In an Addictive LightIn an Addictive Light

Psychodynamic Theory

EGO / “I am-ness” EGO / “I am-ness” DevelopmentDevelopment

EGO / “I am-ness” EGO / “I am-ness” DevelopmentDevelopment

• Addiction occurs in and amongst psychological development (ego or self development).

• First and foremost the self or “I” is created through the desire to be with others as oneself, with all its imperfections and its shortcomings, while recognizing that others are independent, separate and not just there to serve one’s own needs and desires….

OBJECT RELATIONS THEORY

• Addiction occurs in and amongst psychological development (ego or self development).

• First and foremost the self or “I” is created through the desire to be with others as oneself, with all its imperfections and its shortcomings, while recognizing that others are independent, separate and not just there to serve one’s own needs and desires….

OBJECT RELATIONS THEORY

Psychodynamic Theory: Psychodynamic Theory: A Neo-Freudian Object Related Theory A Neo-Freudian Object Related Theory

Psychodynamic Theory: Psychodynamic Theory: A Neo-Freudian Object Related Theory A Neo-Freudian Object Related Theory

• Freud held that behavior is determined by biological drive states that are tempered by social expectation (superego) and through a evolving rational self (ego).

• However;

• His successors (e.g., Kernberg, Mahler, Kohut, and Winnicott’s) work over 60 years holds that our sense of self is defined by the way we are perceived by others and how we perceive or distort our perceptions of others.

• Freud held that behavior is determined by biological drive states that are tempered by social expectation (superego) and through a evolving rational self (ego).

• However;

• His successors (e.g., Kernberg, Mahler, Kohut, and Winnicott’s) work over 60 years holds that our sense of self is defined by the way we are perceived by others and how we perceive or distort our perceptions of others.

Neo-Freudian Philosophical UnderpinningsNeo-Freudian Philosophical UnderpinningsNeo-Freudian Philosophical UnderpinningsNeo-Freudian Philosophical Underpinnings

• Development of “Self” primary goal of human being.

• Thus, we become what we are in order to be able to develop authentic real relationships… And we remain inauthentic or false until we are able to engage another in true dialogue.

- The hook or problem is however…

Developmental ImpassesDevelopmental ImpassesDevelopmental ImpassesDevelopmental Impasses

• We must first be autonomous and independent before we can fully engage each other.

• However, if we do not know our boundaries, we can lose ourselves in our relationships and confuse that which is ours with that which is not ours.

• Hence, “can I be close to another without losing myself and can I really tolerate being alone”?

• We must first be autonomous and independent before we can fully engage each other.

• However, if we do not know our boundaries, we can lose ourselves in our relationships and confuse that which is ours with that which is not ours.

• Hence, “can I be close to another without losing myself and can I really tolerate being alone”?

Enter AddictionEnter AddictionEnter AddictionEnter Addiction

This is an important theme in the treatment of addiction because many addicted sufferers feel at their core that:

1. They don’t know who they are;

2. Their history displays a rash of failed relationships or none at all;

3. They present as unworthy, unlovable, and;

4. They either have rigid boundaries or none at all

This is an important theme in the treatment of addiction because many addicted sufferers feel at their core that:

1. They don’t know who they are;

2. Their history displays a rash of failed relationships or none at all;

3. They present as unworthy, unlovable, and;

4. They either have rigid boundaries or none at all

Enter Addiction (contd).Enter Addiction (contd).Enter Addiction (contd).Enter Addiction (contd).

Ultimately, a persons’ use of a drug or a behaviour is a way to combat their feelings of worthlessness while also burying a sense of emptiness that intermittently permeates their consciousness

And yet through extended use these phenomena only become more hauntingly real leading to further escape via a false-self schema

Ultimately, a persons’ use of a drug or a behaviour is a way to combat their feelings of worthlessness while also burying a sense of emptiness that intermittently permeates their consciousness

And yet through extended use these phenomena only become more hauntingly real leading to further escape via a false-self schema

Enter Addiction (contd).Enter Addiction (contd).Enter Addiction (contd).Enter Addiction (contd).

Thus, addiction can represent or take the form of

Yearning for praise and approval or a merger with an idealized other in order to self-soothe; or it can…

Take the form of sexual acting out with persons, figures, or symbols so as to feel wanted, alive, real, or powerful, or it can be …

An escape through drugs into a fantasy world to keep the void and meaninglessness at bay.

Thus, addiction can represent or take the form of

Yearning for praise and approval or a merger with an idealized other in order to self-soothe; or it can…

Take the form of sexual acting out with persons, figures, or symbols so as to feel wanted, alive, real, or powerful, or it can be …

An escape through drugs into a fantasy world to keep the void and meaninglessness at bay.

Heart of AddictionHeart of AddictionHeart of AddictionHeart of Addiction

Displacement Displacement Displacement Displacement

Lance DodesLance DodesLance DodesLance Dodes

Lance Dodes, M.D. is a Training and Supervising Analyst with the Boston Psychoanalytic Society and Institute and assistant clinical professor of psychiatry at Harvard Medical School.

He has been the Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital) and Director of the Boston Center for Problem Gambling.

He annually chairs the discussion group The Patient with Addiction in Psychotherapy and Psychoanalysis at the fall meeting of the American Psychoanalytic Association.

Lance Dodes, M.D. is a Training and Supervising Analyst with the Boston Psychoanalytic Society and Institute and assistant clinical professor of psychiatry at Harvard Medical School.

He has been the Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital) and Director of the Boston Center for Problem Gambling.

He annually chairs the discussion group The Patient with Addiction in Psychotherapy and Psychoanalysis at the fall meeting of the American Psychoanalytic Association.

Dodes in the news...Dodes in the news...Dodes in the news...Dodes in the news...

Reversing Helplessness: Reversing Helplessness: Factor 1Factor 1

Reversing Helplessness: Reversing Helplessness: Factor 1Factor 1

Take an action that we know will make us feel better

It’s an understanding approach

Making the unconscious / conscious and then doing something about it

I make sense of my behavior

Take an action that we know will make us feel better

It’s an understanding approach

Making the unconscious / conscious and then doing something about it

I make sense of my behavior

Heart of AddictionHeart of AddictionHeart of AddictionHeart of Addiction

Virtually every addictive act is preceded by a feeling of helplessness or powerlessness.

Addictive behavior functions to repair this underlying feeling of helplessness.

It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, or regaining control-over one’s emotional experience and one’s life.

Virtually every addictive act is preceded by a feeling of helplessness or powerlessness.

Addictive behavior functions to repair this underlying feeling of helplessness.

It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, or regaining control-over one’s emotional experience and one’s life.

Vignettes: Regaining Vignettes: Regaining ControlControl

Vignettes: Regaining Vignettes: Regaining ControlControl

Vignettes (cont.)Vignettes (cont.)Vignettes (cont.)Vignettes (cont.)

ParadoxParadoxParadoxParadox

Addictive behavior is out of control, but addiction serves a deeper purpose of regaining control - at least internally

But off course - you eventually create more out of controlness

Dodes believes that helplessness is common, but everyone experiences it a bit differently, it affects us differently, and the circumstances that makes us become helplessness and the dynamics behind them are psychodynamically unique.

Addictive behavior is out of control, but addiction serves a deeper purpose of regaining control - at least internally

But off course - you eventually create more out of controlness

Dodes believes that helplessness is common, but everyone experiences it a bit differently, it affects us differently, and the circumstances that makes us become helplessness and the dynamics behind them are psychodynamically unique.

Explaining the Drive Behind Addiction: Explaining the Drive Behind Addiction: Factor 2Factor 2

Explaining the Drive Behind Addiction: Explaining the Drive Behind Addiction: Factor 2Factor 2

Helplessness leads to a feeling of anger / (rage at being helpless that drives addiction)

These feelings come in subsidiary forms

Identify what things make us feel intolerably helplessness

Root these out, have them expressed

Helplessness leads to a feeling of anger / (rage at being helpless that drives addiction)

These feelings come in subsidiary forms

Identify what things make us feel intolerably helplessness

Root these out, have them expressed

Find the why to the compulsion and why I felt (it when)

Displacement: 3rd FactorDisplacement: 3rd FactorDisplacement: 3rd FactorDisplacement: 3rd Factor

Addiction results from a redirection of energy to a substitute or displaced action because another more direct, action is not considered permissible.

Key is to find that displacement - what is being displaced? (e.g., Michael couldn’t leave his wife stranded)

When actions are taken directly to deal with helplessness, there is no addiction.

Addiction results from a redirection of energy to a substitute or displaced action because another more direct, action is not considered permissible.

Key is to find that displacement - what is being displaced? (e.g., Michael couldn’t leave his wife stranded)

When actions are taken directly to deal with helplessness, there is no addiction.

The Man Who Had No Time The Man Who Had No Time Intro:Intro:

The Man Who Had No Time The Man Who Had No Time Intro:Intro:

Frequented Tony’s Bar most days

Recent Visit to Doc shook him up - You’re drinking every day again -

Given Dodes #

Ted did not drink for two days afterwards - but returned to drinking for two days after that.

Frequented Tony’s Bar most days

Recent Visit to Doc shook him up - You’re drinking every day again -

Given Dodes #

Ted did not drink for two days afterwards - but returned to drinking for two days after that.

Ted Meets with DodesTed Meets with DodesTed Meets with DodesTed Meets with Dodes

Ted - been to a lot of treatment “I Know that I am an alcoholic”

Comes down to will power / stick with the program don’t drink

Lost 12 year marriage as a result of drinking (painful)

Lost job as an financial advisor

Arrested for DUI’s

Considered suicide on a few occasions

Ted - been to a lot of treatment “I Know that I am an alcoholic”

Comes down to will power / stick with the program don’t drink

Lost 12 year marriage as a result of drinking (painful)

Lost job as an financial advisor

Arrested for DUI’s

Considered suicide on a few occasions

Ted Meets With Dodes: Ted Meets With Dodes: Psychodynamic History Psychodynamic History Ted Meets With Dodes: Ted Meets With Dodes: Psychodynamic History Psychodynamic History

Still drinking when sessions began (wasn’t causing crisis)

Only child (father computer programmer mother was research assistant / medical lab)

Ted did well in school (straight A’s elementary through high-school and in sports (football team)

Pushed himself to achieve “I had to accomplish things...Uphold something for the family”

Impressive achievement in college gave him wide selection to schools

Went to a college that fit his Dad’s standards - doing the right thing

Began to drink there “heavily” for the first time

Still drinking when sessions began (wasn’t causing crisis)

Only child (father computer programmer mother was research assistant / medical lab)

Ted did well in school (straight A’s elementary through high-school and in sports (football team)

Pushed himself to achieve “I had to accomplish things...Uphold something for the family”

Impressive achievement in college gave him wide selection to schools

Went to a college that fit his Dad’s standards - doing the right thing

Began to drink there “heavily” for the first time

Ted and Dodes (cont.)Ted and Dodes (cont.)Ted and Dodes (cont.)Ted and Dodes (cont.)

College was when alcohol really started to interfere... In a way, the problem was “really time”... If I’d taken even a quarter of the time I spent drinking to do the studying I should have done (shaking head in disgust)... And after College, just drank more”.

Taking about marriage, fights, spoiled special occasions, failed career as a financial advisor, accounts he’d let slide...

He kept returning to the time he had lost. “If only I could have that time back”

College was when alcohol really started to interfere... In a way, the problem was “really time”... If I’d taken even a quarter of the time I spent drinking to do the studying I should have done (shaking head in disgust)... And after College, just drank more”.

Taking about marriage, fights, spoiled special occasions, failed career as a financial advisor, accounts he’d let slide...

He kept returning to the time he had lost. “If only I could have that time back”

Psychodynamic InsightsPsychodynamic InsightsPsychodynamic InsightsPsychodynamic InsightsInstead of talking about time lost to drinking, Dodes began to learn that Ted regretted other kinds of “time” losses

There’s never enough time to do things- things I really want to do...Never time for myself, time to do stuff that’s really mine

Insight 1) Realization that Ted was not in control of his own life.

Insight 2) Further sessions revealed just how burdened Ted had become (i.e., taking work home)

Insight 3) Pressure coming from the inside “I always should be doing more”

Insight 4) Work hard as an “adult” and “be good” pattern lived out as a child

Instead of talking about time lost to drinking, Dodes began to learn that Ted regretted other kinds of “time” losses

There’s never enough time to do things- things I really want to do...Never time for myself, time to do stuff that’s really mine

Insight 1) Realization that Ted was not in control of his own life.

Insight 2) Further sessions revealed just how burdened Ted had become (i.e., taking work home)

Insight 3) Pressure coming from the inside “I always should be doing more”

Insight 4) Work hard as an “adult” and “be good” pattern lived out as a child

NEV

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TIM

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O B

E M

Y S

ELF

A Core InsightA Core InsightA Core InsightA Core Insight

Pressure to perform at work = VALIDATION

Getting caught in head

Takes on new project >>> Feel stressed at work

“When I am going to have my time”

I started slapping around papers - then said “F - IT”

Pressure to perform at work = VALIDATION

Getting caught in head

Takes on new project >>> Feel stressed at work

“When I am going to have my time”

I started slapping around papers - then said “F - IT”Drinking Displaced not having a choice and Made Up For Freedom

TED IN A NUTSHELLTED IN A NUTSHELLTED IN A NUTSHELLTED IN A NUTSHELL

Choice to drink gave him control over his past feelings of helplessness

Ted started to feel better about his helplessness the “moment” he decided he was going to drink

His rage drove the behavior... Dodes states... “Qualities of rage at helplessness - an intense, narrowed focus, a loss of usual judgement, and a temporary blindness to consequences - are precisely the characteristics that describe addiction...

Choice to drink gave him control over his past feelings of helplessness

Ted started to feel better about his helplessness the “moment” he decided he was going to drink

His rage drove the behavior... Dodes states... “Qualities of rage at helplessness - an intense, narrowed focus, a loss of usual judgement, and a temporary blindness to consequences - are precisely the characteristics that describe addiction...

Summing Up Summing Up DisplacementDisplacementSumming Up Summing Up DisplacementDisplacement

•Addictive behavior at its core has an element of emotional health

•We all fight against helplessness - it is psychologically essential -

•Suffering with an addiction then, does not make you psychologically sicker or less mature than people with a wide variety of other problems

•We can learn to use the addictive drive as a signal that something emotionally wants to be heard, felt, and metabolized

•Addictive behavior at its core has an element of emotional health

•We all fight against helplessness - it is psychologically essential -

•Suffering with an addiction then, does not make you psychologically sicker or less mature than people with a wide variety of other problems

•We can learn to use the addictive drive as a signal that something emotionally wants to be heard, felt, and metabolized

Let’s Jump into Looking at Let’s Jump into Looking at RelaspeRelaspe

Let’s Jump into Looking at Let’s Jump into Looking at RelaspeRelaspe