Working with Addictions: Psychotherapy Part I

From my clinical experience, I have often seen that these behaviors have persisted for a very long time in a person’s life. It is not surprising to see that during the person’s childhood (perhaps beginning in adolescence) there was some use of some substance as a means of coping. In these circumstances, it is important to understand that this means of coping, of attempting to feel better, stems from a time when a person’s resources and abilities were much more limited than they are now as an adult. This awareness becomes an important step in our work together. In some sense the client is misidentifying himself as still being that younger person with fewer resources available. It is vitally important for the client to make this differentiation in time: to see that now is different than then.

One key resource – and one we emphasize in our work together — is the therapeutic power of an interpersonal process, of relationship. It is not infrequent in this work that the client and I see that going back to childhood, the client may have had little help in coping with what distressed him. In many instances, we see that parents or guardians were absent, not involved, or negligent in helping these people manage, tolerate and work through their issues. Often these people felt quite alone and left alone to their own devices to figure out some way to manage. The ways that they have figured out (the “solutions” that are these addictive behaviors) often linger till present day. And most importantly, that feeling of being on one’s own lingers as well. The work of psychotherapy then, through the relationship that is at the core of this work, challenges those basic assumptions and feelings. The client comes to feel that he is not alone. (Of course there are times when referrals to support groups, sometimes rehabilitation programs, are necessary and also help the client feel less alone and recognize more resources that are available to him.) Through the psychotherapy relationship, the client learns to unlearn what he gathered from the past – that he is alone, on his own to figure out how to cope with life’s distresses.

The client has developed these coping strategies as a means to deal with what is thought to be unmanageable, too dreadful and painful to feel. At the heart of our work together is challenging this belief (often made conscious in the thought that “I won’t function” or “I’ll fall apart” if faced with these feelings) and feeling and thinking about what has been thought of as unthinkable and unbearable (especially when alone). The client comes to see that what is causing distress in his life doesn’t have to be skipped over, he doesn’t have to anesthetize himself because of the pain in his life. Through the psychotherapy process, the client learns to better stay with himself and his feelings. He doesn’t have to escape. He and I can then think together about what is causing suffering in his life and what real changes need to be made to alleviate that suffering.

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