Working with Addictions: Predictability

When working with addictions, it is vitally important to understand the role that predictability, and the desire for predictability, has in a person’s life. The repetition of these behaviors creates habit; and with any habit, a person comes to know just what he is going to experience. If it is the habit of drinking to the point of intoxication, if it is indulging in pornography or smoking pot, a person tends to know what will happen. He knows that he will get high; that he will feel differently in his body and his mind than he currently feels. He knows what exhilaration he will feel; what lack of inhibition he’ll experience. (He also “knows,” though this knowledge may be sequestered in hidden recesses of his mind, that there will be a low, a let down, and a reoccurring need to get high again.)

This method of instating a sense of predictability provides a way to feel in control of one’s life, especially when dealing with a vast portion of life experience which feels outside of that control. The feeling of being out of control, and thus terribly vulnerable, is a core component of anxiety. Much of what causes suffering is unpredictable: a sudden change in a person’s finances; an abrupt end to a relationship; a loss. Of course, there are predictable occurrences in life and these too can cause pain and suffering. With any significant change in a person’s life, there may be feelings of powerlessness, lack of control – often challenging a person’s stability and well-being. And when dealing with what is not changing in a person’s life – disturbing feelings of stagnation and ennui — there is often an accompanying feeling of powerlessness. A person who uses some substance is trying to reinstate a sense of control. He or she is trying to cope. The result, however, often falls quite short of the intention. A life of alcoholism becomes a chaotic life. The effects of chronic marijuana use or pornography often contribute to a life without direction, one of futility and stagnation. As one client put it when describing his drinking, his thoughts were mostly focused throughout the day on getting the next drink, and thus his job and his family life suffered.

I have found when working with my clients on their addictions and compulsive behaviors that it is fundamental that we understand how their behavior instills some sense of predictability in their lives. It’s important for us to see this function of their behaviors and then search for better ways of coping.

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July 05, 2011
Psychotherapy and Discovery

Psychotherapy is about discovery. At the heart of the work that the client and I do is the quest for discovery. It might be to discover just what is causing distress and suffering in the person’s life. In this regard, our quest is multi-leveled. There is of course the immediate level: a loss that the person has experienced, a transition, or some maladaptive compulsive or addictive behaviors. And then too there is the search for hidden layers: it may be that these behaviors and habits are symptoms of some more underlying distress.

The foundation of our work is to understand. A client may present with certain rigid patterns of thought or behavior. Perhaps the client obsesses or ruminates on what is dangerous and threatening in the world. Perhaps the client seems locked into patterns of relationship that repeat themselves. In such cases we endeavor to understand so that that understanding can be the foundation on which to base change.

Based on that understanding, we endeavor to discover what changes a person needs to make in his life and what the options are. Here we might first take into account the “solutions” that the person has attempted or continues to implement. In this regard, obsessive thoughts can be one such a “solution.” This type of thinking may give a transitory sense of order and control when a person is plagued with an underlying sense of powerlessness and lack of control. Sometimes the “solution” one has implemented is to repeatedly numb or self-medicate through some compulsive or addictive behavior. Together the client and I think about what other options, what other solutions, real and useful solutions, are available.

Often what brings a client into therapy is what is known and familiar. This might be the addictive or compulsive behaviors a client struggles with. This might be the walls and barriers that a client erects to keep intimacy out. This might be a crippling and denigrating self-critical voice the repetitively plays in his head. Our quest is always to find what is new even in what is old and familiar.

Of course, this quest for discovery often involves traveling through familiar terrain and places. But when the client and I do this together, when we are talking about the past, our interaction allows for something new to emerge. Often that which is new is a realization or thought. Although there are not always “ah ha” moments in every session, my experience suggests that, even when talking about the past and what is familiar, new insights can be gained.

And a lot of times what is new is what the client feels in the session. Talking makes things real. Even if it is talking about what has happened in the past, the experience comes to life in the moment is replete with various feelings from then and now. Sometimes what we discover are feelings that were not felt before. And sometimes we discover the feelings that are felt now.

At the beginning of each session, I do not know where the client and I will go. But that is the thrill and excitement of this work. Only to be matched by those thrilling and exciting moments when a client remembers something, feels something, or gains a new insight. In those moments something new is born in the session.

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