Dr. Corinne Gerwe, PhD (Biological Psychology), CCAS (Certified Clinical Addiction Specialist), CAS (National Certification), is a nationally and internationally recognized expert in addictions and behavioral health treatment.

Dr. Gerwe's work of the past 25 years has focused intensely on creating the Gerwe Orchestration Method (G-OM), a treatment methodology that addresses patterns of behavior created by repeated use of addictive drugs. This revolutionary approach to the prevention and treatment of addiction addresses pivotal developmental issues in relation to chronic addiction, post-traumatic stress disorder (PTSD), and other co-occurring disorders. The method is based on her years of counseling patients in the field of substance abuse treatment and mental health within hospital, prison, and military based systems.

Dr. Gerwe's book The Orchestration of Joy and Suffering: Understanding Chronic Addiction (Algora Publishing 2001), has been widely hailed as a pioneering work in the effort to understand violence and addictive behavior. Readers have commented, “Dr. Gerwe has written a remarkable book. Her creative talent has transformed research and technical information into a highly readable and fascinating conception. The integration of psychological findings with stories and case histories is particularly well done. . . . This work reminds me of the transitional breakthrough of B.F. Skinner's ‘Walden Two’ and ‘Beyond Freedom and Dignity.’ A must read for students of human behavior. . . and for those of us who just struggle to survive.”

Dr. Gerwe conducts clinics around the United State s and abroad to train professionals in her treatment methodology. Her method and research underlying the G-OM, originally published by Elsevier Science in three consecutive articles in the Journal of Substance Abuse Treatment (2001), are currently featured at major international congresses of substance abuse professionals and in the Journal of Groups in Addiction & Recovery (2008) (Haworth Publishing). She is centrally involved in international collaborative efforts through the National Peace Foundation to address the youth addictions/HIV crisis that is severely damaging the social fabric of the Russian Federation, and the effects of trauma in relation to the problem of addiction worldwide. 

Now her Handbook is available as well: The Art of Investigative Psychodynamic Therapy: The Gerwe Orchestration Method (G-OM) (Algora Publishing 2010).

Dr. Gerwe currently heads the Group for Chronic Addiction Research, Inc. (GCAR), based in Saluda, North Carolina and is a clinical associate professor on the Clemson University faculty.

Is it possible that an extraordinary experience in our childhood can change the course of a person's life? Can such "singular episodes" (or a series of episodic experiences) have as much significance in childhood development as hereditary and...

Is it possible that an extraordinary experience in our childhood can change the course of a person's life? Can such "singular episodes" (or a series of episodic experiences) have as much significance in childhood development as hereditary and environmental influences? The author believes that the answer to these questions is yes. Her theory was born out of the course of her own life and her work in the field of substance abuse treatment. Her professional experience provided a forum for investigation, research and development of the High Risk Identification and Prediction Treatment Method (HRIPTM). The HRIPTM explores the link between conditions arising from childhood experiences, behaviors that persist, and the development of chronic addiction and other disorder conditions. The book brings together individuals under treatment as well as such historical figures as Conan Doyle, Charles Darwin, Kafka, Beethoven, Houdini, and Robert Louis Stevenson. They demonstrate the common bond of behavior that affects us all, illustrating how this behavior can be camouflaged, disguised, hidden, misunderstood, ineffectively punished or very effectively praised, and often tragically unaddressed until it is so firmly entrenched neurologically that it becomes powerfully resistant to treatment and rehabilitation efforts. The case histories of notable figures were gathered from literary diaries and letters, literature and poetic texts, autobiographies biographies and media interviews. The clinical case summaries concluding each chapter are taken from the HRIPTM research. Collectively, they provide a fascinating account of how an intricate and far-reaching web of problematic behavior can originate and evolve.

PRELUDE: THE ORCHESTRA The orchestra that soothes me to sleep with the sounds of imagined harps and violins, only to infiltrate my dreams in the midnight hours of moonless nights, the soft sweet slumber of predawn dreams and the restless...

PRELUDE: THE ORCHESTRA The orchestra that soothes me to sleep with the sounds of imagined harps and violins, only to infiltrate my dreams in the midnight hours of moonless nights, the soft sweet slumber of predawn dreams and the restless sleep of an over-excited mind, is the orchestra of my childhood memory. A memory of an experience that occurred in the sixth year of my life. A memory that is as alive in my mind today as the day it happened, so many years ago. On this day, I was chosen from the others in my first grade class. I was instructed to lead a single-file procession down the hall to the auditorium. There was to be a surprise presentation. I had listened carefully to Sister Mary Claver's instructions. Upon reaching the side entrance of the auditorium, I was to halt my class and wait at the open doorway. From this position, I would see the class that had entered the room fifteen minutes before we were to enter. When this class moved on, I was to lead my class into their vacated position in the center of the auditorium. A mark on the floor would indicate where to stop. There, we were to remain for exactly fifteen minutes. When our time was up, I was to exit by leading my class to the opposite doorway so that the next waiting class could follow. I took this assignment very seriously and was pleased that I had been trusted with this responsibility. I adored Sister Mary Claver. She was soft-spoken and kind. I thought she was like an angel. I loved St. Clement School and wanted to do my best there. This was sometimes difficult, because I was often distracted and preoccupied during classtime, despite my efforts to concentrate and pay attention. As a result, I would sometimes miss important information. When this occurred, Sister was never harsh or critical. I would have been devastated if she had been. I tried to stay as quiet as possible so that these episodes would not be noticed, because I could not seem to stop them from happening. I was therefore astonished when she called my name and then gave me what I considered a very special role. Desiring to do my task well, I led my group down the long corridor with concentrated determination. And everything was going just fine ' that is, until I heard the music. We were approaching the door to the auditorium when I first heard the sweet strains of an unfamiliar melodic combination of instrumental sounds. Through the doorway, in my direct line of vision, I could see the class ahead of us. They were standing side-by-side in a horizontal line. They were facing a stage that was not visible from my position. When we reached the entrance and stopped to wait, I began to feel increased excitement as I listened to the strange and wonderful music coming from the unseen source beyond my view. So as not to be distracted from my task, I focused my attention on the rows of folded chairs that lined the walls of the large auditorium. I wondered why we were not permitted to sit on them in arranged rows, like a real audience, instead of always standing in single-file lines. But the melody was so beautiful and different from music that was familiar to me, that I began to compare it with the music that had once filled our home. My attention became re-directed to thoughts of how things had been before everything changed. I could hear the Irish songs of my grandfather and his comical and theatrical way of singing operettas like 'The Lord of the Rings,'� and his 'Hi ho, Hi ho, Hi ho!,'� which created gales of laughter as he outrageously recreated the forest solo. There were the strains of my father's ukulele, purchased somewhere in the Pacific during World War II, as he played and sang his favorite song, Celito Lindo. And the many voices surrounding the old piano in the living room upstairs ' the poor, hard-beaten, yet bravely upright instrument that had been subjected to years of family gatherings and anyone who could pound a melody into submission with undisciplined abandon. This old friend that now stood silent, except for the lonely sounds of my solitary daily practice. The piano lessons that began in my first year at St. Clement would soon end. In a few weeks, I would be joining my parents and younger brother on the farm my father had purchased earlier that year. I would be leaving St. Bernard and St. Clement School to live in a farmhouse that was located some distance from the city. The farmhouse would be a place with few neighbors. What worried me more was that there would be no piano. I wondered if anyone had thought of this as a problem. 'Probably not,'� I thought. I began to feel the very familiar feelings of dread and uncertainty. My father had said this move would be good for us. I was not so sure. I knew his condition was worsening. He was drinking more and was increasingly unable to control his temper. I knew this had something to do with the severe injuries he had suffered during the war. But I did not then understand that he, like many other veterans of his era, was treating his own post-traumatic stress symptoms with alcohol, and that his alcoholism was creating a deteriorating condition that would eventually take his life. The only thing I did know for certain was that there would be no music on the farm and that, for me, this would be a great problem. As my thoughts continued to stray, the feeling of dread became overwhelming. I wondered what was happening there, and what it would be like to live in such an isolated place. Suddenly, I felt a slight nudge from behind and saw the class ahead begin to move toward the exit. The music had stopped. Quickly trying to regain focus on my job, I led my class to the vacated area in the middle of the auditorium, looking straight ahead to make sure I reached the correct spot. Once there, and only then, did I give myself permission to turn toward the stage. There is something insidious about the feeling of dread. It can work inside of you like a sponge, absorbing other feelings, like anticipation, into it as it expands. Had my anticipation and excitement not been interrupted by my worried thoughts, I might not have had such a reaction when I turned toward the stage. Or maybe the light was just right, that day. . . streaming in from the high windows to transform shining brass into a brilliant glow. Maybe it was the contrast of this illumination against the otherwise dark, cavernous space that surrounded the diminutive audience standing at attention. Or the momentary silence that followed our systematic march, when our small shuffling feet stopped and a quiet stillness fell over the room. Whatever it was, the combination of light, movement and sound created an atmosphere that set the stage for what happened next. There, before us, dramatically elevated and framed by soft velvet drapes on an otherwise spartan platform, was a sight that to me seemed magnificent. Gleaming instruments accentuated the elegant appearance of the musicians, who were dressed in black suits and white ties. Sitting erect and semi-circled, they were staring attentively at the tall and imposing man who stood before them. Slowly, he turned away from them and looked down upon us with a fierce hawk-like expression. His piercing eyes glinted under a mass of thick wiry eyebrows and grayish black hair. Although I suspected he was just pretending to be fierce, like my grandfather did when telling one of his stories, I was transfixed by his stern gaze and looming presence. Then, after what seemed several minutes, he bowed gracefully and turned away from us once more to face the orchestra, and raised his baton high above his head where he again dramatically paused. I felt suspended by this action and pulled toward him. It was as if the space between us disappeared until I was held there in his pose. When he finally moved, I felt light, breathless and swept along with the baton. It was like entering a world of musical enchantment. Somehow, in what seemed to be only a few moments of intense and exquisite joy, embraced by the loveliest melody I had ever heard, the worry, dread and everything around me ceased to exist. Captivated by the music, held within the music, the stage and all it encompassed, I was aware of every detail of sound and position. The clarity of each tone, coming from each instrument, combined to make a luxurious sound that lifted me into a place of happiness, calm and weightlessness. A place that I wanted to stay forever. 'Corinne!'� 'Corinne!'� The voice came from some distant place ' then closer ' followed by sounds of laughter. I felt a hand on each shoulder. . . gentle movement, and then the face above me, slowly becoming clearer and the voice repeating, but this time more softly, 'Corinne.'� It was Sister Mary Claver. Beyond her, far away now, I could see the faces of the musicians as their expressions began to change. No longer serious, several began to smile. They had stopped playing their instruments and some started laughing quietly. They were looking in my direction. And then I became more aware of laughter coming from each side of the auditorium. I suddenly realized that except for Sister, I was standing alone. The classmates I had led into the auditorium, who should have been standing to my left, were gathered in the doorway at the exit to the right. They were laughing uproariously. At the left door entrance, another class was waiting and laughing with equal ferocity. They were all laughing. . . laughing at me. It dawned on me that our time had been up for some minutes and that my class must have moved past me without my knowledge. I wondered how long I had stood there like that. How could this have happened, and worst of all, how could I have failed in my task and let Sister Mary Claver down? I desperately wanted to disappear, to go back, to hide or somehow make everyone go away. I could only stand there, shrouded in misery, staring down at the marked spot where I had earlier so conscientiously positioned myself. Sister gently began to move me along with her toward the back door of the auditorium. As she led me from the room, her sweet protective voice and the folds of her black habit were my only shields against the terrible gales of laughter. From this point on, I remember nothing more of this day. However, there were significant changes in my behavior from that day forward'¦

A BEGINNING OVERTURE: PIVOTAL CHILDHOOD EXPERIENCE In recent years, scientific breakthroughs in mind/brain research have revolutionized theories on childhood development. Although the Nature vs. Nurture debate continues, it is now recognized that each child is born with a unique biology that greatly influences, but does not predetermine, life course. The expression or influence of the genes depends on interactions with those in the cell, the body, and in the social and physical world of the child.2 Early childhood is the most crucial and the most vulnerable time in how a child develops, emotionally and intellectually. During the first two years of life, a child learns to regulate feelings and behavior through reciprocal interactions with the parents or caregiver. This vitally important relationship provides the nurturing and protection that is essential to a child's level of security. Within the boundaries of this relationship, a child learns to perceive and respond to emotional cues, develop empathy and form a sense of self. As the child develops the ability to regulate emotions within the framework of a secure environment (one that provides consistent care and guidance), difficult experiences that present challenges can be negotiated with increasing success and autonomy. A child's neuronal development is not only shaped by experiences, but by how a child responds to his or her experiences. Early experiences affect children's later ability to learn and reason.3 When a child does not learn to regulate emotions, or if an experience occurs that propels a child into an emotional realm that is beyond his or her ability to regulate, a behavioral dynamic can be spontaneously constructed to help the child compensate during and after the de-regulating experience. Pivotal experiences are those that result in a distinct change in behavior that alters the child's development and life course to some degree. This work is an effort to shed light on the origin and development of problematic behavior that arises from a unique level of childhood experience. Although childhood trauma and abuse are, of course, highly represented here in relation to this pivotal phenomenon, a much wider range of childhood experience is brought into view to demonstrate the individual nature of a pivotal experience. The conditions and common factors that link certain experiences to behavior that is characterized by repetition, obsessive/compulsive thought and action, and behavior pattern development that insidiously evolves from childhood into adulthood, are presented with clear theoretical explanation and interesting clinical and notable case examples. Two primary dimensions will be explored in relation to these conditions and common factors: $'¢ experiences that generate an extreme distress state of Suffering, and $'¢ experiences that generate an extreme arousal state of Joy. For the purpose of clarity, the terms Suffering and Joy were chosen to represent the two extremes of a spectrum of emotional and physiological states generated by pivotal childhood experience. These states are comprised of a variety of feeling and physical symptom combinations that are unique to each individual. The role of pivotal experience, experience that propels a child into a highly intense-to-extreme dimension of joy or suffering, will be explored in depth in relation to the origin of behavior that sabotages healthy childhood development and creates vulnerability to addiction and many other psychological disorders. Pivotal childhood experience is one of the most underestimated areas of concern in relation to prevention and treatment of these conditions. Behaviors that develop into repetitive and/or obsessive patterns can be linked to a dynamic that occurs during experiences that produce in the child a highly intense-to-extreme emotional state. As feelings occur in response to an experience, the most forceful feature is the set of physical symptoms that is also generated. When feelings and physical symptoms begin to escalate to an extreme level of intensity, the child can experience an emotional state and physiological condition that become overwhelming. Examples of feelings reported during this state include: anger, fear, frustration, terror, excitement, embarrassment, rage, sadness, loneliness, desperation, jealousy, and many others. Examples of physical symptoms reported include: '¢ Visual and hearing distortion or impairment, difficulty breathing, difficulty swallowing, vocal impairment. '¢ Changes in body temperature. Loss of body fluids, through tears, urine, vomit, perspiration, bowel movement. Changes in heart rate. Changes in energy level. Stomach distress. Involuntary body movement (shaking, trembling, twitching). '¢ Changes in skin, such as rashes, flushing, red patches, hives. $'¢ Increased mental activity. Descriptions include mental confusion, racing mind, diminished ability to think clearly, diminished ability to think rationally, pressure or pounding in various regions of the head and face. When a child has an experience that produces a combination of feelings and physical symptoms that increase in intensity toward an extreme level, the behavioral action that effectively works to decrease or alter the distress level to some degree will be registered in the brain and in memory as an effective response for distress-symptom relief. The peak level of an experience of this nature is recorded in such a way that, years later, certain details of the experience can be vividly recalled whenever the episode surfaces in memory. Experiences that produce in the child an extreme state of suffering are often later described as intolerable or unbearable at the point when the behavior takes place. If another experience, or a series of experiences, triggers the feeling and physical symptom combination generated during the initial experience, the associated behavior, which has now become an integral part of the combination, will be repeated'¦. I have thought so many times, listening to addiction relapse patients, how tragic it was that nothing was done for them at the beginning. And even though I have designed a method for addressing the complex conditions that later surface, they are very difficult to treat. I have therefore concluded many of the chapters with examples that illustrate the depth of the problem. In many respects, the only true prevention can and must be done in the early stages. The HRIPTM (High Risk Identification and Prediction Treatment Method) brings forth crucial information that supports the need for early childhood interventions at every level of development. And the most important thing about this is that parents need to be much more aware that the seeds of later problematic conditions can be created during experiences that are characterized by the dynamics described in this text. Once created, the seeds are germinated by the behavioral response that occurs and they grow from behavioral repetition that is often overlooked by all those who surround the child. This is everyone's problem. Many of the problematic behavioral patterns that lead to obsession do not necessarily lead to addiction, but do lead to life-sabotaging actions that overpower the individual. Addiction is just one of the most likely outcomes for many of these people. In today's approach to addiction treatment, shortcut methods addressing here-and-now solution-focused outcomes don't even put a dent in the chronic potential of these people. This is a society problem and the current youth population is exposed to an increasing amount of insecurity and dangerous stimuli that produce the right conditions for these types of experiences. Intervention programs designed to help troubled and/or delinquent children are expanding, but their waiting lists are very long, and getting longer. The mental health issues of the young people they accept are getting more complex. The increase in reliance on prescribed medications is astounding, and the abuse and neglect issues reported are appalling. And these boys and girls are not just from poor families; the private-pay clients come from some of the wealthiest. It is an across-the board-problem. If society continues to depend on later treatment, instead of early prevention, the cost will continue to grow ' unnecessarily. What is the HRIPTM? The High Risk Identification and Prediction Treatment Model (HRIPTM) was developed to increase patient and clinician ability to identify, assess and treat chronic behavioral and addiction risk symptoms more effectively. The HRIPTM was developed over many years of work with chronic patients and criminal offenders within a wide range of addiction treatment and rehabilitation settings, including military, corrections and hospital-based facilities. The primary focus of this method is to unearth information that otherwise would not be revealed, and therefore could not be addressed by whatever treatment approach the individual finds. When core issues remain buried and the individual cannot personally identify, or even understand, what events are important to share or reveal, the most crucial information is often lost in superficial disclosure and mimicking of other patients or clients involved in the treatment process. Therefore, the following chapters focus more on the unearthing process, and what comes forth, than on the treatment approach that is prescribed based on these revelations. The cases chosen as examples for this book represent people who have been in treatment multiple times and who, in most cases, never previously revealed what came forth until they participated in the Orchestration Group Process. When you realize that, then you can see why, for years, I worked on developing a way to identify and expose underlying developmental issues. I knew, from my experience listening to the most chronic patients and offenders, that such issues were creating havoc in their lives and disrupting their recovery processes. The HRIPTM was developed with a consistent and dedicated approach to addressing the chronic nature of addiction and its underlying problems. This method has recently been incorporated into a pilot project in Atlanta for the Georgia State Department of Corrections, Pardons and Parole. From the beginning of my professional career as a counselor assigned to develop relapse prevention programming, to my work today, I have consistently accumulated data that support the link between the developmental period and chronic behavioral and addiction conditions. The HRIPTM methods were designed to investigate the developmental process of each individual, to determine the origin and nature of lifesabotaging patterns of behavior characterized by obsessive/compulsive repetition. In practice, HRIPTM is a highly-structured approach built around the Orchestration Group Process (OGP), in which I used the musical concept as a model to facilitate investigation of the individual within a dynamic, organized and collective process. The Orchestration Group Process (OGP) is a structured format in which one member of the treatment group, in the role of 'group focus,'� shares (describes out loud) one pivotal experience. The session is structured to represent what occurs during an experience. The group facilitator is the conductor, and leads the person who is sharing through the process of identifying what is being recalled in the vivid center of detail that arises in memory. The other group members sit in a semi-circle of rows, set up like an orchestra around the person who is disclosing his or her experience. The first row represents the feeling/physical symptom response; group participants share how each of them might have felt and physically responded if the experience being shared had happened to them. The second row represents the behavioral response; each participant shares how he or she might have behaved in such a situation. The person who is sharing as 'focus'� listens to each disclosure from the others and gains increased insight into his or her own experience, as the others respond by identifying their most powerful feeling, physical symptoms and behavioral responses. The facilitator (conductor) gains vital information about each member of the group during this highly structured process. The case studies that conclude each of the following chapters represent the information that comes to light during the Orchestration Group Process ' crucial information for the patient and his counselors, crucial information that previous treatment processes failed to reveal. Assessment questionnaires and other materials were developed from the OGP to enhance its effectiveness. The HRIPTM Manual, for patients in the program, includes written exercises, charts and other materials designed to educate the patient about the nature and condition of chronic behavioral and addiction relapse and to pinpoint the sabotaging elements that are individual to each case. This collaborative approach to individualized treatment enables the clinician and patient to address together the psychological and physiological dynamics stemming from pre-addiction factors, while recognizing the importance of all other aspects of treatment that address the onset and process of addiction and post-addiction factors. A study conducted to determine the effectiveness of the HRIPTM was published in 2001 in the February issue Journal of Substance Abuse Treatment. The Orchestration of Joy and Suffering was written to help parents, teachers, friends and neighbors to understand problematic conditions that can arise from certain childhood experiences. More importantly, it was from the voices and revelations of those who suffer these conditions to the most chronic degree that this evidence emerged. Corinne F. Gerwe, PhD (Biological Psychology), CCAS (Certified Clinical Addiction Specialist), CAS (National Certification) American Academy of Health Care Providers in the Addictive Disorders (AAHCPAD)