#76 Karen Perlmutter: The Mountain: Reframing Addiction for Families

I want to speak directly to you as someone who may be walking alongside a loved one who is struggling with substance use. In a recent podcast conversation, I interviewed therapist Karen Perlmutter, who specializes in substance abuse and mental illness and has over a decade of experience working with families. Our discussion focused on her evidence-based curriculum designed specifically for families, available through her practice, Collaborative Counseling LLC. Karen’s work exists because she has seen how much pain families carry and how often they are left out of the treatment process, and she is committed to making sure you do not have to navigate this alone.

Karen shared how, early in her career, she focused almost entirely on the person with the addiction and realized later that she had a major blind spot: she was not fully seeing the mountain that families are climbing at the very same time. She uses “the mountain” as a central metaphor in her work. Addiction sits at the top, and on one side is the person who is using substances, struggling in their own way. On the other side is the family, scrambling to reach them, often exhausted, scared, and confused. Karen’s curriculum is about building a bridge between those two sides, helping families deeply understand what their loved one is facing while also honoring the very real and valid struggles families experience themselves.

In our conversation, Karen described what she calls a “desperation for restoration.” Families remember their loved one at their best and are desperate to get that version of them back. Out of that desperation, many of us try to fix, rescue, control, and manage every aspect of our loved one’s life. These efforts are loving and understandable, but as Karen points out, they often backfire or become counterproductive. In her course, she walks families through practical, step-by-step ways to move out of crisis-driven reactions and into more effective, compassionate responses that actually support change rather than unintentionally fueling the cycle.

Karen also talked about shame as one of the heaviest burdens families carry. You might find yourself asking where you went wrong, what you could have done differently, or why this is happening in your family. Karen emphasizes that addiction is a complex disease with biological, psychological, social, and spiritual components. It is rarely, if ever, about one person’s failure or one family’s flaw. She shared the story of a father who came to see that he was responsible for only a small piece of his child’s struggle, and how that realization allowed him to move out of paralyzing guilt and into a place where he could actually be helpful. Her curriculum is designed to help families untangle blame, understand the true complexity of addiction, and find support from other families so they no longer feel isolated or uniquely defective.

One of the most frightening issues Karen and I discussed is suicidal language. Many families hear statements like “I can’t do this anymore” or “Maybe it would be better if I weren’t here” and are thrown into terror. Karen explains that this kind of language can sometimes express overwhelming feelings, sometimes be used in a manipulative way, and sometimes signal real, imminent danger. In her course, she teaches a concept she calls “language precision” to help families listen more carefully to what is being communicated, respond thoughtfully rather than reactively, and know when and how to seek professional help. Her goal is for families to take all suicidal language seriously, but not to be held hostage by it.

Another core element of Karen’s approach is helping families set value-based boundaries. Many of us set boundaries in the heat of the moment: “If you ever do this again, you are out,” or “I’m done helping you forever.” These kinds of boundaries come from real pain, but they are often unsustainable and confusing for everyone. Karen instead encourages families to identify their core values, such as safety, honesty, respect, and kindness, and to create boundaries that flow from those values. That can translate into limits around money, substances in the home, behavior in shared spaces, or how communication is handled. When boundaries are rooted in values rather than raw emotion, they tend to be more consistent, clearer, and more likely to be upheld.

We also talked about the pressure families feel around “self-care.” Karen acknowledges that when you are in constant crisis, being told to take a bubble bath or relax can feel dismissive or impossible. In her experience, families first need help stabilizing the immediate chaos—understanding what is happening, putting some initial boundaries in place, and getting educated about the illness. Only after that groundwork is laid does self-care begin to feel possible. Throughout her course, she weaves in realistic, practical forms of self-care and emphasizes the importance of connecting with other families and supportive professionals. Karen is clear that families deserve support and that their well-being matters, not only for their own sake but because a more grounded, supported parent, partner, or sibling can show up more effectively for a loved one.

All of these insights are built into the family course Karen you can find at collaborativecounseling.podia.com. It is a structured, evidence-based guide for families navigating addiction, covering understanding the disease, using the mountain metaphor, working through shame and comparison, responding to suicidal language, setting value-based boundaries, and slowly reclaiming your own life and health in the process. The course is designed so you can move at your own pace, revisit key concepts, and use it as a shared framework for conversations within your family.

Transcript

Jennifer Maneely: 0:00

Welcome to the Unbreakable Boundaries podcast with your host, myself, Jennifer Maneely. I have a really special guest today. Her name is Karen Perlmutter, and she has - she is a therapist. Her website and all of her awesome information is - you can find that at Collaborative Counseling llc.com And I just want to kind of introduce her, just really quickly. I've had a couple of really amazing conversations. I'm so excited, because it's so hard in this field where you find other people who are very interested in working with the family side of people that have substance abuse issues. So, whenever I find them, I get so excited, and Karen has over a decade of experience working as a therapist that specializes in treatment of substance abuse and mental illness, and has developed a particular interest in supporting the holistic needs of families who are affected by these struggles, which I think is just amazing. I think the more people we can find that help to help the families, the better we all are. She has developed an evidence-based curriculum for families coping with substance use and enjoys speaking in a variety of settings, offering education, skills, and hope. I have actually started going through some of her course that she has put together, which is amazing, and that's where I thought we could start. But Karen, thank you so much for being on the podcast.

Karen: 1:28

Thank you for having me. I'm really excited to be here.

Jennifer Maneely: 1:30

Yeah, and I actually, I'd start, I told her right before I hit the record button that I had started her course, and where she starts is something that is called the mountain, and I love the analogy of the mountain, because it just makes things so clear, because one of the things that I struggle with the most is finding that families have a hard time understanding what their role is, what their part is, with their loved one, they're like, but my loved one is the problem, I don't have the problem that they have, there's nothing wrong with me, and you know, Karen does a great job of explaining that, so if you could just give your a little bit of the mountain,

Karen: 2:19

yeah, yeah, I'm happy to, you know, I think in order to understand that metaphor, and, and I am an incredibly visual, metaphorical person, so the whole course, every session, is a different metaphor, actually, to help me wrap my head around these incredibly complex concepts, but I think, in order to understand where that visual comes from. I want to share a little bit about my history and the work that I've done, because it's directly related to why I view it the way that I view it. So, you know, I started my career actually about 20 years ago working in sort of an underserved population, mostly folks struggling with opiate addictions, you know, sort of an unemployed, underemployed, a lower socioeconomic demographic, so you know, within a short period of time, I really fell in love with the work, I found the clients to be, you know, sensitive and compassionate and creative and intelligent, and things that I guess I didn't expect to find with the addicted population, and really just fell in love with the work, but what was a complete blind spot for me for the whole first, I mean, almost 10 years of my career was that there was another side to this story, and the reason I mentioned that I worked with a lower, a lower socioeconomic group originally, the reason that is relevant is that their families, I imagine, just didn't have the resources to be a part of the therapeutic process, right? Maybe they didn't have their own car, you know, to get there, or they had their, they had to work several jobs, or they had their own untreated mental health issues, or all the things that people struggle with when there's poverty. I can only imagine that there was for every one of the the recovering clients I worked with a family that was also suffering alongside them, but, but it really, I mean, I'm a little embarrassed to say it, but it is what it is. They, they were a blind spot for me, like I saw these clients in a vacuum, right? Like, they came in, they were sort of an entity of themselves, and I didn't think of them as part of a greater system. We just wanted to treat them and help them through their trauma and their coping skills, and to rebuild their lives, and it wasn't till significantly later in my career that. I took a job at a medical institution that we had more of a mix, we still served, you know, the lower socioeconomic population, but because it was an institution with a really good reputation, we also started seeing, you know, more affluent families, we started seeing, you know, people with professional lives and careers, engineers, and, you know, physicians were now my clients, and you know that's a bit more of an empowered group of people, which means their families also are a bit more empowered, and they're showing up and saying, like, we want to be a part of this process, and I'm concerned about my kid, and I want to know, you know, I want to know what to do about my husband, and where are the resources for me, and that kind of thing. So, you know, therein grew my, you know, I began the journey of understanding that there was an entire other side of the mountain, so to speak, so I began thinking of addiction as something that really sort of sits at the top. I mean, it was, it was evident to me that, you know, the person struggling with the disease is not the bad guy. I had spent 10 years at that point, you know, getting to know these people who were often hurting deeply sensitive people, sometimes you know, kind of tormented folks, but, but not bad people. They had many of them had done bad things, but they weren't bad people, guys. I was like, well, the disease is the bad guy, not, not, it's not the person struggling. And then there's this whole other side, right, and and they're struggling too, and in some ways that are very similar to their addicted loved one, and in some ways very different, but struggling nonetheless, and sort of this parallel way, and the other thing that struck me as so interesting was how little understanding the addicted or recovering person, how little their understanding was of what their family was going through, and how little the family understood what the addicted person was truly going through. They could see the damage that the person was doing, but to really understand their pain, and I thought, oh my god, it's like the mountain, they can't see around to the other side, so I became really fascinated with that concept, and wanting to help both sides, and almost build a bridge between those two worlds to help them sort of collectively fight the bad guy, which was the disease, right, not each other,

Jennifer Maneely: 7:39

yeah, which I think is a great analogy, where it's like you're just on either sides of the mountain, right? You can't see around it, really, so you can't really understand what each one of you're going through, and then it's, it's, you know, each each side of the mountain has something different that they're working on, it's a different challenge, right, it's not that like the loved one with the addiction that has their set of challenges over on one side of the mountain, and then you got the families that have their set of challenges, which is not the same challenges, even if it is in the context. What would you say would be for the family side the challenge that they're facing the most when it comes to their loved one?

Karen: 8:32

Well, I think you know, interestingly enough, some of the parallels or some of the issues that the family is facing in a strange way sort of mirror the problems that the addicted person is facing, and I know that sounds strange, right? Because you know, the family isn't, you know, let's say that a person is deep in addiction and desperate and doing what they need to do to get to their drug, and they're, you know, forging checks or something like that, I'm not suggesting, like, oh, the family's on the other side of the mountain, and they're also forging checks, right? That doesn't, you know, that doesn't make a lot of sense, but you know, I tend to find that there's, you know, an addicted person develops obsession with their drug, they develop compulsive behaviors to get to their drug and sort of start losing their sense of identity and you know their healthy sense of self as this disease progresses. The same sort of things happen to the family, it just looks a little bit different, like the obsession on the family side is not with getting to a drug, but it's with fixing their loved one, right?

Jennifer Maneely: 9:47

Right, yeah.

Karen: 9:48

So I end up thinking of, like, you know, an addicted person goes through the day with this chatter in their head, constantly thinking about, you know, how to hide what they're doing. Doing how to maintain their self-image, you know, how to continue denying what they need to deny to get to make it through the day, you know, that chatter is constantly going in their ear about how to, you know, how to keep all their lies, you know, organized, and that sort of thing. The family has chatter too, but it looks more like, you know, what is my loved one up to? What are they doing? Are they, you know, are did they make it to that interview? Like, I, you know, I don't know. They look funny. Their eyes look strange to me last night. Should I confront them? Should I not confront them? Are they going to get matched? Should I walk on eggshells? You know, there's so.. you know, I think that the, the family begins to lose their own identity to a little bit because they're trying to live in two worlds, they're trying to live their own life, and then they're also almost obsessing over their loved one's life, because I mean it's coming from a place of love and fear and shame and all those things, they just want their family to be okay, they want their loved one to be okay, but it becomes almost an obsession. So, I think I think that the probably the biggest challenge is trying to navigate your own world while also sort of living with one foot in somebody else's.

Jennifer Maneely: 11:17

Yeah, and you know, I think I think that's interesting, because, and I don't know about you, and this, this may hold true for you, it may not, but a lot of the times I'm getting like I'm working with the families that don't know anything really about addiction and substance use, and they're just out here just kind of floundering, because a lot of times I think families like they have this vision in their mind about what a family of substance use looks like, right? You know, everybody is doing drugs with everybody, and not that that doesn't happen, absolutely, that's in a really extreme, you know, example, a lot of times where, but that's kind of what our picture has a tendency to be, and then you have these families that are struggling, they're like, I don't know anything about this world, I don't know anything about what to do, this isn't how I raised Johnny, this wasn't how Sarah was supposed to be, you know, like they had these, these big dreams ahead of them, right, for their kids, and then that kind of starts looking a little different as they go on, so I guess my, my question then is around that, is like, what would you say, and I know you have, like, the mountain, but when you have someone that doesn't know anything about substance use, what would.. what's like one of the first things that you tell people in terms of education around addiction? Yeah,

Karen: 13:00

you know, I think that there is this natural, I call it the desperation for restoration, which is kind of a mouthful, but it's like this desperation to restore your person, to bring them back to their best self, right? Like I always say, like if you're a parent, you remember that child when they were, you know, a beautiful little four year old swirling around the living room, or you know, oh, they had so much, you know, potential in baseball, in middle school, or it's, and it's like, how did we get here, right? Like, you're the, you, I call the family the torch bearer, like you're the, you're the one who is like holding that knowledge of how amazing this person could be, and, and you want so badly, I mean, sometimes even more than they want it for themselves, right, to get restored, like you. So we're sort of sometimes like dragging, trying to drag our loved one back to sanity with us, and sometimes they don't want it, sometimes they're not ready for it, sometimes they don't feel worthy of it, sometimes they want, they want it, but truly don't know how to get there, and it becomes like the blind leading the blind, right? Because you, as a family member who has maybe has no knowledge of addiction, you, you can't be the Sherpa that brings them back to recovery, because that's not your journey. You don't know, right? In fact, they'll get very, like, often annoyed and critical, like, you don't know about this, don't tell me how to do, you know, you're not in recovery, you don't know anything about this, which is kind of true. So, you know, I think families have such good intentions, and so many families end up sort of making the same choices, they end up like just doing the same things that ultimately are unproductive or counterproductive, you know, that I'll give an example, which is that the family keeps thinking, like, well, my loved one is stressed, you know, like maybe because they, they've gotten into this hole of addiction, and now they have, you know, a record, they can't get a job, or they don't have money. Need to buy a car, maybe we'll just buy them a car, and they'll get back on their feet. If we could just.. there's sort of this, like, if we could stay one step ahead of them, maybe we can pave the path for them, right? Right. And it's.. it's not.. and that's just one example of so many that families sort of predictably fall into that, like it just makes sense that if we just do these things, they'll turn a corner, or we'll help them get on the right track. And I always, it'll remind families, you know, that's not an illogical thought. I mean, you're playing by the rules, the disease doesn't play by the rules, though.

Jennifer Maneely: 15:37

This particular delivery set of rules, yes,

Karen: 15:39

it, you know, I think one thing that's really strange to me, as you know, I don't know if this was implied from what I was saying, I'm sort of an anomaly in my field, because I'm not in recovery, and most of my, many of my colleagues are in recovery, that's why they choose this field, but you know, after working with addiction for 20 years in a strange way, like I feel like it's like a, it's, it's, I sort of speak the language, it makes sense to me, like there is a logic that addiction follows, it's just not yours, right, it's not logical,

Jennifer Maneely: 16:12

right, but it is predictable when you know, when you know the rules,

Karen: 16:17

yes,

Jennifer Maneely: 16:17

when you understand how

Karen: 16:20

addiction ticks you, right? Like, yeah, it is.

Jennifer Maneely: 16:22

It is a very predictable thing, and that's that's one of the things that I, you know, try to kind of teach families that I work with, is the level of predictability. I was like, listen, I know exactly where they're at, and I can pretty much pinpoint what's getting ready to happen next. Now, I'm not a fortune teller, it just means that I'm just that predictable, because I understand the rules and the context that we're in in this world. So, right,

Karen: 16:46

your loved one is not predictable, but the disease is right. Just like certain types of cancers, we can sort of guesstimate how it's going to progress, because we've seen that type of cancer progress that way so many times. I didn't really answer your question, but I guess my answer would be the first step for these four families is to remove the shame. I, you know, I say you fell into the same, I call it the witch's brew or the co-addicted stew. I say you sort of, you fell into the pot, you didn't mean to, every family does, because you tried to respond rationally to an irrational disease, so the first step is to remove the shame, and then jump into the education. Right, you have to sort of say, listen, we truly were doing what made sense to us, but now we see we need to educate ourselves and understand how this particular disease works, right, so that we can recalibrate to playing a healthier role, and that I mean, that's really why I created the course, because I wanted families to understand not only what the rule book was, but what is the family's role in navigating all of this, and it does look quite different than I think what we into, what intuition brings us to,

Jennifer Maneely: 17:58

right, and, and you know, you had mentioned a little bit of shame, so I just want to tap into that a little bit, because this is something that I feel like families really suffer a lot with, and most, most people, maybe not all of them, but most people are suffering with this idea that they think that somehow that that the addiction, the substance use, somehow it was their fault, right, and that, that now they're trying to, it seems like they're trying to rectify some sort of fault that they had that they've created in their mind, that's not something. So, what? So, when you got family members that are struggling with this idea, how do you help navigate them through that?

Karen: 18:40

Sure, you know, I think that there are certain things in life that do kind of nicely and neatly fall into what I call a plus b equals c logic, right? Like, you kick a ball, it rolls across the room. No, I got that wrong, but like your foot touches the ball, it rolls across the room, and therefore the ball has rolled, or that kind of thing, right? Like, like that makes sense. There are things in life that function that way. Addiction and the family role is just simply not an A plus B equals C formula, and I think for parents a lot of times it looks like this. A represents a parent's only job is to produce a child that launches successfully into the world, right? And, like, you know, looks good, acts good, becomes a contributing member of society. Like, hey, it's my only job to do that, right. And then B is, well, my kid didn't do that. My kid has my kid has problems, like all my friends' kids are finishing law school and getting married, and my kid just got arrested again, right? Or what, or whatever the scenario is. So that's B. So then in their mind it has to become C, right? It's like, well, therefore I'm. Must have been a bad parent, like, where did I miss the memo on how everyone else got it right, and I.. and that's not what happened in our story, and I mean, I understand. I think our brains want to rectify things in very clean ways, even if it means beating ourselves up, right? Like, we want to be self-critical, you know, it's like, well, I want to make sense of this, so it must just be that I was a terrible parent, you know. I think again it goes back to the education that this disease is sort of a tangled web, it's a disease, and there's a few other diseases like this, but not a ton that have biological components, they have psychological components, you know, like, like traumas and underlying depression and anxiety, genetics that, that come into it. There's social components, and I don't, I don't just mean like who your peer group is. When we say social components, we're always like, oh, they hung out with the wrong kids in high school or something, and that is, that can be part of it, but social components means a lot of different things. It could even be like, you know, we were a home that, you know, didn't talk about feelings a lot, or maybe there was an intergenerational pattern of trauma that we didn't start, that started three generations earlier, that sort of led to a cycle of shame and secrecy, or privacy or different things like that could be social contributors, and then sort of a spiritual element to it also, and I don't mean religious, I'm going to define spiritual as like a sense of purpose, meaning, and connection, right, and there's a million reasons why a person could lose their way with purpose, meaning, and connection in the world that that has nothing to do with how their parents raised them, right. There's a lot of, you know, you could have a miscarriage, you could lose your job, you could, you know, be burned by a friend. There's a million things that could happen. So, you know, I think we want to over simplify this, but I think when we really look at the picture of what role we played in this, you know, I think there are times that we can, once we do understand that whole biological, psychological, social, spiritual disease, and say, well, there's a lot of parts that feed into what creates addiction, we can have a more realistic look and say, all right, well, I remember this one, Dad, I drew this visual out, which I'm not drawing out for you, but it kind of showed the four components, and I explained all, you know, I gave like many examples of things that could happen in a person's life, and you know, genetics and family history, and all sorts of stuff, and the dad, looking at it with this kind of cocked face, and couldn't tell what he was thinking, and he goes, I thought I caused the whole thing. I caused like 5% and he goes, I can live with 5% which he goes, and I can work on the 5% I can make amends for the stuff, you know, like, yeah, maybe I wasn't super emotionally available when he was a kid, but I was doing the best I could, and I can do better now, and you know, I think that it's, I think we can kind of put it all in perspective and realize we were doing the best we could with what we had, and if there were a couple things that we needed to do differently or have a different perspective on now, okay, it's never too late to work on those things, but that doesn't mean that that we were powerful enough to cause the disease,

Jennifer Maneely: 23:21

right. Absolutely, absolutely not. And you know to that, to that end, there's like a lot of like different culture things to that happen, because I know that I have family members that are constantly telling me, and one that comparison thing, right. Well, Johnny's not, you know, Bobby over here is getting out of law school, and Johnny is, you know, just getting out of treatment for the 20th time, right? And it's like, how, like, it's exhaust that whole comparison thing, but then how often do parents actually feel that pressure from their community of like, hey, get your kid in check, or the subtle things that sometimes you hear, like, I'll be out talking to someone that doesn't, that doesn't, that's not really familiar with any of this, they have young kids, and they'll say, oh, I would never let my kids behave like that, or do that, or like, you know what's wrong with it. So, we have that culture thing as well, and this is something that I spend a great deal of time working with families on, is paying attention to the culture, right, in and being mindful of when we hear that, not to take those things to heart and personally, so what would you say to someone who's just really struggling? Both these are two kind of different things, but I'm going to lump them into one question, but that culture, as well as the comparison, because I do think some of it ties in. Together, as well,

Karen: 25:02

I think for some families the temptation is to isolate because you just don't want to go to church and see the people whose kids are doing great, right, or you don't want to really let people know how, how insane your home was last night, or you know how bad things got, and your kid was, you know, high and screaming that they were going to kill themselves, or you know, some of these horrible things that sort of ensue, and then we have to kind of smile for the neighbors, right? So I think a lot of times people choose to isolate, and you know, I mean, it's sort of like the disease festers on isolation, like the disease is winning, you know, like for both, for both the addicted person and for the family, when isolation is the choice that you make, but, but that being said, it's true, there's a lot of people that just simply won't understand what your experiences, and you're right, particularly when they have younger kids, I mean, my goodness, we, you know, all have all sorts of things to say about how other people are doing things wrong until we've, we've been in their shoes, you know. I think one of the most essential pieces of sanity for families going through this is to be amongst other families that are going through similar things, you know, just sort of.. I always say, like, you know, just sort of like an Alcoholics Anonymous meeting is for a recovering alcoholic. I mean, it's just as important that we sort of find our ways to the, you know, wherever these family support communities exist, whether they're on the internet or Al-Anon meetings.. it, where I live in Charleston, South Carolina, there's a, there's a lot of family support communities, there's quite a few to choose from, which I know is rare, but you know, these families sort of huddle together, you know, it's like they get together in sort of the, you know, the corners of the of the society, and they meet on Monday nights, and a bunch of them come, you know, 3040, 50 families, and, and they're, they can see that there's other wonderful families out there, you know. They're looking around, being like, well, these people don't look half bad, you know, like they're, they seem like they were probably good parents. They kind of, you know, talk like me, look like me, you know, and they, they sort of find this collective place where they can sort of laugh together, cry together, you know, sometimes have that dark humor that you have only with people who understand your pain, and I think that's really healing for the families, whether you get it through the internet, if you don't live in a place like Charleston, or you find communities in your local area, I think it's a sanity saver, it's like you go through your life with a lot of people that don't fully understand, you know, like what a show your home was last night, or what you're dealing with, you know, but you know, like on Monday night or Thursday night, or whatever night you go to your group, like you're going to be with your people, and they're going to get it, and everyone's going to be like nodding and saying, like,"Amen, girl, I get it, or "Amen, but your buddy, like, I understand, you know, and like you'll know you're not crazy because you're not, not the only family going through this. I can tell you, if you're out there and you are, you don't know anyone else who is facing this, because a lot of families tragically don't know a single other family going through this that I, that I meet. I can tell you, I mean, the majority of my career is families parading into my office that can all relate to this idea of, you know, their kid is the one who's struggling in this way or that way. You are most certainly not alone, you just kind of have to find your people.

Jennifer Maneely: 28:34

Yeah, yeah, that's such a big thing. I read a lot of Brene Brown. I love Brene Brown, and she talks. This has been one of the more helpful things in terms of that comparison, that listening to people. She talks about the arena, right? And she, she, she.. I'm summing it up. This is not her exact words, but I'm summing it up, and through my interpretation, where it's like, don't listen to people who aren't in the same arena, as yeah,

Karen: 29:06

yes,

Jennifer Maneely: 29:07

right, because it's like, yes, if you're, if, if we're working out of the same playbook, if we're having the same understanding, the similar experiences that we can relate, then, then, yes, we can help each other, but outside of that, people who are in that arena can't really give us what it is that we're looking for, what we need, or the understanding, or any of those things. So that whole thing, and I think a lot about that in my life too, is because I get - I mean, I'm always getting unsolicited advice, just because that's people are just love to help, right? People just love to help, and I'm like, okay, I listen, but sometimes I'm like, but you're not even close to the same arena that I, that I'm in, and so then, and then I can kind of, you know, move that on. So, thank you for, you know, going into that, but you said something that reminded me I wanted to touch on. This, you had said something about their kid screaming that they're going to kill themselves,

Karen: 30:06

which

Jennifer Maneely: 30:06

is not an uncommon pattern of behavior. It seems so unpredictable, and so, you know, that kind of.. I don't want to call it dramatic in a negative way, but it is. It's pretty.. it's a.. it's just regulated, for sure, regulated, and that always sends, like, the parents in a tailspin, and all of these things. What, what was be some, I guess, guidance to give families who are struggling when you do have a kid that is consistently threatening suicide, whether overtly or subliminally,

Karen: 30:44

right. Well, I think that type of language holds you hostage, right. I mean, if the minute somebody says I'm going to kill myself, you're sort of paralyzed with this sense of responsibility that if I make the next wrong move, then they could die because of me, right, because I read this wrong or did the wrong thing, and it's so it becomes sort of a hostage situation, and you know there's a lot of reasons people use that type of language, particularly addicted folks, and it's not always manipulative, sometimes though they do learn the power of those words, and realize that they can kind of hold you hostage, you know, like I said, that's not always the case, but you know, there's a.. there's.. I think even when I was a young clinician, that language obviously scared me, right? I would sort of freeze in the way a family would, like, oh my gosh, I have to now go into this protocol and make sure I do everything right, and over the years I've learned that that freeze really means a lot of different things at different times for people, right. So I will say this: the disease of addiction is one that I've come to call a disease of discomfort intolerance, which means that over time a person struggling with addiction becomes less and less able to tolerate what we see as a normal spectrum of discomforts that happen in one's life, right? And I say, like, anything from the mundane, like sitting in traffic, you know, that we get annoyed, but it's like, well, that's life, you know, everyone's sitting in traffic right now, like I'm not unique in that way, right, all the way to more extreme, like death of a loved one, you know, that kind of thing. So the disease naturally, it's one of those predictable elements of addiction, it naturally over time makes somebody less tolerant of discomfort, and you end up, you allow swearing light on this.

Jennifer Maneely: 32:48

I allow all swearing, even

Karen: 32:49

courage. It's okay, good. So I always say, like, you know, we all understand that discomfort comes on a spectrum, like, and we deal with different degrees of, like, "ooh, my office is chilly, you know, all the way to like really extreme stressors for an addicted person, that all becomes over time just like a big, I say, like picture it as like this big messy ball of yarn that's all tangled, and it's just called shit I can't handle, a whole thing is shit I can't handle, right? And for them, a lot of I'm digressing a little bit, but it's sort of relevant to my answer, recovery ultimately is the unraveling of that yarn and helping them get back to seeing that they can tolerate discomfort, and they don't need to run from it, don't need to escape it. It can be a very long process of unraveling the yarn and learning coping tools, but the reason I say that is that it is, it is fairly common that somebody in addiction is going to more quickly get to the I can't handle this shit

Jennifer Maneely: 33:49

right

Karen: 33:50

state of mind than somebody who maybe is has a bigger tolerance for discomfort in their life, if that makes sense, right? So we're more likely to say, like, I'm just gonna kill myself or something like that, so the first thing I

will say is this: 34:04

as a family member, you are not responsible to be their suicide assessor, and I'll, you know, I am qualified to sue to do suicide assessment, right? I'm a licensed therapist, I still would not be want to be the final word on that, with if it was my own child or my own husband, because I'm too emotionally involved, right? So I don't know what I'm going to share. I don't want you to feel that you need to put on your clinician's hat with your loved one. If you have any question, then you let a let someone who is a professional but also be not emotionally entangled in the outcome, be the one to make these decisions, but I do think it's important for families to understand that, you know, suicidal language is also a continuum, and sometimes a person is saying it because they really just want you to know that they're feeling over. So they're using big language to let you know that sort of the way a toddler is like screaming because they can't have a cookie, they just want you to know, like I'm feeling overwhelmed right now, but they actually have no intention to kill themselves, and they have no intent, you know, they wouldn't do it, they don't want to, they don't want to end their life, they want to live, they're just using big language to prove a point, on the way other end of that continuum, there is somebody who has truly reckoned with the idea of their life ending, and, and have you know, sort of accepted the reality of that. They think they're a burden to society or their family, and they truly are prepared to end their life. And then there's all these places in the middle, right? Like, there's there are people that will, if you ask them further, like, what did you mean when you said that? Or even give them. Sometimes I'll give clients like almost multiple choice options, because they might not have the language, they don't know what they mean when they say it, because they maybe haven't done that emotional intelligence work yet. It might be like, well, if the plane I'm on crashes, that would be fine, but I wouldn't actually do anything about it, right? Or, like, if I didn't wake up one day, you know, life's been hard, I'd be okay with that, but, like, oh god, no, I would never actually like initiate killing myself, you know, so there's, there's really a whole continuum. So I, with families and my recovering clients, I introduce the concept language precision, and I say, if we're going to use language like that, we need to be as precise as possible, because if somebody means that they, you know, have a gun, are not afraid to use it, have reckoned with the end of their life, you know. Then the intervention is going to look really different than if they're just trying to tell us that they're overwhelmed and want to use big words to explain that, right? So I will often educate the families on the different points on that continuum, so they have that language, and they could say, Can you help me understand what you mean when you say that, right? And if they're not able to get more clarity, if the person says right away, like, oh, I was just saying it to you know, to be dramatic or whatever, fine, then we have an answer. If they still feel unclear, we always default to I'm going to take you seriously,

Jennifer Maneely: 37:25

right?

Karen: 37:26

Well, even if you're not serious, I'm going to take you seriously and treat it like a serious posturing towards self-harm. If the loved one is not serious, that the language will change quickly, because they don't want to be admitted to a psych hospital just because they're not using precise language, if that makes sense,

Jennifer Maneely: 37:46

right? right. I like how you, I like how you define that, and kind of, you know, I guess diving in a little bit more to create that, you know, precise language, and giving them the opportunity to redescribe what it is, and that kind of navigates through, because as you had said, sometimes it's not a manipulation, but sometimes it is a manipulation, right? And we can't always tell, like, where we live on that, and it's like, you shouldn't have to, you're like, you said you're not the professional,

Karen: 38:21

not your job. If it's sort of a quick clarification, I mean, one time one of my kids used language like that, and I stopped, and I said, "Those are really serious words, so we're going to stop right here in the conversation, and we're going to clarify what you meant by that, right? If you can, and I gave him some options, like along that continuum, because I didn't think he would know what the options were. I mean, I think he had thought it through enough to know what he meant, and he very quickly clarified for me, I just want you to know how pissed I am. And I said, great, let's use that language, then let's say you have no idea how pissed I am, and it was sort of a, it was just like a gentle correction on language precision, yeah, which was helpful. If you know, if I had any lingering questions after that, he did clarify it for me, but if I had any lingering questions, I would have pursued professional support.

Jennifer Maneely: 39:18

Well, and this is, and this is because we're, you know, we're talking about language, we're talking about giving people options, and it's, it's fascinating and interesting to me, like how little, and I struggle with this myself sometimes, where I need, like, some help in terms of languaging what it is that I'm experiencing, because it's like, I don't always know what it is know what it is, I can just feel like when you do have, as you describe that big ball of yarn, of like shit I just can't handle. It does get to that point, because it's like it's just a big ball of yarn. I don't, can't even find the end to start unraveling

Karen: 39:56

it. It's so true, it's so true,

Jennifer Maneely: 39:58

right? And it's like I think. A lot of times this is what you know families are experiencing, or they're experiencing this big ball of yarn, and they don't even know where the end is to start unraveling, but then you also like, societally, and they're like, "Oh, you just need to go get some help for yourself, and whatever, and it's like, "Well, that's not helping me find the end of the yarn to start unraveling, right, like big thing that I have going on that I don't even know how to articulate, and people like, oh, you got to ask for what you need, you got to ask for help, and they're like,

Unknown: 40:32

know what I need, right?

Jennifer Maneely: 40:33

I don't know what it is that I need, because I can't even make sense of the feelings that I'm experiencing, and the experiences like, I don't know, I don't know how to ask for what I need, and I think that's really like an important thing to kind of dive in a little bit, is how does someone ask for help when they don't even know what it is that they need?

Karen: 40:57

Yeah, that's a what a great question, and I think that it really is, I mean, sometimes it's sort of like this comes in stages, right? Like, there's three steps to this. If, if we're in a forest fire, metaphorically, the first step is that we need to make the fire stop burning, right? Right. The second step is that we need to maybe fly over the forest with a helicopter and assess the damage, inventory the damage, right. And then the third is we need to start like regrowing trees, like dropping seeds and watching them like begin to regrow, that kind of thing, right. So I think in some ways we have to figure out which stage of that we're in, right? Like, is the fire still burning? Am I still like in the insanity of all of this, or is it like, okay, my loved one has gone off to long-term rehab, and or I just set a boundary and walked away from my addicted spouse, and I'm now in a safe space, or you know, like, where am I in that journey, right? And you know, I think that the expectation that I'm going to be able to begin unraveling all of the emotions that come with this right away is probably just unrealistic. In fact, this is very similar, because I work with recovering substance abusers, and I work with families, as you know, both in my practice, often separately, sometimes together, but I have both demographics in my, in my caseload, and it usually is about, I mean, this might sound extreme if you're sort of new to the journey, or still, like, very much in it, but it's usually not until about a year, sometimes two years after the fire has stopped burning that we are able to in any productive way begin unraveling like the whole emotional like wtf was that right like what did we just go through kind of thing like oh my god like what was that so I don't actually ask for that journey early on, that that comes naturally, like it comes organically. Clients will come in after that, have continued to see me after, like, a year, and they're like, I just feel this need to start sharing some things I haven't shared with you before about what I'm like. All right, great, let's

Jennifer Maneely: 43:17

do that. Right, awesome,

Karen: 43:19

you're ready now, right? Like, I had a colleague that said, like, your house was on fire and the doorknob has finally cooled down enough to, like, open it and go in, right? So I'm like, great, the doorknob has cooled down enough, or the forest fire has cooled down enough that we can actually walk through and begin assessing, like, that's great, but I think there's an expectation that we're supposed to do that work really early on, and from a therapy perspective, I don't have that expectation. In fact, I don't find it productive early on to try to unpack all the trauma of it. I think really it's practical things that happen first, you know, getting yourself aligned with people that are further in the journey as a family, you know, sort of finding those people at Al-Anon that are further in the process to take you under their wing, or finding a therapist that can help you figure out the basics of, like, how do I feel safe tonight when I get home, or how can we get through this, you know, this period and get my loved one off to treatment, so I can breathe, or, you know, whatever. I think a lot of it is very, very practical early, and the more kind of existential journey happens much later.

Jennifer Maneely: 44:28

Yes, yes, I definitely agree with that. Like, when we're kind of in that crisis mode, it's really hard to make any moves forward internally with ourselves and the emotional stuff. It's like, first we have to, as, as my mom and I will laugh, we'll say we have to get the cow out of the ditch first, and then then we can start thinking about how it got in there, but first we just got to get the cow out of the ditch.

Karen: 44:54

I think that's a great way to describe it. I mean, there are families that call me, and I know they have so. Much work to do, and they deserve that's the word I always use. It's not that you, you're being punished like you need to do. You have, like, I don't mean like you're such a hot mess, you have so much work to do. I mean, like, my God, you've been in it. You deserve, you deserve support here. So, I'll find a family that you know really deserves a tremendous amount of support, but you know, I'm suggesting to them, you know, you could go to the support group, or you could, you know, start taking my online course, or.. and I can see there, I mean, they're sort of looking at me like, you don't, you don't understand my, my child's my overdose, like I'm not going to go take a yoga class, like no, like right, I mean, and I get it, so I back off, and I say, like, just like you said, the cow needs to get out of the ditch first, and we need to, they're not going to see anything until their loved one is, you know, at least in a temporarily safe place, or we, or we can figure out some sort of a short-term intervention to stabilize the boat from rocking, and that's usually where we begin,

Jennifer Maneely: 46:03

right, right, excellent. So I have one final question for you, and obviously this is called the Unbreakable Boundaries podcast, and so I would love to kind of hear, what would you say is like the most common boundary that you feel like you're telling your families to implement in their relationship with their loved

Karen: 46:32

one. Okay, this is a great question. I'm going to give a little bit of a workaround answer, because of the way I approach boundaries, and section three and four of the course are my overview of the philosophical approach toward boundaries that I take, so I wouldn't, I don't have like a specific, like I tell them not to drive the car, like I don't have a concrete one like that, because I approach it more philosophically, I use a model called Value Based Boundaries, and the reason I do that is because a lot of our boundaries, when we start this journey, are emotionally driven, right? Like, I'm, I'm angry at this person, so I'm gonna set it a piss and angry based boundary, right, get out of the house kind of thing, right. And then I feel guilty, so then I sort of shift the playing field because I feel guilty that I kick them out, right. And I like change the rule book, and then and then they take advantage, so then I feel resentful, so then I set a resentment-based boundary, and I, it sort of becomes like a dog chasing its tail, like I say, like we become, we start chasing our own emotional tail with our boundaries. I think you know, emotions are understanding our emotions, they are important information, you know. If we feel resentful or we feel fear, those are important, but it is important data to help us know what our boundaries are. But generally speaking, I really want families to be setting their boundaries based on what I call your highest prioritized values, and that means doing some work ahead of time, it doesn't mean in the moment, kind of doing a fly by the seat of your pants kind of, you know, I'm going to decide right this minute what's going to happen, kind of thing, because, like I said, then you'll be feeling something different five minutes later, and then it's unreliable, if we understand that what we need to feel sane, what we need for our children, what we need to be able to make it through our work day, to make it through our life to have a stable home. What we need are values like safety, consideration, meaning everyone who lives in the house is as considered as everybody else, right? Like, what we need is honesty, what we need is, you know, kindness or reciprocity, or that kind of thing. If we can figure out what are the things that I need to live in a sane relationship with this person, that's where the boundaries end up getting formed, right? So, so the question isn't what is my boundary, the question is what makes me feel unsafe.

Jennifer Maneely: 49:29

Yeah, yeah, does that really? Yeah, no, absolutely. I really appreciate that's why I like so the unbreakable boundaries. That's why I named it that, is because it does take a much more philosophical approach, like you were explaining, which I think is a really wonderful answer, and thank you for answering it like that, because that is very in alignment with where it's like, how do we.. it's not like, okay, this person does this and this is what you do, this person does this, it's more of like a lifestyle of being very clear about what. It is that you're willing to accept in your life, and what it is that you're not willing to accept, based on the person that you want to be, right, based on the things that you hold true. So, it's like, we, you know, we set boundaries sometimes, we may have to set boundaries around, like, behaviors, right, certain things around the safety, around the values that we want to maintain the sanity in our lives, the things that we also need, right. Yes, they're needing things, but we can't always give them everything that they need. But it doesn't mean that we can't set our boundaries around some of the things that we need, right. So I really appreciate that answer, because that's like the unbreakable boundaries is that lifestyle movement of how do you start trusting yourself, how do you start listening to yourself, how do you gain confidence in yourself to do these things for ourselves to create the life, no matter what's happening externally, that we need, right, a lot of that values values,

Karen: 51:03

yeah, you know, I think this is one of those things that I had said earlier, and I think we were both saying, like, there's a lot that our intuition tells us to do when it comes to addiction that doesn't really work with addiction specifically, right? Like, it doesn't fit with addiction, and I think that one of the things are we intuitively think we're supposed to do is set boundaries that are actually kind of coercive and I know that sounds that word sounds pretty dirty but I don't mean it a dirty way yeah yeah maybe but I guess I mean like we think we're supposed to set a boundary to change or fix them right like I'm supposed to teach them a lesson, or I'm supposed to let them know, right? You know, I'm trying to, I'm setting a boundary to motivate them, right? Like, I'll, I'm not going to buy you a car if you don't go to AA meetings, or whatever, right? Like, that's not a boundary, that's more of a coercion. You're trying to change somebody else's behavior. What I have found, and you know, I think, you know, 10 to 20 years of a longevity study on this, of you know, even just anecdotally, what I've seen over the 20 years, never mind what the research shows. I think one of the things that's really fascinating is trying to coerce another person into change, even though it's tempting, it's not effective, I've never seen it be effective. What is effective, and I get to witness this so often that I mean, I am drinking the Kool-Aid on this. I believe this. What is effective is that when you begin changing and saying I deserve relationships that have these values in it, and you just say, like, I want you in my life, but you're going to have to meet me over here with the values rather than me continuing to bend toward you without the values. When you began having higher standards of what your relationships look like, including with your addicted loved one, more often than not, I will never make a promise your loved one will definitely change. I won't. I will never promise that, but

Jennifer Maneely: 53:03

that's out of your control,

Karen: 53:04

right? Right. But more often than not, that becomes a pretty powerful influencer on your loved one, because they start realizing they're not going to get what they want from you or from that relationship if they're not willing to join you in a more valued way of living, and that becomes more intrinsically motivating to people to want to find recovery, and so when the family changes and works on themselves more often, I see the addicted person kind of be like, oh, things are changing around here.

Jennifer Maneely: 53:37

Absolutely,

Karen: 53:38

I better start working on myself too, right, and that right, so it's sort of, it's so counterintuitive that the most productive thing we can do is a help ourselves to help ourselves, but hey, it actually is more likely to trickle down and increase our loved ones likelihood of better outcomes as well,

Jennifer Maneely: 53:58

but we can't also try to help ourselves just to be coercive, right? Like,

Karen: 54:03

oh girl, we have.. I have these conversations all the time with families. I'm like, are you.. what's your true..

Jennifer Maneely: 54:09

I'm gonna try to find that formula here, and it's just so

Karen: 54:15

true. I think it's misinterpreted so often through that old lens, because families are so used to being kind of well-intended, but coercive, that it's like, well, I'm going to go to Al-Anon because maybe they'll copy me and go to,

Jennifer Maneely: 54:27

right, right,

Karen: 54:28

right, or I'll be going to stop drinking because for my health, but really because I know they're watching and I hope they'll stop drinking too. We really have to tap in. What is my true intention? Is it because I deserve better,

Jennifer Maneely: 54:39

right,

Karen: 54:40

or is it because I secretly am still trying to coerce them, I'm just changing the language about how I'm doing it. Well,

Jennifer Maneely: 54:46

it's the same exact thing about, like, recovery too. It's like, you know, we say to people, like, you can only recover for yourselves, you can't recover for anybody else. It doesn't mean that certain things won't get you. There initially, right? So I think a lot of times, like, the families come and they're trying to, like, learn how to get their kid to do, or their loves want to do what they want them to do, like that. They're trying to learn that formula, and that's what kind of gets them in the door a lot. And then they start learning over time that that it's like, oh, this is really for me, this is what I gotta do for me. This is, you know, the things, but at some point it has to switch to where it's like you're doing the work really for you, not to try to get something external to happen that's out of your control, right. And so I mean, there's plenty of people that start the recovery process, because of, you know, maybe they got court ordered, or they're just kind of backed into a corner, and then they get in there, and they're like, you know, maybe I do want that,

Karen: 55:52

that's right, yeah, that's that's right, I sometimes joke that when families come in, it's like they come in thinking that they want to buy a vacuum cleaner, but they really need to buy a microwave, like a microwave, you know. So it's like they come and being like,'Hey, could you teach me how to fix my loved one, and I'll take perfect notes, and I'll do it perfectly. And right, you know, our job is sometimes to try to convince them, like, 'I know you think you need a vacuum cleaner, but I promise it's a microwave that you need.

Jennifer Maneely: 56:19

Yeah, it's really. it

Karen: 56:22

just takes time to kind of make that transition, and I think that when you hear it, you know, especially the influence of other families, you know, it starts clicking, you know, I don't think we always understand it the first time we hear it, we hear it, and we're like, oh yeah, that makes sense, but then we keep doing the same old stuff as a family, I think it's, you know, I always say you have to hear it 300 times from 300 different people in 300 different ways, and they all become sort of like little threads that make a strong rope, and it's like the more that you hear it, you know, at a meeting, in a book you read on a podcast, you know, it's like you start like they all start to form this new way of thinking until you really realize it is you that has to change for your own sake, and that your loved one may be positively influenced by you changing, but you were never powerful enough to fix them, right? You have to fix who you have control over, which is you, you

Jennifer Maneely: 57:21

and only you, and yes. Well, I just want to really thank you so much for coming on. This has been a great conversation. I could go all day with you, because I just, I love it. I love being able to talk to someone who really understands, who, like, you know, I can relate to, and I'm, I know that, like, my audience will get so much out of this, because it's just been a really great conversation, and I really appreciate you. Now, you have.. we, we've been kind of talking about your course, so can you just tell people how, if they are interested, which I think is great foundational work for anybody to start going down. If the.. if the.. if you're in this world, if you're trying to figure out what to do with your loved one. I think the course is a great foundational course. I highly recommend it to anyone who's listening. So, if you could just please tell people how they can find

Karen: 58:10

it. Yeah, thanks. It is easy to find. It's at Collaborative Counseling dot podia p o d i a.com Collaborative counseling.podia.com That's the access page. There's a whole bunch of information about the course, actually at the bottom of the page. If you scroll all the way down at the bottom, there is a freebie 15 minute session. If you, if you want to get. I think I even mentioned it about the co addiction stew. I talked about that just briefly to just get a little bit of a feel for the course and how it works, if you want to kind of sample it. But yeah, I would love for you to check it out. It is six, about 45 minute sessions. The full course is about 645 minute sessions. It's on demand, self paced, and it's I, I hope you get a lot out of

Jennifer Maneely: 59:05

it. Yeah, excellent. And now, if you, you are in South Carolina, so if I have any listeners out there in South Carolina that want to work with Karen, please feel free to reach out and get in touch with her. How can people find you? Yeah, so it's not the course. Yeah,

Karen: 59:25

my regular office website, my private practice is www dot collaborative counseling llc.com and you're welcome to reach out to me through there. I often have limited availability, but I'm happy to chat, you can sometimes you'll catch me at a time that I just have somebody move, or so it's always worth a try, and if not, I'm happy to, you know, try to connect you with somebody else, or I'm always, I'm always, this is such a complicated world to navigate, I'm always happy to help families sort of find the. Way, or you know, show them ropes a little bit in a way that I can,

Jennifer Maneely: 1:00:04

right? Right. Well, thank you. Thank you again, Karen. I really appreciate you coming on. Thank

Karen: 1:00:09

you for having me. It's really fun to talk with somebody who shares my passion.

Jennifer Maneely: 1:00:14

And thank you for listening to this podcast. If you want to listen to more or find more information out about this podcast and more of what I do to help families. You can go check out my podcast website at Unbreakable Boundaries podcast.com It's full of other great podcasts, just like this one, full of other great resources. And please remember to share this podcast with others, because you never know who may need to hear this. People are often hiding their battles in this arena, and sharing is a great way to provide this valuable resource to a person. You can also go check out my professional website to see more about how I help families at the Recovering family.org And don't forget, there is always hope, even when things seem the most hopeless.