Getting to the heart of addiction therapy.
This is a theme close to my heart. I have my own experience of going through addiction treatment, being in recovery from an addiction, experiencing addiction support groups and working as a psychotherapist in residential rehab clinics in West London.
There is a lot I like about this way of working. In particular it provides a formidable sense of community and hope and it can really motivate some individuals to change their behaviours and embrace a new way of life.
The old 12 step wisdom of people laughing in recognition when they talk of 'their addict head' saying or doing this or that, is actually a brilliant way to externalise the addictive part and to start to relate to it from a more curious, adult place. Belonging to a group, finding out that one is not alone, lessens shame and decreases the sense of isolation that goes hand in hand with experiences of addiction.
In the type of addiction therapy I offer I like to integrate a trauma informed way of working with addictive parts as an attempt to soothe an underlying pain, together with more traditional ways of working with addiction. An example of this is the work of Janina Fisher, the structural dissociation model and Internal Family Systems that I talk about in one of my previous posts.
One of the main ways in which this model differs from the traditional addiction treatment model is that it promotes relating to addictive parts mindfully, with curiosity and compassion, without judgement. This is sometimes in contrast with the discourse in addiction circles which can sometimes be quite shaming. In my view these addictive parts, regardless of the negative consequences they may be causing, are there for a reason.
Whilst working with people in primary and secondary addiction treatment, I have seen people find some relief in understanding the link between their addictive part and their pain and in learning new ways to regulate their nervous system. However some challenges still remain.
For example whereas healing from trauma often emphasises the experience of helping the clients feel safe as a prerequisite for the healing to take place, addiction treatment, in my experience, can sometimes foster a culture of challenge where people's defences are sometimes tackled too directly, in my view, without the necessary thought given to the consequences of this or to the shaming undertones this may have.
Arguably, it is also sometimes a culture where there is an assumption of the therapist knowing better than the client. Whilst this is understandable when thinking of some of the negative consequences of addiction, I still find this position problematic, as it communicates judgement towards some parts of the client's experience.
Another useful lens that I have found in working with addiction is the more transpersonal way of working of looking at the qualities in the object or substance that we long for as the qualities that we are called to develop in ourselves to reach more of our potential. However, in my view, in order to access these deeper levels of reflection, this deeper gold in one's addiction, it might be necessary to address the more personal layer of pain at a mind, body and heart level first.
Unless we understand the function that these addictive parts play in soothing an underlying distress coming from past experiences, and equip people to be able to identify triggers and to be able to make themselves feel better with new resources, we are in my opinion less likely to be able support people to achieve a long term change.
Picture by Katarzyna Urbanek on Unsplash