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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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Corona Virus …… is in my garden!

Early in lockdown I turned  to my garden for the first time in a long time and my thoughts took an interesting turn which I wanted to share with you.

I spotted the jasmine shrub which had overgrown and was ‘invading’ my garden!  It had put deep star shaped roots all over the garden which were impossible to pull out. It was a ‘threat’, ‘invasive’, ‘runaway’, ‘contagious’.

I felt a mixture of feelings as I contemplated the consequences of my gardening neglect…..

….. overwhelm –it’s everywhere,

….. I’m not strong enough to beat it,

….. It’s spreading to my neighbours,

….. It will overpower and kill everything………maybe it will kill me…….

Kneeling on the infected earth,   demoralised, defeated and sweaty,  I  reflected awhile.

My garden had become a metaphor for the Coronavirus.

I wondered how I could make use of this metaphor to help me to come to terms with this unprecedented shocking world situation which was turning mine and others’ lives upside down and inside out.

I realised that although I couldn’t personally make any inroads into conquering the Corona virus, my humble garden would be a  much smaller and more manageable project.

Renewed hope reconnected me to resilience and perseverance. I hacked and chopped, I cut and cleared,  I dug and dug with a fervour ignited by my hatred of this virus, this ‘C ‘ word.

I cleared, I sorted, I ordered.  I took a longer view.  I wouldn’t manage to clear this weed today but if I kept at it I might succeed. Onward.

And magically as my garden was transforming, becoming clear and free from jasmine chaos, so my mind was becoming  clear and free.  Clear spaces of rich brown fertile earth reappeared in my mind.

And in this clear space Creativity bloomed.  I began to imagine possibilities for planting, for creating a lush healthy future for my garden.  My garden became a visible and experiential  dis-confirmation of the prevailing world crisis. Where the news was predicting death doom and disaster, my garden foretold of  renewal, regeneration and growth.

My garden remains undeterred by Covid-19 and lockdown.  Ever since March 23rd it  has behaved exactly the same as it always has. Spring arrived as usual, the leaves unfurling from trees and shrubs, new life shooting up from the ground apparently back from the dead.  This absolute predictability, regularity, repetition, this infinite miracle of nature has offered comfort and connection for me in this time of isolation and powerlessness.

As a Dramatherapist I seek  to work with Metaphor, Symbol, Image as a way of re-presenting reality.  I seek to connect, those things which are held inside of us with those things which are on the outside.

 

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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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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Living with Borderline Personality Disorder

Borderline Personality Disorder (BPD), also know as Emotionally Unstable Personality Disorder, is a thought to affect between 0.7 and 2% of the general population. While estimates vary, it is considered that the disorder is predominantly diagnosed in women (75%).

So what is BPD? On a generic level, BPD is characterised by having difficulties in how you feel and think about yourself and other people. This can manifest in feeling insecure in relationships and consistently worrying that people will abandon you. This can bring about intense feelings that are very painful and difficult to mange, and they can last anything from a few hours to many days. This can make it hard to make and maintain stable relationships as the intense emotions and abandonment fears can push other people away. People with BPD often don’t have a strong sense of self and will try to change who they are depending on the person they are relating to.

The difficult feelings that are associated with BPD can often lead people to act impulsively, have strong feelings of anger that are hard to control and often self-harming or suicidal feelings. At the most difficult times, they may also experience paranoia or dissociation.

The causes of BPD aren’t clear, but there are some factors that appear with most people that can lead to a diagnosis of BPD. These are environmental factors when growing up, such as feeling unsupported, afraid or upset, with little validation. Family difficulties such as addictions in the parents or any kind of neglect or abuse can also lead to BPD. In additions to these factors, having an inherent emotional sensitivity can also be a factor that can lead to BPD.

So what should you do if you have been diagnosed with BPD? The first thing to consider is whether or not the diagnosis is correct. BPD is a controversial diagnosis as in itself it is hard to diagnose. The disorder shares a lot of commonalities with other personality disorders, and also with other conditions such as depression, bipolar-disorder and PTSD. For some people the diagnosis is a relief as the difficult feelings they experience now start to make sense. For others, having the label of BPD is unhelpful and doesn’t seem to capture their experience. Whatever way you feel about your diagnosis, it is important to get help so you can learn to manage your difficult emotions.

While there are a few treatments available for BPD, the one that is recommended by the NICE guidelines is Dialectical Behaviour Therapy (DBT). In DBT therapy, you will focus on acceptance and change. Accepting yourself is a fundamental part of building a sense of self, and leads the way to making positive changes in how you experience life. You will also start to learn emotional regulation skills so you are not swamped by difficult emotions, but instead learn to accept them and let them go. One of the key tools for this is mindfulness, as this allows you to really see what you are thinking and feeling, and allows you to distance yourself from these thoughts and feelings and stay rooted in the present moment. DBT therapy does take commitment to change, but it can allow you experience life in a more positive and balanced way.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Online Therapy

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

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New Year’s Resolutions – why change might be so difficult

The start of a new year feels like a good time to make resolutions to change your life. Cut down on drinking, learn something new, be more efficient, be kinder, be more sociable or get fit.

Gym memberships regularly peak in January, increasing by 10%-20% but how many of those new memberships are used? According to research by Fridge Raiders, published in the Daily Mail in March 2019, 23% of Britons have gym memberships but only 12% use them often. They estimate that more than 4 billion pounds a year is wasted on unused gym memberships.

The reasons given for the 50 percent who did not attend regularly or at all, were to do with feeling self-conscious or intimidated, thinking that everyone was watching, finding repetitive activity boring and not knowing how to use the gym equipment. These could be valid reasons but Robert Kegan and Lisa Laskow Lahey think it goes deeper. They ask why do we stick with the status quo when we are unhappy or unwell and know that change will make us feel better or even make us live longer? Kegan and Lahey have been researching the resistance to change for many years. In their book Immunity to Change (2009) they discovered that strongly held values, often unconscious, prevented both collective and individual change.

The most quoted finding from their studies comes from interviews with patients with heart disease who were told they must change their habits around eating, drinking, smoking and exercise and take their medication otherwise they would die. Kegan and Lahey found that only one in seven was able to make the necessary changes. Making further enquiries they discovered that although patients recognised the imperative of their doctor’s advice there were deep seated beliefs that contradicted their desire to get well.

A composite example would be a man who said that cutting down on food and drink and taking medication for ‘old people’ would make him feel he was old and weak. This challenged his idea of himself as a competent man in the midst of a productive life. Beneath this was his fear of becoming incapacitated and dying that brought back memories of his father’s illness and death. At a deep level the fears that prevented him taking care of himself were the very things that were likely to happen to him if did not change his habits.

There are many other examples in their book. Another composite example would be a manager who wanted to be more collaborative and involve his team in decision-making.  Until he participated in the research he did not realise how much his fear of being a weak leader prevented him from being open to the ideas of others. This feeling stemmed from the unspoken culture of ‘you must be strong otherwise you won’t survive’ in the family he grew up in and was an integral belief about himself. When he could recognise this belief and its negative impact he was able to ask for support to change and eventually become a better and happier leader.

Kegan and Lahey’s research helps us understand why it might be so hard to change our habits to improve our lives. They offer an alternative to castigating ourselves for our indiscipline and lack of commitment and, I think, suggest that we begin by being kind to ourselves and curious.

 

References – 

https://www.dailymail.co.uk/news/article-6765171/Britons-spend-4-billion-year-unused-gym-memberships-new-survey-reveals.html

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

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