Monthly Archives: June 2014

The Universal Addiction

Although we talk about addiction to alcohol, drugs, food, fame, money, sex, pain, etc., these aren’t the real addiction. They are just signs that point us to the true addiction.

We are addicted to not being here now. I don’t want to feel what I’m feeling; I want to feel something else. I don’t want reality to be what it is; I want it to be something else. I don’t want to be where I am; I want to be somewhere else. I don’t want to be the way I am; I want to be some other way. I don’t want to be in this moment; I want to be in the next one. I don’t want to be in the present; I want to be in the past or the future. We are addicted to not being here, feeling the way we feel, in this moment. Thus, we are addicted to an imaginary time, an imaginary me, an imaginary other, an imaginary experience, in the future when “all will be well.” This is our basic addiction. Food, drugs, alcohol, sex, fame, and food are just tools we use to run away from the reality of our inner life now to an imaginary experience always receding away into the future.

We imagine if we could just be different, feel different, and think differently than we are, feel, and think in this moment, that we would finally be calm, at rest, and at home. And yet, this addiction to imagination, the future, to the not me, and the not you, keeps us eternally away from home. We remain frantic wanderers rushing to the next moment, hoping to find a different me, a different experience, a different you, a different feeling. We end up running our entire lives, living a life on the run, away from ourselves in this moment.

Strangely, in our rush to find rest, calm, and home, we run from the only home we ever have, the home that is always here, the home that never has left us: our inner life in this moment.

We run and run, seeking the experience that we think will complete us. In fact, we are already complete. It’s just that we don’t like the completeness of who we are, what we feel, and what we think in this moment. The experience we fear in this moment we think we need to run from. In fact, fear is a sign. It points us to where we need to dive: into ourselves now. When we bear who we are, what we feel, what we resist in this moment, the healing begins. The marriage between the inner you and outer you begins, only to be repeated again and again in every moment.

The surprise is that everything inside ourselves that we have run away from has always been reaching out to us for our love and acceptance. We thought we needed to race to an imaginary experience in the future rather than sit down and be transformed by the experience of our feelings now. We thought we needed to be different rather than bear how we are now. We thought we lacked wholeness we could find in the future rather than bear the uncomfortable, yet pregnant, wholeness of who we are in this moment. We thought we needed some special, amazing external experience in the future to be reborn, not realizing that the messy pain and confusion of our feelings could be the womb in which we would be reborn. We thought we were far away from home and had to race to get there, not realizing we have always already been home in this moment, with all the feelings and struggles within us that are necessary for our healing and growth.

We thought we had to rush to find wholeness, calm, and a home. We forgot that trees are in no rush to grow; they just grow. The sun does not rush to have a sunrise; it just rises. A rose bud does not rush to blossom; it just blossoms. Every one of us is a bud, with this internal urge to blossom. We experience that urge to blossom in the form of feelings, anxiety, and defenses (we are very messy flowers!). We would never tear a rose bud apart to make it grow. A rose bud never says it should be different, it should be farther along, it should already be a blossom. It bears the inner pressure of life which causes the bud to grow and push those petals out to finally form the flower. Can we sit with that internal pressure of our feelings and anxiety? Can we let ourselves blossom?

What will happen? a patient asks. Can we bear not knowing who you will blossom into? Can we accept that you are a mystery, the unknown? Can we accept that we are all addicted to not being here, now, as we are? Can we accept that we are all terrified of becoming someone whom we don’t yet know yet? Can we accept that we make awful predictions about who we will become, who we will find inside us? Can we accept that we seek awful certainty to avoid the unknown you who is about to be born?

How can I judge addicts? I am one. We all are addicts. We are all addicted to not being in this moment, not feeling what we feel, not thinking what we think, not being who we are. We are addicted to imaginary images of ourselves in the future: the real drugs! Oh, if I could only be like that imaginary image! That would be a fix!! That would be a high!!

But then reality keeps showing up in the form of me, my inner life. Ever faithful, it rises every day for my attention, my love, and my acceptance. It keeps asking me, “Are you willing to love me now in this moment, so this reunion of us can begin the healing journey?” “But I feel so addicted to this beautiful image of me that I wish I could be.” And my inner life keeps asking, “So can we accept your addiction too? What if your addiction to an ideal image in the future is not the problem? What if your rejection of yourself in this moment is the doorway to the calm, rest, and wholeness you have been seeking? What if how you are in this moment is precisely what we need to accept?”

Every day we are addicts. Every day we are overcoming our addiction to not being who we are and what we feel in this moment. That is the universal addiction underneath all the others.

ISTDP and Addictions

“Can you do a post on using ISTDP with addictions clients? I work at a private in-patient addictions center. Although addicts vary a lot in their traumatic history and attachment problems, they consistently are unable to sit with their emotional experience. The addiction almost always boils down to a powerful avoidance of the self. It can be difficult to work experientially because withdrawal states compound anxiety greatly. Mindfulness, breath work, IFS, and focusing can work wonders in many people. Another constant is a powerful superego. ISTDP’s emphasis on staying with the alliance and the client’s will has helped me a lot. I mistakenly thought I could go where I wanted as long as I was very empathic. But empathy doesn’t work unless the alliance is formed and maintained. Thank you for any help in using ISTDP for addictions.” Thanks to one of our community members from Maryland for this question!

If we leave the medical aspects of addiction to the side, let’s focus on the psychological treatment of people who suffer from addictions. First of all, the triangle of conflict is this: they experience feelings; feelings trigger high levels of anxiety; and, among their defenses, they use drugs to numb away their feelings and anxiety.

Their low affect tolerance manifests in behaviors: impulsive speech, acting out, racing speech. These are, of course, regressive defenses. In session, the patient may impulsively speak over you as soon as she has a feeling. The patient, having difficulty tolerating his feeling, may stand up from his chair and walk around the room. As soon as the patient has a feeling, he becomes anxious, and his speech starts racing.

Their low affect tolerance also is manifest in their defenses: projection, denial, and splitting. A patient who sees that he has a problem suddenly projects, asking, “Do you think that’s a problem?” Or he sees a problem, becomes anxious, and uses the defense of denial, “Yeah, I use drugs, but that’s not causing any problems on my job.” Or he sees a problem, becomes anxious, and then uses the defense of splitting. “I could have a problem with drugs, but who knows? I don’t know. You’re the expert on this!”

When regressive defenses of racing speech, acting out, impulsive speech, projection, denial, and splitting do not work sufficiently to help the patient avoid the experience of his feelings and anxiety, he will use drugs to numb away his feelings and anxiety.

Unless we help the patient learn to bear his feelings and regulate his anxiety, his risk for relapse into drug addiction will remain high. It is easy to judge these patients for being unable to sit with their experience. But we must remember that their experience of anxiety is often extremely high and would be unbearable for anyone. That’s why anxiety identification and regulation is essential for this group of patients. You can see how to do that in my DVD of the Fragile Patient on my website www.istdpinstitute.com.

Getting started can be hard with these patients. Why? Forming a relationship triggers high levels of feeling and anxiety which they have trouble bearing. Thus, to avoid those feelings they often start by denying that they have a problem, or they project that someone else thinks they have a problem. If they have no problem, they have no need to depend upon you. Thus, no feelings arise over depending on you.

Th: What’s the problem you would like me to help you with?

Pt: I don’t have a problem. [Denial]

Th: And yet you are here. [Note the contradiction between what he says (no problem) and does (comes to a therapist’s office)]

Pt: Well the rehabilitation people thought I should be here. [Projection]

Th: They may have thought it was a good idea for you to come [Block projection], but we still don’t know why you came.

Pt: I don’t know. Things are going great. [Denial]

Th: That’s wonderful. [Mirror denial]

Pt: [fidgets in chair] What do you think I should work on? [Projection]

Th: I have no idea. [Block projection] It may be you don’t have a problem. [Mirror denial]

Pt: That’s what I think. [Denial]

Th: That’s a wonderful position to be in. [Mirror denial]

 

Maintain your stance until the patient reveals a problem to work on. This could take as long as an hour. My forthcoming video of the addict who claimed he had no problem shows how I work with a patient for fifty-one minutes before he admits to having a problem! There is no rush. Do not push the patient to admit to a problem. If you confront the addict, his feelings and anxiety will rise, often leading to acting out and risk of relapse. Instead, patiently stay where he is, mirroring his denial and blocking his projections. Eventually, the problem will emerge.

 

Next, we find out whether it is his will to work on the problem. After all, just because he has a problem doesn’t mean he wants to work on it with you!

 

Pt: Yeah, the drugs are a problem, but that’s not something I want to work on with you. [Denial of will to work on the problem]

Th: Ok. [Pause for the patient’s response. His anxiety will rise as he begins to realize that you won’t argue, as he begins to realize that you will explore nothing unless it is his will to do so.]

Pt: Ok, what?

Th: If you don’t want to work on your problem, you don’t have to. It’s your life and your decision. [Blocking the projection that you are going to force him to look at something he does not want to look at.]

Pt: But aren’t you supposed to dig? [Projection of will onto the therapist]

Th: No. That’s not my job. If you want to dig within yourself and reveal what you’ve dug up so we can help you with what’s inside of you, we can do that. But if there’s digging to be done, only you can dig in you. That’s not something I have the right to do. [Blocking projection]

Pt: But aren’t we supposed to dig? [Projection]

Th: It’s not a matter of what we are supposed to do. The question is: what do you want to do? And you may not want to dig within yourself. You may not want to work on this problem. [Block projection]

 

Again, keep blocking the projection of will until the patient decides that it is his will to work on his problem with you. Don’t move forward unless the patient wants to move forward. His problem, his decision.

 

Once he decides it is his will to work on his problem, you can move forward. However, once you do so, the patient may become overwhelmed with anxiety. Then we use the graded approach and anxiety regulation, which you have read about in my book, Co-Creating Change: Effective Dynamic Therapy Techniques.

 

With addicts there are a few special techniques that can be extremely important. For them, feelings and anxiety rise very rapidly. When this happens, patients can move to projection within a few seconds, leading to a misalliance. As soon as you see a sign of anxiety in the patient, intervene. Intervene before the patient goes to the next sentence and defense. Intervene before the “fire” gets worse. As soon as you see a sign of anxiety, ask: “Are you aware of feeling anxious right now?” As soon as the patient says yes, interrupt and ask: “Where are you feeling the anxiety in your body right now?” Block all defenses and projections to keep the patient’s attention focused on the experience of anxiety. The patient will be able to bear the physical sensations alone if you block all the defenses and projections. If the patient keeps talking, the defenses and projections will worsen the experience of anxiety making it unbearable. Thus, your rapid blocking of defenses will help the patient keep his attention focused on the physical sensations of anxiety.

 

If his anxiety does not come down within a few minutes, his projections are probably sustaining the projective anxiety. Thus, find out what projections the patient is using that make him afraid of you (projective anxiety). Then restructure those projections and anxiety should finally drop. Remember: your empathy will not help if the patient is in relation to a projection instead of you. If he is in a misalliance with a projection, he will experience your empathy as your attempt to trick him into trusting you. It’s not enough that you are empathic; the patient must first be in relation to you.

This post got long quickly. Next time we’ll talk about superego pathology and the secret addiction, which drugs merely cover.