasks a breeze. With his newfound energy, he was ready to move into the fifth (orange) stage and focus on expansion and achievement. John was jumping with at least three new ideas each week for expansion that interested him. Once people acquire a new set of eyes for gazing on a world of sparkling possibilities, they also need a filter for sorting all those opportunities. I suggested that he develop a set of six questions that would help him evaluate each potential opportunity. His questions were:

1. Is it, or will it be, profitable, and when?

2. Will this allow me to do better work as a therapist?

3. Will I have fun doing this?

4. What's my gut feeling about this opportunity?

5. What do I gain if I say no?

6. What do I gain if I say yes?

How did these questions help John sort through the onslaught of possible opportunities? One of his colleagues who had many legal contacts had built a practice of couples therapy with court-referred families. He asked John to join him in setting up a partnership to offer workshops and training for other mental health therapists who do the same kind of court-referred counseling. The colleague said the referral rate from the courts and lawyers was substantial, but many therapists didn't know how to do strategic, effective counseling with this population; he and John would show them. Using the six questions above, John thought that it could be very profitable, but only after about two years of hard work and marketing the workshops. He was expert in couples counseling and enjoyed training others, but decided that this project, while interesting in itself, wouldn't actually help him become a better therapist. As to whether it would be fun and what his gut feeling was, John said, "I'm not sure. I like the guy quite a lot, but the 'fun' part of the deal would probably be outweighed by the sheer drudgery of getting it off the ground." What would he gain from saying no? More time to pursue interests that he really knew he liked. What would he gain from saying yes? Possibly a new income stream--training could be a good profit generator down the road. In the end, John decided against the offer since the negatives seemed to predominate.

 

Marketing is itself a daunting word for therapists, who generally loathe any suggestion of self-promotion. To help them conquer this hurdle and begin taking marketing steps networking, becoming involved in community activities, teaching courses at local adult ed colleges, writing articles for local newspapers, etc.--I imbue them with the basic principle that should undergird all their business-building efforts. Base your actions on love, not fear. Fear-based marketing, for example, would be a therapist who grimly settles down to make phone calls to people he doesn't know well, detesting the whole process and saying, "I loathe doing this, but if I don't, my practice won't survive." In coaching sessions, we talk about these feelings, and I ask, "Is it possible to imagine a way of doing this that might not seem so bad, might even make you like it?" Generally, we get into a discussion of the clinician's love for her own work and pride in her vocation, her deep belief that she does have something good that will truly help people, her realization (beneath the reluctance to make the call) that the person she's calling might be glad to hear about what she's offering and welcome collaboration.

One clinician I worked with called an oncologist she knew. She told him how much she admired him and his reputation for kindliness and patience with scared, desperate patients, and said she wanted to let him know that one of her own specialties was working with very sick or dying people and their families. This clinician made the call in a spirit of love for her work, for the good she knew she could do, and from a conviction that she and the physician might make a very good team. The doctor felt both flattered and receptive--here was someone to whom he could refer people for the kind of help he didn't have the time or expertise to give.

At this heady stage of entering orange territory, feeling an upsurge of personal power and emotional zest, many therapists become aware of a small, tough little worm gnawing away at their euphoria, signified by the words ambition and profit. These terms, along with competition, so normal to the business world, are often anathema to therapists. John, for example, would be energetically talking about potential new opportunities when suddenly, looking crestfallen, he'd say something like, "Boy, I'm beginning to sound like a real estate developer, not a therapist."

Again I asked him what it might be in his family of origin that made him so uncomfortable with ambition and profit. "My father was in sales and worked for a variety of bosses," he began. "He often complained about his current boss and how owning a company gave a person a swollen head. We weren't poor, but he was always worried about money and it was a constant source of tension in our family. I want to be able to retire someday, and I need to make more money. It's now or never. But I get a lot of negative thoughts and feelings when I try to stretch too far in the direction of seeing this as a real business and making more money. I begin to feel that I'm selfish and attention-grabbing, and I can hear my father saying I'm getting too big for my britches and setting myself up for a fall."

 

I often invite proprietors to "embrace their ambition"--clearly a tough sell for therapists, who think that too much emphasis on ambition and profit signify self-absorption and greed. So I suggest to clinicians that they think of ambition as a kind of emotional fuel, a motivating force that frees their passion, imagination, and creativity. Ambition is really a synonym for desire, emerging from the same impulse that helped get them through school, then into training internships, and, finally, into their own private practices. I suggest they ask themselves what they fear about ambition and then allow themselves to do a little daydreaming about their ideal future. What--no matter how apparently improbable, grandiose or Walter Mitty-ish--would they most like to see happen to themselves and their businesses? They don't have to act on every ambitious thought or fancy, but allowing their minds to wander in this way helps detoxify ambition and gets them in touch with their own aspirations.

Evolutionary Stages

After orange, there's another swing of the pendulum to a third, latter-life evolutionary stage with its own phases, the first of which is green. If orange is characterized by the drive for achievement and material success, green represents a move in the other direction, toward the integration of more humanistic values into one's work life. The characteristics of this stage are a desire for deeper personal or spiritual connections, a yearning to experience again the soul-deep inspiration that brought them to the work in the first place. People signal they're ready for this stage when they complain that, for all their material and professional success--the practices (perhaps several offices) purring along at full occupancy, the workshops they're asked to conduct, the book chapters they're writing--they feel something lacking. Green is the color of congruence, when any incongruity between professional success and personal identity becomes painfully obvious.

John, who'd just entered the orange stage and was exuberantly enjoying the world of prospects and achievement after having been in a safe, but confined business situation, wouldn't be ready to shift into the next (green) stage for a while. But another client, Clara, is experiencing "symptoms of green." A social worker with many years of experience, she no longer sees clients. Instead, she owns and operates a healing center that she built from a solo operation to a prosperous, 15-person organization housed in a large commercial property that she owns in a busy Midwestern suburb. She employs mental health professionals, massage therapists, and physical therapists. She's an excellent businesswoman and a natural marketer, who actually enjoys calling total strangers to talk about her practice. She considers each call a kind of adventure into the unknown.

But when Clara called me, she said that, in spite of her obvious success, she was feeling dissatisfied and burned out. She felt tired much of the time, and although she had a heavy workload, she thought this tiredness was from feeling less personally connected to what she'd built. More and more, she felt less like a healer with a real gift for connecting with people in pain and more like the harried CEO of, say, an expanding widget plant. "As each year goes by, I feel less sure about my direction," she said. "I'm always marketing, planning, or thinking about some business problem--staffing, expansion, leveraging our space needs, or looking for increased areas of profitability. I wanted to create something meaningful with this center, something that would genuinely help people and contribute something to the community. I've done that, I think. But I've kind of lost sense of what it means to me. I feel I've lost something important, which I had when I was just struggling to make ends meet.

 

"And besides, " Clara said forlornly, "I feel lonely. I don't know any nearby therapists in my situation that I can talk to for support. All the professional clinicians I know imagine I couldn't possibly have any complaints or needs. It sounds like a joke, but I'm a case study of 'lonely at the top.'"

Sometimes, in the midst of material success, we forget that even though we've "made it," we're still evolving. The pendulum doesn't stop swinging just because we now command a six-figure income and a staff of subordinates. Since the classic signals of a business owner who's entering the green stage are concerns about isolation and lack of meaning, the objectives of that stage usually include building a deeper community, relaxing boss-employee hierarchies by sharing more power, and taking steps to renew old passions and explore the spiritual dimensions of life.

For clinicians in this stage, I've created a checklist of 60 evocative words that elicit core values--including, for example, "creativity," "learning," "enlightenment," "sacredness," "compassion," "adventure," "inspiration," "accomplishment," "understanding," "wholeness," "connection," "fairness," and the like. I ask therapists to pick their top four that they feel define them and their work at some fundamental level. Which words, I inquire, draw from them an almost automatic sense that "this is really me?" Next, we look at whether those values are now reflected in their practice. What would bring more passion into their work lives? How can they make their professional lives more deeply congruent with their deepest values? Because the hallmark of coaching is to help people take action--not just speculate about personal philosophies--we then work on concrete steps to bring their practices more in line with their ideals.

Since one of Clara's core values was "healing," she began to realize that she missed the hands-on experience of doing therapy. So she hired a part-time operations manager to take on some administrative tasks, freeing her to see a few clients every week. At the end of the year, she reported feeling exhilarated again about her work, having rediscovered her fascination and passion for doing therapy itself. During this time, she also created a professional network of about a dozen business leaders who met regularly to talk about their concerns, and a smaller, more intimate, circle of entrepreneurs who became friends as well as associates. She now felt the "connecting" instincts that drew her to the field in the first place had been reborn.

 

There are two stages beyond green--yellow and turquoise--which represent, each in its own way, a leap into a transcendent kind of thinking and feeling about work and professional identity. The yellow stage--a phase of deep creative regeneration--occurs when a seasoned, mature, successful entrepreneur makes a profound life change and breaks away entirely from his or her old route to explore new territory, just for the sake of newness.

At one workshop, for example, I asked attendees to talk for a few minutes about their practices--where they felt they were in the trajectory of profession and career, given the eight, color-coded stages of evolution. After several practitioners had spoken about their aspirations and frustrations--most were in the early and middle stages--one woman raised her hand and said that she and her husband had built a successful group practice. "I feel now that I've achieved every professional goal I set out to achieve, including what many here today are still seeking," she said. "Now I'm ready to do something completely different. Next year at this time, I know I'll no longer be associated with this practice. I don't yet know exactly what it is I'm going to do--though I've got some ideas--but I know it'll be a departure. My husband and the group aren't happy about my decision, but I feel very deeply that it's time for me to go off on my own, in an entirely new direction." As she spoke, the room became very quiet; she was clearly at a different crossroads than any of the others. When I asked the attendees what stage they thought she'd approached, they shouted out, "yellow." A therapist at this stage is willing to provoke some chaos, relying on her flexibility and the synchronicity around her. Her knowledge and competency as a therapist and businessperson are retained and integrated as she ventures into this new phase of life and work.

The last stage is the rarefied turquoise stage, an idealized "holistic" domain, in which business owners see all the many levels of interaction possible and utilize the state of "flow" for the best, easiest performance from individuals. Turquoise businesses are attuned to the delicate balance of interlocking life forces and aspire to spiritual connectivity. As exclusive a coterie as this stage represents, many people nonetheless can experience turquoise moments--states of flow, when thinking, feeling, and action seem united.

 

Marla, a psychologist in private practice for a decade, says there are months at a time where she feels that her therapy business operates effortlessly. In the early years, she did a lot of hard work--making contacts, finding the right office, getting her policies to reflect her values, building her reputation and her skills. She joined associations to keep her name out there, spoke at any conference that would have her, and learned how to fill a practice with referrals so that she could side-step managed care and stay independent. "My practice stays as full as I want it to be," she says. "I make good money, I gross over $100,000, which is enough to support myself and my family and to have the life-style that I want. I love the clients I work with. I love the work I do. I get to take whatever training appeals to me to stay fresh and motivated. I feel very connected within my community and have a lot of professional support around me. I don't have to hustle or promote myself in any way. Good referrals come in regularly, from all the contacts I so carefully made in the past. I can be very selective and only see clients I want to work with. After a long day of seeing clients, I don't feel drained. Instead I feel full, as though I just finished a very satisfying gourmet meal."

Meanwhile, back on planet earth, we therapists are mostly still trying to reconcile the ethics and values of our chosen profession with what we often feel are the unsavory truths of the business world. And yet, it's the business itself, our own business, that gives us the most freedom to practice our vocations with the greatest degree of integrity and personal choice. As therapists, we often consider ourselves to be masters of change. If we can begin to see that our businesses are themselves evolving organisms, with their own identities and strengths and weaknesses--just like our clients--we might be better able not only to master the process of their change and development, but to enjoy watching them, and ourselves, grow.

Lynn Grodzki, L.C.S.W., P.C.C., is a psychotherapist and business coach in private practice. She's the author of Building Your Ideal Private Practice and 12 Months to Your Ideal Private Practice: A Workbook and editor of The New Private Practice: Therapist-Coaches Share Stories, Strategies, and Advice . She can be reached at her website: www.privatepracticesuccess.com. Address: 910 La Grande Road, Silver Spring, MD 20903. E-mails to the author may be sent to lynn@privatepracticesuccess.com. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.

Tuesday, 30 December 2008 15:57

The End of Innocence

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The End of Innocence

Reconsidering Our Concepts of Victimhood

Dusty Miller

Whether delivered by hand grenade or by hurricane, by fist, machete, or burning plane, traumatic experiences are universal across cultures, and so are attempts to heal them. How well those attempts succeed depends in part on the stories a culture tells itself about victimizers and victimhood--about recovery, wholeness, and resilience. This is particularly true of intimate family violence, which broke into the light in the late 20th century, casting ripples that continue to this day.

As a systems therapist, incest survivor, and recovering alcoholic, I've lived through several stages of our culture's attempt to come to terms with child sexual abuse--as a victim in the silent 1950s; as a therapy client in the oblivious 1960s and 1970s; and as a psychotherapist in the 1980s and 1990s, when once-dismissed accounts of abuse filled my therapy practice (and my television screen) only to be partly discredited within the decade during another swing of the cultural pendulum.

We clinicians are still feeling our way toward a middle path, one that avoids the extremes of disempowering pity and "buck-up" denial. Our clients (and if we're survivors, we ourselves) still struggle to negotiate what sociologist Ervin Goffman called "spoiled identity": the isolating experience of being cast outside the circle of "normal" life, along with gays, paraplegics, and madwomen. Helping a client move from subjugation by the worst thing that ever happened to me to a nuanced and effective life has turned out to be more complex--and oddly enough, more commonplace--than I imagined when I first sought help.

One in a Million

The simplest version of my own story begins with my father. After he came home from World War II, he led at least three separate lives: one in Manhattan with his German mistress and her mother, who followed him to the States; one with my mother and me in Northampton, Massachusetts; and one in my bedroom at night, with my mother seemingly oblivious and asleep at the other end of our house.

Photographs of me at 3, before that secret life began, show a cheerful little girl, eyes full of delight, almost always smiling at the camera, smiling at the man taking the pictures--her father. In my kindergarten picture, taken two years later, my body expresses what none of us would put into words for 20 years. Around the kindergarten table the children sit, posture-perfect, hands folded in front, eyes gazing alertly at the photographer, all of the faces smiling--except one. Thin and awkward, my arms and legs sprawled weirdly over the little chair, my mouth hanging open and my eyes staring vacantly off into space, I'm the only one not looking at the camera.

The year was 1950, a time so different from the present as to be almost another country--a postwar, post-Holocaust world, cocooned in a vast cultural silence about victimization and the aftereffects of victimization. In this world, bleached of any reference to trauma, alcoholism, or child sexual abuse, there was no such thing as Megan's Law, Battered Child Syndrome, the Betty Ford Center, or Post-Traumatic Stress Disorder.

According to a leading psychiatric text, incest was something that happened only once in a million families. No child I knew ever told me she'd been repeatedly struck in the face (as I had) by a father who at other times was playful, loving, and kind. Until I was 17, I didn't try to tell anybody--not even my beloved godmother--that my father forced me to perform sexually. Nor before I was 24 did anyone believe me.

In 1962, as a frightened freshman at Cornell University, I made my way to the college counseling center. I was 17 and an excellent student, but I was already drinking heavily, sleeping around, and generally confused by my sexuality. In my initial interview, I wasn't explicit about my father's incestuous abuse. But I talked about my unhealthy closeness to him, my fear and loneliness, and my feelings of being "different" from others my age.

I began counseling with the head of the center. He asked me endless questions about my relationship with my mother . Although I kept trying to talk about my father, this man said it was because of my "overclose" mother-daughter attachment that I was experiencing the plague of bisexual attractions and recommended that I spend the summer with my father in his one-bedroom apartment in Manhattan. I fled from my would-be helper and waited seven years to try to speak again.

Thoreau once said that it takes two to tell the truth: one to speak and one to listen. The first person to listen to me was Florika, a bright young Romanian immigrant whose father had not only sexually abused her but had begun force-feeding her amphetamines at 13, when she faltered as a virtuoso child violinist. I met her when I was 24, living in New Haven, Connecticut, after graduating from Cornell. I was drinking a lot at the time, working in a women's carpentry collective, practicing karate, learning to run the printing press at a radical newspaper, and playing drums in the New Haven Women's Liberation Rock Band, where Florika was the bass player. Many were the nights we roamed New Haven together, spray-painting buildings with graffiti urging women to smash the patriarchy.


We were alone in the dark in Florika's apartment one night, high on marijuana, when I experienced a state of wordless, paralyzing, bodily fear that I'd now call a flashback. Wrapping me tightly in a blanket the way she'd learned in a mental hospital, Florika told me soothingly that I'd be alright. Finally, she crooned that she "understood" me.

"What do you understand?" I asked.

"That you're one of us," she whispered.

I don't remember exactly what I said next, but I'll never forget the relief that followed my first stumbling words of disclosure and our mutual recognition. For the first time, I heard that I wasn't the only one. In that era of denial, I don't think I yet realized that incest had ever happened to anyone except Florika and me.

Within 24 hours, Florika had also introduced me to the daily use of amphetamines--something that made me feel powerfully in control even though I'd never been more out of control. The pseudocloseness of shared addiction felt familiar, like the secrecy, stimulation, and shame I'd lived so many nights in my father's house.

My pattern of what we now call "trauma reenactment" went undetected for years by mental health professionals: our profession played a cultural role analogous to the Non-Protecting Bystander in the incestuous family system--like my mother sleeping at the other end of the house. Psychiatrists and psychologists repeatedly beat the bushes for any explanation rather than the obvious ones: that I was telling the truth about my sexual abuse; that I was desperately trying to soothe a neurobiology disregulated by trauma; and that my addictions were creating major physical, psychological, and practical problems of their own.

Counterbalancing Experiences

If this narrow story of trauma, rage, misdiagnosis, therapeutic mistreatment, and spoiled identity was all there were to tell, I'd be dead by now--as dead as Florika, who took a fatal overdose of heroin in her late twenties while working as a Hollywood studio musician. But my life, like most lives, included commonplace and counterbalancing experiences that had nothing to do with abuse: the emotional support of my godmother and many teachers; a wordless enjoyment of the natural world; and successful involvements in school, radical politics, work, and athletics.


During my college summers in the '60s, for instance, I was part of the movement to register African American voters in the Deep South, where I met people whose sources of resilience were very different from my own. I particularly remember Jereldine Johnson, a powerfully built African American woman who lived with her 13 children (plus me for one summer) in a cabin in rural Tennessee. Scorching sun; red clay in skin, hair, nostrils; smoke of the wood stove, even when it was 100 degrees out; crying babies--all were part of Jereldine's daily life.

In prayer meetings and rallies in small rural churches in the cotton fields, Jereldine and her neighbors faced poverty, violence, and racism together--with songs, testimonies, political action, and energetic joy. Everyone participated. Everyone, no matter how uneducated or beaten down, was assumed to have something to offer. In contrast to the isolated inner struggle of the abuse survivor, traumatic experiences among the African Americans I met in the South were confronted communally and held in a spiritual perspective, leading to something other than bitterness and despair. It was years before I could put into practice what Jereldine had shown me, and I returned home alone at the summer's end, still closely guarding the secret of my sexual victimization--except when I was drunk (which was often).

So it went until an early winter day in 1978, a year after my father's death, when I found myself in a car on an interstate in Connecticut, being driven back to my job (as a dorm counselor near my childhood home in Northampton, Massachusetts) by someone I hardly knew. After I opened the car door and tried to jump onto the freeway--it seemed like a good idea at the time--the terrified driver delivered me struggling and shouting to the emergency room of a hospital off the nearest exit.

Three days drunk, covered with blood from self-inflicted cuts, my hair disheveled, dressed in jeans and an old army shirt of my dad's, even my gender was unrecognizable. I was wrestled into submission by six emergency room workers, injected with a paralyzing amount of Thorazine, and transported by ambulance to a locked ward for violent women at the Connecticut state hospital in Waterbury. I was 34.


I sobered up in a gloomy, disinfectant-smelling darkness. Was I in a barracks, a dorm, or a concentration camp? I'd stayed briefly in private psychiatric hospitals before, but never had I been forcibly locked in with other violent, despairing women. Life had finally thrown in my face what a half-dozen therapists had overlooked. For a decade, my episodically competent days had been fueled by amphetamines, caffeine, rage, and prescribed antipsychotic drugs like Stelazine; in the evenings, I'd mellowed out with tranquilizers, gin, and sex with near-strangers. This regimen of prescribed and self-prescribed drugging had worsened my flashbacks until they mimicked transient psychotic states.

I don't know what diagnoses I'd been given by my well-intentioned New Haven psychologist, Dr. M., who'd minimized my alcoholism and repeatedly told me that my memories of incest were fantasies representing my disguised yearning for my father. But I suspect my bulging file contained references to borderline personality disorder or depression with psychotic features. Like thousands of other traumatically abused and misdiagnosed women, I was well on my way to developing the "spoiled identity" of a chronic mental patient. Dr. M. had led me to believe that I'd spend the rest of my life in and out of psychiatric units like the one I then found myself in at Waterbury.

Only my middle-class connections, I suspect, saved me from involuntary commitment. Two days after my arrival, three well-dressed, college-educated friends appeared in the middle of an ice storm and talked their way into meeting with the psychiatrist on call. "She needs to be in detox," said the psychiatrist, and released me to them.

It was the beginning of the end of my addictions.

Two months later, in another locked psych unit after another violent, drunken altercation, a psychologist suggested I move to the alcohol treatment unit one floor below. I agreed and for six rocky weeks, I self-consciously sat through 12-step meetings, heard about a Higher Power, and got used to the idea that I was powerless over alcohol and that my life had become unmanageable.


Once I stopped abusing drugs and alcohol, my flashbacks and dissociated states lessened markedly. With my friends' encouragement, I weaned myself from the overpowering antipsychotic medications that had kept me groggy and debilitated. I'd given up the spoiled identity of the mental patient in favor of the more accurate--and therefore more helpful--label of the recovering addict and alcoholic. But in 12-step meetings, I often felt awkward and out of place, and there were still parts of my story that I couldn't tell.

The Politics of Truth

Clean and sober, I returned to graduate school and shot like a rocket from chronic PTSD and rampant addiction to what seemed like the other end of the rainbow. Within six years, I was "Dr. Miller," a clinical psychologist doing postdoctoral work in family and narrative therapy at the University of Calgary Medical School in Alberta. On one memorable day, I visited a Canadian mental hospital as a consultant and expert on domestic violence and addiction. I'll never forget a social worker's giving me an enormous key, which opened all the wards, including a locked ward similar to the one I'd been committed to in Connecticut. Holding that key and remembering the movie King of Hearts , I was tempted to open every door. I was also irrationally terrified that my identity as a former mental patient would somehow be exposed.

As a family systems therapist, I loved drawing connections between a family's surface pain and hidden issues of addiction, patriarchal social assumptions, and domestic violence. I loved the "difficult" families, especially the mistrustful, mislabeled, and misunderstood mothers. I loved being mentored by iconoclastic family therapists who did battle with The System, personified by well-intentioned but oblivious social workers, psychologists, and psychiatrists like those who'd mislabeled and mistreated me.

Then one day in 1985, I sat behind a one-way mirror supervising a graduate student working with a father and his young daughter. Someone in the therapy room--I can't now remember who--said the word "incest," and it resonated through the microphone and into my observation room. A student next to me whispered a question, but I couldn't hear her words. Tears fell onto my hands as I twisted them in my lap.


When I confided in a senior family therapist, he told me not to get too involved and to just do my job. It sounded like the message I'd been given as a child: don't rock the boat, only remember the good times, and don't air family business in public.

But times had changed. If power consists in part in determining whose stories will be told and whose believed, the balance of power was shifting. Stories like mine were being whispered to a new generation of women therapists, spoken out loud in new 12-step meetings for adult children of alcoholics, and aired among feminists involved in the movement to stop domestic violence. The floodgates had opened. Control of the politics of truth had moved from the experts to the experienced.

After nearly a century in which the mental health field had dismissed reports like mine as fantasies, we victims lost patience with being spoken about and began to speak for ourselves. If our culture wanted to play Non-Protecting Bystander, we'd strip away the collective ignorance that had served as its shield. Like gay people and people of color before us, we defiantly embraced and began to dismantle the spoiled identity we'd been assigned. Oprah Winfrey, Maya Angelou, former U.S. Senator Paula Hawkins, and former Miss America Marilyn Van Derbur all said on television that they'd been sexually abused as children. By becoming vocal, we challenged the family and cultural role we'd been assigned: to suffer in silence, save everyone else from discomfort, and internalize the damage.

In the face of the carefree old public narrative--that incest was either imagined or consensual, and in any case, only occurred in one in a million families--we faced what lay in plain sight: that child sexual and physical abuse were real, damaging, and prevalent; and so were rape and other forms of family violence. If childhood and family trauma could be stopped and effectively treated, we figured, whole categories of the DSM --borderline personality disorder, dissociative disorders, substance abuse, cutting, sex addiction, other behavioral addictions, PTSD, and even some forms of anxiety and depression--might practically disappear. The elephant that had crashed unrecognized outside the windows of the consulting room for 80 years was finally seen and named.


We of this new generation of feminist clinicians saw childhood trauma for what it was. What we didn't know--and didn't know we didn't know--was how to treat the multiple layers of disruption it had caused. We recognized the critical importance of telling the story, but not that telling too much, too fast, to a relative stranger could retraumatize us and our clients. Stuck in a Manichean universe, which divided humanity into evil perpetrators and innocent victims, we had no nuanced language for the complex spiritual wounds of intimate violence: the conflicted familial bonds of love and pain; the sense of being isolated and unsafe in the universe; the distrust of the body, love, or pleasure; and the questioning of God's intentions after profound human betrayal. We didn't know that an individualistic and secular talking cure could only take us and our clients half the way home.

By the mid-1980s, we clinicians were experimenting with hypnotherapy, cognitive-behavioral work, and psychodynamic approaches that sometimes fostered inaccurate recall, retraumatization, family cut offs, and regression. Exposure therapy (developed for combat vets), for example, had been used effectively to desensitize adult women who'd suffered a single incident of rape. But when incest survivors repeated their stories over and over, they relived their traumas physiologically, along with the complex relational wounding of betrayal by a close family member. The biologically based rage, terror, and helplessness that followed were then often turned against the self in the form of renewed cutting, self-destruction, and addiction.

I remember, for instance, an incest survivor in Northampton who was coping well and working in a responsible position at a local title insurance company. After entering therapy, she became grossly obese, stopped working, and, to my knowledge, has never worked again.

I'd reentered therapy myself in the mid-1980s and, for the first time, I was assembling a coherent life narrative with a clinician who believed me. But if this was the validation I'd sought, why did I feel worse after nearly every session? Helpless and enraged after reliving detail after detail of how my father had hurt me and my mother had abandoned me, I'd walk out of her office and end up in an expensive shop in Northampton, flipping out my MasterCard for beautiful clothes I couldn't afford.


I stopped exercising, gained weight, and became increasingly isolated. I could barely work. My glands were swollen, my joints ached, I slept erratically, and I was acutely lonely. So it went until I quit therapy--because my therapist continued to insist that I confront my widowed, 80-year-old mother with her failure to protect me.

I wasn't alone in my misgivings. In the early 1990s, I was frequently asked to consult with bewildered therapists, whose clients had entered therapy doing more or less okay and had then fallen apart. I particularly remember Frieda, a talented sculptor who'd been in therapy for seven years. She'd stopped working on her art, became a child instead of a partner to her husband, and was drinking too much and neglecting her children. In consultation, I asked why she was persisting with therapy that apparently wasn't doing any good. I suggested--much to her therapist's shock and dismay--that Frieda take a break from individual therapy, try a group focused on building present-time, real-life competence, return to sculpting, and go to Alcoholics Anonymous.

Frieda's therapy had been modeled on a psychodynamic approach influenced by British researcher John Bowlby, the expert on mother-infant attachment. The idea was to compensate for early betrayal and "insecure attachment" by providing clients with a dynamic, reparative, and trustworthy therapeutic relationship.

In practice, this often meant making excuses for destructive behavior and implying that nothing better could be expected of someone so horribly damaged. The focus was on the wounded child to the exclusion of the competent adult. To make matters worse, many therapists eventually became exhausted by the role of ministering angel and turned punitive with their clients.

This therapeutic quicksand was responsible for slogans, buttons, and bumper stickers like "It's got to get worse before it gets better" and "It's never too late to have a happy childhood." In Northampton, where I live, adult women walked around with teddy bears in their backpacks--and some, I hate to say, still do. Many became disconnected from any community but the community of survivors, and any identity beyond the spoiled identity of victimhood. Their lives consisted mostly of living alone, writing in journals about what had happened to them, and making the rounds of group therapy, individual sessions, support groups, and inpatient units.


Some channeled their rage into confronting or cutting off from their parents, but few looked out the window into a larger social world. No effective equivalent of Mothers Against Drunk Driving emerged to lobby for the next generation of kids. Social attention was diverted instead to a phantasmagorical distraction: the notion--never, to my satisfaction, confirmed--that secretive, satanic cults had subjected thousands of American children to ritual abuse. In Northampton, this hit home when a new psychiatrist took over the women's wing of a nearby psychiatric hospital. Until managed care put an end to it, patients referred there for brief stays emerged, months later, bearing diagnoses of multiple personality disorder and living in terror of the cult members who, they said, had devastated their childhoods.

That's why, when the False Memory Syndrome Foundation (FSMF) burst on the scene in 1992 and began challenging professional licenses and picketing therapists for "splitting up families," I felt ambivalent. On the one hand, they represented such a backlash. On the other hand, as I quietly said behind closed doors, they had a point. We were walking into dense fog where it was hard to tell what was real and what wasn't. Given the way I hadn't been believed myself for so many decades, I wanted the story told by victims about their victimizers to be always simple and always true. It wasn't turning out that way. Yet it was almost taboo among us to admit that much of what we were doing wasn't working. Anyone who criticized therapeutic practice risked being identified with the FMSF, whose members were presumed to all be Abusers and Non-Protecting Bystanders. A new elephant had entered the consulting room, and we were in denial all over again.

Nurturing the Competent Adult

In this state of unease and not-knowing, I reached beyond the incest recovery movement. In 1995, I drove to Burlington, Vermont, for a weekend workshop in "Just Therapy," a New Zealand approach connected to both the Narrative Therapy movement and indigenous movements for social justice. Led by a white man, a Maori man, and a Samoan woman, all from New Zealand, the group opened every session with chanting and prayer, challenging us bemused, secular Americans to do the same.


That day, I awoke to the spiritual thinness of the therapeutic work we were doing. Within the incest recovery movement, victims had been assigned a debilitated and isolated purity, while abusers and nonprotecting parents were monsters without humanity or compensating strengths. In this black-and-white universe--with good and evil people neatly divided--our clients remained as trapped in spoiled identity as their perpetrators, cut off from humanity as a whole, from their own failings and strengths, and from the healing power of acceptance.

I thought variously of Gandhi's independence movement, of Alcoholics Anonymous, and of the Civil Rights movement, all of which had flourished rather than imploded. What had been their secret? Despite their enormous differences, all had transformed participants--and the culture at large--in a way I can only describe as spiritual. All had acted in the present moment--cognizant of, but not enslaved by, the past. All had faith in something bigger than themselves, and none demonized their purported enemies. Could the trauma survivors' movement do the same?

At around this time, I came across journal articles by the pioneering research clinicians Bessel van der Kolk of Boston University and Marsha Linehan of the University of Washington. Both turned attention from the psyche to the body of the trauma victim and hypothesized that self-harmful behavior like cutting could be an attempt to soothe chronic neurobiological disregulation. If this were true, our clients couldn't think, talk, confront, cathart, or "re-story" their way to wholeness. Their nervous systems were continually telling them that the past was the present. Rather than a prolonged version of the Primal Scream, they needed new ways to learn to reregulate their disturbed neurophysiologies.

At this point--please bear with me here--I took up tennis. I was in my late forties and out of shape, and I just wanted to get more play, joy, and exercise into my life. My tennis teacher, Deedie Steele, became such a model of encouraging and demanding realism that if I were still supervising clinical graduate students, I'd require them to watch her teach tennis.

Deedie thought anyone could become a competent tennis player, and her teaching reflected both kindly encouragement and a precise analysis of everything I needed to do to improve. Standing across the net from me on the public court in Northampton, she watched how I placed and moved my feet, knees, elbows, and wrists as carefully as if she were preparing me for Wimbledon. She showed me in minute, persistent detail how to make necessary changes. Good therapists, I thought one sunny day as I ran sweating around the court returning her serves and trying to pay attention to my right wrist, are like Deedie: they believe that each client can function as an effective adult, and they help them gain the skills necessary to make this happen.


In the classroom, in supervisions, and in my therapy office, I widened the lens and began thinking in similar terms, analyzing precisely the outer (relational) skills and inner (self-calming) skills that trauma survivors needed to function better. Then I taught these skills, whether they were considered "therapy" or not. I began asking questions that were once outside the therapist's domain: How much do you exercise? What do you eat? Do you have a sense of a Higher Power or a Protective Presence in your life? How do you play and express yourself creatively? Do you meditate? Are you getting enough sleep?

In my own life, things were moving, too. I entered a long-term relationship with someone who helped me learn to play and have fun. We renovated a house together in Northampton with the help of our son-in-law, a contractor, and I became part of a family that included grown children and grandkids.

I also returned to 12-step meetings--and there, too, things had changed. Women participate more actively in the recovery movement now, and I felt freer to share my story. The time I spent in those church basement rooms opened a door to a deeper spiritual yearning. After years of dabbling in Buddhist books, I began meditating regularly and discovered, in Pema Chodren and Thich Nhat Hanh, the notion of impermanence. This basic Buddhist tenet--that the "self" isn't fixed and that all circumstances and states of mind pass was the perfect antidote to the sense of doomed identity that had brought me to my knees in that mental hospital in Connecticut. I became more solid--and yet, oddly enough, more open to friends and strangers. I was living a fuller life than many people who'd never been abused.

Leaving a church basement one night, I found myself rethinking the whole question of victimhood, healing, and wholeness. As much as my clients needed to understand the links between their victimization and self-destructiveness, I thought, they needed even more to take an ordinary place within the web of life.

In 1995, my graduate students at Antioch New England university suggested we incorporate what I was trying with individual clients into group therapy. Our first three-month group was held in the offices of a domestic violence program in Greenfield, Massachusetts. This notoriously poor, predominantly white area of northwestern Massachusetts is a landscape of played-out farms, abandoned brick factories, and tattered, triple-decker apartments lining the side streets of decaying, 19th-century mill towns. Unemployment is high, and so are heroin addiction, crack use, and domestic violence.


Our first eight participants were women who'd repeatedly called the domestic violence center's hotline--most of them grandmothers, foster mothers, and single mothers with staggering histories of childhood abuse, alcoholism, cutting, drugging, enmeshment in battering relationships, and visits to local psychiatric inpatient units and emergency rooms.

We opened the first session by teaching the women simply to breathe with awareness. Then we talked about the links between their childhood histories, their addictions, and the way they had internalized all three roles: Victim, Abuser, and Bystander. Each week, we asked how trauma had affected them, but we also asked about the roots of their resilience--their successful coping strategies and the people they remembered who'd been there for them, even if not consistently.

Over time, we taught them to turn to other members of the group for support rather than to the group leaders. They painted and drew. In brief guided meditations, we helped them connect to something bigger than themselves. That opened the door to developing a felt sense of Protective Presence, evoked from memories of protective adults, beloved pets, nature, and compassionate religious teachers like Jesus and the Buddha. They learned to reliably evoke this presence to remind themselves that even though they'd been victimized, they'd also been whole people all along.

In the last three weeks of the three-month group, we focused on how they intended to give back to the larger community. Some returned to Alcoholics Anonymous or Narcotics Anonymous. Others went back to school, college, or work. Others chose to volunteer in the storefront drop-in centers I'd helped organize with other therapists, community activists, a small order of radical Catholic nuns, and a visionary federal project dedicated to supporting innovative work with trauma survivors. Self-destructive behaviors diminished and, perhaps more important, participants created an identity for themselves that included, but wasn't limited to, their traumatic past.

Since then, I've trained more than 200 women with histories of trauma, most of them poor, with limited education. I call this program ATRIUM (Addiction and Trauma Recovery Integration Model) after the entry chamber of the heart. The metaphor is meant to suggest that the groups are just a starting point. Their graduates now lead similar groups in local prisons, jail diversion projects, AIDS programs, and the three drop-in centers for survivors. Many of these women--among them many welfare-dependent single mothers and grandmothers--have turned out to be more effective group leaders than some of the highly educated professionals that I've trained. They're helping create what may be the therapy of the 21st century: a blend of peer support, psychoeducation, interpersonal skills training, meditation, creative expression, spirituality, and community action.


Time Is a River

I'm now close to 60--a middle-class, middle-aged professional living on Prospect Street in Northampton, Massachusetts--the same street I grew up on. I still occasionally see women in town with teddy bears in their backpacks and buttons saying "It's never too late to have a happy childhood." I want to tell them that their button is wrong: it is too late. Time is a river that runs in only one direction. Trauma survivors--be they Vietnam veterans, Cambodians, Holocaust survivors, sexually victimized women, or firefighters who escaped from the World Trade Center--never become people to whom trauma didn't happen. But the ripples that flow outward from every traumatic event don't have to sink us, define us, or assign us a single identity. "Victim," I want to tell them, describes a specific moment in time, not permanent self-definition. This is a comforting aspect of the impermanence that transforms every emotional state.

As a culture, we're only just waking from sleep. It's long been easier to blame people covertly for their reactions to childhood abuse than to face what happened to them. We pay staggering public health bills for the addicted and traumatized, but we balk at spending on preventing that trauma in the first place. Protective workers charged with investigating crimes against children, for example, make less than half what we pay the police officers who investigate adult crimes.

There are a few hopeful signs that this may change. In the wake of the priest scandals and the collective public wounding of the September 2001 attacks, words like victim and trauma have enlarged their meanings beyond the mostly female holders of this particular spoiled identity. The psychic damage suffered by the firemen and construction workers of Ground Zero made it clear that not only Vietnam veterans and sexual-abuse survivors suffer from PTSD. Nobody's yet suggested that the "heroes" of 9/11 are part of a culture of complaint. As Jack Rosenthal put it last fall in the New York Times Sunday Magazine, "Before 9/11, trauma often referred to the horrible physical injuries seen on E.R. Now the psychiatric use of the term may just as likely be referring to the time bombs that 9/11 lodged in the minds of thousands."

Meanwhile, I'm continuing to play tennis. Thanks to expert coaching and hard work, our aging, ragtag team, The Courtesans, has progressed from dead last to a respectable standing in our local league. When I travel to Washington, D.C., these days to meet with the federal agencies that fund our grass-roots projects in Franklin County, I sometimes pass the Mall, where, during huge women's rights rallies, I played in the New Haven Women's Liberation Rock Band with Florika. I think back 30 years to that desperate, unconscious, distrustful, and enraged young woman, three days drunk and covered with self-inflicted cuts, who was shot full of Thorazine and bundled off to a state hospital in Connecticut. She'd be both contemptuous and amazed to see who she's become: a physically healthy professional woman who works inside the system without ever quite joining it. And although I still hold in my heart that wild young woman and understand how she came to be, the river of life has flowed a long way since then, and she's now only part of me.

Dusty Miller, Ed.D., is director of the Atrium Consultation and Training Institute in Northampton, Massachusetts. She's the author of Women Who Hurt Themselves; Your Surviving Spirit: A Workbook of Spiritual Resources for Coping with Trauma; and numerous other publications on trauma and addiction. She's also the codirector of the Willing Spirit Retreat Center in Cape Cod, Massachusetts. Address: 229 Prospect Street, Northampton, MA 01060. E-mails to the author may be sent to dustymi@aol.com.

Resources

Barrett, Mary Jo. "Healing from Trauma." In Spiritual Resources in Family Therapy, edited by Froma Walsh, 193-209. New York: Guilford, 1999.

Chodron, Pema. Awakening Loving-Kindness. Boston: Shambhala Publications, 1996.

Herman, Judith Lewis. Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. New York: Basic Books, 1992.

Jordan, Judith V., et al. Women's Growth in Connection: Writings from the Stone Center. New York: Guilford Press, 1991.

Linehan, Marsha. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993.

Miller, Dusty. "Incest: The Heart of Darkness." In Secrets in Families and Family Therapy, edited by Evan Imber-Black. New York: W. W. Norton, 1993.

----. Women Who Hurt Themselves: A Book of Hope and Understanding. New York: Basic Books, 1994.

----. "Challenging Self-Harm Through Transformation of the Trauma Story." In Sexual Addiction and Compulsivity, 3, no. 3 (1994): 213-27.

----. Your Surviving Spirit: A Spiritual Workbook for Coping with Trauma. Oakland: New Harbinger Publications, 2003.

Miller, Dusty, and Laurie Guidry. Addictions and Trauma Recovery: Healing the Body, Mind and Spirit. New York: W. W. Norton, 2001.

Najavits, Lisa, R. D. Weiss, S. R. Shaw, and L. R. Muenz. "Seeking Safety: Outcome of a New Cognitive-Behavioral Psychotherapy for Women with Posttraumatic Stress Disorder and Substance Dependence." Journal of Traumatic Stress, 11, no. 3 (1998): 437-56.

van der Kolk, Bessel, Alexander McFarlane, and Lars Weiseth. Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: Guilford Press, 1996.