Trich as Addiction: A Holistic Perspective
**(If you don't already know what TLC is, it is the Trichotillomania
Learning Center - and the only Not-for Profit Association for
Trichotillomania. Their Website is www.trich.org. They have encouraged
me and others to post and distribute our notes from the TLC Retreat
sessions, in order to help as many people as possible!) I recommend that
you look through their site ... the Calendar section lists events and
Support Groups (who know they may be in your area).
**This was another session I didn't get to at the recent TLC Retreat,
(Aug '01), but the presenter sent me her notes. Claudia Miles is a
recovered TTM'er, who went into her field so that she could help others.
At one point she mentions 12-step reovery programs similar to AA, the
group as a whole at the retreat are finding that AA 12-step doesn't work
(has to be more specific to TTM), which the 7-step below is.
**I am too cynical for that type of meditation below, but if you can get
into it, l can see how it would be extremely helpful. She also mentions
the need to sometimes go 'deeper physchologically' which many of the
doctors disagreed with for the majority of ttm'ers. I liked what she
said about meeting your needs first. There was 2 personality
characteristics that really stuck out at the retreat for a large % of us
- -Perfectionism, and being a DOORMAT for our families and friends!
______________________________________________
TTM article
Dear Pam,
Here is the article I wrote followed by a visualization I do with
clients. I hope this is helpful.
Best wishes to you in your healing journey. Sincerely, Claudia Miles
(P.S. If you are interested in a phone session to support your recovery
or offer any help I can, if you are interested in working from my
perspective, or my consulting with your therapist (if you are working
with one who doesn't know about trich) please call me at my office at
415/460-9737 and we can set one up. Consultations are $100. I would have
you answer some questions for me first via e-mail and then set up a
session. I only make these appointments by phone.) 415/460-9737 or
415/451-7122.
______________________________________________
Trichotillomania as Addiction: A Holistic Perspective by Claudia Miles,
M.A., MFTI
*****When I entered graduate school to earn my master's degree in
counseling psychology, I had no idea I'd end up specializing in
trichotillomania. This, despite the agonizing reality that I had pulled
out my own hair for over 20 years on a daily basis, causing not only
bald spots but an increasing sense of shame and self-loathing. No matter
what I tried (gloves, bandannas, conditioner, hair cuts,
"determination," scathing self-criticism), I couldn't stop. Today, with
the exception of a three-month relapse in 1994, I have been pull-free
since 1989.
*****I have worked with hair pullers for nearly five years now, a group
that comprises 80 percent of my practice. I lead three therapy groups
for pullers (one for children 11 to 13), and see many others
individually. All my clients are in "recovery," in that they have all
taken that all-important first step: They have summoned the courage to
admit to another person that they pull out their hair and cannot stop;
they have sought help.
*****The most meaningful and effective way I've found to work with trich
is to conceptualize it as an addiction. This allows people to see that,
despite its high price tag, trich offers them pleasure--that a part of
them, a needy and wounded part most likely, will have a hard time
letting go of this haven, no matter how much they believe they want to.
Appearances to the contrary, seeing trich as an addiction brings in the
element of choice, something we at first resist, but a concept crucial
to the healing process. I often suggest to clients that when they are
pulling, they take the attitude that they are choosing to pull. Such an
awareness can be very empowering.
*****The most common definition of addiction is: a pleasurable or
self-soothing activity that offers immediate gratification, allows one
to escape painful feelings or thoughts, and that one continues to engage
in despite adverse consequences. Sound familiar? If so, you may be
interested in Gary Zukav's book, "Seat of the Soul'--especially the
chapter on addictions. Zukav believes, as I do, that uncovering and
facing addictions can be a path to meaningful growth: By facing them
directly, by being willing to confront whatever is beneath them--often
our greatest fears--we evolve as human beings. This is how I see our
"work."
*****One client who has pulled very little for about six months told me
that after a recent painful therapy session, she went home and pulled
for two hours straight. The moment she stopped, however, she burst into
tears and felt the profound grief she'd wanted to keep at bay. She said
later that she had never seen so clearly the connection between pulling
and "numbing out." By actually feeling the grief, she was able to move
through it She's pulled little since.
*****"But I pull when I'm not even aware of it," you might protest. "I'm
often simply watching TV, talking on the phone or reading, not in the
midst of an inner conflict."
*****That may be true--it was for me, and is for most of my clients. My
episodes of pulling can not always be traced so directly to a painful
incident or stressful experience, but when I forced myself not to pull,
even for a couple days, I felt heightened anxiety, fear or sadness. And
when I stopped pulling for good, when I could no longer crawl into the
womb-like safety of the pulling trance, fears of abandonment, aloneness,
and insecurity had to be dealt with.
*****I work with people to uncover and face their fears. If they are
willing, I sit with them in their angst, despair and grief. Some, you
may be surprised, also must learn to allow themselves self-esteem,
success and intimacy, things they never believed they deserved, and
which may change their roles with friends, family and in their
community. When you play self-sacrificing martyr long enough, people
expect you always to say yes to requests. They may become peeved when
you don't.
*****The need to put one's self first, at least sometimes, seems to me
universal among pullers.
*****"But I don't want to be selfish," you may protest. Remember,
being selfish means (i) always putting one's self first, and never
considering others needs; this is not what I'm suggesting. The fact is,
never considering your own needs can be just as destructive. How can you
be a loving parent, friend, sister and lover if you are always operating
at half-mast, feeling resentful, empty and depleted?
*****Most people want to know WHY they pull. I understand their
curiousity. While some medical research--and my own experience--points
to a variety of physical factors, I see hair pulling as a more a "soul"
problem than a medical one. My own belief, based on my personal and
professional experience, is that trich, like alcoholism, is both genetic
and physiological, but that this is not WHY we pull anymore than it
explains why the alcoholic picks up her first drink. I feel we are born
with the predisposition, and a variety of events, some severe, some less
so, can trigger it.
*****Triggers most often happen in childhood. Even those pullers with
so-called "normal" childhoods suffer the slights and indignities of
growing up (such as adolescence). Others suffer more serious injury such
as the death of a parent or sibling at a young age. Some, tragically,
are physically or sexually abused, or grew up in alcoholic households.
Still others were given the message one way or another, and repeatedly,
that they are not living up to parental expectations, and by extension,
that they are simply, unlovable. This is a kind of tragedy, too, and is
what I see most frequently. Nevertheless, why would hair pulling be a
response to any of these things?
*****Pulling, plain and simple, is an escape hatch. If you've read
anything on trich, or have it yourself, you are well aware of
"trance-like" pulling. Whether one shuts down or numbs out first, and
then begins pulling, or starts pulling and then goes into a "trance," we
are clearly dealing with an altered state one. Such a state can shut out
parents yelling at each other, being teased at school, or simply feeling
so worthless and empty it seems intolerable. For some people--most, in
fact--pulling was a best friend in those early years. It allowed you to
"go away," when in fact, you couldn't leave. It gave solace. You may
even want to thank your pulling for having protected you when you had no
other way out.
*****If you are now an adult, though, you have the power to help
yourselves in ways you couldn't then: You can go to therapy and learn to
tolerate painful feelings (a fact of life) and also joy; you can learn
to love yourselves--whether or not you are pulling; and you can
physically leave abusive or unhealthy situations. You can, if need be,
reduce contact with your family and create a new one: a network of
people who love and support you just as you are.
*****I actually tell my clients not to worry about pulling when they
first enter treatment, a direction they often find shocking. "But if I
don't at least try to curb my pulling, I'll pull so much more." Let me
tell you how my clients "curb" their pulling. They engage in the most
hateful, cruel and nasty self-talk imaginable. After pulling, they tell
themselves they are sick and disgusting. They tell themselves they are
"pathetic" for not being able to stop, weak, bizarre and grotesque. Can
you imagine saying this to someone you dislike, let alone a friend? Such
self-abuse creates a vicious cycle that becomes deeply ingrained.
*****There are two things I tell my clients they will need to do to
recover: One is to stop mentally chastizing themselves in the way I've
described. It takes work, but is possible to forgive one's self and
develop compassion for the wounded part of the self that longs for the
comfort pulling brings. The second thing is to develop awareness. A
formal meditation practice is not necessary, but reading a book such as
Thich Nhat Hanh's "Miracle of Mindfulness" will aid you in bringing
mindfulness into your daily life. The more you use your breath as a tool
to center yourself and bring yourself into the present (if you're
feeling regret, you're in the past; if you're worrying, you're in the
future), the more likely you are to start becoming aware (i)before you
pull. This is the "easiest" time to stop; once you've started pulling,
the addiction has been sparked and you're battling the beast. Heightened
awareness, thus, is essential.
*****Though I do see value in behavioral and cognitive techniques,
particularly with children, with adults I experience the need to go
deeper in the psychological sense. There are often deep feelings of
worthlessness and shame that have been ingrained as the result of one's
pulling, coupled with childhood issues that may have initially set off
the addiction, and these must be dealt with. Replacing pulling behavior
with an "alternate" behavior, without doing the inner work, is, in my
opinion, like covering over a splinter with a Band-aid. It works for a
while, but eventually you have to get in there and pull that splinter
out. And yes, pulling it out can hurt like hell, especially if it's been
festering for years. But how else can you truly heal?
*****The following are what I call my Seven Stages of Healing for (Teen
and Adult) Compulsive Hair Pullers. As you'll see, these are not quick
fixes, but I hope you find them useful. I also recommend attending any
12-step meeting (such as Alcoholics Anonymous) and mentally substituting
"hair pulling" for alcohol. I found the 12-steps enormously helpful in
my own recovery as do some of my clients.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Seven Stages of Healing for Compulsive Hair Pullers By Claudia Miles,
M.A., MFTI
***I. Acceptance: Accepting the self as worthy and/or lovable, even
while still pulling. Though it seems paradoxical, if one is able to
accept one's self as a puller, the pulling no longer has the charge or
the negative "pay off" for the psyche.
***II. Self Forgiveness: Forgiving the self; ending the shame/self-blame
cycle. Viewing the puller as an unhappy and frightened child who needs
love and soothing, not as a "disgusting," "weak," or "bad" part of the
self. Changing one's attitude accordingly.
***III. Investigation Listening to the message of the "Inner Puller:"
Some part of the self is trying to get our attention via the pulling; if
we can hear the message behind the pulling, the pulling no longer has a
purpose. (If the pulling is 'saying' "my needs aren't being met," and
the puller learns to express those desires to either him/herself or a
partner, this can lessen the need to pull.)
***IV. Understanding Pulling as Self-Soothing: Understanding that in
pulling, one is trying to soothe oneself, not self-destruct, often in
the midst of painful feelings "grief, anger, anxiety. To address this,
we learn to 1) listen to and be with feelings that seem "intolerable,"
so it is not necessary to escape via pulling; 2) learn to soothe oneself
in other ways such as loving self-talk, an attitude of compassion toward
the self, and engaging in activities that both feel good and are
supportive of the self; 3) learn and practice relaxation techniques.
***V. Waking Up: Bringing awareness to the process of pulling so that
one begins to "wake up" sooner in the pulling experience. This is done
through relaxation, meditation and developing the "observer" within.
(Read: "Zen Mind, Beginners Mind" by Suzuki; "Miracle of Mindfulness" by
Thich Nhat Hanh.)
***VI. Hope: Believing that it is possible to "get well" can be an
important stage in healing. (This would be Step Two in 12-step
programs.) This can often be achieved by getting to know other pullers
who have stopped. Prayer, meditation, and other spiritual involvement
can also help (Steps 3 and 11 for 12-steppers).
***VII. Addressing the Habit: Sometimes, when all the other inner work
has been done, one is still left with the "habit" of pulling when
watching TV, talking on the phone, driving, etc. Once self-blame, shame
and self-loathing have been addressed, behavioral techniques "choosing
an alternate activity to do with one's hands, for example" can be
helpful.
______________________________________________
Claudia Miles, M.A. is a registered Marriage and Family Intern who
practices in Marin County, California. Interested clients and fellow
professionals may reach her at 415/451-7122.
______________________________________________
Meditation
Try this 1-2 times per week
**Close your eyes. Take at least 10 deep breaths, inhaling through the
nose for five counts, exhaling through the mouth for five counts; hold
for a few seconds at the end of each inhale and exhale.
**Imagine that you are inhaling (taking in) relaxation, and exhaling
(letting out) stress. Inhale relaxation; exhale stress.
**In your mind, go to a beautiful, relaxing natural spot where you feel
safe. A beach, a meadow, a garden, a forest, etcetera. (If you prefer,
you can choose an indoor spot like a special room.) It is important that
you choose a spot where you feel safe.
**Imagine a figure in the distance walking toward you. You can't see her
clearly, but you have a sense that this is your inner hair puller.
**As she comes into view, you see yourself at a young age. (You'll know
how old she is when you see her, but she's probably under 12.)
**Invite her to sit down. Notice her reaction -- and yours. She may or
may not feel comfortable sitting down. Tell her that you would like to
get to know her. Again, notice her reaction. She might be very
interested, but more likely she ignores you, or perhaps even acts out in
some way. Be open to whatever her reaction.
**Tell her that you realize it would be difficult, if not impossible,
for her to trust you right now because you've been out of touch so long.
And that you don't expect or need her to trust you right now, that she
can take her time. Also, let her know that you're going to keep coming
back to connect with her, and that you will NOT ABANDON HER. (It's
important not to make this promise unless you intend to keep it.) Tell
her she'll NEVER be alone again, that she now has what she didn't have
long ago, a CHAMPION, someone who will be there for her NO MATTER WHAT.
**Tell her you realize that the hair pulling has been her way of
communicating with you and trying to get your attention. That you didn't
realize that in the past, and now that you do, you really want to know
what it is she wants and/or needs. Again, she may not be ready to tell
you this at first. Let her know you are willing to wait.
**Ask her to share with you what she has been trying to communicate via
hairpulling. Listen. Wait. (Return to this step regularly). Ask
her to share anything else she would like to share. Again, listen, wait,
and let her know that you'll be ready to hear her whenever she's ready.
Ask her any other questions that you would like.
**At this point (when you both feel safe), you may want to gently let
her know that she no longer needs to get your attention via pulling
because you will continue to check in with her regularly and really
listen to her. Remember, you need her as much as she needs you. Notice
her--and your--reaction.
(Depending on her age, she could be acting out in some way.)
**Promise her (only if you're willing to keep such a promise) that you
will check in with her on a regular basis to see what she needs. Ask her
if you can give her a hug. If she says yes (which she might not the
first time), hold her tightly. If she says no, continue on.
**Tell her you want to keep her next to your heart always. Watch as she
becomes smaller and smaller, right in front of you, just small enough to
fit inside your heart.
**At this time, put her inside your heart. Return to your breath,
allowing yourself to integrate the experience. Breath slowly, in and
out, inhaling through your nose, exhaling through your mouth, until you
feel ready to open your eyes.
**IMPORTANT NOTE: This exercise may bring up a lot of emotion, therefore
do not undertake it if it feels too scary and you have no support such
as a group, a therapist, or even a good friend who is willing to be
there for you afterward. Ideally, if you have a therapist, you may wish
him/her to lead you through it.
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