The Function of Psychotherapy in Recovery

“Who are you?” – Lyrics, The Who
Alcoholics Anonymous addresses THE DISEASE OF ALCOHOLISM (or addiction) and outlines the most successful approach to recovery – twelve steps - an elegant little formula to take responsibility for one’s actions, stop blaming, and begin to make oneself useful, while also aligning oneself with the Divine Forces, AKA God’s will or fate. This is summarized as, “Clean house. Trust God. Help others.” The AA recovery community embraces the newcomer with the slogan “let us love you until you love yourself.” It is understood that the alcoholic is dealing with a chronic condition, requiring ongoing treatment and support – provided by lifelong AA membership. Some alcoholics achieve sobriety and begin a new life as they follow the suggested twelve-step program. So far, so good.
An estimated 85% of addicts suffer from CO-OCCURRING DISORDERS – having survived emotional trauma in childhood, such as neglect, abandonment, death, sexual and emotional abuse, and/or violence. Such a child is not encouraged and empowered to develop properly and remains fear-based, forever seeking attention and pleasure to “take the edge of.” If the abuse occurred within the family, most likely the victim role has become part of the person’s identity and they don’t even know it. This is incorporated in the victim’s sense of self – and s/he sees herself as hopeless and helpless, wile endowing “the other” with power, forever blaming and expecting the outside to fix her. About 85% of addicts experience depression, consistent anxiety, PTSD or other overwhelming emotional states or intrusive thought processes, struggle with an anger problem or other difficulties with relationships – AND THIS IS WHY many addicts relapse in spite of their best efforts, finding it impossible to maintain sobriety with AA alone.
EARLY RECOVERY can be stressful when the addict becomes overwhelmed with troubling thought content and high-intensity desires and aversions. Flooded by feelings s/he doesn’t understand, she may try to self-medicate. This can trigger a regression, a return to fragmentation, and she would lose interest in getting better - and shift to process addictions, such as sex & love addiction, eating disorders, thrill seeking, gambling, shopping, or relapse with substances (street drugs or prescription) etc. A survivor of child abuse typically lacks self-love and self-care and proceeds to re-traumatize herself during a life-style of suffering and agitation. It’s just what she knows.
This is where INPATIENT TREATMENT comes in. Peer support, psychotherapy, counseling, guidance, psycho-education, and safety within a stabilizing structured environment for 90 days minimum – is a known time frame for change of habitual behavior patterns. In residential treatment the addict is protected from herself and her own self-destructive behaviors. On a practical level it is about establishing and practicing new habits, while also developing endurance – a solid foundation for ongoing recovery.
In PSYCHOTHERAPY the patient gets to check in with her own consciousness on a weekly basis, thereby creating continuity of the mental process, which is otherwise fragmented and acted out by unpredictable and destructive behaviors. Psychotherapy counteracts the vague resistant indifference that can creep in and precede a relapse. Twelve-step work is about learning the “language of recovery,” but if the foundation is crumbling, the patient finds it impossible to tolerate her overwhelming fears. In order to face the wreckage of the past and establish a functional life the patient needs the chance to heal her childhood and make sense of the underlying issues, which cause such devastation in her life. Otherwise, many patients may not have the willingness to “hang in“ long enough for the psychic change to occur –– and give up.
THE WORK IN PSYCHOTHERAPY is about developing a sense of self and discovering her truth in the presence of another person who kindly “holds up a mirror.” The therapist provides a “safe holding environment” for a “corrective emotional experience” to take place. The relationship itself is the main aspect for healing to occur – a kind of re-parenting, where adverse childhood experiences are transformed. The patient gets to be seen, heard, and understood, knowing that her thoughts and feelings do matter, after all – her forgotten and hidden memories become known and s/he gets the space to put it all together. Dysfunctional thought patterns are gradually replaced by insight and good judgment. S/he develops impulse control, while new neuronal connections are established in the brain – and hyper-alertness* wanes over time. Evidently, such processes take time. On the basis of a good therapeutic alliance, emotional injuries can be processed and the psyche can (eventually) become whole.
A GOOD THERAPIST becomes irreplaceable, just like a friend or family member (although one eventually outgrows the therapist). Such a therapist has the function of a healer, confidant, priest, rabbi, or shaman. S/he carries hope that healing is possible, that the patient is not fundamentally broken, in spite of everything that happened, in spite of guilt and shame over unspeakable experiences and actions – and that the patient deserves to stand up for herself and set boundaries when necessary. While the time frame in residential treatment is necessarily limited and solution-focused, psychotherapy can make the metamorphosis possible. Otherwise, some addicts turn around and go back into the swamp… It happens.
“We must work through our story, before the unresolved elements of our story kill us."
- quote, Jeff Brown
* see also cognitive restructuring and neuro-remapping