S1 E4: Pia Mellody on the Meadows Model
Meadows Senior Fellow Pia Mellody sits down with host David Condos for the conclusion of this two-part conversation. Today, she takes a deep dive into her model of developmental immaturity and explains how understanding our childhood trauma can help us become more functional adults.
Click here to listen to part one of our conversation with Pia Mellody.
David Condos: Welcome back, Pia Mellody. So good to have you with us here at the Rio Retreat Center at the Meadows campus in Wickenburg, Arizona. Thank you for being with us.
Pia Mellody: Thank you, this is fun, I’m enjoying talking to you.
David: Very good, glad to have you here. In the last part of our conversation, we looked at the history of the meadows, your history, your story and how that played into it. Now we’re going to dive a little bit deeper into the treatment, and specifically the Meadows Model.
David: To start that off, could you introduce us to the model and how it covers all the bases looking at the whole person?
Pia: Well, it was simple. What it was, is that we could talk to them about what happened to them and that they needed to do trauma work and take them through trauma work and continue to work on their core issues and how to be an adult.
Then they had to go through a process learning how to be more relational, and then refer them on to people who had done the work, who had trained with me. Then we found out that as our culture was getting more driven by drugs and alcohol and sexuality and everything else that a lot of the people where they got couldn’t simply go from inpatient to six months of outpatient care. They really had to spend a lot of time in outpatient care. Because the nature of their trauma was so serious and more serious than it was before.
David: Right. It had been their whole life building up to this. It wasn’t going to be a certain amount of weeks or months and then it was over.
Pia: No, I noticed that a lot of the people that I trained wound up working with somebody a year, two, three years, they just needed more help, because they had very serious arrested development from all the craziness, I think in the culture. Now we’re getting people too that have been traumatized in war on top of everything else.
That takes a lot longer to heal from too. There’s just a lot more trauma that I think has been happening in the world since when I started figuring this out in the ’70s and ’80s. I think we’ve gotten much more complicated, much more complex, and it injures people to a deeper level.
David: Yes. Then as you were seeing all these issues crop up is specifically related to that. You eventually put this into the developmental immaturity issues kind of chart to a program?
David: Talk us through that. What are the elements of that?
Pia: What happened was that as I was talking and learning more, the issues were getting a little more complex. I decided that the best thing I could do for people to really look at something and begin to understand it so they can use it. I developed this overview of a developmental immaturity. There are four columns to it and I’m going to add another one to it anyway.
The first column is to talk about childhood trauma. They get some understanding of what they needed and what they didn’t get. I made a chart on this first column, there are five issues, on every column, they’re the same five issues. I made it a little more complex, so people could gradually build the depth of the model one by one. The first–
David: It’s kind of a step by step.
Pia: It’s a step by step. The first thing is to understand that the nature of the child is important to understand, the nature of who you are as a child is important to understand and to understand until the day you die. I wrote down the nature of a child, all children, the first one and the most important one is all children are valuable.
The fact that they’re a child, and sometimes difficult to handle doesn’t make them less than. It means they’re being normal as a child, what happens is that they don’t have parents that are mature enough to handle the child’s immaturity. Isn’t that weird?
Pia: Their child winds up with arrested development because the parent wasn’t mature enough to teach them how to be mature. I don’t know what’s going on, but there’s a lot more arrested development, and it’s getting worse. I think it’s related to being out of control with drugs, alcohol, and sex early. That causes a deep arrested development, so a lot of people have to spend more time in therapy to really get it.
David: It’s starting earlier, it’s getting more complicated, and that requires a more comprehensive approach when you’re looking at–
Pia: Yes, it takes much more time. The nature of a child is valuable, vulnerable, imperfect. The nature of a child is to be imperfect. The nature of all human beings is to be imperfect. None of us are gods and goddesses.
David: That’s everyone.
Pia: Yes. It doesn’t mean they’re less than it means they’re human. Do you know just teaching somebody that is very difficult? That everybody has to do the business of monitoring themselves, so they’re not obnoxious to other people. You have to learn how to contain yourself, how to contain them, how to speak simply, like, “Hey, I just heard you say, blah, blah, blah and what I’m thinking is, blah, blah, blah, and about that I made myself feel angry. I really would appreciate it if you’d stop doing that.” That’s how you learn to talk.
David: Yes, and just having that communication.
Pia: You stop blaming. All people are dependent. They have to depend on other people, but they have to learn to take care of themselves through the point where they’re not too dependent, and all people are spontaneous, and they have to learn to regulate their spontaneity. That’s the nature of a child and that the child has to be taught to regulate that over the years.
The second column is a description of the internal life. It’s called the core issues, but they are the five primary symptoms of codependence for arrested development. They don’t esteem themselves from the idea of inherent worth. They waffle back and forth between less than and better than. Do you ever notice yourself doing that like one day you can beat yourself up and the next time you find yourself looking down on somebody? Well, in between less than and better than is the functional adult. When– [crosstalk]
David: It’s that balance.
Pia: Yes, it’s that balance. Have you ever known anybody that did too much self-care? They’re always in the gym, they are always focused on their eating.
David: That extremes that you’re talking about.
Pia: They were so obsessed in that they’re hard to handle a relationship. There’s two things here in terms of dependency issues. You can be too dependent on others, or you also can be needless, wantless, never ask anybody for help or too dependent on them. The last one is a moderation issue.
The two extremes are you’re in control of being out of control or out of control of being in control. Your business isn’t to control people unless you’re a jailer, your business is to control yourself. The primary sense of the codependence are those is that second column, have trouble esteeming yourself, have trouble with personal boundaries, have trouble with poor self-care, and have trouble with moderation issues.
Then the next one are secondary symptoms in trying to control other people, hanging out resentment all the time, having trouble figuring out how to be related to a power greater than yourself, which is a spirituality issue. These are secondary issues, addiction issues, mood disorders, physical illness, all that. See, the second column, which I went over are more important than that fourth one, but the fourth one has to be taken care of before you can do the second column.
The last one is problems being intimate. The one thing I learned which is absolutely– I remember when I finally figured this out, I was really gobsmacked. If you don’t esteem yourself, you can’t esteem your partner. You can’t esteem your relationship. If you don’t esteem your partner and you don’t esteem yourself, there’s no way you’re going to esteem your relationship and marriage. You have to be able to esteem your partnership in order to work it well. If you don’t know who you are and are busy avoiding it, you can’t be honest.
David: And that honesty is required for a healthy relationship.
Pia: Yes, and a good life.
David: You’ve mentioned the idea of boundaries a couple of times. Could you describe what role that plays in all of this?
Pia: Boundaries are everything. To learn to protect yourself from other people physically, sexually, intellectually, emotionally. Protect yourself from others, but still stay with them and contain yourself so you’re not throwing up on other people is the boundary issue.
Without boundaries, you can’t even begin to model. The first things you have to do is learn to protect yourself from others when you’re around them and contain yourself so you’re not obnoxious to other people. That’s the beginning of recovery from codependent basically.
Then you have to learn to accept the fact that you have to, and you’re the only one that can self-discipline. Your therapist isn’t going to ride in your car with you. You have to start taking responsibility for being a functional person. It’s not just therapy, is a way to live your life in a functional way. Also, if you don’t do all this other stuff, you won’t be honest and the dishonesty will literally infect your life.
Anyway, that chart right there is when I’m training, I use it a lot. I teach my people to use it all the time and I live it. I tell them if you’re really going to take this on and treat people with this whole thing, what you’re going to have to do is really do it. Guess what, if you’re telling them about this is what’s functional and you don’t do it, they’re going to look at you and not trust you.
David: Right, because you have to do it for yourself.
Pia: You have to do it for yourself and you certainly need to demonstrate recovery to your patients. One time I made a mistake, honestly, I don’t remember what it was anymore, but in group I think I said something snarky to a man I was working with and I turned to him and said, “Listen could you turn and look at me a minute? What I just did to you was absolutely disrespectful and inappropriate and I want to apologize to you.”
He looked at me and he got big tears in his eyes and said, “Thank you.” I said, “Okay, let’s do it again.” We started it again and I did it in a functional way. That’s recovery, it’s deep.
David: You’ve used the term functional adult to describe this journey or the goal of where this is all leading. How do you help people learn how to do that, how to be a functional adult?
Pia: Well, the most important thing is teach them how to value themselves. How to go through a process enough so they realize that their strengths don’t make them better than and their weaknesses don’t make them less than. Their strengths is your journey, your mistakes are your teachers and you teach that so they’ll start embracing those ideas instead of ignoring them, for example.
This is the kind of thing you have to teach. The other thing you really have to teach them is really how to use a boundary when they’re being intimate and there are four different ways you can be intimate.
That when somebody’s out of control that you push back on them without making a big deal of it, but that you push back. When they stop you, you then confront them with the talking boundary like, “You just said, blah, blah blah to me. What I think about that is you’re being highly disrespectful and I’m angry about that and I don’t want you to do that to me again.” You start really using the process in your life.
David: As you’ve been putting all this together, you’ve been discovering this for yourself as you were talking with patients and learning about this because nobody was teaching you, you were discovering this for the first time. How would you describe that this has affected you? The ways that you can be real and how it’s taught you things through this process?
Pia: Well, the best way I could describe it is until I really learned it and could use it, until I did that, it was like driving a jalopy that was breaking down all the time.
David:What’s that? What’s a jalopy?
Pia: A jalopy?
Pia: An old car that can barely run. Just a pain in the butt to be. Once I really learned it, I was more like a Maserati. Not better than either. Just my life got a lot easier and I felt a lot better and it was fun. It takes a lot of self-discipline to learn the model and then make yourself do it. It’s easier to be a jerk until you decide that being a jerk is very injurious to other people and you need to contain yourself in the interest of other people. See, that’s maturity.
David: That’s a good point. It is in most circumstances easier to be a jerk when you think about being a kid or arrested development situations. If somebody steals a kid’s toy or does something that they don’t like, it’s instant that that’s what naturally comes up out of us in response to that and so that’s something we have to work on. We have to learn.
Pia: It’s easier if the parents you grew up with were fairly mature and you automatically mimic them. If your parents were screwed up and addicts and immature and part of the problem, you have a long road to hoe because you have to unlearn that and then learn how to be more functional, but people usually get quite a bit of relief. I know when I started to get more mature I felt a lot of joy.
David: It ends up being better for yourself and for others.
Pia: I call it being part of the solution rather than part of the problem. I don’t want to be a problem to other people. I certainly don’t want to be a problem to myself doing that, so it’s a discipline.
I used to do it because I knew I had to do it. Now I just do it because of what I said I want to be part of the solution, I don’t want to dive into the problem. Enjoy myself while I’m mulling around in the mud but then I have to clean it off and apologize and that’s harder than just doing the right thing in the first place and that’s how people learn. It’s easier.
David: I know looking at helping people become functioning adults, as you’ve called them, the term that the Meadows uses for that approach is this post-induction therapy. Talk us through that. What does that entail?
Pia: Post induction therapy means that you first have to go through trauma work. From the trauma you’ve had in your family of origin, period. You have to do that and in that process of that trauma work, you begin to understand what a functional adult is and what a child acts like and learn to discipline yourself into acting more like a functional adult.
It’s pretty complex. You do trauma work, but then you also have to do core work so that you can learn to be a functional adult and behave. Then the last issue is in learning to be intimate with yourself, then you have to learn to be intimate with others. It’s a complex thing that covers all bases. Also, you learn too that if you don’t have the energy to be relationally, you don’t get in. Bill recently said something he wanted to talk about.
David: That’s your husband?
Pia: Yes. I think he wanted to talk about one of my sons and I said, “Sweetie, I’m so tired right now and grumpy and the subject is difficult for me. I don’t think we ought to talk about it right now. I don’t think I will be very kind to you in discussing it. Can we put it off till tomorrow at breakfast then we can talk about what you want to talk about?” He knows enough to say yes because when I tell him that I don’t have the energy to contain myself, he knows it gets really unpleasant, but I don’t manipulate him with that. That’s real recovery.
What this treatment teaches people to be is a functional adult and how to be relational with self in a reasonable way, and how to be relational with other people. You become part of the solution on a planet rather than being the problem.
David: Then looking at how all these elements come together here in the Meadows. How do you describe the way that trauma specifically is woven through all the elements of treatment in a way that is special and unique to the Meadows and the Meadows’ model?
Pia: Basically, the model was developed there and so the model is a cornerstone of everything they do. Now there’s a lot of other things they do too, like the neurological work they do as people and having family come and do with their family and also learning how to be relational with their group members and then other people in the community. The first thing they do in that area, start teaching them boundaries, which is a major part and it needs to be getting in there early.
They monitor how the person’s boundaries are working in the group and getting them to recognize when they’re out of boundaries, which means having no boundary at all and throwing up on other people where they’ve gone to a wall and shutdown. Because nothing- and a wall is not a boundary. A boundary is halfway in between a wall and nothing.
The second thing they do is they do use some work in there to get them to start talking about what happened to them and learn as they’re talking, and they start feeling all these big emotions that they learn to instead of stuff them, or they attach to start breathing into their emotions and releasing them so they can start emotionally regulating themselves and learning how to use the talking boundary when they’re speaking to other people.
Like I say, “Come in to group,” and they say, “You know, so and so did this to me.” So patient. I would say, “Well, how did you react to that?” They said, “I didn’t. I shut myself down. I went in the bathroom and cried.” I said, “Okay, so you didn’t feel up to confronting anything at that point?” “No, I wasn’t able to do it.” “Okay, so let’s role play. Let’s have one of your group members be him. We’ll have them pretend to be this person, and then you’re sitting here and what I want you to do is confront him using your talking boundary about what he did to you.”
Okay, so that means they put chair to chair like this. Then they get the distance they need and then this one will play the person who did it and then they’ll use their talking boundary. “Harry, when I was standing in line this morning getting ready to get my breakfast, what happened is that you kept yanking the back of my hair and it really hurt. What I think about that is that you are being aggressive and disrespectful to me about that. I’m angry and I don’t want you to touch anything about me again.” Do you follow me?
David: That’s the talking boundary that you were talking about?
Pia: Yes, that’s the talking boundary. So they get to practice on somebody else. You don’t say, “Okay, go out in group, go this morning, next morning. You could find them and confront them, you don’t do that. They have them practice confronting something real that happened to them.
David:Yes. There’s the family part, the relational part, the becoming an adult part but it all kind of comes back to the individual trauma that everyone has, right?
Pia: Yes, because you see in this person’s history, what happened is that she had a brother that was physically abusing her all the time. When the guy yanked her hair, she age regress to about four and couldn’t talk, so then I walked– the therapist would walk them through, “Okay, let’s get in your functional thought. The part of your esteem, yourself and within has functional boundary, is able to be real, is into good self-care and an attitude of moderation in all things.” That’s the functional adult.
So, “Okay, now using your talking boundary, we’ve Charlotte over there, talk to her as she is he then say, ‘Listen, what you did to me in the line the other day was blah, blah blah. What I think was blah, blah blah and about that I feel.'” So they get to practice on something that’s quite real or it may be something happened with a group member and they do it with a group member. It’s all kinds of things. It’s really quite complex but the model is throughout the whole thing because the model is about being a human being and being functional instead of dysfunctional.
David: Pia Mellody is the senior clinical advisor for Meadows Behavioral Healthcare based in Wickenburg, Arizona. You can find out more about Pia and the rest of the Meadow senior fellows at meadowsbh.com.
To check out more episodes of this podcast and find all kinds of other resources and tools for Meadows Behavioral Healthcare, visit beyondtheorypodcast.com. Finally, thank you for listening and I hope you’ll join us again next time for another episode of Beyond Theory.