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Readers of this blog or any of my books know that addiction is neither more nor less than a psychological symptom -- just one of the ways we all have to manage emotional stress. Indeed, addictions are simply a subset of the intensely-driven behaviors we call "compulsions." (If you are a new reader of this blog, please take a look at some of the earlier posts, especially "The Psychology of Addiction," "Breaking Addiction," and "Answers to Addiction Questions.") We also know that psychotherapy is an optimal treatment for compulsive behaviors that have a psychological cause (which is all of them except the small group caused by the biological illness "OCD", for which SSRIs are a primary treatment). It follows that psychotherapy, when performed with knowledge of how addiction works psychologically, is optimal treatment for most people with addictions.
But how can anyone decide whether he or she is receiving good psychotherapy for an addiction? Here are a few problems to watch out for:
1. The therapy is focused on why you should stop the behavior, or on its bad consequences. Thinking about this once or twice is okay, but it should never be a center of attention. You have many people in your life who can tell you about the risks of continued addictive behavior, and you are yourself probably the world's expert on the troubles you've faced as a result of your addiction. You don't need a therapist to remind you about it. More importantly, a focus on why you should stop or the harm caused by addiction is a waste of valuable therapy time. The goal of treatment is to help understand the cause of addictive behavior, not its consequences, so you can use your understanding to become the master of an addiction, rather than its slave.
2. The therapy is focused on the details of the addictive behavior itself. For example, a significant time is spent looking at whether you had vodka or beer, or whether you lost 200 dollars or 2000 dollars at the casino, or how you obtained a drug, or how long you compulsively played a video game. These details are, in the end, of no importance to the goal of understanding why you drank or gambled or used a drug or felt compelled to keep playing. Worse, they distract from this task by implying that there is a fundamental difference between one episode and the next rather than looking for the theme that underlies all of the addictive episodes.
3. Too little attention is paid to looking backward from the moment of doing an addictive behavior, or (even better) looking backward from the moment you first thought about doing it. If you keep in mind that you are looking for emotional precipitants of the urge to perform an addictive act, then it's obvious that it's important to carefully look backward to what preceded it. That will enable you to identify the theme that is always the precipitant of addictive thoughts.
4. Too little attention is paid to looking at who you are as a person, psychologically speaking. After all, the entire focus of therapy for any problem, including the symptom we call addiction, should be toward understanding the emotional factors that drive it. Otherwise, trying to treat any symptom is like trying to wrestle with a tiger while wearing a blindfold. As I've described elsewhere, feelings of overwhelming helplessness always precede and precipitate addictive behavior. What makes any one person feel overwhelmingly helpless is idiosyncratic -- it's different for different people. But what is invariably true is that the issues that create feelings of overwhelming helplessness -- and lead to addictive behavior -- are always at the heart of whatever is troubling that person, in general. This is to be expected, since whatever issues lead to feelings of overwhelming helplessness will always be those that are most emotionally problematic to that person. So, you should expect that your therapy will move easily back and forth from trying to identify the emotional theme which leads to addictive thoughts, to the rest of what is important in your life: your past experiences, your current relationships with others, your feelings about yourself, and so forth. If you are coming to understand how your addiction fits with who you are an individual, versus seeing it as a thing in itself, you're on the right path.
Psychotherapy for addiction should look exactly like psychotherapy for any other problem, with the addition of close inspection of the emotional purpose of addictive behavior to reverse feelings of overwhelming helplessness. When you are working to recognize and understand why certain situations or relationships lead you to feel so overwhelmingly trapped, you are in perfect position to figure out why these situations make you feel so trapped. That is a direct route to understanding what troubles you, in general. In turn, knowing what troubles you in general allows you to predict when addictive urges will arise in the future. If this sounds like what you are doing, you're in good shape.
