Humanistic Addiction Psychotherapy – Overview
Foundational Concepts
People take drugs for reasons, reasons that need to be respected and, in many cases, directly addressed – sometimes before the patient will be willing to make changes in their drug and alcohol use. (Tatarsky)
Multiplicity of Self: In this model, the internal world of patients is conceived of as containing different parts, selves, modes, or identities – many of which are playing or may play a role in the patient’s suffering, drug use, and healing and recovery. Patients change, heal, and recover in fundamental ways as they re-balance, re-organize, and re-structure their inner worlds. (Kellogg)
Components of Treatment
Therapeutic Alliance
- A central factor in successful recovery
- Therapists demonstrate
- Love
- Empathic Listening
- Authenticity and Optimism
- Courage and Determination
- Within the context of their own personal style
Complexity and Multiplicity
- The Reasons for Problematic Drug and Alcohol Use Can Generally be Organized into Six Domains
- Self-Stimulation/Avoidant Coping
- Self-Soothing/Avoidant Coping
- Drug-Based Biological Changes/Medical Issues
- Physical and Medically-based Pain-Driven Use
- Social Identity – Groups, Subcultures, Friendship Networks
- Social Oppression
- Identifying and Respecting the Motivations for Change
- Threats to Family/Parental/Relational Roles
- Job Loss/Economic Damage/Prestige Threat
- Existential/Spiritual Issues
- Health Concerns
- Legal Problems
- Other Reasons
Decisional Balance
- Positives and Negatives of Drug Use
- Positives and Negatives of Change
Creating a Mode Map
- Identifying the Different Parts, Modes, Energies, and Archetypes
Dialogue Work/Chairwork
- Giving Voice to all of the Different Parts, Modes, Energies and Archetypes – on Both Sides
- Clearly and Strongly
- Everyone Speaks Several Times
- Both a Diagnostic and a Motivational Practice
- Identify, Connect with, and Begin to Empower the Inner Leader, Healthy Adult Mode, Ego, etc.
- Usually a Part that is Concerned About the Drug Use
Identify and Label Specific Mode-Use Patterns
- Use the Five Domains as a Guide
- Some Modes may be Substance-Specific
Goal-Setting/Problem List Development (Persons)
- Mode-Use Patterns
- Work with the Drug Use First?
- Work with the Underlying Problem/Psychopathology First and Monitor the Drug Use?
- Do Both Simultaneously?
- Harm Reduction, Moderation, “Nonaddictive” Use, or Cessation?
- Institutional Goals (If Applicable)
- Embrace Them
- Ally with Patient Against Them and Use Harm Reduction Strategies (Wallace)
- Work with Other Therapeutic Problems
Techniques: Vertical Interventions
- Treating the Underlying Pain and Psychopathology
- Psychotherapeutic Domains
- Problems Connected to the Past
- Trauma, Grief, and Moral Failure
- Problems Connected to the Present
- Depression, Anxiety Disorders, Assertiveness, Personality Disorders
- Problems Connected to the Future
- Existential Life Decisions, Identity Creation, Anxiety, Recovery, Hero’s Journey
- Problems Connected to the Past
- Six Categories of Intervention
- Relational
- Cognitive
- Behavioral
- Existential
- Experiential
- Meditative/Self-Soothing
Techniques: Horizontal Interventions
- Substance Use Management/Harm Reduction (Bigg)
- Reducing the Amount Consumed
- Changing the Methods of Use
- Reducing the Time of Involvement
- Altering the Context of Use
- Drug Substitution
- Learning Overdose Prevention Measures/Naloxone
- Relapse Prevention (Marlatt)
- Understanding and Identifying Triggers, Cues, and High-Risk Situations
- Skills Training
- Cognitive Restructuring, Relaxation Therapy, Distraction, Social Support, Mindfulness/Urge Surfing
- Assertiveness
- Drink and Drug Refusal
- Ideal Use Plan (Tatarsky)
- Contingency Management/Positive Reinforcement Systems
- Mutually Choosing a Target Behavior
- Safer Use, Reduction, or Cessation
- Attendance
- Other Treatment Goals
- Mutually Choosing a Target Behavior
Identity Transformation
- The Foundation of Long-Term Recovery
- Developing Identities that are Reinforcing and Meaningful
- Which Challenge and Replace Those Based on Drug Use
- Creating and Restructuring Identities
- Self-Definitions – Values and Choices
- “Who Are You and Who Do You Want To Be?”
- Reference and Membership Groups
- Identity-based Actions
- Identity Dialogues
Monitoring and Working with Countertransference
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