Born and raised in Denmark, Bettina Ottenstein came to the U.S. almost 20 years ago. In search of a long-term career that she wouldn't easily tire of, she went to grad school and became a licensed marriage and family therapist. She had known about Promises for many years, and when the opportunity arose to join the team, she seized it. A Resource for the Entire Family As one of two full-time family therapists at Promises, Bettina's focus is on relationships. After setting goals with each client in the first week of treatment, clients begin addressing the self-defeating behaviors that have followed them from childhood into adulthood. If clinically appropriate and desired by the client, Bettina welcomes family into the treatment process. Family can include a partner, spouse, parent, child, best friend \u2013 anyone who will serve as the client's primary support when they leave treatment. Depending on the family's location, family sessions can be held by phone, in person or via Skype. Each client at Promises is assigned a family therapist in addition to their primary therapist. Family therapists conduct one-on-one sessions with clients, weekly sessions with the family and a family day twice a month. "The client is the one who comes to treatment, but the whole family has been affected by addiction," Bettina says. "To ensure that everyone's needs are met, we provide groups for clients and families that are both psychoeducational and therapeutic, all in a safe environment where families are surrounded by other families in similar situations. During an incredibly difficult time, families don't have to feel alone." Bettina is a resource for family members, answering questions and providing updates on client progress, as well as the therapist that clients see after they leave Promises. She shares what they've been working on, where they left off, what approach seems to work best, and how to get the entire family engaged in treatment so that the client can seamlessly transition into the next stage of treatment rather than starting over. Bosom Buddies: Substance Abuse and Trauma In addition to individual, group and family sessions, Bettina leads a group that focuses on trauma and substance abuse. Called Seeking Safety, a therapy Bettina has been specially trained in, this group covers 25 treatment topics, ranging from honesty and self-care to setting boundaries and healthy relationships. Seeking Safety is an adaptation of cognitive-behavioral therapy that has proven effective for treating substance abuse and trauma in outcome studies. "The first step is to get rid of the substance so that symptoms of trauma and other mental health disorders are no longer masked, but that's just the beginning," Bettina explains. "Next, we work on developing safe coping skills, improving understanding and reducing shame. Once the client has this solid foundation in place they can begin other forms of trauma work such as EMDR [Eye Movement Desensitization and Reprocessing] and Somatic Experiencing." Bettina says that a large percentage of her clients have post-traumatic stress disorder (PTSD), unresolved grief or traumatic grief. "PTSD and substance abuse are very good friends," Bettina explains. "PTSD can lead to substance abuse as people try to cope with symptoms or feel better or even get to sleep at night. Substance abuse can also lead to PTSD because people are especially vulnerable to dangerous, traumatic situations when they're under the influence." Here's a common scenario: People with PTSD use drugs and alcohol to cope with their symptoms, and then substance abuse puts them at risk for more trauma. They rely on drugs even more, exposing them to even more trauma, thus fueling the cycle. In families where one or both parents abuse drugs or alcohol, children may develop PTSD, setting into motion an early cycle of trauma and self-medication. "Like substance abuse, PTSD creates issues in relationships," Bettina says. "Some of the more difficult behaviors families often attribute to substance abuse or a mental health disorder, such as explosive anger or control issues, may actually be symptoms of PTSD." Proper diagnosis is critical for recovery. Only when PTSD is identified can clients and family members develop compassion and empathy. While that doesn't excuse the client's substance abuse and other destructive behaviors, a common understanding puts everyone in a position to make healthy changes and opens up the opportunity for healing. It may seem obvious that an important starting point for trauma recovery is talking about the traumatic experience(s), but shame and fear prevent many from doing so. Bettina doesn't shy away from these conversations. Clients who exhibit PTSD symptoms use therapy sessions, handouts and exercises to learn about their condition. Using a reading from Seeking Safety, Bettina assures them that they are not crazy, weak or flawed, and that PTSD is a normal reaction to abnormal events. Many clients, especially those who hadn't been diagnosed before they arrived at Promises, are relieved to find out that they have a mental health disorder that is treatable. The Joy of Helping Others Heal Working with substance abuse and mental illness is difficult work, and Bettina has practiced in some of the most challenging settings, including a group home for adolescent girls and a psychiatric hospital. Why does she do it? "Because I love working with people," she says. "By entrusting me with their stories, their goals and their healing process, the clients give me as much as I give them. I get a lot of joy from this work." Bettina utilizes a variety of approaches and theories in her work, but at the core of her treatment philosophy are collaboration and authenticity. She is a team player, someone clients can be up front with, who is 100 percent dedicated to them and the work she does. "I have expertise that I'm more than willing to share, but I'm not the 'expert,'" Bettina says. "I do everything I can \u2013 reading, training and collaborating \u2013 to help my clients, but my clients are the experts on their lives. What they have to tell me is just as important as what I think they need to hear from me."