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In the treatment of addictions and their psychological understanding, cognitive-behavioural and motivation approaches have been paramount. In contrast, the psychodynamic contribution has been muted. This book redresses this imbalance by bringing together a team of senior clinicians with psychotherapeutic backgrounds as well as extensive experience in addiction. Stress is placed on the diversity of psychodynamic understanding and its relevance to the everyday problems met by addicted individuals. The first theoretical part of the book is followed by examples from group and individual therapy, and the foreword is written by Dr Edward Khantzian. The Psychodynamics of Addiction will be of interest to psychotherapists who may lack experience in addiction, and to other clinicians working in the field - doctors, nurses and psychologists. Introduction - Review of Different Schools: Container and Contained: The School of Bion - The Application of Bowlby’s Attachment Theory to the Psychotherapy of Addictions - The Vulnerable Self: Heinz Kohut and the Addictions - Therapy: Dynamics of Addiction in the Clinical Situation - Psychodynamic Assessment of Drug Addicts - Individual Psychotherapy with Addicted People - Group Therapy for Addiction - Helping the Helpers: Psychodynamic Perspective on Relapse Prevention in Addiction - In Search of A Reliable Container: Staff Supervision in a DDU -Countertransference with Addicts - Addiction and the Family: Growing up with Alchohol or Drug Abuse in the Family - References - Index
This book provides clinicians and students with insights on the use of psychodynamic therapy to treat drug abuse and addiction, combining theory with clinical case material. The perspectives of analysts such as Abraham, Rado, Zimmel, Tibout, Wurmser, Khanzian, Krystal and McDougall are reviewed alongside original and more recent conceptualizations of drug addiction and recovery based on Kleinian, Winnicottian and Kohutian ideas. The case material deals with clinical phenomena that characterize working with this complex population, such as intense projective identification, countertransference difficulties and relapses. The theoretical analysis covers a range of concepts, such as John Steiner's psychic shelters and Betty Joseph's near-death-addiction, which are yet to be fully explored in the context of addiction. Prevalent topics in the addiction field, such as the reward system, the cycle of change and the 12-step program, are also discussed in relation to psychodynamic theory and practice. Written by an experienced therapist, Psychodynamic Approaches for Treatment of Drug Abuse and Addiction is useful reading for anyone looking to understand how psychodynamic thought is applicable in the treatment of drug abuse and addiction. It may also be of some relevance to those working on treating alcohol use disorders and behavioral addictions.
For many practitioners, sifting through the diverse and complex methods available for treating substance abusers can be just as daunting as working with the addict. Drawing on over 30 years of experience, Edward Kaufman has developed a pragmatic approach to treatment that systematically integrates techniques from a variety of influences--from object relations and cognitive-behavioral therapy to structural family therapy and the Twelve-Step movement. Covering the myriad problems encountered with alcoholics and addicts, he presents a workable approach that can be utilized by a broad audience of therapists at varying levels of training in psychotherapy and/or substance abuse. Each of the chapters provides the details necessary for understanding and treating the substance abuser with psychodynamic therapy. The book outlines the personality and psychopathology of addicted persons, taking into account psychodynamic theory, codependent patterns, and risk factors that may predispose individuals to substance abuse. Recognizing the gender specificity of certain issues, the book then describes topics relevant to addicted women, with discussion of personality traits, gender-specific considerations for psychotherapy, feminist therapy, and how women fare in Twelve-Step groups. A chapter on defense mechanisms focuses on denial, projection, and rationalization, and another chapter describes the three most common personality disorders among addicted persons--antisocial, narcissistic, and borderline. Illustrating the approach with case histories, the author describes his three-phase psychotherapeutic method. The first phase--assessment to abstinence--involves evaluation, motivation, detoxification, incorporating the family and social network, developing a method for abstinence, and delineating a workable treatment contract. The second phase--early recovery (sobriety)--focuses on methods for helping an abuser remain drug and alcohol free. Relapse prevention strategies and a variety of coping methods are outlined, and methods are presented for teaching abusers to recognize situations that may provoke their use of drugs, the reasons for relapse, and the psychodynamics of their addictions. Finally, the third phase--advanced recovery (intimacy and autonomy)--addresses such issues as the ability to love in an intimate way, self-sufficiency in work and creativity, and the development of relaxing, pleasurable leisure skills. The therapist's role in transference and countertransference, and the substantial value of interactional methods to create change, particularly in clients with personality disorders, are examined. The book's final chapters focus on the integration of group and family therapy with the proposed individual therapy model. A phase-related model of group therapy is presented, and multiple-family and couples groups are discussed, with a synthesis of several family therapy approaches that emphasize structural and psychodynamic family techniques. Valuable to a wide audience of mental health professionals working with substance abusers, this book will help the addiction therapist to utilize psychodynamic constructs more effectively, and the psychotherapist to incorporate the tools of such programs as Alcoholics Anonymous. It is also ideal as a primary text or supplemental reading for courses dealing with the treatment of substance abuse.
What can psychoanalysis contribute to an understanding of the etiology, treatment, and prevention of substance abuse? Here, Louis Berger contests both the orthodox view of substance abuse as a "disease" explicable within the medical model, and the fashionable dissenting view that substance abuse is a habit controllable through the "willpower" fostered by superficial treatment approaches. According to Berger, substance abuse is first and foremost a symptom. He argues that it is only by grasping this fact that we can understand why standard approaches to treatment and prevention have failed. Berger invokes a wide spectrum of recent analytic insights about infant and child development, the psychology of narcissism, and primitive character disorders in making the case that substance abuse masks serious preoedipal (or "midrange") psychopathology. Such psychopathology, operating at both cultural and person levels, explains why certain individuals become dependent on illicit drugs; it is equally revelatory of why the substance abuse "establishment" -- and society at large -- continues to misconstrue the nature of the problem and to proffer ill-conceived and ineffective remedies. After thoroughly examining the motives, conscious and unconscious, that maintain "mainstream" myths about substance abuse, Berger points the way to alternative approaches to prevention and treatment.
The Psychodynamics and Psychology of Gambling is the first volume in the four-volume The Gambling Theory and Research Series. Author Mikal Aasved felt a need to fill what he perceived to be a lack of background sources or reviews of literature pertaining to gambling theory and research. This series will present major findings of leading researchers as they study the causes and effects of gambling, both recreational and excessive. This first entry in the series reviews the most influential psychodynamic and psychological theories that explain why people gamble. Psychoanalytical theorists discussed include Freud, Von Hattingberg, Fenichel, Bergler, Simmel, Greenson, Stekel, and others. Aasved includes sections on behavioral (learning or reinforcement theory) psychological approaches to gambling with discussion of Skinner's ideas and research findings as well as Pavlov's principles. This book begins with the question 'Why do people gamble?' and offers many theories proposed by clinicians, laboratory and field researchers, and participants as they seek to explain the motivation behind gambling. The differences between gambling as entertainment and gambling compulsion is a focus of much research. Aasved addresses ideas set forth as to why some people are able to control their gambling and others cannot, even when it means sacrificing their jobs, family, and material possessions. This text provides a comprehensive background into theories of addiction research as studied by leaders in the field.
Passionate, professional, and unfailingly astute, Dr. Khantzian examines his patients' internal worlds, revealing vulnerabilities while uncovering resiliency and strength. This book, comprehensive in scope, abundant in clinical material, and written with clarity and intelligence, provides a depth of understanding of substance use disorders and an increased hope for recovery.
Drugs and drug use are an integral part of human culture. Yet we know hardly anything about drugs, at least not the kind of knowledge that would help us to understand how drugs affect people and how people beome addicted to drugs. This is most surprising in the light of the vast amount of knowledge accumulated in the sciences. Psychoanalysis might not be an obvious choice for the treatment of addiction. Nevertheless, it is in an excellent position to make a contribution to a problem that has so far defied much of our understanding. By inviting people to speak about themselves, psychoanalysis has established a unique way of collecting clinical material, a material that surely must be immediately relevant coming as it does from the horse's mouth. With addiction on the increase, this fact alone justifies the necessity for a different approach.Providing a theoretical foundation for the argument that psychoanalysis should be seriously considered, and where possible incorporated into the treament of addicts, this thoughtful and innovative book can serve as an orientation in the ongoing front-line battle with addicts and addiction.
Cyclical Psychodynamics and the Contextual Self articulates in new ways the essential features and most recent extensions of Paul Wachtel's powerfully integrative theory of cyclical psychodynamics. Wachtel is widely regarded as the leading advocate for integrative thinking in personality theory and the theory and practice of psychotherapy. He is a contributor to cutting edge thought in the realm of relational psychoanalysis and to highlighting the ways in which the relational point of view provides especially fertile ground for integrating psychoanalytic insights with the ideas and methods of other theoretical and therapeutic orientations. In this book, Wachtel extends his integration of psychoanalytic, cognitive-behavioral, systemic, and experiential viewpoints to examine closely the nature of the inner world of subjectivity, its relation to the transactional world of daily life experiences, and the impact on both the larger social and cultural forces that both shape and are shaped by individual experience. Here, he discusses in a uniquely comprehensive fashiong the subtleties of the clinical interaction, the findings of systematic research, and the role of social, economic, and historical forces in our lives. The chapters in this book help to transcend the tunnel vision that can lead therapists of different orientations to ignore the important discoveries and innovations from competing approaches. Explicating the pervasive role of vicious circles and self-fulfilling prophecies in our lives, Cyclical Psychodynamics and the Contextual Self shows how deeply intertwined the subjective, the intersubjective, and the cultural realms are, and points to new pathways to therapeutic and social change. Both a theoretical tour de force and an immensely practical guide to clinical practice, this book will be essential reading for psychoanalysts, psychotherapists and students of human behavior of all backgrounds and theoretical orientations.