Lance Dodes, MD, (http://www.lancedodes.com)  is, in my opinion, one of the the best writers on addiction,  He is a psychoanalyst,  and has been the director of substance abuse treatment at two institutions,   and Director of the Boston Center for Problem Gambling…

Sexual feelings that occur in the therapy relationship can be a huge problem for therapists, particularly those that are relatively inexperienced…

Assuming that most therapists have had their primitive, childlike narcissistic needs met while growing up, they still have certain mature mirroring and idealizing needs that at least some of their clients should gratify if they are to find their work interesting and rewarding.

In a previous posting, I discussed the normal, mature narcissistic needs that therapists need to have gratified,  at least some of the time,  in their work with their clients…

Many therapists have the point of view that they are only required to meet their clients’ needs for support, empathy, therapeutic skill; and to have no needs of their own in the therapeutic relationship…

The common definition of addiction is that it’s very damaging for the addicted person.  I suggest, however, that we expand the definition to include socially acceptable addictions, activities that have benefited the individual.  Sometimes  even the wider society, in important ways.   These behaviors can be classified as addictions, however,  if the person has compulsively kept indulging in them  even when they have been   detrimental to some areas of the person’s life and to people who were close to them.

If we therapists are any good at our jobs, we become very attached to many of our clients.  We feel pain when they’re experiencing shame,  sadness and fear.  We’re  pleased when they feel proud about  dealing effectively with a person or issue with which they’ve had difficulty .  We are joyful when they feel exhilarated about  some significant achievement in their job or profession or sport.  We  feel pity for them and angry at those who have mistreated, abused and  wronged them  And our own self-esteem can zoom when they express affection and appreciation to us for helping them.

Back in the 60s and 70’s there was a great emphasis on living in the present.  Ram Das’s book Be Here Now was very popular.  And Fritz Perls, in his workshops for therapists at Esalen also stressed being present-centered as a way of cutting down  on the obsessive style that one found in therapists who were trained in Freudian analytic therapy.  The Freudian approach emphasized  thinking about one’s problems in living,  the therapist’s main activity being the making of  cognitive interpretations.    Although Perls didn’t spell it out, what he was really getting at was being in the sensory present.

Most people see  addictions as negative because they often have dire results for the addicted person and others in his or her life.   Alcohol can result in poor health, premature  death for the alcoholic and injury or even death for people unlucky enough to be on the road while she or he  is driving.   Compulsive gambling practically always results in the loss of money, sometimes vast sums.    We are now finding that addiction to sugar has very negative effects on health, partially responsible for the epidemic increase of  obesity in the US.  Compulsive shopping can result in bankruptcy.

One of the most pernicious, costly and destructive beliefs in the US is the idea that certain substances, like drugs and alcohol, are addictive in themselves.  In other words, almost anyone, if they are exposed to marijuana or heroin or cocaine, are going to become addicted to it and not be able to curb their usage.   The public acceptance of this belief has resulted in the  War on Drugs, which has probably cost us over a trillion dollars over the years,  countless deaths and a huge prison population increase.

Michael Clemmons, a Gestalt therapist, has written a very  useful  description of the process the addicted person goes through in his book, Getting Beyond Sobriety:  Clinical approaches to long-term recovery.  It was published by the Gestalt Press in 1997 and updated in 2005.   Clemmons uses the Gestalt concept of the Cycle of Experience, developed by Joseph Zinker, a long-time member of  the Gestalt Institute of Cleveland, to explain the addictive person’s cognitive and emotional process when dealing with painful or frightening emotions.   He also contrasts it with  the non-addictive person’s way of dealing with painful emotions.

Perhaps the most difficulty clients in psychotherapy have is learning to deal effectively with the  internal sub-self that is critical and hostile toward themselves. .Many  psychological theorists have described  it.   Freud called it the super-ego, Eric Berne the Critical Parent, Friz Perls  the Topdog. 

Part III:  Helping clients learn how to use their emotions:  The final step is helping clients learn how to use their emotions skillfully and appropriately in their everyday lives.  Emotions are always experienced in a particular context and clients have to learn appropriate ways to deal with emotion within the context in which it arises. 

In a recent posting, I discussed therapists who tend to take too much responsibility for clients who present themselves as helpless,  hoping the therapists will magically cure them.

A very popular idea in our society is that addictions are caused by diseases and are completely the result of genetic factors.  It does appear, from much research (e.g., Dick and Agrawal, 2008) that genetic makeup can contribute to alcohol and drug abuse.     But much addictive behavior, in my experience,  is partially caused by other factors:  underlying anxiety and depression from not having worked through the traumatic effects of childhood abuse and neglect; the negative example of having seen  parents and other adults solve their problems by the use of alcohol and drugs;  starting to drink or use drugs at an early age so that it becomes a habit by adulthood;  and finally, one’s social milieu.  For example, if a person’s  main social contacts are at bars or with friends and relatives who drink heavily, they are more apt to  become and stay addicted to alcohol.

In my last posting, I discussed loneliness and how it feels.  In this one, I discuss what can be done to lessen the intensity of the feeling and healthy ways to deal with it.

Firstly, it is important  to identify the emotion of loneliness and allow oneself to feel it.  That may be a tall order since it is usually a very painful feeling, which many people avoid experiencing.   But like any negative emotion, you can only make a positive change in your loneliness by first allowing it to come to awareness.

I recently went to a local farmers market and became aware of an  uncomfortable, vaguely depressed mood that I have experienced many times before when by myself in a public place:   a restaurant, a  shopping mall,  a movie theatre before the movie starts, or just walking down a busy city street.  I realized  at the market that I was feeling lonely and that I usually attempt to avoid  this painful affect by trying to escape it in various ways:  striking up a conversation with a stranger, leaving the public  scene as quickly as possible,  trying to vicariously enjoy  the interactions that I observed people having with each other.

Most therapists have had the experience of psychotherapy clients who feel helpless and depressed, and  lack the belief that they have the power to change their lives.  They implicitly or explicitly expect the therapist to “cure” them.  And many therapists, particularly those who are new to the profession,  try to take the responsibility of making these clients change.  This, in my experience, is usually doomed to failure.  Here are the reasons:

I believe it was John Gottman  who has said that couples therapy is the most difficult type of therapy for therapists to do and the least successful in terms of percentage of positive outcomes.  Part of the reason for this, I think,  is that the therapist has the difficult task of needing to understand and be empathic to each partner’s individual  issues, while at the same time, understanding and addressing, dispassionately, the dynamics of the relationship.

One issue that is relatively neglected by most psychotherapists is the extent of their clients’ degree of physical activity.  This is partly understandable since psychotherapy is, at least as practiced by most therapists, a very sedentary activity and, my admittedly limited impression is that most therapists don’t  exercise themselves.   I recently handed out a questionnaire concerning personal exercise at a professional meeting of therapists and very few bothered to fill it out and return it.