Over the years I have devised a three tiered way of working with clients. Think of an iceberg divided into 3 parts. The top part of the iceberg is the bit that clients usually present in therapy with. They come to me stating that they are obsessively and compulsively using a substance or addictive behaviour, such as gambling or watching pornography. If they are using a substance such as alcohol or cocaine daily then the first thing we need to work on is stopping that behaviour so that they can become psychologically available for counselling. At this point the work that I may be doing with the client may look and feel more like advice and guidance rather than therapy. This is the bit that is visible. We will look at what support the client can access, what are the barriers to them accessing that support. Helping the client understand that life has to be better clean and sober than it is using or drinking. This looks and feels different to every individual but in my experience has to be about connection to their life and others in some meaningful form or other. It may be a connection to other recovering people, a connection with a hobby such as yoga, running or painting. Again this is more effective in making the client have a sense of wellbeing if they are connected to others practicing/participating in the same thing. I remember one of my clients describing to me the importance of having found her tribe. She had tried the 12 step model of attending mutual aid meetings but had not felt comfortable with this. She went on to use therapy weekly combined with yoga for the next 12 months. Within her yoga practice she met a lot of other likeminded people. She felt connected. She had found a place where she felt she belonged. Addiction more often than not takes a person to a place of isolation. I now understand isolation to be something born from a sense of shame and self-loathing. It doesn’t start out that way. It starts out as using substances on your own primarily so as to not be seen to using too much, not having to explain yourself, an underlying sense that the way your using is not quite right, maybe a sense of paranoia if other people are around, it may even be you just don’t want to have to share your stash. Whatever the reasons may start out as somewhere along the line something changes. That desire to be alone turns into a need to be alone. Facing other people becomes too difficult whether it be due to shame, embarrassment, social anxiety, depression, paranoia, psychosis and the result is the same – addicts spend more and more time alone due to need not want.
Once the client has connected to their lives in some meaningful way the addiction tends to decrease. The next layer of the iceberg is the bit that is just under the water. This is the way the client thinks and feels. It may be that they are reluctantly making connections in their life by attending AA/NA meetings or joining other types of groups as discussed above. At this point my work focuses on why they are thinking in the way that they are and have been doing. It is really important here to remember that addiction is an illness of the mind, a distortion of thinking, hence the reason why it is treated in psychiatric hospitals. Clients are not making life style choices to go and throw away all the good stuff in their lives. They are dealing with thought patterns that are distorting the truth. The number one thought offender that this client group present with is ‘This time it will be different/better! Second offending thought is ‘just this one, I will stop/give up tomorrow’. Often clients presenting at this stage are suffering with a mind that feels like it is on overdrive. It is often described as ‘the washing machine mind’ This is the point where the client is starting to face the reality of the damage they have caused to themselves and everyone around them. They are also projecting into the future worrying about how they are going to move forward and recover what often they have lost – relationships, jobs, driving licence, self respect. For the addict at this stage these relentless thoughts can drive them crazy and the one way they know to shut their mind up is to use their substance of choice. hence this is the point in therapy where we start to look at what tools they can develop to stop their mind racing other than returning to their drug of choice and to the addictive cycle. I use such techniques as mindfulness .https://neuroscienceofmindfulness.com/sympathetic-and-parasympathetic-nervous-system/ This helps the client to begin to focus on the present moment using breathing and relaxation techniques. This starts to bring the body from the sympathetic nervous system (fight or flight) to the parasympathetic nervous system (rest and digest). This helps reduce cortisol; levels thus reducing stress which in turn helps the mind to slow down and become more present. At this point the brain is laying down new neural linguistic pathways that are helping the client to move away from the reward system of the addiction neural pathway to the reward system of using breathing to help feel calm. mindfulness on its own in my experience is not sufficient at this point to slow the mind down. There needs to be a way for the client to challenge some of these negative thought processes. At this point I will use CBT techniques to help the client search out what thoughts they are having that drive them to behave in negative ways. Often these thoughts are below the level of consciousness so it is my job as the therapist to help the client raise these thoughts into their conscious mind so that they can challenge them. Typical examples of negative thought drivers are ‘you’re not smart enough to do that’, ‘you’re lazy’, ‘you’re selfish’. These thoughts often have been fed to the client during early childhood and have become the clients own negative critical parent voice. I will help the client challenge those thoughts by asking if they are behaving in a selfish way today are they being lazy today are you smart enough to do that today. Often the client can find evidence to suggest that because they have stopped using that they are not any of those things in the present moment. Sometimes we will find evidence to suggest that they still are behaving in those ways and that becomes another focus for therapy and helps them change their behaviour.
Once the mind starts to slow down and the client feels like they are less traumatised we can start to look at the final layer of the pyramid. This is the bit that is often deep under the water. This is the part where we explore what has been the initial underlying cause for the client to start using in the first place. It is important to state that this is not always a linear way of working. Sometimes the underlying reason for using is so prevalent that it comes out within the first couple of sessions. I will never close a client down but sometimes it is more useful for them to park it whilst we address the active addiction with a very clear understanding that we will go back to the initial trauma and it is given the important space it deserves. We have to explore that initial discomfort otherwise it will reoccur and the client is then in great danger of relapse. Sometimes it can take a while for the client to stop blaming themselves and saying they only used because they were ‘hedonistic’ or ‘they just liked to party’. Therapy is never about blaming somebody else and always about understanding why things happen and exploring the clients response and coping mechanisms to those events. My experience has shown that there is nearly always some form of trauma underlying addiction. Remember trauma is subjective. What is traumatic to me may not be traumatic to you and vice versa. Once that trauma is identified we can work together to heal that pain by bringing it out into the open. Shining a light on it and helping the client understand that their reaction to the events have not been about them being bad people, morally corrupt people but hurt people who have found faulty coping mechanisms for dealing with that pain. It is often useful to involve the family at this point if they are available and open to being supportive. It is important for them to develop compassion for ‘their addict’ without blaming themselves for their loved ones addiction. Often the family members themselves may need therapy at this time to come to terms with their experience of loving an addict.
Here at Victoria Abadi Therapies we understand that the process of recovery can take time. We are currently working from premises in Hale, Altrincham and Wilmslow to provide the above services.
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