22 March 2017

How People Change – The Therapeutic Process in Addiction Recovery

The Therapeutic Process of Addiction Recovery

Most people come to therapy because they want change to happen, and nowhere is this more true than in the field of addiction.

Addicts are often unrealistic; they expect someone else to change rather than themselves – a partner, boss or loved one. Sometimes they think that a purely external factor needs to change, such as moving to live in another country. Sometimes they even expect the therapist to change. They don’t want to look at themselves; all they really want is a result: for the pain to cease.

The medical world has long been built around a passive ‘doctor – patient’ relationship, with the idea that the patient can lie back and wait for someone to fix them. Even the word ‘patient’ implies the act of waiting and enduring, rather than actively taking part in your own recovery. This is particularly problematic for addiction therapy, and newcomers to addiction treatment can have misconceptions about how it actually works. Often they think it will be like a hospital visit, that someone else is going to do all the hard work for them. But with therapy this is not the case. Nobody else can fix them. The patient has to take responsibility for this themselves.

Just understanding this fact is one of the hardest parts of recovery. Many addicts are stuck in ‘victim mode’, which means that they find it easier to blame circumstances or other people for their addiction rather than themselves. Blaming an unhappy childhood, for example, can be a perfect excuse for some to keep their habit going, while deciding to leave the comfort zone and do things differently can be a scary prospect. But it must be done. As the great psychotherapist and addiction expert Carl Jung said, “I am not what happened to me. I am what I choose to become”.

So therapy is all about change? Wrong – a large part of therapy is about acceptance. It is the combination of these two aspects that will make the therapeutic process work. As Reinhold Niebuhr put it in the Serenity Prayer:

“God grant me the serenity to accept the things I cannot change, courage to change the things I can and the wisdom to know the difference”.

So how does therapy work in practice?

First off, the ground rules have to be established: at their simplest, the patient has to bring to the process the three basics of honesty, openness and willingness to change; without these, a successful outcome is unlikely. In return, the therapist must bring to the patient respect, empathy and understanding. With these ground rules in place, a healthy therapeutic relationship can be established.

But for progress to be made, it then becomes crucial for the patient to take responsibility for recovery, which means surrendering to the treatment programme and doing whatever it takes to recover, in the same way as a person with any form of terminal illness will follow a recovery programme that offers hope of success. In reality, these things are not so different: addiction too is often a terminal illness, if left untreated.

Then comes the often painful but essential process of facing reality, which will probably mean dealing with the denial that many addicts have towards their condition and its consequences. There are three essential truths that the patient must admit and accept:

This is what your behaviour was like

This is how it makes others feel and think about you

This is how it makes you feel about yourself.

By accepting this reality, the patient becomes ready to face the crucial questions: how do you feel about this situation and what do you, with help, want to do about it?

Getting to this point is hard, but there are two things that have proved incredibly effective in helping along the way: group therapy and something less tangible – the ‘X Factor’ of spirituality. Together, these two make up the corner stones of the highly unusual but remarkably effective model of the 12 step therapy programme, which was introduced by the founding fathers of the Alcoholics Anonymous movement in the mid 1930’s.

The inclusion of spirituality – the concept that recovering addicts need help from a ‘power greater than themselves’ (it does not have to be a God of any particular religion) – may be seen as a logical progression after the addict has fully admitted and accepted the powerlessness and unmanageability in their lives that was caused by addiction. By asking for help and exploring their spiritual side, many patients find that they are filling a void created by the absence of addiction.

It does not stop there however. In fact it never stops at all, until we are dead. Change and acceptance can be undone and addiction is only ever in remission – an addict is never ‘cured’. The new habits and attitudes that are learnt in the first periods of recovery must be nurtured even decades later. Sobriety can be the start of a happy and fulfilling life – but the price is eternal vigilance.

 

References:

Serenity Prayer – Reinhold Niebuhr. C 1935

Memories, Dreams, Reflections – Authors Carl Jung and Aniela Jaffé. Publisher 1962 Exlibris

The necessary and sufficient of therapeutic personality change – Author Carl Rogers. Publisher 1957 Journal of Consulting Psychology

Letter to Bill W – Dr Carl Jung – 1961 (AA Grapevine January 1963)

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