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Do’s and Don’ts in Psychotherapy for People Who Have Addictions
All people are human beings. As obvious as this is, it is often forgotten in treatment of people suffering with addictions. Instead of seeing them as folks with a very common behavioral symptom arising from understandable human feelings and conflicts, in our society we have labeled them as though they are somehow different from everyone else, requiring a special label: “addicts,” or “substance abusers.”
It has even become routine to say these people have a distinct diagnosis: “Substance Abuse Disorder.”
Sadly, many professionals believe that by calling a behavior a “disorder” they have done something useful, important or even scientific. The opposite is the case. Labeling behaviors as disorders or diseases tells us nothing about the cause of these problems, how they work, or how to treat them. Indeed, calling a behavior a “diagnosis” makes things worse, because it implies this is something wholly different from the all the other compulsive behaviors that we do understand quite well.
I know many very well-qualified therapists, people whom I would trust to treat my friends and family, who forget everything they know about human beings once a person with an addiction walks into their offices.-Lance DodesOnce professionals buy the idea that their patients have a disorder or a disease, they think of them differently. I know many very well-qualified therapists, people whom I would trust to treat my friends and family, who forget everything they know about human beings once a person with an addiction walks into their offices. They mistakenly think they have little to offer these people and send them off to addiction counselors who typically have far less education and training in human psychology or, just as bad, tell them that they should be in two treatments at the same time: meeting with the addiction counselor for their addictive behavior and meeting with themselves for everything else. This plan shows a gross misunderstanding of the fact that addictions are just one aspect of a person’s psychology, common emotional symptoms shared by much of humanity.
Trying to separate treatment of addiction from a good psychotherapy actually undermines the opportunity to focus on the emotional factors that create addictive thoughts, which is the most critical part of any treatment. How to do this, either for yourself or in a psychotherapy was, in fact, the subject of my book, Breaking Addiction.
All of the above suggests some guidelines for seeking psychotherapy, if you have an addiction:
- Find a therapist who will treat you like a person. Anyone who diagnoses you with “substance abuse disorder” or a similar label is telling you he or she thinks of addiction in the most superficial way possible and is either not interested in exploring the issues behind the behavior or doesn’t understand the essentially psychological nature of addiction.
- Find a therapist who will treat your addiction, not refer you to somebody else to deal with it. This means not sending you to an addiction counselor who almost always will be a person with little training or education in human psychology as I mentioned above, but it also means not sending you off to a self-help group. The success rate for AA is between 5% and 8%, a fact that most therapists don’t realize.
Sending you to a non-professional support group also should raise strong suspicions that the therapist doesn’t know how to treat it as part of psychotherapy. And if you do try a 12-step approach, it’s key that you be prepared to leave quickly unless you are in that 5-8% group.
When the 12-step approach isn’t helping you, never believe that it’s because you haven’t “worked the program” hard enough. That’s a common message among 12-step members and it is both insulting and scientifically wrong.
My colleague and I reviewed all the scientific studies about this in our recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry and we found that only a small group benefits from staying longer; for the other 90%, there is no evidence that proves staying longer does any good at all).
- In therapy, talk about the feelings and issues that preceded addictive thoughts or acts, not about the consequences of addiction, as I mentioned above (and described in Breaking Addiction). It’s understandable to spend time regretting the consequences of behavior, but it has no lasting therapeutic value. What you want to learn about is what leads to the behavior, not what follows from it.
- Seek a therapist who understands that the occasions when you have addictive thoughts are golden opportunities to understand what made them arise, not occasions for self-criticism or a reason to try to suppress these thoughts.
- Don’t expect a quick cure. Since addiction is not some unique diagnosis separate from the rest of human life, we should have the same expectations from its treatment as we do for any other human problem. We don’t expect a compulsion to clean your house, wash your hands, overeat, or work too much to disappear when you enter psychotherapy. Those behaviors may persist as you are working out the factors that lead to them. Even though this is self-evident, people still sometimes say they don’t have time to work out the factors behind addiction because it is so dangerous. But this reasoning is backwards.
The fact that addictions are dangerous is all the more reason to pursue a treatment that roots out its cause. And it is important to keep in mind that the success rates of the alternative, superficial or support-based, interventions (like AA) are awful. It is one of the tragedies of modern life that so many people think they should stick with these support programs despite never getting better, losing years and decades of their lives rather than seeking a more knowledgeable treatment.
- Don’t judge your progress on the basis of how much your behavior has changed. We have all been flooded with the idea that measurable behavioral results, preferably in numerical terms, are the only way to know the effectiveness of any treatment. But most of us realize that the most meaningful and important changes are within a person’s inner world. Yes, those changes often show up in behavior, but not always, and not necessarily at the same time as progress is being made inside.
Think of a person’s self-esteem gradually improving, but there being no clear behavioral way to measure that. Or, think of a person feeling less alone in the world. He or she might make more friends, but also might just feel more at peace, and less lonely. There is simply not a good correlation between measurable behavioral change and therapeutic progress.
Of course, everyone has the same goals with addictive behavior: having it end or, at the very least, having it cause less harm. But measuring your progress on the basis of the number of times per week you drink, eat, or clean the house should not be the basis for evaluating what’s happening in good psychotherapy.
…the most meaningful and important changes are within a person’s inner world. Yes, those changes often show up in behavior, but not always, and not necessarily at the same time as progress is being made inside.-Lance Dodes
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