a total stranger one black day
knocked living the hell out of me-

who found forgiveness hard because
my(as it happened) self he was

-but now that fiend and I are such
immortal friends the other’s each     e.e. cummings

Perls, the founder of Gestalt Therapy, writes that addiction treatment phases must embrace all aspects of life for the individual to become who he wants to be and  “no cure can have lasting effect or be more than a suppression of impulses unless the alcoholic (‘adult’ suckling) progresses to the stage of biting and chewing” the unassimilated life experiences.

To this end, I have developed an MPTP approach for the treatment of addictions that is phasic, overlapping, and gender neutral. It is I/Thou relationship based, non-judgmental and stresses empowerment to transform one’s life in the desired direction. This treatment model initiates and honors awareness of “what is” in the personal, familial, and social realm. Abstinence of addictive-type behaviors is not dictated as they are considered attempts at maintaining contact with self/other/substance and as such are meaningful expressions of self-assertion. Rather, this approach exemplifies respect for the integrity of the individual and voluntary adherence to the treatment process and as such facilitates an emerging awareness of personal participation in creating destructive habits and self-defeating lifestyles and necessary emotional motivation to change. (Beisser (1970) writes that “change occurs when one becomes what he is, not when he tries to be what he is not”- the Gestalt paradoxical theory of change.

Freud recognized that the creation of defenses leading to the compulsion to repeat behaviors is an attempt to gain organismic equilibrium. When the “Self” cannot function and develop optimally, this fluid transformation of energy in the service of the individual is called a creative adjustment in Gestalt therapy, and emerges organically from the experience. Its continuation depends on environmental support and may eventually become rigidified, a habit, possibly leading into addictions. Freud called this organismic state “Seelenkrankheit”, literally translated, “soul sickness”. Adler, Horney later interpreted this concept “Seelenkrankheit” as an individual’s need to manipulate the environment to gain an illusion of control over others to maintain personal integrity and a sense of “Self” in the struggle for survival.  In this spirit, addiction becomes the means in the search for a “Self”.

I have suggested that many substance overusers suffer from stunted emotional development resulting from early deprivation, neglect and other traumas. Equally often, developmental stuckness occurs at a very early age accounting for unhelpful attitudes and behaviors so prevalent in addicted adolescents and adults. Whatever the reason, they have intimate knowledge, possibly unaware, of an existence filled with pain, rage, and an inability to self-care healthily. Drug taking becomes a welcome avenue to numb pain or bring about a sense of aliveness. Thus addictive practices provide an illusion of being in control of one’s life and managing chaos while actively participating in the creation of more chaos. I often hear statements such as “If only…  I could have one more binge, a better job, and a more understanding wife… then…. Or…when I have a certain income, when my back feels better, when I kill myself… then… in spite of their experiences to the contrary and the reality that these wished-for conditions are a lie.

The coach/therapist relationship has particular significance when in the presence of an addicted person struggling in the search to find his way.  (For ease of writing I shall use the pronoun “he” throughout; women are of course very much included.) Not only will the client feel like “one of them”, the addict,  against “us (me, Clinician)”- the I/it phenomenon, a perception many learned during previous treatment attempts, but he also feels dread given the hint of a possibility of a longed-for relationship with a caring other. This is frightening at best and a daunting commitment for both clinician/client. However, from the perspective of the MPTP with its sub-theme of “Addiction: In Search for a Self” the coach/therapist brings into the therapeutic encounter an attitude of I/Thou allowing for meeting the client without judgment of where and how he is and without pretense of having superior knowledge and the ability to “fix” him. This being “with” is not a technique, a method to be practiced on…but rather it emanates from authentic caring and a conviction of the worth and sanctity of each individual struggling in the process of finding his unique self. My encounter with S. exemplifies the awesome power inherent in this self-less therapeutic approach:

An Employee Assistant Program referred S. to me for addiction treatment evaluation.

This is his story:

He reports that he spent his youth in several foster homes having been abandoned by both his mother and father. He described some of these homes adequate but a third extremely brutal. He was beaten, sexually abused, starved, to keep him in line. Eventually, at the age of 14, he escaped and attempted to make it on his own. He did so with the help of daily, non-stop marijuana smoking. He became a bicycle repairman to earn some money. In addition to smoking pot non-stop, riding his bicycle kept him somewhat sane.  My being with him non-judgmentally and interested in his experiences, finding inherent strengths and connections in his story to find purpose in his 15-year substance overuse; not immediately proposing a treatment plan and to expect him to stop use of the illegal substance, so impacted him that he abruptly terminated after three sessions. Years later, I received a bouquet of roses with a long letter, stating among many things, that the three sessions literally saved and changed his life. He stopped, because my warm, positive attitude toward him was more than he could bear even though he always longed for that kind of understanding. Subsequently, he had entered other treatment programs always being keenly aware that something was deeply missing. He wanted to return for “a little” more therapy with me, to which I agreed. We slowly developed a mutually satisfying I/Thou relationship. Initially feeling like an “it” object, with loving therapeutic support and patience, he was eventually able to develop an “I” and a” we-us” and begin genuine healing. A year into the therapy, he disappeared again as quickly as he reappeared. This is his process and can be none other.

Multi-Phasic Transformation Awareness Statement. (MPTASÓ)

The MPTAS are elaborations on the awareness and growth continuum in an individual’s transformation process from pre-addicted existence, to an eventually confluent relationship with suffering and addictive life style to a lively existence with “Self” and others and the world. Therapy, a microcosmic laboratory for learning, raises individuals’ awareness to the “what” and the “how” of their process in their search for meaning and in finding the “ Self”. The awareness statements are summary statements of accomplished growth as it emerges organically out of the coaching/therapeutic process. I believe organically, because progression toward a healthier life style in relationship with others proceeds sequentially. Developmental lags are mediated and self-care/being cared-for eases early deprivation. This is always a uniquely individual process not a recipe-type prescription for health. Every individual requires different attention in differing degrees, at different times. That is the reason for the general tenor, even vagueness of the awareness statements/ summary statements. As such, they allow for the greatest variability in expressing individuals’ unique needs, wants and achievements.

I have been asked what the purpose of the statements is and what they add to the process. My immediate answer is “a lot”, addicted individuals truly enjoy working in this format because within it, they can envision and experience their own life process for change. I am always amazed with what ease and absence of shame and guilt clients are able to point out where their awareness necessitates deepening.  The choice to and how to continue is always with the client even though, most are learning for the first time the complexities inherent in the process of choosing). Certain MPTAS may require more time and effort; others can be accomplished with relative ease. There is also significant overlap. Coaching/therapy must begin where the client experiences earliest disruption in the client’s healthy development occurs. It is not a coach/therapist’s responsibility to get the person to where they want to be in life, but to be available in every possibly way to support his unfolding. This is in essence what Laura Perls’ basic belief expresses: “provide only enough support to enable the client to help himself”.

If you would like more information on the Multi-Phasic Transformation Process™, check out my ebook, Multi-Phasic Transformation Process.

Who would have thought that my meanderings over “What is Addiction” in my last blog would lead me to an Ezine article by Melanie Solomon, July 11, 2010 and her amazing book AA-Not the Only Way — Your One Stop Resource Guide to 12-Step Alternatives–Second Edition? In it she cites many statistics based on government research and other reputable institutions that validated my experience working in the treatment field for 30 years. I felt happy for my clients gratified given the many programs for recovery and beyond that I have designed and taught with passion, conviction, and results.

I have long been a supporter of views and research by people like Stanton Peele, Herbert Fingarette, and Thomas Szasz, Gordon Marlatt as well as George Vaillant, Edward J Khantzian and other more traditional researchers and writers. Their work has brought an important counterpoint to what appears a one-sided view of addictions and treatment. Why is this crucial? Because I believe we human beings are much too complex, creative, strengths and value based to be defined by a simple disease label, Addiction, and AA attendance that promise success. Perhaps some of the behaviors when under the influence can be lumped into categories but not the human being who engages in these behaviors. Hence we need treatment programs (is treatment the right word?) who see individuals as unique and respected for who and how they are in the moment and that their being where they are has meaning and purpose even if we don’t understand that. I do not imply that anything goes or works – to the contrary – choice, responsibility, and consequences are musts to gain freedom and often require learning many long-forgotten developmental skills. However, how to make it happen? The answer lies deep within each individual. In Gestalt we call this an interdependent, co-created process in the ongoing present in a I/Thou dialogical relationship.

Now to the above question – what is the answer, the right approach? The client has the answers, clinicians do not. We may have hopes, wants, and dreams for our clients, we may be well-trained with all kinds of degrees but a client will render us helpless if we attempt to know better. Our presence serves to support, listen, and assist birthing the long-forgotten “I” and never work harder than the client will or do more than s/he is able to process. As a Gestalt Clinician, I work from a relational, dialogical perspective and have the flexibility to approach a client’s present needs from almost any perspective i.e. I can work with the Bodymind, emotions, feelings cognitions, perceptions which are all interconnected as long as the focus is the client and not my agenda.

Given that treatment outcomes are rather low no matter what treatment is offered, the question remains, what makes the concept that many roads lead to Rome so unacceptable? Is this a competition; if one approach works why would another approach be excluded? Is it not possible that just as individuals from different cultures may have their own ways of problem solving that those in the addicted population may have their own preferences for getting beyond sobriety? Before we all take ourselves too seriously let’s not forget that 77 – 82% cure themselves (Solomon 7.11.2010) without using formalized treatment.

My belief has always been and still is. If it works, great, if it does not meet your needs, look for another approach – and don’t forget to consider your Self in the equation.

Let’s celebrate the many men and women who dedicate their lives to find answers to the elusive questions posed by addiction and human nature and are willing to create innovative programs.

As for myself, I want to celebrate my clients, their stamina and determination to create a life worth living because or in spite of their overuse of substances. There is no better remedy to gain freedom from addiction and dreaded relapse than to fulfill one’s potential as a human Being. I hope that alll find a program that speaks to their heart and soul – one human being to another. You are not

“Once an Addict, always an Addict”
rather you are
“Once a Human being always a Human being”
always in the process of becoming

References:

Fingarette, Herbert. Heavy Drinking. ISBN 0-520-06754-1
Khantzian, Edward J. Addiction and the Vulnerable Self. ISBN 0-89862-172-0
Langer, Ellen J. Mind-Fulness. ISBN 0-201-09502-5; ISBN 0-201-52341-8
Szasz, Thomas. Ceremonial Chemistry. ISBN 1-55691-0193
Vaillant, George E. Spiritual Evolution. ISBN 978-07679-2657-7

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