Toward a Humanistic
Addiction Psychotherapy
Scott Kellogg, PhD
Diana Calvario
Mechanisms of Change
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Leonardo Da Vinci
Drug Use is Meaningful
Drug Use is Meaningful
People use substances in problematic ways for a
range of reasons
Reasons that need to be respected
In many cases, they will need to be addressed
directly
Sometimes before the person is ready to
decrease or cease their use of substances
(Tatarsky)
Multiplicity of Self
Dancing of the Selves
By Brenda Clews
Id, Ego, and Superego
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Schema Mode Therapy
Multiplicity of Self
The internal world of patients is conceived of as
containing different parts, selves, modes, or
identities –
Many of which may not only play a role in a
patient’s suffering and drug use,
But also in his or her healing and recovery
Gestalt Chairwork
http://www.atpweb.org/grof/slideshow2/image-
pages/pix.asp?cp=148&pp=1
Taken by
Stanislav Grof,
MD, PhD
Frederick “Fritz” Perls, MD Developed
Chairwork into a Psychotherapeutic Art Form
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Greater Internal Freedom
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Freedom
By Louis Parsons
Increased Personal Complexity
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Gradualism
Crossing
Infinity
Diana
Calvario
Gradualism
Embrace and Work with Complexity
Harm Reduction as a Method
Not a Goal in Itself
Small Steps
Substance Use Goals
Short-Term
Monitoring Use
Harm Reduction
Moderation
Cessation
Long-Term
Abstinence
Moderation
“Non-addictive” Use
Methods of Healing
Wide Rothko (2008) by Joao Vasco Paiva
http://www.siusoon.com/dat/2010/07/31/hong-kong-contemporary-art-biennial-awards-2009/
Therapeutic Relationship
Therapeutic Relationship
Love
Empathic Listening
Authenticity and Optimism
Courage and Determination
Heroic Self
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Margaret Mark and Carol Pearson
Heroic
Self/
Healthy
Adult
Difficult
External
Realities
Social
Oppression
No Future
Orientaton
Anxiety and
Internal
Suffering
Physical
Pain
Self-
Soothing
Drug Use
Self-
Stimulation
Drug Use
Inner Critic
Attack
Before Treatment
Trauma and
Loss
Heroic
Self/
Healthy
Adult
Claiming the
Future
Facing
Fear
Confronting
Self-Hatred
Taking
Action
Self-Directed
Choices
Resisting
Pressure
Controlling
Drug Use
Reducing
Harm
During and After Treatment
Self-
Compassion
Existential Language
This is the Language of the Heroic Self
“I want”
“I am deciding to”
“I am choosing to”
“I will”
“I will not”
Horizontal and Vertical
Interventions
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Interventions
Horizontal Interventions
Those focused on controlling and/or
discontinuing drug use
Vertical Interventions
Those that are used to address and treat the
underlying issues and co-occurring
psychopathology
Horizontal Interventions
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Decisional Balance
Positives of Drug Use
Immediate physical pleasure
(10)
Escape/Feeling more “there”
(10)
Feels more emotion (10)
Reduces social anxiety (6)
Shuts out critic (7)
People will know “real” self (7)
Positives of Change
Feel a greater sense self
discipline (9)
Would be more productive (10)
Help him be more comfortable
with self (8)
Greater confidence (6)
Negatives of Drug Use
Feels guilty (7)
Others are concerned (6)
Not as productive (10)
Feels like it a crutch (10)
Feels bad (7)
Health Problems (7)
Negatives of Change
Would not enjoy life as much (9)
Would be ignoring a part of
himself (10)
Breaking up with something he
loves – a hard breakup (9)
Decisional Balance
Motivational Forces
Self- Stimulation:
Using To Feel Alive,
Powerful, Good,
and Joyful
Self Medication:
Using To Reduce Pain
and Suffering;
Using To Feel
More Comfortable
Existential Issues:
Desire For a Better Future
Fear: Health and
Life Concerns
Relapse Prevention
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Relapse Prevention
Involves working with patients to:
Understand triggers and cues
Identify high-risk situations
Develop such coping skills as:
Cognitive Restructuring,
Assertiveness – Drink and Drug Refusal
Urge Surfing
Substance-Use Management
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Substance Use Management
Helping people use drugs in ways that are safer
Including
Reducing the amount consumed
Changing methods of use
Reducing the time of involvement
Changing the context of use
Drug substitution (Dan Bigg, 2008)
Overdose Prevention/Naloxone
Ideal Use Plan
“If you were to use drugs or alcohol in such a
way as to maximize the pleasure and benefit you
gain from them while minimizing the pain and
danger involved, what would that look like?”
Can they implement this?
What interferes or stops this from happening? (Tatarsky & Kellogg, 2010)
Contingency Management
Contingency Management
Uses positive reinforcement principles to:
Improve retention
Decrease substance use
Encourage harm-reducing and recovery-
related behaviors
Contingency Management
Harm Reduction, Moderation or Abstinence
Patient Choice
Set Weekly Goal
Decrease the Fee if They Achieve Goal
Increase the Fee if They Do Not Achieve the
Goal
Profoundly Empowering
Increasing Control – Small Steps
Vertical Interventions
41http://feralhouse.com/press/15tolife/press/socialist_worker_1203.html
Anthony Papa
“The Heart of Addictive Disorders is Suffering”
– Edward J. Khantzian, MD
Healing the Past
Grief and Loss
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Interpersonal Trauma
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Claiming the Present
Inner Critic
Your Harsh Inner
Critic…
Methanie Dempsay Binder
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Creating the Future
Voice Work/Assertiveness
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Helping Patients Develop and Strengthen their
Voice of Respectful Desire
Heroic Existentialism
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Dr. William James President Theodore Roosevelt Dr. Albert Schweitzer
“We like to be reminded that our central calling,
our main task on this planet, is the heroic.”
– Dr. Ernest Becker
Heroic Existentialism
An Injustice to be Remedied and Corrected
A Suffering to be Healed and Relieved
Something of Beauty to be Protected and
Preserved
Someone or Something that is Loved to be
Nurtured and Developed
Identity Theory
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The Case of N
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Identity and Recovery
The core idea:
Drug use will decrease and eventually cease or moderate as:
Nondrug-using identities become more central, reinforcing, and important to individuals
And as they compete with and replace the Drug-Using Identity
(Anderson, 1998; Biernacki, 1986; Granfield & Cloud, 1996; Kellogg, 1993)
Identities are a Way for the
Heroic Self to Create a New
Future
The War on Drugs interferes with Identity Creation;
Therefore the War on Drugs interferes with
Healing and Recovery
Jane Uitti – Two Chairs
(www.janeuitti.com)
Dialogues and Encounters
Positives of Drug Use
Immediate physical pleasure
(10)
Escape/Feeling more “there”
(10)
Feels more emotion (10)
Reduces social anxiety (6)
Shuts out critic (7)
People will know “real” self (7)
Positives of Change
Feel a greater sense self
discipline (9)
Would be more productive (10)
Help him be more comfortable
with self (8)
Greater confidence (6)
Negatives of Drug Use
Feels guilty (7)
Others are concerned (6)
Not as productive (10)
Feels like it a crutch (10)
Feels bad (7)
Health Problems (7)
Negatives of Change
Would not enjoy life as much (9)
Would be ignoring a part of
himself (10)
Breaking up with something he
loves – a hard breakup (9)
Decisional Balance
Basic Motivational Dialogue
Desire to
Stop, Reduce, Or
Change The Pattern
Desire to
Continue Using
Substances
Strategic Guidelines
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Strategic Guidelines
“Superego-Based Change says: “I should…”;
however,
“Ego-Based” Change says: “I want…”
Patients heal and recover by:
Strengthening the part that wants to change
Not by persuading the part that wants to use
to desire recovery
Desire Engages with Desire
Diana Calvario