12-Step Programs & Therapy: Do They Mesh? | Dr Frank Yeomans
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- Опубліковано 26 чер 2024
- Dr. Frank Yeomans discusses the benefits of joining a 12-step program and how going through The Steps might interact with a person's therapeutic process. Substance abuse and personality disorders frequently coexist in a person, so the question of "therapy or 12-step" is a real one for many people.
How does someone reconcile or balance ideas of powerlessness and responsibility? Can you have a 'higher power' without being religious? Why is the 4th-step inventory so difficult, and is there an equivalent in therapy? Why is it so hard to face certain parts of ourselves? Can therapy offer a sense of community, or can it be 'spiritual'? Could there be a 12-step program for personality disorders? What is the point of therapy, or a 12-step program? What is the most important step in a therapy treating severe personality disorder?
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Frank Yeomans is an expert clinician who makes use of Transference-Focused Psychotherapy in his practice treating NPD and BPD. In fact, he co-wrote the manual on TFP for Borderline Personality Disorder!
Check out our interview of Otto Kernberg (who mentored Frank Yeomans) for lots more related material: • Dr. Otto Kernberg
For more information about BORDERLINE, the feature-length documentary we made about BPD, please visit: borderlinethefilm.com
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The fact that you bring these true professionals in youtube, is invaluable. UA-cam is so cluttered with self certified experts spewing absolute nonsense.
12 step for addiction devastated my sobriety. Particularly the fourth step which involves basically criticizing one’s own self and not applying apology in a judicial sense. Other people have roles in our psychology and that is the serious truth. It wasn’t until I got into clinical therapy and was diagnosed with BPD that I started to understand my extremely intense emotions of abandonment. One has to absolutely work with a psychologist in order to come out the other side. Also, I am a very altruistic person. I try to do right by my fellow man. An ego deflation system as AA was absolutely not what I needed. I needed something that would raise my self esteem and place my delusions in relationships in perspective. No sponsor was able to do this. His statements are very optimistic, even with a narcissistic diagnosis. Remember the crux of BPD is emotional dis regulation. That can mean a lot of this is experienced internally.
BPD doesn’t really tell the therapist much… one has to examine what type of BPD it is…
I so feel you!!!! 🌹
Powerlessness is not helplessness. Powerlessness is about acceptance. :)
Powerlessness is still a dangerous lie to tell people.
@@joliechronicles3831 it’s not a lie . If you are an addict or drunk , you are powerless over that substance. It’s in control. You seem confused
In my opinion "powerlessness" is about 'not god (-like)' or emphasizing that one does not have 'god-like power over e.g. alcohol because your life is unmanageable'.
Sometimes people believe they can beat an addiction by possessing "super-human" strength or willpower and/or they need to do it alone. However, powerlessness suggests that they don't need to do it alone and others who go through similar challenges can be of help.
That is 100% true and the comments above don't seem to understand the true meaning as used in 12 step work. I am powerless over Opiates and cocaine, and admitting that was a HUGE part of my recovery. Has nothing to do with God, being alone, getting help or being weak. Its an admittance that once you use, you are powerless over the drug. You gain your power back by not using.
@D Powerlessness over drugs is something every addict has, once you get that first one in you. It's a choice, to be powerless after or to become empowered by not using.
Love this channel!
SUCH A BRILLIANT MIND!!!!!
Damn, I love listening to him!
Wow... the best 5th step description (example) Ive heard !
Find your wounds and wounders and look at your own part in it
Idk why but 12 step programs were akin to trying out religion for me. I just went away feeling worse. It felt culty and cliquey. I wasn't comfortable sharing my deepest stuff with other addicts I needed a professional. I'm cluster b and CBT and DBT therapy has been amazing. 🙏🙏💖💖
I honestly believe that addiction is it’s own personality disorder in a similar class as BPD and NPD.
They call it SUD, substance use disorder. It certainly mess with the personality.
It is in a lot of cases BPD and NPD. Untreated. They is no such things has "alcoholism". Least of all "alcoholic thinking".
Editing distracting again. I’m not sure what it’s supposed to add to the material
Top Material here!
It really is an aggression in every small thing that we do. I blame myself very much for knowing it but doing it again and again to people who I love the most. I had trouble realizing that I have BPD for lack of external aggression. But that's just because I'm that introverted so I do it to myself physically and psychically but to others only subtly psychological.
Wrong, wrong, wrong.
Listen to this podcast : Shame, Guilt, and Ruminations with Donald Carveth, Ph.D.
What Yeomans has also touched on these few last videos, is the paranoid schizoid & depressive position. They are extremely useful concepts. And in this podcast, Donald Carveth (who you can btw find here in youtube), goes though it quite well.
He points out how these self attacks, are actually a way to avoid guilt. As longs as you attack yourself, you can avoid real reparative guilt. If you think about it, how does this blaming of yourself help the other? It has nothing to do with the other, its all about you.
You can find the podcasts by googling.
@@Nobody-Nowhere thank you. I will check the podcast! And if you have any other podcast suggestions on this matter I'll be very glad. 🍀
@@Linlin.things I have not found anything better or more condensed on the subject of paranoid schizoid & depressive positions. Overall, i think its worth to explore these positions, to understand them. As it offers you a valuable perspective. And is also closely connected to the splitting mechanism. Melanie Klein was the one who came up with these theories. Donald Carveth has a long video lecture series on Kleinian theory, if that interest you. You can find it on his channel.
Also, i could recommend reading Otto Kernberg's book "Aggression in Personality Disorders and Perversions". You can also find Kernberg's interviews on this channel, he is the one who put borderline on the map. The book explains really well how affects function, and where the anger actually originates. The most interesting part of these books is that they offer clinical case examples, so you have examples on how things play out in practical sense in interactions.
All in all, i can say that stick with the professionals and avoid youtubers. Even if it takes a bit more time to understand the theoretical concepts, its worth it. I think the object relations view, is what is the most beneficial in understanding how we relate to other people. And this is exactly what Kernberg uses, as does Yeomans. And its based on Kleinian psychoanalysis.
12 step done well as the Dr. said help’s. Moral inventory is important but not turned to legalism. Therapy done well depending on emotional and underline mental disability. Having and retaining healthy relationships and knowing the skill’s to maintain them brings growth. Honesty with one self is necessary and fruitful but it takes time. Establishing a good network of people is essential.
My 30+ years of working in addiction have seen the horrors of 12-Step-shaming! 12-Steps works about as often as a placebo. 12-Step shaming is no better than religious shaming. Word to the wise, stay away from the shamers in 12-Step.
Alcoholic Anonymous is not about shaming. Quite the opposite. It takes the shame out of addiction. Instead you see and meet people who are struggling or who have struggled in the past. These people share their experience, strength and hope in meetings. There is lots of laughter and camaraderie in the meetings. Addiction is a disease of isolation and shame. In meetings you remove that shame and it's a "hey, we're in this together" vibe. If someone shames you, they aren't working a good program. But to each his/her own.
I agree, I have chronic anxiety, they kept saying your not working the program. That’s there way out of everything where as a person is suffering with intense symptoms. They made feel awful about myself. They have no knowledge on trauma. They never evolve & there are many, many very sick people full of ego.
@D Your experience has been validated by many people who have sought professional mental health treatment because AA didn't help them heal their deep emotional wounds. Thank you for sharing your experience.
@@DrDavidPhD Without the sobriety that man people get from AA their psychotherapy would be useless. Thank God I had a psychiatrist wise enough to understand this simple fact before he began delving into my childhood. He made it clear that until I got clean he couldn’t possibly know what my real issues were. I got clean.
@@Lilynite10 Who is they? A bunch of recovering drunks? It’s not called Anxiety Anonymous, it’s called Alcoholics Anonymous, that’s the only thing you’ll have in common with most of those people. Use them to help you find sobriety and get professional help to unwind your daddy issues.
I don't know....I can absolutely see the value in asking "do you see how this behaviour would feel aggressive to someone else?".....but I'm not sure trying to convince them that they INTENDED aggression, in a moment where they were so focused on their own pain it's impossible to consider someone else's, is going to do anything other than gaslight them and shame them with your own projections.
There's a discussion in some depth of this issue in Jeffrey Seinfeld's (American object relations theorist and psychotherapist) book, The Empty Core (1991). Seinfeld, similarly to Yeomans, values 12 step programs as often very helpful, and discusses the relationship between the emptiness depression that is so characteristic of borderline, schizoid, and narcissistic personality disorders (Seinfeld's focus in the book is on the schizoid PD), and addictions. The book is a bit difficult to find these days but is available in various reference libraries and can be found online if you look in the right places.
So interesting. Thk you for the knowledge and reference!
The admission that one is powerless only works if one believes in a higher power and leans on that power instead of on the self. That doesn’t take away from accountability, or at least, it shouldn’t. It must be part of the personality disorder to use the “powerless” realization to dodge accountability.
Without the sobriety that I got from the 12 Steps psychotherapy would have been useless.
This will be a long comment. Enough for an article, and I will save the text, but this is definitely a good place to share it, so here we go 😊
I spent about a year in ACA (Adult Children of Alcoholics and other dysfunctional families). I attended several meetings (groups), often 4-5 per week. In the beginning it was wonderful. It helped me to break out of almost total isolation, I learned to listen without commenting (at first strange with my family background....), felt useful/needed by doing service...
A bad thing was the cultish aspects. You had to praise the program, the steps, the prayer and how much these had helped you to become a better person (better than the rest of people outside of the program....) in one group, with 5 meetings a week.... you were even told NOT to share anything from therapy or other ways to understand and heal..... At the same time as the program talks about every person's way being unique...... Definitely a RED FLAG 🚩
I left when I realized that these rooms, in spite of the "recommendations, were NOT a healing environment but basically just an alternative set of absolute rules and truths, mainly narcisstically organized/controlled. Agression and fear as soon as you did not stick to praise" The Family", it's steps and its truths, just like in any cult/dysfunctional family
There are many rules (recommendations) created to make meetings "safe" but I have seen "old timers" use some of them to abuse/control/silence and the system with sponsors - sponsesces is easily used by narcisstic "old timers" as a source of getting narcisstic supply. Supply from (stupid...) newcomers that are lured in with a "honeymoon" pretty much like in any any cult or relationship based on emotional control. Like a pyramid game, lots of newcomers, many leave but enough stay to feed those higher up..... No wonder they claim you have to keep going to meetings forever.....
Knowing some of the history behind ACA, sometimes called ACoA might (?) help to understand. The origin of ACA, back in the early 80ies (?) was a small group of teenage children of AA parents that felt that, even though their parents might had become sober NOTHING else had improved.... In the start it existed free from other 12-step programs, was loosely structured and so small that it almost disappeared. To save it some "good" adults (from AA) was invited. This seemed like a good idea at that time but, unfortunately, got the not so wanted consequense that it began to lose its uniqueness and move towards basically becoming a copy of what they originally were an attempt to break free/understand/heal from....
There are still 12 slightly, but importantly, different steps formulated exclusively for ACA. These steps almost... made it to become STANDARD for the groups, but by then "the parents" had had already taken back the control and the official steps became the same as in AA. Steps formulated in the 30ies.... with the only goal being to stop drinking, NOTHING about healing the cause to why you drink (drug, eat, gamble, have sex... If you are in any of these "subgroups")
Groups/meetings are still "allowed" to use these "alternative" steps but most people don't even know they exist. In Stockholm, some years ago when I was active, there was one, out of at least 12 meetings that kept these steps but there were often voices raised that also this group should confirm to the "standard steps".....
One of the main difference is in step 4. In the "alternative" version you are NOT ONLY focusing on what is wrong with yourself and your wrong doings but also what was wrong with your environment, your parents, the family dynamic. Coming from a narcisstic family and several narcisstic relationships (where I was the "bad guy"). I had already spent some 55 years trying to understand what was wrong with me, without ever being able to become "good enough".... Starting to look more outside me, the games I had learned to play/accept was a crucial step to even begin my "healing journey".
Looking at your own faults is essential for all of us. The problem is that those that need it the most (people high on narcissistic traits) will always find a way to avoid it and, if possible turn it against us "loosers".
By the way... In 12-step programs there is something referred to as the 13:th step and 13:th steppers. These are old timers picking up newcomers for sexual partners. Bill, one of the two "founding fathers" , a married man, was known to be a notorious 13:th stepper.....
Some people say:"12-steps, by narcissits for narcissists". I don't like to be that black and white, there are good people and good ideas, but in general.....
I'd love to chat...
@@cherylmoschitto_outwardsilenceDo you like to talk about this even though you, as far as I can see, seem to be a "believer"? Pls don't take this personally, I just talk from my own experience of "believers" and I don't mind discussing the topic with anyone, especially not with "insiders" that are still attending meetings.
Omg!!!!! THIS! Thank you I felt the same way! 🌹
As a therapist and lawyer, I have nothing good to say
on the AA 12 step. This is because, in part, of the dangers of anonymity (specifically how it allows avoidance of accountability), the complete lack of standards for leadership (anyone can lay claim to leadership position), and the sundry motivations that must be identified and negotiated by fellow members (there is a difference between "intention" to stop alcohol, and the motivation). The 4th step is a group exposure similar to that used by Synanon and similar cult like groups. AA in particular, insists that the AA program is the only way to cope with your "disease" and without which you will die (see the Big Book). Members who leave the group are routinely cut-off and shunned. There are no protocols for screening sponsors who have inordinate power over the raw and vulnerable new members. Please take a closer look at AA programs YOURSEL, rather than relying on reports from AA members. Check the statistical success rates, which are quite low, among the lowest of available programs. What AA does have is a good PR department, which, thankfully, is losing ground as more and more stories are coming out of the terrible abuses that are perpetrated on "newbies" such as sexual abuse of women known as "13th Stepping" (look it up if you have not been told) the financial and emotional exploitation of newcomers by older members whose credibility is defined within the group according to how many years they claim sobriety. But observe - there is no background check and no way to verify claims of the established members. Since addiction involves significant self-deception, it should not surprise that many of the predators who troll the "rooms" are discovered to be liars. Your work with the TFP model is fantastic. So it quite surprises me that you are seemingly recommending AA without having examined first-hand what has become a growing scandal that is already starting to burst and every bit as bad as the pedophile priests did in the 1990s. As is often the case, we plaintiff lawyers have the benefit of discovery and subpoena, and so get a look behind the curtain of secrecy, anonymity and exaggerated claims, but the public will eventually learn the full extent of the wrongdoing and coverup.
No doubt, there are some sincere AA chapters, however, the aforementioned structural problems, institutional cover-up, and group-think indoctrination all mitigate against recommendation and, increasingly present an outright danger. ( Even AA responsible AA members privately acknowledge these issues. ) Any caring relatives or spouses: If your loved ones are considering AA, at the very least attend the meetings with them, and be aware of the risks they take entering the "rooms"
The photo thing. Was it aggression, or lack of empathy. Not being able to feel what they feel. But I suppose if they had cognitive empathy they would know what the other would feel, and may either want that, or not realise its effects because empathy is not well rounded. Does the aggression stem from blame, and inability to express frustration honestly. do get a message from society to suppress aggression, control it within limits of course yes. Maybe assertiveness or negotiation skills are a very significant life skill that needs learning in order not to be passive aggressive.
interesting video ✅
Hi! I've never heard about this "12 Step Program", could you make a video on it, or suggest to me a reliable resource to deepen? Anyway, the video was really interesting, especially the last example! Thank you very much, as usual 😉
it's Alcoholics Anonymous or Narcotics Anonymous. There are meetings available all over the world. You can get information online and there is a central office you can call to find online or in person meetings in your area.
@@birdgirl2289 Ok, thanks! It was just a curiosity...
There are also 12 step programs for friends and family of people suffering from addiction: Al-Anon, Nar-Anon. Of course, these are pretty much ignored since the person with the addiction is the center of the universe and destruction of oneself and others....
So many people go to 12 stop group for yrs without working the steps and/or sponsors weild a power. The BB was intended for people who were isolated. Undoubtedly fellowship is important, but at some point you've gotta work it for & by you so your not stuck blaming others
I wonder if everyone with a need for AA, alcoholism and addiction is BPD and or NPD? And so maybe all 12 Step programs already are 12 step programs for personality disorders.
I think you’re on to something that I’ve theorized in my personal work with people who experience addiction. I think more fundamentally, many people who cope with substances have disrupted attachment and problems with emotion regulation, both of which are factors that characterize personality disorders.
Yes... With you on this question. The one thing I will say from personal experience - though I have not heavily partaken in the 12 steps (mine was specifically for an eating disorder and I found OA not great for me on helping me manage food and ultimately needed to go to in patient treatment). Anyway, when I did do the AA stuff for marijuana I found the promise of the program - "you will get better if you do this and stop" not to line up with my stopping. I began venturing into the steps, but was in so much emotional pain, I couldn't hold to the stopping. When I went into PD treatment, I appreciated my therapists telling me they weren't sure I would get better, that they could offer me no guarantees. Scary as that was to hear, I appreciated the truth of unassurance. It felt more honest to me. That said, I bow down to the 12 steps. They have helped SO MANY people.
Some say "By narcissists for narcissists".... In my experience there are good people, good ideas and good traditions/recommendations but the system can be gamed.... and I have never been in "rooms" with that much narcissism and fear of trusting your own truths as well as more modern science about brain, trauma and healing.
@@healcptsd6467 Like any other group or religion - some people make it work and use it to do good, some people are jerks, some people take it to an extreme. It's why I don't blame religion for the terrible things done in the name of the religion - it's human nature and that human nature came first. It's our innate aggression and the messed up ways we can divert it or express it that causes the bad and evil in the world, not the rationale.
@@suzanne6441 Many groups run by dinosaurs are closed-minded and exclusive. Bill W. and Dr. Bob are probably turning over in their graves.
these well intended ideals dont often translate into a working reality
I fully agree! And wrote some about it 😉
Accept that one is powerless.....against whatever the focus on the 12-step program is, doc, not powerless in general, right?
yes. we are powerless over the substance once it is in our bodies. we only have the power to stop taking that first drink or drug one day at a time, at first one minute at a time. the longer you abstain, the easier it gets to abstain. AA or NA is for some the only way to begin to stop the compulsion to seek comfort in the substance. Doing it on our own, became impossible. We tried. So it's "I" maybe can't but together "we" can. If that makes sense.
@@birdgirl2289 @Bird Girl I'm saying, he's making an oddly misinformed over generalization about 12-step programs. And the powerlessness is just a metaphor really or a mental ploy, it's more about a capitulation, a mental surrender. But he's making a generalization about powerlessness as almost an affect or identity, which he's saying makes therapy more challenging. Y'all feel me?
Too much editing. It becomes distracting to have the frame rapidly changing. Other than that though the quality is good
What helped you with eating disorder?
Good question. I am going to do a video on this.... Stay tuned. But, in short, CBT and exposure therapy to the foods that I feared. It was NOT easy and required good treaters and total willingness on my part to do whatever it took.
@@BorderlinerNotes interesting that you say total willingness in your part. The biggest part of 12 step groups of Honesty, Open-mindedness and Willingness... HOW. And working the steps. I've applied the steps to my eating and bad relationships and my depression and have found relief. It does work if you work it. And there are other ways to recover, and the 12 step literature humbly acknowledges that. I personally don't feel as though either of you have enough information to be talking about 12 step fellowships unless you have "studied" them first hand for as long as you would study in school. Having been various 12 step fellowships for about 12 years I would say you are spreading disinformation which is harmful to those who could benefit.
The 12 steps are vital for getting healthy and doing our 3rd and 4th step. Step 1 about powerless is about not going back to the drug and drink.
A higher power can be anything and that's why they made SMART recovery. It works if we work it. I disagree with the people with addiction most also have personality disorder?.. That's not true. The drug or drink is only a symptom of the dis-ease. I don't know about that being factual. God can be anything. The equivalent is to whatever you believe in. 12 steps and therapy both work.
I have had plenty of other woman that I sponsored that didn't believe in "God" and we worked through in during step 4 or before. The 4th step is so important and a huge part of growth. I haven't seen success in recovery without step 4. To own is to grow. I am trying to understand BPD more. There's truth in that kind of call and maliciousness.
It is sad... So what do they want out of it? Attention?!!
"They"? Why don't you write "So what do YOU want out of it?"
I suggest watchign the still face experiment that might explain the borderline beauvoir as most have grown up there whole lives in the still face experiment. Its on UA-cam
AA never helped me. Made me worse.
The editing is giving me difficulty in dealing with the complexity of reality.
They mesh, for all the wrong reasons.
A person with EUPD can never be trusted with their emotions.'' ---
Please stop video editing, it makes only worse :)
12 step for addiction devastated my sobriety. Particularly the fourth step which involves basically criticizing one’s own self and not applying apology in a judicial sense. Other people have roles in our psychology and that is the serious truth. It wasn’t until I got into clinical therapy and was diagnosed with BPD that I started to understand my extremely intense emotions of abandonment. One has to absolutely work with a psychologist in order to come out the other side. Also, I am a very altruistic person. I try to do right by my fellow man. An ego deflation system as AA was absolutely not what I needed. I needed something that would raise my self esteem and place my delusions in relationships in perspective. No sponsor was able to do this. His statements are very optimistic, even with a narcissistic diagnosis. Remember the crux of BPD is emotional dis regulation. That can mean a lot of this is experienced internally.
BPD doesn’t really tell the therapist much… one has to examine what type of BPD it is…