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A Conversation About Shame and Self-Compassion With Neuroscientist Marc Lewis

I had the pleasure of speaking with Marc Lewis over Zoom about addiction, neuroscience, shame, and self-compassion. Lewis is a neuroscientist and professor emeritus in developmental psychology. He is the author or co-author of over 70 journal publications in psychology and neuroscience, and the author of two books. Lewis currently writes for the popular press, blogs, and speaks internationally on the science, experience, and treatment of addiction.

Can you talk about how shame contributes to and then exacerbates addiction?

Shame is often the result of trauma. If you’ve been traumatized one way or another—whether it’s been verbal or physical or sexual abuse or some other misfortune—you often feel like you’re the one who’s done wrong, or that you didn’t respond the way you should have. You feel like you aren’t the right person and blame yourself. The result is overwhelming and extensive shame and self-punishment.

Shame is extremely painful to carry around, so people start using substances and feel relief. It warms them up and makes them feel like they can offload this weight they’re carrying for a while. But the insidious part is that the addiction itself can instigate further shame. It often does, since people don’t think particularly well of addicts. So the shame keeps accumulating in a feedback cycle.

You’ve talked about Internal Family Systems [the therapeutic modality], and how when we validate all the different parts of ourselves, it can help us challenge stories about our wrongness or unworthiness. Can you talk more about that?

The basic idea is that we have different parts of us, and sometimes those parts are at war with one another—not listening to or hearing each other. They include very young parts that still feel really strong emotions and can’t defend themselves from them. That’s where the shame, fear, anxiety, and anger accumulate.

Then there are protectors—the parts we develop to help ourselves act and feel better. In the case of addiction, very often they are trying to help us get away from negative emotions. This is the part that’s often called the firefighter. The idea is that when firefighters come, they just spray out the fire and leave a huge mess and don’t care. Just put out the fire and leave.

The firefighter is the reactive part. It’s the part that says, “F*ck this, I am not going to feel this anymore. I know how to feel better. I’m just going to take this drug.” That’s reacting to other parts that are more judgmental, more rational—all the “should” parts.

In psychotherapy, you help people talk with those parts—acknowledge them, accept them, and forgive them. Even value them, which sounds odd because some of those parts get you in trouble, but the idea is to recognize that they are trying to help you in whatever way they can. Some of those ways leave a mess, but they’re still trying to help.

There’s a strong emphasis on self-compassion. You ground yourself in your Self with a capital S. It’s ironically kind of similar to what Buddhists call the non-self because there’s a sense that it extends and it’s not egotistical; it’s just here, present, aware, and insightful. When you are anchored in that place you can much more easily send compassion to the different parts.

This morning I listened to a meditation that was, “How to Stop Blaming Yourself.” I thought, “Exactly! That’s pretty much the same goal as IFS.” So it doesn’t have to be IFS. There are many ways to think about how to forgive ourselves, and how to alleviate the sense of self-abuse that we so often carry around.

Have you come across people in your therapy who have a hard time accessing the different parts of self?

Some people take to it like a duck to water; they already have their internal world pretty much divided into parts, so it’s easy for them. A lot of people recognize the internal critic or judge—especially people who use substances or drink a lot, because there’s so much stigma. They have a pretty powerful internal critic who says, “How dare you do that. Again?!” That can be very familiar to people.

Other people, it takes longer. You need to guide them. It’s a meditation-like process in some ways. It involves some mindfulness, some looking inside and being with yourself. We use guided imagery a fair bit to identify and elucidate the different parts.

How does your own experience of addiction inform your work as a therapist?

A lot. It’s well known in the addiction therapy world that people who have serious troubles with addiction feel a lot more comfortable talking about them with someone who’s been there. People get a sense that if you haven’t been there, you don’t know what it’s like. No matter how much you think you know—how much empathy and compassion you can access—you’re still never going to really understand. Trust gets laid down quickly if the counselor or therapist has been there, especially if they’re able to share some thoughts or feelings about the experience.

How does your understanding of neuroscience inform your therapy practice? Or does it?

It doesn’t very much these days. Except for example if people see the idea of parts in Internal Family Systems as too metaphorical—like a fairytale or a mystical orientation. Then I can switch to neuroscience language and say, “Hey, there’s a lot of connections between your ventral striatum and midbrain dopamine centers and whatever regions of prefrontal cortex.”

The brain forms synaptic networks, assemblies, patterns, and configurations. Those configurations are the interpretations we carry with us through life, and they are the ones we want to explore. But using brain terms makes the diverse parts of ourselves difficult to access, so then we switch to more metaphorical language based on guided imagery.

But we’re talking about reality; it’s not just spinning tales here. I studied addiction neuroscience for a long time, and there’s no doubt that the impulsive and compulsive urges—what we usually call craving—are real. They’re parts of your brain that are highly activated and very focused on a particular reward.

It’s not easy to turn that off; it’s biological. Everything that’s psychological is fundamentally biological. So there’s another advantage to introducing neuroscience ideas: they help people recognize that habits have a biological basis—that it takes time to rewire those networks—so it becomes easier for them to forgive themselves for how difficult it is to turn off feelings and impulses they know are hurting them.

My next question relates to that. You wrote on a recent blog, “When people ask whether addiction is psychological or biological or social, they’re asking the wrong question.” What do you think they should be asking?

Nowadays in psychology and related sciences, they often talk about the biopsychosocial model. They throw them all together, because people recognize: “You know what? These systems are all acting at the same time.” It’s not one or the other; it can’t be.

Traditionally, if you say it’s biological, you are assuming that addiction is a pathology. But that’s not a rational assumption, because everything is biological—learning is biological; falling in love is biological. Once you realize that biology does not imply pathology, you don’t tend to make these category errors that it’s one or the other.

I always thought it was counterintuitive to pathologize it if people are self-medicating for feeling shame or wrongness.

Yeah, self-medication is a useful way of talking about substance use. When people take drugs or drink alcohol, they’re medicating their stressful feelings. We’re all just trying to feel okay.


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As we continue to grow Amatus Health, the need to stay competitive and differentiate ourselves in unique ways is crucial. Building creative approaches to reach more people will take our company to new heights. This is why I am pleased to announce that we are officially rebranding. Our new national name, TruHealing Addiction & Mental Health Treatment, will eventually replace Amatus Recovery Centers.

You may be asking, “Why are we doing this?” This new name will give us national uniformity and help brand ourselves as a whole, which will be done in phases. You will still see our existing facility names co-branded with TruHealing for the time being.

Healing is what we do. Everyone who comes through our doors is in a moment of profound struggle in their lives. We support them through a life-changing process of healing and recovery, and they leave our facilities changed. This new name is a representation of that process. As mentioned above, it also allows us to have a national brand, which will make us a recognizable name in the addiction and mental health field.

In summation, these changes present an excellent opportunity for our organization to develop our mission, vision, and purpose. I look forward to prosperous growth as we head in a new and positive direction.


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Mark Gold
Amatus Health

Dr. Adam Cusner, PhD is an organizational psychologist by training and has brought his decade-plus experience to the healthcare field serving as the Executive Vice President of Operations for a 22-facility portfolio of skilled nursing facilities, assisted living and independent living centers across Ohio and Arizona, with an annual revenue over $250MM. While serving in this position, Dr. Cusner brought accelerated growth to these facilities, while increasing employee retention and workflow optimization. Dr. Cusner has a proven track record in the healthcare industry of providing successful leadership through his financial acumen, strategic planning, interpersonal skills, along with his ability to build strong, effective teams.


Dr. Cusner’s credentials include a Philosophy Doctorate in Organizational Psychology (PhD) from Cleveland State University, a Master of Arts in Psychology (MA) from Boston College with an emphasis on Psychology of Work, a Bachelor of Science in Psychology (BS) from Boston University with an emphasis in Organizational Behavior in Business and is a board-certified Nursing Home Administrator (LNHA). He has published and presented research articles in the field of organizational psychology at national healthcare conferences. Dr. Cusner is completing a book on organizational psychology in the healthcare field, which is expected to be published late early summer 2022. He is also a member of the American Psychological Association (APA), has served as the APA’s Division 17 communications chair, is a member of the Society for Industrial Organizational Psychologists (SIOP), and was selected as a professional reviewer for national conference research presentations.


Dr. Cusner is an advocate for his employees and is drawn to the tie between culture and quality. His extensive strategic and operational skills have delivered a high degree of success across all department levels. Dr. Cusner facilitated the establishment of an in-house financial team to provide billing and collections, accounts payable, vendor management, along with financial reporting. This provided $1.5MM annualized savings. Further, he developed department efficiencies for: Medical Staff recruitment, service-line growth, quality and safety, corporate accountability of budgetary expectations balanced with direct reporting to investor groups.


Dr. Cusner coordinated the financial turnaround of a 300 bed CCRC (skilled nursing, assisted living and an independent living center) in Arizona, which has been epitomized as the most financially challenging state to manage CCRC facilities. Dr. Cusner also strengthened the business growth of the Ohio facilities by 12%. He was recognized by the Governor for demonstrating a “care-conscious approach” during COVID, when Dr. Cusner carefully consolidated facility residents to accommodate staff and improve clinical care. Dr. Cusner demonstrates a results-driven culture by delivering a high-quality level of care and employee engagement.

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Yaffa Atias is the Director of Special Projects at Amatus Health. Atias is a leadership professional with a decade of experience in healthcare. She holds a BA in interdisciplinary studies from Thomas Edison State College, and a Master’s in Healthcare Management with a concentration in project management from Stevenson University. She completed her graduate capstone at Mosaic Community Services, now an affiliate of Sheppard Pratt.


In her role at Amatus, Atias leads and manages interdisciplinary team projects, creates solutions for any operational gaps, and continually strives for quality improvement in all processes. Atias led the organization’s COVID-19 preparedness strategy, resulting in all facilities remaining operational, and in 600 employees being retained as staff without resigning out of fear. In her role so far, she implemented licensure for three new states.


Atias believes Amatus Health and TruHealing stand out because every employee, from corporate to center staff, has a real passion for helping people. Atias shares this passion, “My natural compass always tugged me to behavioral health. I’ve always been fascinated by the human psyche. I have also been intimately privy to those suffering from mental illness and substance use. I later understood that my experiences weren’t unique, and quickly realized how pressing the need really is to effectively prevent and address. Moreover, how life-changing proper intervention truly is.”


Atias was born in Los Angeles, California and grew up in Israel and Maryland.

Melissa McCarthy is the Vice President of Business Development at Amatus Health. With a decade of experience in the behavioral healthcare and addiction treatment industry, McCarthy is passionate about recovery. She has her finger on the pulse of marketing trends, with the end goal of helping businesses grow so they can serve more people in need.


McCarthy has worked at large enterprise recovery centers across the country spearheading business development teams. She has a wide range of experience, including transforming a third-party digital marketing and client acquisition services company into a full-continuum behavioral healthcare provider, managing several successful rebrands, and growing annual revenue fivefold.


As VP of Business Development, McCarthy leads a team of over 20 business development professionals nationwide. She manages client acquisition, coordinates in-service trainings with various referents and hospitals, and presents at conferences on addiction and mental health disorder treatment.


“Sadly, many individuals die waiting for access to life-saving behavioral healthcare services,” says McCarthy. “I am in relentless pursuit of better—better access, better care delivery and better outcomes. I consider it a privilege to work in an environment where miracles unfold daily.”


McCarthy lives in Maryland with her daughter.

Hometown: Saugus, MA


Passions & interests: The greatest passion of mine is being able to dig into the work with men in early recovery. There is nothing better than witnessing and being a part of the change. My journey in long-term recovery has taught me to value the little things in life that I am now able to do. I love to do anything that allows me to be present with my wife, family, and friends. My wife and I enjoy traveling, trying new foods, and taking long motorcycle rides with our friends. If I am not on the road working or with my wife, I am studying or playing softball.


The best part of my job is being able to show up for my team and clients; they all mean the world to me. I get to brainstorm and strategize with tons of different personalities. A lot of the team does not know, but I love learning from them. If I am not learning something about our industry or workplace, I am certainly learning how to effectively collaborate with different types of individuals.


Together, we can change the narrative and be a part of the solution to better treat those trapped in the problem.

Allison was born in Columbus, Ohio and was raised in South Florida. She graduated from the University of Florida’s College of Journalism and Communications. After college, Allison started working at the largest talent agency in the world, William Morris Endeavor. There, she learned marketing from top leaders specializing in global PR and endorsement campaigns, in both the Latin and English markets.


Through strategic public relations and creative campaign concepts, Allison has secured more than 200 national broadcast and print media placements for behavioral healthcare organizations. She brings over 15 years of marketing and PR experience, with a strong background in leading communications strategy for addiction treatment and behavioral healthcare facilities. In her role as VP of Communications, she oversees branding, public relations, social media, marketing, events, and content creation.


In her spare time, she loves cooking, boating, yoga, and traveling. She and her husband Bryan reside in Boca Raton, Florida.

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Avi Burstein is VP of Clinical Services at Amatus Health. He manages all therapeutic programming at all facilities nationwide.


Avi is originally from New York, and graduated from Ferkauf Graduate School of Psychology. He brings over 13 years of experience in the Behavioral Healthcare Industry, in both the public and private sectors. He is passionate about therapeutic communities and the fellowship they foster between patients. Through his work in LGBTQIA, urban, rural, and religiously observant populations, Avi recognizes that each patient is unique. Therefore, he strives to ensure clinical approaches, staffing, administration, and education meet the expectation of each community Amatus Health serves.


“Our work must also include ending the societal stigma surrounding such conditions by building safe and supportive networks that include clients’ families whenever possible,” Avi said. “By valuing change and owning imperfections, we can strive to be better providers and walk through the door of recovery with our clients.”

Avi Burstein is VP of Clinical Services at Amatus Health. He manages all therapeutic programming at all facilities nationwide.


Avi is originally from New York, and graduated from Ferkauf Graduate School of Psychology. He brings over 13 years of experience in the Behavioral Healthcare Industry, in both the public and private sectors. He is passionate about therapeutic communities and the fellowship they foster between patients. Through his work in LGBTQIA, urban, rural, and religiously observant populations, Avi recognizes that each patient is unique. Therefore, he strives to ensure clinical approaches, staffing, administration, and education meet the expectation of each community Amatus Health serves.


“Our work must also include ending the societal stigma surrounding such conditions by building safe and supportive networks that include clients’ families whenever possible,” Avi said. “By valuing change and owning imperfections, we can strive to be better providers and walk through the door of recovery with our clients.”

Marty Markovits is the Chief Information Officer at TruHealing. He oversees the people, processes, and technologies of the whole organization to ensure the business is running smoothly.


Markovits grew up in Brooklyn, NY (which he calls “the greatest city on Earth”) and graduated with a degree in Clinical Psychology from Queens College.


Markovits is a veteran in Information Technology within the healthcare field. He ensures that IT processes are simple, cost-effective, and secure. His expertise spans the entire healthcare domain, from billing and claims, to clinical, to Human Resources. He says, “My passion is to provide fully automated and operationally meaningful Business Intelligence analytics, with absolute data integrity.”

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Hometown: Savannah, GA


Passions & Interests: I spend my time outside of work with my wife and children and am actively involved in various community needs and causes.


The best part of my job is knowing that we are creating a safe, healthy, nonjudgmental environment where people can come and better their lives. There is nothing more satisfying than helping others learn to live again and piece their lives back together as they become strong, productive members of society.

Together, we can bring families back together and promote healing and well-being.


With over 16 years of proven executive leadership and driving company growth, Mark Gold’s momentum for success isn’t slowing down anytime soon. He serves as the CEO of Amatus Health, one of the fastest-growing, behavioral healthcare organizations in the country.

Possessing an excellent handling of clinical compliance and high performance standards, Mark established 14 CARF/JCT accredited addiction and mental health treatment centers and three ancillary healthcare businesses. Mark’s natural leadership skills as well as his creative thought process to generate new revenue strategies make him one of the most sought-after professionals in healthcare. Mark has a track record of leading organizations to outstanding ROI on overall portfolio performance. In addition, his expertise includes workforce planning, growth revenue, high client and investor satisfaction.

Aside from daily business oversight, Mark invests in his staff and helps build their professional development. His commitment to his colleagues and employees toward advancement and inclusiveness helps them achieve goals, builds connections, and provides a competitive advantage in the healthcare field.

Corporate and Charitable Leadership

Mark has been instrumental in building healthy communities and providing access and quality healthcare to underserved populations. His service in the community is a testament to his passion and selfless dedication to the cause of eradicating addictive disorders and stigma.

He launched several prevention and education programs and created the first-ever “Social Justice” scholarship fund of over $750,000.00 to help communities of color into inpatient drug treatment. Mark says, “The best part of my role is the knowledge that what we do impacts countless lives, with far-reaching effects,” he said. “It is incredibly rewarding to be part of a team that guides individuals onto a safe and accessible path to healing and recovery.”

He is a board member of Ahavas Chaim, a non-profit that offers at-risk teenagers crisis intervention and mental health support. He is also a committee member of the organizations Bonei Olam and Chai Lifeline Mid-Atlantic.

Personal and Educational Background

Mark studied Talmudic Law at Yeshiva’s Mir Yerushalayim in Israel. In Mark’s free time, he loves snowboarding, boating, and spending time with his wife and children.