Addiction: Not Just a Behavior...

I’ve spent a good part of my career helping people recover from addictions—whether the addiction is to alcohol, drugs, tobacco, food, gambling, sex, or other compulsive behavior. Whatever the addiction, most of my clients have discovered the same thing: changing the behavior is only one step toward meaningful recovery. Oddly, changing the behavior is the easier step (and even that is not very easy). The harder work centers on changing the thinking and relationships that have evolved in tandem with the addiction. Addictions have a compulsive quality about them; addictive behaviors continue despite the losses that typically accrue as the addiction progresses. Patterns of thinking and behavior develop with addiction; these patterns of thinking and behaving impede optimal functioning and typically eventuate in a narrowing of the addicted person's world. (Loss is a hallmark of addiction: loss of family, friends, money, time, and health are unfortunately only the most obvious losses. There are many, many others.) Neurologically, addictions actually change the brain’s chemistry and make-up. (I recall the first time I saw PET images of the brain of a person who used cocaine, thinking “No wonder addiction is so hard to treat; I can see the patterns of conditioning being laid down in the brain.”)

In and of itself, addiction is an enormously complex problem. Addictions develop for a variety of reasons. Compulsive behaviors always serve a purpose—however dysfunctional it might be—but the purpose may not be readily apparent. For example, many people use substances or engage in a compulsive behavior in order to “feel better.” Whenever I hear a client tell me that he or she uses alcohol, for example, to “feel better,” I usually ask, “better than what?” The answer reveals additional issues: depression, anxiety, social disconnection and isolation, conflicted family relationships, histories of trauma (physical, emotional, sexual), grief, confusion, loss of a sense of self-efficacy and control. However, there are often even deeper issues—issues that go to the core of one’s sense of self and relatedness to the world.

Addictions frequently mask very deep issues--all of which must be addressed and treated. Therapy typically requires work on multiple levels. Understanding the meaning of the compulsive behavior is an important step toward changing it, but it is only a step. Careful exploration of how the addiction has impacted the client’s perceptions, thinking, beliefs, and relationships is the focus of a great deal of therapeutic work. Treating underlying psychiatric disorders is yet another layer of treatment. Helping clients enlarge their perceptions, develop awareness of distortions in thinking, and correct their distorted thinking patterns is a significant part of the work. Similarly, challenging the belief systems that arise from the addiction is an important component of the work. Learning, practicing and mastering new coping skills, and applying those skills to everyday life is still another level of work.

In addition, therapeutic work can extend to intimates and family members: families need help because addiction affects them in overt and subtle ways. Effective clinical work with family systems impacted by addiction often parallels the work with the addicted person. The family must recover too. In fact, it’s been my experience that sustained recovery from addiction can only occur when both the addicted person and the family recover together.

At the most fundamental level, though, therapeutic work must center on discerning addiction’s deepest roots. Such careful exploration and analysis is essential for meaningful recovery, healing, and enduring wellness.

Over the next few blog postings, I’ll reflect on various aspects of addiction. It’s huge, many tentacled issue—and one that affects many more people than might be apparent.

"Here I am..."

I’ve come to understand that one of the most powerful experiences that psychotherapy offers is the opportunity to be seen, understood and accepted. Being seen for who you are—in your deeply complex humanity—is a rare experience, but one that is essential to mental health and well-being. We are rarely seen as whole people. We inhabit social personas, showing the world only those parts of us deemed “acceptable.” Most of us inhabit roles: parent, child, sibling, lawyer, manager, nurse, police officer, designer, student, patient, ad infinitum. If we let them, roles can come to define us and circumscribe our behavior, and those with whom we interact will only know small parts of us.

Similarly, we often refrain from expressing our thoughts and feelings—for many, many reasons: self-protection, the desire to protect others, fear of being perceived as inadequate or uninformed, shame. In addition, our thoughts often have many nuances that remain unspoken, further preventing us from being fully seen.

Indeed, we are complex people—people with passions, needs, aspirations, and wounds that others do not readily perceive. And sometimes we keep some of those passions and needs hidden from ourselves, out of consciousness, tucked away in the recesses of our minds. We do not fully see ourselves; others cannot possibly see us either. The end result is depression, ennui, unsatisfying relationships, a life less than fully lived.

Many people come into therapy with a deeply felt desire to be seen and known in all their complexities. This desire is often not fully conscious and is almost always unarticulated. But we want to be known as people who have lives beyond the roles we’ve been assigned, beyond our social personas. We are not just “mother,” or “husband,” or “nurse,” or “teacher,” or “abused spouse,” or “cancer patient.” We are so much more, and we want to be fully seen and accepted as such.

Yet, it is hard to be seen for who we are, just as it is hard to see others for who they are. There are too many filters: preconceptions and prejudices, early family experiences, traumas, defenses, beliefs, moods, patterns of communication, social rules and expectations all get in the way of our ability to see and be seen.

Although many people enter therapy hoping to address a specific problem or symptom, they also enter therapy with a deeply held, but unspoken desire to be seen and accepted for who they are. Being seen for who you really are is a profoundly intimate experience. As such, being seen requires courage: to be seen is to be vulnerable. Asking another to see you in all your humanity (“warts and all”) is to invite intimacy and risk acceptance. No wonder intimate relationships are so challenging! No wonder many people are ambivalent about going to therapy!

There are too few opportunities to be seen in our world. While Facebook and other social media give the illusion of being available to be seen, they do not require the courage of intimacy. Social media merely offer glimpses into the lives of their users.

One of the many gifts offered by psychotherapy is the opportunity to be seen. However, it is an opportunity most people approach with some trepidation—and understandably so! While it can be a relief to be seen by another person, it can also be terrifying. Being seen elicits defenses, and the impulse to flee is strong, especially since the feelings of vulnerability can seem so raw.

And so it is that therapy also offers another gift: an opportunity to enter a process where it can become safe to be seen. Allowing yourself to be vulnerable—allowing yourself to be seen by another human being—is a process that, with sensitivity, attention and great care, develops over time.

In today’s world, the psychotherapist’s consulting room can be one of the few places where you can develop the courage to be seen—and then be seen! By offering safety and carefully attending to the deepest reality of each client, the therapist invites the client to say, in effect, “Here I am.” When a client can genuinely say this, and then allow him/herself to actually be seen, the work of self-acceptance and healing has begun.