This post will talk about the different views on treating substance abuse by
looking at the themes of determinism, reflective ability, mindfulness, self-awareness of a person’s emotional self, moral compass, freedom, disassociation, empathy, and addiction.
I will propose the controversial suggestion that some addiction interventions might be unintentionally decreasing a person’s ability to freely make a choice in the space between a stimulus and a response. I will suggest that telling a person that they lack control might be encouraging and/or enabling a lacking of consciousness or growth of a person’s reflective ability.
I will finish with my suggested intervention.
Let me first submit that the degree of disassociation exhibited by the client can very often make the therapist ‘feel’ as though there is no hope in fostering increased reflection in a client. The pressure to ‘fix’ in a limited time frame (from the therapist, the client, and/or a third party payer) can make the task of dramatically reducing a dissociative state in the name of curing an addiction seem impossible or at least impractical.
Certain people’s addictions are such a liability to the safety of themselves and the community that it would be difficult to allow the space for my alternative intervention, as the risks would be very high. The unfortunate tradeoff is that by controlling a person’s addiction for them, we might foster external dependency… this is sometimes arguably the ‘lesser of two evils.’
Let me further submit that the intervention that I am suggesting can take lots of work, perseverance, and diligence. If the client is required to show some level of improvement, but is not willing to put forth a courageous amount of effort, my alternative intervention will often displays its’ deficit (as it never takes the freedom of choice from the client).
I was reading a great blog post by Laura Scheck MA, (http://lauraschenck.com/mindfulness-and-acceptance/mindfulness-addictive-behaviors) in which she shared the following quote from one of the most famous existentialists-
“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” – Viktor Frankl
Her blog post and this quote brought up my question listed below.
The question that I am asking – When an addiction intervention suggests that a clients must accept “a complete lack of control” over the addiction, does doing so inhibit the growth of a person’s reflective ability?
Do you think that when an intervention claims that a person must accept that they ‘have no control over the substance’ they are impeding the client’s ability to develop a conscious awareness of the “space” in-between stimulus and response?
Are some interventions so lacking in their understanding or agreement of mindfulness that they are actually pushing “functional” cognitive rigidity on clients instead of offering the gift of reflection (Reflection, I believe, happens when there is consciousness of and in the ‘space’)?
I do understand that increasing emotional acceptance/consciousness and mindfulness is often the longer road… and yet I worry that sometimes our felt helplessness as a field pushes us to fix one form of cognitive determinism (stimulus- response without the ‘space’… behaviors dictated by rigid beliefs) with another more ‘functional’ form of cognitive determinism.
Succinctly the question becomes, “do you believe that there is always freedom in the space… or are there some stimuli that allow no freedom in the space… no opportunity for choice?”
It seems that some addiction interventions are making what I believe to be a false claim. They appear to be telling their clients that their intervention can eliminate 100% of the appeal of the stimulus and if this is not possible then the person must fearfully avoid the stimulus, as they will not have the power of choice in the presence of that stimulus.
- Ex. the client must either have no desire for alcohol or must rigidly and (ironically) obsessively avoid all situations involving alcohol.
Personally I believe more in helping clients recognize the “space” so that they can allow themselves the freedom to make the decision which is in their best interests.
By fostering a greater self-awareness and a more collaborative relationship with a person’s emotional and cognitive self, I find people are more likely to make the “right” choice.
What do emotions have to do with addiction behaviors?
I find that sometimes people are so isolated from their emotional self that they are able to successfully ignore the empathetic reasons to not abuse a substance or to engage in a destructive behavior… when therapy increases a client’s reflective ability the “space” before the reaction enters into their conscious awareness…
When therapy increases a person’s ability to ‘sit with’ and to accept their emotional experience then that increased emotional ability can influence the choice in the “space”.
What is a Dissociative state? (Note – I use the term very freely and loosely… in the DSM V the term is reserved for only the most severe ‘out of body’ symptoms. By my definition, I would contest that most of us are in a dissociative state the majority of the time and many of us are basically always in a dissociative state.
A dissociative state is when a person is on autopilot… they are reacting to their thoughts and/ or emotions without having a conscious awareness of their thoughts or emotions… or they are having no outward reaction to their emotions as they have successfully separated themselves from their own emotional experience.
It is very difficult to understand: who you are, how you impact other people, how you are truly feeling, why you are thinking what you’re thinking, and what the origin of your belief system is etc when you are in a dissociative state.
In a dissociative state a person lacks the ability to be empathetic to themselves or to other people.
- If a person gains a conscious understanding of their own emotional experience and the emotional experience of another person, they can use that emotional information to help them in making a choice (I call this ‘creating a moral compass’).
- As long as a person has developed a reflective ability, or a space in-between stimulus and response to exhibit the freedom of choice, the emotional content will often encourage people to make decisions in the best interest of everyone.
- This does not mean that a person in a dissociative state will always act in a ‘bad’ way… if they are to act in a ‘good’ way it is simply because they are engaging in a learned automatic behavior.
By my definition (which again is not technically accurate) a person is in a dissociative state will believe that:
- They are their thoughts – instead of being the observer or the creator of the thoughts.
- They are their behaviors – instead of being the chooser of the behaviors.
- They are their emotions – instead of being the experiencer of the emotions.
What is Reflection?
Reflection is the ability to watch or to observe your thoughts without being automatically driven to a predictable action (such as a ruminating thought pattern or a behavior).
Reflection is also the ability to watch or observe your emotional experience without being automatically driven to a predictable action (such as the outward expression of just one of the multitudes of emotions that are typically experienced as a result to any given stimulus).
Research by people such as Dr. Dan Siegel (http://drdansiegel.com/ ) has given scientific credence to how mindfulness practices can increase a person’s reflective ability.
How does Therapy help a dissociative state?
When a person is met with genuine empathy they feel a safety to reflect upon their authentic self. The therapist then further encourages this reflection with a vast array of differing ‘techniques’.
- The empathy from the therapist encourages the client to be empathetic to him/herself (I know this sounds weird and as if I am using the word ‘empathy’ incorrectly… but you can be aware of your emotions without being your emotions… this is different than emotional avoidance which is when your aren’t reacting to your emotions because you are either unaware of them or intentionally submitting them.)
- This is why clients miraculously heal in therapy though it is sometimes difficult for the client to articulate what was done to ‘fix’ the ‘problem’. Many if not most therapists believe that clients have everything they need to find their own solutions… it is within this reflective development that a client gains consciousness of the solutions they carried all along.
- You know the expression ‘listen to your gut’ or “follow your intuition’… easier said than done right? Therapy helps your find your intuition so that you can let it guide you.
How does mindfulness increase reflection?
Mindfulness is simply non-judgmentally observing the present moment.
Our thoughts generally concern the past or the future so that we are not actually ‘present’ in the present moment (we are in the past or the future in terms of our perceptual awareness).
When we project a judgment onto a stimulus in our environment we do not allow our selves to see the actual stimulus (we are looking instead at our projection).
Perhaps you can see how it would be difficult to make the right choice concerning an addiction if you were not present…
- If your mind is in the past, the future, or lost in a projection than who is present to make your decisions?
- Who is conscious of the external forces trying to control you?
By following the breath, engaging in a body scan, or interacting with the environment as if you know nothing about it, we use a different part of the brain than is typically more dominant in western cultures. Again see Dan Siegel’s literature and for more about mindfulness click ‘mindfulness’ on the right of this page under categories.
The part of the brain that is active while in a state of Mindfulness is also used for reflection. As with most things in the body, use increases mass and function.
My Alternative Addiction Intervention (to engage in all behaviors would be the ideal… any part is in itself beneficial)
* Offer an empathetic and accepting therapeutic environment to encourage the client to reflect upon his/her life. This process can build insight into the origins of the addiction and can also serve to heal old wounds that may be encouraging addictive behaviors.
* Offer mindfulness training and teach the client how to practice mindfulness daily. Offer a short explanation of what it means to be in a ‘mindful state’ during everyday activities and foster an increase of this state. Mindfulness skills can increase a client’s reflective ability so that they have a freedom of choice in-between stimulus and response.
* Encourage the client to follow the nutrition and exercise recommendation provided by the medical community. Often addictions serve to cover up the symptoms which arise from an unhealthy lifestyle. By practicing wellness a person can dramatically reduce stress and anxiety while increasing hope and happiness… the need for the addiction is generally diminished as health is healing and rewarding.
* Encourage the client to contemplate the addiction from multiple perspectives.
- What are the emotional, cognitive, and physical benefits from engaging with the addiction?
- What life experiences have encouraged the growth of the addiction?
- What family rules, rituals, or customs etc are related to the addiction?
- What is the goal or what value is achieved by engaging with the addiction?
- What other activities could be engaged in that would bring similar benefits?
* Provide a safe and supportive place for the client to be emotionally available and vulnerable… allow the client to experience their emotional self with curiosity and without trying to alter or control the emotions that surface. Often our bodies or our intuition will guide us to the best decision… we must learn how to listen if we are going to hear the bodies advice.
* Once the client has attained a degree of emotional availability and has increased his/her reflective ability allow them to authentically articulate realistic expectations for each step of the process. If certain people or environments have too much control over the client… the client can choose to avoid those influences at certain stages.
* Offer family or couples counseling to increase the adult attachment. Foster an environment for the clients to learn how to successfully and authentically communicate. Healthy supportive relationships with open emotional expression can serve to motivate the client to persevere through the difficult task of change. Healthy relationships can often diminish the need for the effects of the addiction (we require healthy relationships for our biology to function optimally) – see any attachments theorist work, such as Sue Johnson, for more information.
* Allow a space for the client to process feeling, such as guilt, disappointment or embarrassment, that surface with the newfound insight and emotional availability. Guilt and shame can derail progress… Forgiveness is a gift for your self… forgiveness can come from acceptance, compassion and empathy.
* Use existentialism and narrative techniques to encourage the client to make meaning of their addiction while writing a new life story in which they overcame the vice which was controlling them.
* Validate, honor, and confirm the changed person. Help them to believe in this newly free person by genuinely believing in them.
* Offer the client the space to continue their journey towards an increase in wellness that was before unfathomable. Often therapy stops here as therapy is very often thought of as a tool for the elimination of problems. Therapy can continue here with the goal of increasing positives as opposed to decreasing negatives.
At this point the client will be functioning well above average and will be free, authentic, available, and conscious. This is undoubtedly the road less traveled… and perhaps this path might be difficult to swallow in a culture of quick fixes, but the result of such efforts will be life itself… to live free of atomization.
This intervention has the purpose of increasing consciousness, empathy, and freedom… This intervention is based on the humanistic viewpoint that we are all innately good.
I would not argue that this is the quickest way to eliminate a specific symptom… I would suggest that it is the way to empower a client to resolve most anything.
A therapist could theoretically alter a client’s belief systems, but a therapist would not be able to force an unwilling client on this journey towards emancipation… the therapist can gently and confidently lead… but ultimately the client must bring dedication.
Do you agree or disagree? I would love to here your comments.
The main question is, “do you believe that there is always freedom in the space between stimulus and response… or are there some stimuli that allow no freedom in the space… no opportunity for choice?”