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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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Loss

You can hold yourself back from the sufferings of the world, that is something you are free to do and it accords with your nature, but perhaps this very holding back is the one suffering you could avoid.” ? Franz Kafka

In this blog, I wanted to write about Loss and try and explain a bit about what the hell we are supposed to do with it! I think loss is perhaps one of the things that I find it hard to think isn’t a feature of almost every encounter I experience as a Psychotherapist, and perhaps as a human, it is a pervasive part of being human, a painful part but a part none the less.

I encounter loss in the therapeutic encounter in a huge range of experiences, from the sudden tragic losses due to bereavement; due to the more ambiguous everyday losses of identity due to the on going vicissitudes of life and changing circumstances. These include the loss of who we are when our situations change, the loss of childhood experienced by parents and their children, due to adolescence, the loss of a much loved work identity in retirement and of course the frequent and painful losses when relationship change or end. So what do we do when, as a colleague poignantly put it, “ the glue dissolves”.

During my training, and in the literature, there is much talk of processing these losses, the need to mourn etc. and about what can happen when these things get stuck, but what do  these things actually mean?“

I think a lot of what I’m doing as a therapist is trying to reflect mentally through my experience and the sharing of my experience of being with someone, a mirror to them so they can come to understand what it is they are doing. Often in grief, there is pain and this pain has to be managed, feelings have to be managed. I will seek through this reflective process to help clients understand what they are doing to manage their grief, not to judge it as good or bad but simply to bring some awareness to it, so it can be thought about. Often, through this exploration of these important-survival strategies, and over time, the experience of grief often so raw and frightening can start to be experienced, to allow it bit by bit to be felt, the good and bad of what has been lost to be experienced and allowed to pass, or at least survived. Sometimes a loss has to examined from many different angles, many times over. Loss is painful and hard to stay with.

Darian Leader in his excellent book, The New Black, revisits Freud’s concepts of Mourning and Melancholia, to explore a more nuanced experience of loss and argues that, modern society has created a pressure to package and treat loss and that this has created a simplistic definition that can be biologically defined and then treated by adjusting the chemicals within the brain via medication. This has led to the many complex and often unconscious causes of depression being narrowed and linked to biological markers that can be targeted via drugs. That’s not to say drugs can’t be helpful, they can be, but they rarely resolve the underlying causes.

Leader while praising Freud’s new thinking about depression, argues that he misses a vital element of mourning, its communal aspect and looks at various cultures and the way in which they share the process of mourning.

For me I am struck by the Musician Nick Cave and his wife; Susie’s, much documented loss of one of their twin boys, aged 15. Nick Cave, has since that loss and after a period of retreat, sought to engage with his audience and to open himself to the experience of loss, he writes a webpage called the Red letter diaries, has gone on speaking tours and often engages and shares in the stories of loss with his audience. He cites this as an essential part of what has helped him survive this tragedy. As he says there are an awful lot of mourners out there.

Both Cave and Leader cite the Buddhist story of a Mother who loses her baby and has the dead baby  strapped to her chest, a monk says that she must find some mustard seeds from a house that has experienced no loss and as she goes from house to house in search of these, never finding a house that has experienced no loss, but as she comes into the contact with the various losses of each house and in the sharing of their grief’s she is eventually able to lay her baby to rest.

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 –

Post Natal Depression in Mothers & Fathers

The Therapeutic Relationship and the Unconsious

A Nation Divided

Adolescence: the trials and tribulations

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Who might be helped by Psychoanalytic Psychotherapy

In second of two video interviews, Paul Salvage discusses who may benefit from psychoanalytic psychotherapy and explains how it has evolved since the days of Freud.  Paul is a UKCP registered psychoanalytic psychotherapist who works with individuals from our Hove practice.

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Post Natal Depression in Mothers & Fathers

In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to post natal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving.  I think it applies also to fathers and to same sex couples and heterosexual couples where the caring of the infant is more equally shared.

Blum’s paper, titled the, “Psychodynamics of Postpartum depression”, is available on the web.

The paper draws a distinction between baby blues which he defines as the hormonal induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’ 

He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that the Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111. 

The focus is then on the possible  ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts. 

Dependency Conflicts

In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, a self-denial of the caregivers own needs, they can seek to repress their own essential vulnerability and needs and get  depressed.

Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good a reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of  independence.

Anger Conflicts

A conflict with feelings of anger, which can feel counter to the role of caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts, or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.

Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.

Parenthood conflicts

Caring for baby can stir up unresolved and unprocessed feelings about the caregivers own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition the caregiver, giving the baby what it didn’t receive, can be gratifying but  can also stir up the wounds of what they, the caregiver, didn’t receive. 

I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-

  1. The baby is not her own (mental) conception. 
  2. The baby is not the one of childhood play, father’s child, brother’s child, etc. 
  3. The baby is not magically produced. 
  4. The baby is a danger to her body in pregnancy and at birth. 
  5. The baby is an interference with her private life, a challenge to preoccupation. 
  6. To a greater or lesser extent a mother feels that her own mother demands a baby, so that her baby is produced to placate her mother. 
  7. The baby hurts her nipples even by suckling, which is at first a chewing activity. 
  8. He is ruthless, treats her as scum, an unpaid servant, a slave. 
  9. She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself. 
  10. He tries to hurt her, periodically bites her, all in love. 
  11. He shows disillusionment about her. 
  12. His excited love is cupboard love, so that having got what he wants he throws her away like orange peel. 
  13. The baby at first must dominate, he must be protected from coincidences, life must unfold at the baby’s rate and all this needs his mother’s continuous and detailed study. For instance, she must not be anxious when holding him, etc. 
  14. At first he does not know at all what she does or what she sacrifices for him. Especially he cannot allow for her hate. 
  15. He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.
  16. After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn’t he sweet!’ 
  17. If she fails him at the start she knows he will pay her out for ever.
  18. He excites her but frustrates—she mustn’t eat him or trade in sex with him. 

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74. 

 

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 –

The Therapeutic Relationship and the Unconsious

A Nation Divided

Adolescence: the trials and tribulations

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