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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.

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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’.

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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.

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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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How Psychotherapy Taught me to Live Life

This piece is written by a ‘fictional’ client who is a composite of three real-life clients who have shared their experience of psychotherapy with me.  Some details have been changed to ensure confidentiality, however, the thoughts feeling and experiences expressed are those of three very real clients:

When I came to psychotherapy I did not even really know what it was.  I knew I needed something because I knew I was struggling but whether that something was counselling, psychotherapy or what I simply had no idea.

As well as not having much of an idea about what to expect from my psychotherapy, I also had no idea about how long it would take.  And I was impatient!  It is therefore with a surprise that I look back upon my two-year journey of weekly one-to-one psychotherapy with some degree of awe with regards to how little I really understood what I needed and for how long; from my initial impatience, a sense of appreciation and security developed from knowing that on Tuesdays, at 5pm, I would be seeing my psychotherapist.

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Where I say that psychotherapy taught me how to live life, I mean this in the sense of courageously living rather than existing.

Prior to psychotherapy I approached life and relationships from a default fear position.  Not that I knew that at the time – the way I was all seemed perfectly normal to me.  Normal is, after all what we are familiar with.

However, part of me also know that I felt unfulfilled and lacking in purpose and meaning.  Meaning in terms of my own desires and meaning in terms of what relationships could offer me.

It has been through a slow process of learning to be in relationship with my psychotherapist that I have slowly learnt to have a healthy relationship with myself.  Through being held in mind, I have learnt to hold myself on mind.  And through trusting that the relationship with my psychotherapist was and is genuine, I have come to accept that just perhaps, relationships with others have something to offer me.

I am now two years into my ‘ongoing’ psychotherapy relationship.  It has been hard, frustrating, frightening, constructive, containing and life enhancing all in equal measure.  The only commitment: we both show up each week for the session.

How have I changed

Most of all I have let go of the past.  My experiences still happened, of course.  There is no magic to undo that.  However I have accepted that I can still have a life without having gotten what I needed as a child.  And through this have come to accept that I can treat myself differently to how I experienced my parents treating me.

My relationship with myself

‘Has psychotherapy made you happy?’, people I know sometimes ask me.  No.  But then happiness is not the purpose of life.  I do, however, at times feel content and even happy.  More importantly, I am able to feel the full range of human emotions without running away from them.  I can navigate my emotional world using my mind in a way I simply could not before psychotherapy and instead would use all sorts of distractions to avoid feeling.

My relationship to others

I have far deeper and more authentic relationships with others – something I now realise I avoided in the past for fear of them really seeing me and then rejecting me.

Relationships have become important to me and I am far more able to tolerate difference in those around me – to accept that they have different minds.

In summary

Put simply, my life now has substance.  I know more about who I am, who I have been and how I spent much of my life hiding from myself and others because of not feeling accepted; I now have compassion for this part of me.

Mark is an integrative psychotherapist primarily informed by attachment theory and object relations psychotherapy.  He works relationally and sees individuals and couples in Hove and Lewes.

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How body stability creates psychic stability

There is No Such Thing as a Baby

I frequently blog about the importance about including the body in the process of psychotherapy and how the unconscious resides in the body.  However, unlike many ‘body psychotherapists,’ I believe that the involvement of the body is more profound than identifying the presence of the body in the process. Let me explain using one of Donald Winnicott’s most famous quotes, “There is no such thing as a baby.”

Winnicott famously made this statement in 1947. On face value, it may seem somewhat absurd. After all, we have all seen babies and know they exist. However, the reality is far more complicated, because every baby that any one of us has ever seen is only visible because it is in a relationship with its primary carer (which for simplicity, I shall refer to as its mother).

A baby cannot exist alone but is essentially part of a relationship.  Babies exist in an absolute state of dependence, such that the infant (the word is taken from the Latin – ‘infans’ – not able to speak) has no knowledge of maternal care, as this would require the knowledge of ‘an other’ providing the care.  The baby therefore is essentially indivisible from its mother and thus cannot exist in its own right.  The infant’s experience relies on the mother’s ability to merge with, and adapt to, her baby.  Therefore, whenever we see a baby, we actually see a baby, its mother, the relationship between the two and also the wider social context within which that baby lives and has come to be.

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There is No Such Thing as a Body

The same principle can be applied to a body.  There is no such thing as a body in its own right.  A body is created, shaped, moulded and exists within the relationship that the mother of the owner of the body has had with it.  In other words, the body and how it is experienced by the person in the body is contingent on the relationship that the baby has with the mother and the wider environment. This then dictates the relationship that the owner of said body, has with him or herself (if any.)

Why Does the Body Matter?

Psychotherapy is about many things, but one of the primary tenets is that it is a relationship within which the client/patient can, through relating to the therapist, establish a relationship with themselves. Having a relationship with ourselves includes having a relationship with our body. However, I believe that too many psychotherapists assume that such a relationship is necessarily experienced as helpful by the client at the outset of therapy, or even possible.

The Body as an Enemy

If we come to inhabit, or embody, our bodies through the relationship with our mothers and the wider social context, and our mothers were abusive to us, then the experience of our body can be one of ambivalence (‘I don’t really care about my body”) through to experiencing the body as dangerous, attacking or not our own.

Examples of where internalised abuse/hatred is expressed towards the body include cutting and burning the skin through to anorexia and bulimia, to name a few.

Risk of Trauma

Assuming a pre-existing, or even conceptually possible positive relationship between a client and their body on the part of the psychotherapist is naive. At worst, it risks re-traumatising the client.

If, for the client, all that is bad resides in their body, then they need to slowly find a way to ‘meet’ their body in a different context and to tentatively form a different relationship with their body – to reclaim it from the ‘bad’ parent. The therapeutic process involves creating a different relationship with ourselves, one in which we are able to leave the echoes of past formative relationships behind. At the very least, we need to learn to think about ourselves as players in those stories in a different way. In the same way, we need to learn to relate to our body as our own and as our friend, guide and an integral part of us.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further reading

Body psychotherapy

What is attachment and why does it matter?

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What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud.  Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use.  Modern science has the capacity to empirically prove how those ingredients work through neuroscience research.  In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy.  Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

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In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes.  If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change.  However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist.  Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship?  In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment.  However, to recap, psychotherapy is about re-parenting.  On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind.  Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough?  It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further reading on this subject:

How does counselling or psychotherapy work?

What is transference?

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What is Intimacy?

From ‘the family’ to ‘the couple’

There has been a historical shift from ‘the family’ to ‘the couple’ as the central organising unit in contemporary life, with an emphasis on intimate connection. The ‘ideal’ couple of today are both friends and lovers immersed in a disclosing intimacy of mind and body. For previous generations, the modern discourse on intimacy would be an anathema. Where once we may have ploughed the land together, bound by a common task to a shared end, today we talk. Rather than being a by-product of a long-term relationship, intimacy is now a prerequisite for one. Today, we expect much more of our intimate relationships, including personal happiness and sexual fulfilment, yet we lack the role models for the new intimacy we seek. No longer bound together simply by survival needs, and with sex separated from reproduction, our closest relationships become conduits for ‘higher’ intimacy ideals.

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Our early experiences of intimacy

Our understanding of intimacy and intimate connection is grounded in our social, biological and psychological histories. In the evolutionary account, ‘attachment’ is a biological imperative rooted in an infant’s need to maintain physical proximity to its caregiver to ensure survival.  Our early emotional attachments, though, are not simply about protection from present danger. They are also about the emotional and psychological human need for a secure base. Our physiological and mental development always takes place in a relational context. Our emotional responses are organised and regulated through our formative relational experiences of the presence and absence, sounds, smells, gaze and touch received from our caregivers. Herein our attachment styles are forged, informing our later capacities and appetites for intimacy.

We receive our initial cues about how the social world works in our families, and here too, we learn the rules of intimacy. We learn whether we are supposed to be strong, competitive, angry, sad or tender. We treat as truth the things we learn about love, trust and life. We make decisions about the world and ourselves on the basis of these truths. Many of these decisions (made out of conscious awareness) will have great bearing on our adult emotional lives. When our attachment experience is secure, we are less likely to struggle with psychological issues of self-worth. When it is not, for myriad reasons, such as traumatic experience, loss, separation and fundamental failures of attunement, we are more likely to develop core beliefs about ourselves as not being ‘lovable’, ‘enough’ or any number of injunctions against being important, being visible or belonging. These will inevitably play out in our intimate adult relationships. The developing infant is continuously learning about the boundaries between self and other at the same time being schooled in the power dynamics of intimacy. We all bring the legacy of intimate childhood relationships to our adult pairings, activating our original relational templates to confirm old and new beliefs about our value and worth. We navigate a perilous path between ‘too much’ and ‘not enough’ proximity and distance, me, you and we.

How couples therapy can help

Our need for meaningful connection remains throughout our lifespan. In its absence, symptoms from physical illness and depression to addiction may develop. Therapy can support couples in tracing the lineage and source of their beliefs and assumptions about intimacy and in an exploration of their disappointments and discontents, as they are experienced in the here and now context of their relationships. The couple willing to risk the emotional vulnerability of open-ended conversations about the tensions, conflicts and failures in their relationship be they sexual or domestic are indeed brave. True intimacy requires the recognition and will to balance the dual imperatives of individuality and interdependence, amongst other things.

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Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor who is available at our Hove practice.

Further reading on this and related subjects:

How does attachment influence parenting?

Aims and goals of couples’ therapy

Love, commitment and desire in the age of choice

Relational therapy – a view

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