Exploring Beneath Addiction

In the last several years it has become more and more clear in the media as well as within the mental health profession that addiction has become an out-of-control epidemic, especially addictions to meth, opioids, and heroin.

I supervise post-grad interns who work with this population (addicts of all substances), many of whom are homeless and/or ex-incarcerated. Most of these clients have years, if not decades, of addictive patterns of behavior well established, such as lying, cheating, and portraying some level of aggression or passive-aggressive behavior. Many are dually diagnosed with other mental illnesses and have suffered various traumas during the course of their lives.

These entrenched behaviors often become like masks or shields for the people living inside of them, seemingly impenetrable to those working with them. So many layers of harm from others, self harm, and harm done to others are woven into the horrific disease of addiction, that it seems extremely difficult to unravel and find the human being strangling inside.

Exploring beneath this quagmire of addiction requires the willingness to suspend judgment and presumptions about the limitations of hope placed on or by this person. Societal norms and personal records of misconduct have put boxes of low expectations on addicts. To find the real people hiding in these boxes is the primary challenge of therapy, as I see it. As we go about the careful process of doing so, we need to help that person exposed learn to not be afraid of who he or she really is, but to have the courage to heal and embrace the broken goodness within.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Multicultural Counseling: Working with People of Color

It is well-documented that working with minority populations can be challenging for therapists, especially for white therapists, largely because of trust and specific cultural issues. Because the current, if not ongoing, issues of racism and bigotry have been brought into the spotlight so starkly once again, I find it to be important and timely to look at these challenges more deeply, so that we, as therapists, can more effectively be part of the solution rather than contribute to the problem.

Williams and Levitt (2007)¹ studied the differences between the values of therapists and clients as they relate to multiculturalism. They found substantial evidence supporting the fact that real value differences exist between therapists and clients and, “therapists cannot be value-neutral and that they routinely convey their values with clients.” (p. 256) Therefore, they say, “the potential exists for therapists to consciously or unconsciously influence clients to become more like themselves.” They point out that most therapists are unaware of the potential negative effects of sharing such values with the client, because they do so intending to benefit the client. Within a multicultural context, there is a higher probability of alienation, shame and/or indoctrination for the client in ways that either shut down the treatment or is counter-indicated for real progress to be gained.

According to the research, among the most prominent ethnic minority groups in this country (African-Americans², Latinos³, Native-Americans⁴, Asian-Americans⁵ and Middle Eastern Americans), common themes exist in their overall experiences with therapy. Additionally, there is vast underutilization of mental health services, primarily for the following reasons: a sense of alienation and shame, stereotyping and lack of trust in the therapist (particularly a white therapist).

Because this phenomenon is so embedded in horrific histories as well as ongoing cultural disparities, it often seems insurmountable to rectify. But it is my strong conviction that we in this field can, and must, put every effort into positively intervening in this issue by fully recognizing it and, coming from a place of authenticity, fully focus respectfully on the unique cultural backgrounds and qualities of each human being we encounter.

¹Williams, D., & Levitt, H. M. (2008). Clients’ experiences of difference with therapists: Sustaining faith in psychotherapy. Psychotherapy Research, 18(3), 256-270.

²Thompson, V. L. S., Bazile, A., & Akbar, M. (2004). African Americans’ perceptions of psychotherapy and psychotherapists. Professional psychology: Research and practice, 35(1), 19.

³Comas-Diaz, L. (2006). Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 43(4), 436.

⁴Heinrich, R. K., Corbine, J. L., & Thomas, K. R. (1990). Counseling Native Americans. Journal of Counseling & Development, 69(2), 128-133 and Trujillo, A. (2000). Psychotherapy with Native Americans: A view into the role of religion and spirituality.

⁵Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental health services research, 3(4), 201-214.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

 

 

Tapping into Therapeutic Creativity

Many times, we as therapists can feel “stuck” in the process of doing therapy, either with a particular client or more generally with a certain population. It may be an adolescent not wanting to be in therapy, a very depressed older individual or a couple so entrenched in a non-stop pattern of arguing you feel a need for a megaphone just to interject some redirection.

In most, if not all, of these cases we need some moments of calm and self-clarity to be sure, but it might also be helpful to “think outside of the box” as well. Try introducing creative interventions such as art (music, visual arts, poetry or prose).

We could certainly draw from our own experiences by offering stories, metaphors or pieces of music, but I have found it to be much more profound when tapping into the creativity of the clients themselves. Their own storytelling, poetry, artwork, music, etc. can be much more compelling, meaningful and healing if they are left untouched in a respectful manner. That is, we don’t interpret or judge in any way, but instead encourage growth by allowing clients’ creative outlets to portray whatever meaning and purpose they are attempting to express.

A word of caution: those of us who are not specifically trained or certified in expressive art therapies should use these modalities carefully and only adjunctively to the work we are trained in. However, creativity in all its wonderful forms, used with care, can be transformative in moving the therapeutic process forward.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Meaning and Purpose

Victor Frankl is perhaps one the most famous leaders in the discussion of meaning.  In his signature book, Man’s Search for Meaning, he talks about his many years as a prisoner in Auschwitz where mere survival was the source of meaning, and yet in such a deplorable setting, the search for further meaning became even more important. In this book he says, “Striving to find a meaning in one’s life is the primary motivational force.” (2006, p.99)

To explore our daily sense of meaning and purpose may be a more significant starting point.  For instance, one meaning may be about just getting out of bed every day and going to work or getting the kids off to school for that day. The larger purpose in the daily tasks are obviously about making a living, parenting or getting an education, but those sometimes get lost in the details. Therefore, we can lose sight of this grander perspective and perhaps develop a sense of meaninglessness or lack of purpose.

It is when we “get stuck in the weeds” of life that we are prone to have more existential anxiety about the meaning of our lives; about our identity as human beings. Many times we may not be fully aware of the complete nature of this anxiety, we just know that we feel something’s missing.

This feeling is amplified exponentially, of course, by experiences of trauma or loss. Depending on the severity and timing of such destructive life events, it can be that an individual has not been able to develop such an identity or that identity has been seriously damaged.

Breaking out of this existential angst or repairing an identity to a fuller meaning and purpose is a central part of psychotherapy. There are several ways in which a therapist can be helpful in this process. The primary way is through the qualitative tone in the relationship. If therapists can genuinely provide a comprehensive presence of respect for the client sitting in front of us, we can better foster the opportunity for the growth of internal respect.

We can then foster and support the courage of our client to widen the lens from the mundane existence of daily living. To understand a larger scope of life to include a more solid sense of meaning, such as a spiritual, values or a cause-driven sense of purpose.

Finally, we can assist in the creative process that the client embarks on to build the tools and resources necessary to implement and grow into a restored identity.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic