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Analytic Therapy for Addictions

In this blog I want to briefly explore the analytic approach to addictions.  Freud stated that his aim in Psychoanalysis was to help the patient transform ‘hysterical misery into common unhappiness’. In Buddhism, a central concept is that of Dukkha, commonly translated as ‘suffering’, ‘unhappiness’, ‘pain’, or ‘stress‘. It refers to the fundamental painfulness of mundane life.

Henry David Thoreau (1854) declared that most men lead a life of quiet desperation.

As depressing as these concepts seem, the intention is actually to relieve suffering, that it is the excess of suffering that we visit upon ourselves by an excess of demand, the demand to be excessively happy, to criticize and shame ourselves for not being ‘good enough’, the sadistic internal voices that berate us for the shortcomings of what is often an unachievable internal ideal that creates an unbearable pressure.

Modern life is designed to sell us things. One the most successful early pioneers of advertising, Edward Bernays was a nephew of Freuds and advertising has very successfully realized that we are driven to buys things that we imagine will make us feel better about ourselves, that within the object brought is an identity of ourselves as, better, more desirable, happier etc, in short to offer us promises of less painful or even pain free lives.

Zizek notes that the unconscious ideology of today is the demand to ‘enjoy’.

In terms of addictions, especially the addictions, now facilitated by the internet, and even more so by the internet in the pocket, the phone; gambling, pornography and shopping, these promises are ever ready. Its is also worth noting that addictions can be hidden in seemingly healthy pursuits; healthy eating, work, exercising, that can also be used as an avoidance of emotional pain through compulsive stimulation.

There are broadly speaking two approaches to therapy and to treating addictions and their underlying causes, the conscious strategies and good advice model and the more exploratory underlying approaches. Both have their place and it may be necessary to utilize both to really address issues.

The first model; involves CBT and specialist structured interventions; – managing access to the source of addictions, keeping diaries, replacing destructive habits with healthier ones and these will be more advice led. Sometimes it may necessary to utilize these approaches to try and get something under control. However, what these models may not do is to really dig down and get underneath the causes of the problems. The addictions are often the symptoms of underlying traumas and difficulties, sometimes these are not conscious and this is where the analytic or exploratory approach focuses its beam. The problem with not doing this, is that in true wac-a-mole style, the underlying causes tend to resurface and one addiction will merely be replaced with another.

Lance Dodes (2019) an analyst specializing in addictions highlights three pertinent areas of exploration:-

  1. Feelings of helplessness or powerlessness, produced by specific situations whose meanings interact with prior traumas. In this situation the additive act or even just the decision to undertake an addictive act can help the person regain a sense of control. The exploration of the issues leading to these feelings can unpick the unconscious feelings leading to the urges and ‘allow anticipation of future addictive urges, with the possibility of mastering the behaviour.’
  2. These feelings of powerlessness are often related to past traumas and difficult experiences often in relation to the clients attachment history, which has led to internal feelings of powerlessness and corresponding feelings of rage against these feelings.
  3. These feelings are displaced into addictions, through therapy these feelings that were once felt to be overwhelming and unbearable can over time and within a strong therapeutic relationship begin to be able to be felt to be understood and able to be experienced, often through the experience of the therapist being able to face and contain the feelings with and alongside the sufferer.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

Loss

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconsious

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“Should I stay, or should I go?” What does easing the lockdown mean to you?

I have found the Clash’s song of this title playing over in my mind when thinking about the current easing of the social lock down in the UK. It seems to me that we all, to some degree or another, now face a dilemma whether to stay or go.

Straight away, it is important to acknowledge the relationship of this dilemma to levels of freedom and privilege. It is true that some people have little or no choice about whether to go back into their workplace.  We all face very differing health concerns, with those in the ‘extremely vulnerable clinical group’ likely to feel greatest levels of concern and anxiety about going outside.  There has also been concerning, though unsurprising, expositions of inequalities in terms of health risks, with poorer and BAME people having greater chances of fatality.

However, in my experience these will not prevent them from experiencing similar kinds of conflicts at this time. It is a reality that a great many of us will, to some degree or another, be starting to wonder about how or when or whether we return to ‘normal’.

I have been wondering myself about this dilemma but I am also interested in how it might tap into broader questions about how we think about ourselves in relationship to our worlds – both outside and inside.

There is no doubt this has been a strange and disturbing time and of course we are no way through it. The sudden exponential growth of the virus and pandemic was frightening, and many felt traumatised by the level of crisis and what felt like an intense threat to our mortality. The war metaphors and imagery referenced by our government, while perhaps intended to help rally a ‘blitz spirit’, in all likelihood, simply added to the terror already felt by many.

The orders to lock down came as a relief for many people. We had permission to retreat and protect ourselves against what had suddenly become a hostile world. This was and is a necessary response but one that also exacerbated the fear of the outside world engendered by the virus and the rhetoric used about it.

We all responded differently to the retreat and this of course varied at different times. There are those who found and continue to find the lock down liberating, others who found and find it oppressive.  Of course, we are also living in different circumstances which add or detract from the benefits of the protection it offers. For example, it has been widely reported that incidents of domestic violence and abuse have increased during this period. Many were able to work easily from home, many were not and there was, and is still, differences between the level of risk for those going into work. And many have lost work or continue to face this as an increasing prospect.

External factors aside, our relationship to the pandemic and the lock down response will also key into aspects of our own internal worlds. A reluctance to move out of lock down could arise for those of us who tend to use retreat as a defence. It makes sense that the bubble offered by the lock down could tap into and heighten historical ways of managing difficult realities through strategies of self-seclusion. At the same time, those of us who have particularly found the lack of purpose and activity in the lock down difficult may have developed defences around keeping busy as a means of warding away difficult or painful feelings.  This could lead to a manic response to the easing of restrictions – perhaps a rushing quickly back into the world and ‘normality’.

Of course, both states may be at play in us at different times, but I am wondering about our overall tendencies that will shape how we are likely to interpret, and respond to, this shift in government advice.

Reflecting on my starting title, I wonder now about the aptness of the Clash song. It seems the transition from lock down to ‘normality’ (whatever that means) is not going to be as either/or as staying or leaving a relationship. It looks likely anyway that we are going to experience further Covid outbreaks with many expert views suggesting the current easing as premature and a second wave imminent.  We can therefore most probably anticipate more lock downs, perhaps even soon.

So, it feels more appropriate to think about a dialectic in/out situation we find ourselves facing requiring complex navigations. How we proceed and find our way through these difficult and disturbing times and those ahead, will be dictated by many external factors but also our own internal worlds and their responses, conscious and unconscious, to the different experiences of this pandemic.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2e

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A desire to change

One of my favourite papers is by Dr Sebastian Kraemer, called ‘Something Happens: Elements of Therapeutic Change’.  This blog helps break down what therapists and clients set out to do, as they sit together in a therapy room both hoping that change can be immobilised from a stuck situation.

This is first of eight short blogs exploring the eight elements of change identified as:

1. A desire to change

2. A primary task

3. A theory of mind and a method of treatment

4. Courage and honesty

5. A specific narrative

6. Neutrality and reflectiveness

7. A tradition

8. Something happens

 

A desire to change: As the client and therapist sit face to face in their first session progress has already begun  – the desire to change has been acknowledged and acted on.  The request for help to a therapist has been made and the therapist has accepted this. 

However long a therapist has been practicing – having collected skills, theories and techniques along the way – each new client brings a unique story and request for help.  They bring their stories of strength, courage and endurance alongside their stories of distress, confusion and pain.  Just turning up to the appointment is an act of bravery, it is our role as therapists to acknowledge and respect the clients vulnerability; walking alongside them as they take action to change.

On first meeting, many clients report that they have noticed shifts in their thinking, changes in behaviour and an increased sense of hopefulness that things can be different – this is before the first session.  This could possibly be a placebo effect or could be understood further in the context of the research around models of change.

In the early 1980’s Proschaska and DiClemete set out five stages of change. Upon arriving at their first session clients are already in transit between Stage Three and Stage Four 3 of this theory – monumental shifts in awareness and readiness have already taken place:

Stage One. Pre-contemplation – the ‘I’m not ready’ stage

I am unaware or under-aware of a problem and have not got plan to change – leave me alone.

Stage Two. Contemplation – the ‘I’m getting ready’ stage

I am aware I have a problem to address but do not have the motivation or commitment to change my behaviour as yet. – leave me alone but watch this space.

Stage Three. Preparation – the ‘I am ready’ stage  

I have researched and planned a way to change.and my initial goals are clear – no time to talk I’m busy!

Preparation is considered the most important stage of the model – relapse is considered to be 50 per more probable if the preparation stage is not undertaken

– ON YOUR FIRST SESSION YOU ARE HERE –

Stage Four. Action – the ‘I am implementing my plan’  

I am making changes to my behaviour, my environment and my choices. I have sought help in this process and am being encouraged to feel more hopeful about the future

Stage Five. Maintenance – ‘I have changed and I want to keep it that way’ stage.

Work and effort is still required to maintain positive changes and prevent relapse.

A desire for change is important to begin the work however sometimes it becomes clear change may bring difficulties and risks that had not been contemplated originally.  Resistance to the change may then come into play and the work takes a different turn as goals are reviewed.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

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Anxiety, Fear states, Trauma

Why do we get anxious and fearful?

The anxiety /fear response is the brain’s way of trying to keep us safe and healthy. Anxiety serves as a faithful reminder of things which the brain assesses need to be avoided, based on past experience. Most of this experience is past or learned experience. This is important in understanding the role of anxiety and fear states.

Firstly anxiety and fear are natural emotions which are built into our biochemistry in order to ensure survival. The fright flight fight response takes place in the lower ‘old brain’ and is vital to promote survival. This is the area of the brain which we probably all have had some experience of in recent days and weeks with the Corona virus pandemic. This response is what we are seeing with a frightened population stockpiling food and resources and even fighting over supplies.

Secondly alongside the biochemical response of the old brain, we each have individual mental and emotional responses which are very variable

Understanding that the brain is a pattern seeking machine is really helpful here in understanding these variable responses. The brain simply reproduces a response based on past similar experience.

In order to treat anxiety we need to look at these patterns.

Different schools of therapy  have different approaches.

Behavioural  therapy looks at how thinking influences feelings and how to interrupt that pattern.

Psychodynamic therapy seeks to understand and connect past experience (which may be outside of our awareness) with the current response. A therapist can help the client to decontaminate, to understand, and process those experiences which may be outside of our awareness.

Creative psychotherapies such as Dramatherapy, Art Therapy and Music Therapy specialise in helping the client to access, process and release, out of awareness experience in very safe non directive ways. These therapies are especially indicated where there is trauma, neglect and attachment issues which are causing or contributing to anxiety and fear states.

Mindfulness therapy is very beneficial for anxiety,  fear states and panic attacks. It works by showing the client how to learn to place awareness in the body, the feelings, sensations- to  notice the thinking and then to return to body awareness. It becomes possible to observe thoughts passing as if watching a video, and then to return to the calm still space within the body.

Over time in mindfulness therapy, a new awareness begins to develop which interrupts the fear response. The mind develops an ability to dis -identify with the thinking, the feelings and the sensations which create and support the anxiety fear response. The ability to return to the still quiet space within is a skill that can be developed with practice both within and outside of sessions.

 

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and  groups. Magdalena is available at our Brighton and Hove Practice.

Further reading by Magdalena Whitehouse –
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CORONAVIRUS – How Psychotherapy can help you navigate your way through the crisis

I am writing this blog four days after the UK government imposed an effective ‘lockdown’ in response to the spread of the Covid-19 virus.  Inevitably this crisis will have a considerable impact on all of us be it emotionally, financially, physically, spiritually and psychologically. Depending on our character, disposition and ways of thinking we will experience the impact in specific and particular ways. We may be very aware of feeling lonely, anxious, frightened, overwhelmed, sick, vulnerable, frustrated, bored, angry and our unconscious fears almost certainly will be highlighted by this unprecedented situation.

From what my clients have been telling me over the last couple of weeks it seems to me that the most difficult aspect of this situation for people is the uncertainty.  We don’t how long the threat of the virus will stop us from leading our ‘normal’ lives.  We don’t know what life will be like at the end, how it will end and what the longer lasting effects will be on us, our families, our communities and the world at large.

As human beings we struggle with uncertainties and ‘not knowing’. We may not always be aware of it but the lack of certainty the ‘not knowing’ makes us feel afraid, ill at ease, out of control and so in order to protect ourselves from these uncomfortable feelings we unconsciously replace them with the illusion that we are in control and therefore we know exactly what will happen. Being certain, knowing what will happen narrows the mind, reduces the questions and makes life feel easier.  We usually forget to focus on the present moment and instead we make plans for the future, focussing on what we are going to do, where we’ll go, what we’ll buy, who we’ll see etc, confirming our illusion that we know what will happen and that we are in control.

Focussing on the future works until we are faced with a crisis or we are under threat then we focus completely on the present moment, it takes up all our thinking.  The present moment right now is frightening and for many people this is overwhelming.  Many people are struggling to bear the awfulness of it and the feelings of uncertainty they are having to cope with.

The reality is we cannot change what is happening, we cannot control outside forces we can only change the way we think about them and therefore how we feel in response to them.  In essence this is the work of psychotherapy.

Having a therapist to talk to at this time can help you bear the uncertainties of life and what feels overwhelming.  As therapists we are trained to work with the ‘not knowing’ and are therefore uniquely placed to help you face uncertainty and anxiety – it is our medium and what we work with all the time in our consulting rooms. Having a space where you can verbalise your anxieties and reframe your life so it becomes more bearable is invaluable right now.

 

Please follow the links to find out more about about our therapists and the types of therapy services we offer.  We have practices in Hove and Lewes.  Online therapy is also available.

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