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.

Gestalt Theory states that “Change happens when one becomes who he really is, not when he tries to become what he is not” (Beisser, p. 77, 1970). This principle of change implies that in the process of maturation an individual introjects familial and societal attitudes and beliefs about himself that may eventually interfere with healthy organismic self-regulation. Messages (Gremlins) such as: “You’ll never amount to anything,” “You are just like your father,” “Girls don’t do that,” “You should be nice to your mother,” “You are so selfish,” “You shouldn’t be such a sissy,” “Don’t tell,” abound in difficult family or social systems and are believed and absorbed as truths by healthily egocentric children. The inherent potential for developing is often truncated and the capacity to realize one’s inherent strengths is diminished.

Children who internalize these parental messages often feel conflicted, unnatural, and bad as they are maturing. Eventually, self-alienation becomes the foreground and may be expressed in addictive behaviors and poor mental health during and after adolescence. They feel disconnected from their actions and statements such as the following abound: “That’s not like me.” “I can’t believe I did that.” “I don’t know where this was coming from?” “I’ll never amount to anything no matter what I try.” “I am not fit to live!” These unhealthy internalized beliefs are visibly supported and observed in a client’s posture, tone of voice, and unhelpful repetitive behaviors.

Therapist/Coaches provide clients the opportunity to explore experientially and question the validity of their belief systems and behaviors for their usefulness in the present context. With this process clients can experiment with new possibilities and discover opportunities to modify or replace parts, or all, of a given belief with a synthesized, more ego-syntonic alternative that can be assimilated and eventually integrated.

John had been told all his life that he was a lazy bum just like his father. When ready to graduate from high school, he wanted to take advantage of a job opportunity that started at 8 A.M. John didn’t want to get up that early and wanted different hours but was denied the request. Initially, with his usual “I want what I want and how and when I want it” attitude, he laughingly dismissed the job offer. His therapist/coach explored the wisdom of his polarized decision-making attitude and invited him to a two-chair experiment with the goal of exploring his contradictory attitudes. One position really wanted a good job, the other, the “but” side was afraid of failing, as he discovered. Working this process, John was able to say that he really wanted a job AND that he was afraid of failing – a very deep fear that he learned early and throughout his childhood. He said that he could still hear his drunken father yelling at him that he’ll never amount to anything in life and that he’ll become just like him (the father).

John took the first steps in undoing a long-standing personal belief by accepting the reality of the complex situation. Now he could begin to explore truth from fiction, use his inherent strengths of courage and perseverance and begin differentiating what belongs to him and what does not. He may succeed only partially, or get to like starting his day early, in either case, rigidified behavior changed. This experiment required creativity and skill in establishing the appropriate Yin and Yang and to proceed with sensitivity and focus, considering the usefulness and practicality of each. AND, cognition alone does not create change; rather awareness of what is and synthesizing beliefs and wants supported by a strong emotional charge, allows for change to occur.

Clinicians must have the patience to stay with a client’s process. It bears repeating that rather than to attempt to fix a client’s problems and symptoms, staying with the client by getting out of the way and allowing the process to unfold on its own, is ultimately more helpful. Professionals must be sufficiently tuned in to know when contextual confrontation or challenges are called for. They must have the skills and confidence to be intuitively creative and flexible when attempting any experiment including the huge experiment of addiction treatment (Zinker, 1977).

A Therapist/Coach gives only as much support as is necessary and only as much as the client truly wants. The individual must be afforded the opportunity to look deep inside to find the answers while the Therapist/Coach accompanies him on his journey to realize inherent potential in his own way and in his own time.

The holistic and positive aspects of Gestalt therapy makes it ideal for the treatment of any addiction related problem.  It allows for the greatest possible treatment variables in approaching individual differences, stresses the uniqueness of each person, admires the resiliency of the human spirit, and appreciates the integrity and spirituality of any individual.

Gestalt therapy sees the whole as greater than the sum of its parts.  It bridges the gap between cognitive and behavioral therapies by including the body, emotions, senses, and the phenomenological field of the individual as a context for the decision making processes and their behavioral execution.  One of Gestalt’s major premises is that all our coping mechanisms are creative adjustments to the stresses of life depending on the developmental readiness of the individual: Creative, because they are chosen among several alternatives; and adjustments, because they alter the experience in some way.  Gestalt therapy presumes that the individual organism attempts to self-regulate, and all coping mechanisms are considered positive until they no longer serve well their intended purpose.

The Gestalt awareness/experience/contact cycle can be demonstrated as follows:

When healthy individuals are thirsty, they allow the emergence of their need for water to become figural:

through the awareness of sensations (dry throat)

through identification of need (I am thirsty)

to activation of energy (go to the water faucet)

to action (pouring water and drinking it)

to contact (cool water feels good)

to enjoying the process of need satisfaction and withdrawal, leading to organismic homeostasis (no longer thirsty).

When this natural completion of the cycle becomes blocked, dysfunction occurs and the individual becomes stuck in habitual behavior patterns.  Considering the chaotic histories of most substance abusers, a clear figure (need) cannot emerge.  Thus, the awareness-contact-withdrawal cycle is interrupted through misidentification of sensations and inappropriate need fulfillment.  Eventually behaviors become rigid, then they become addictive patters that do not allow self-regulation and homeostasis to occur.

Examining the interruptions

In addiction treatment it is imperative that this cycle and its interruptions be examined in the context of the individuals’ problems, relationships, and environmental field.

The Gestalt 10-Step Program for Addiction and Trauma Recovery organizes the evaluation of the client’s lifestyle in the context of the awareness-experience cycle and the recovery stages from addictions or related problems (See table 1).  They also serve to make individuals co-responsible for their lives, stress decisions and choices, relationships, and the person’s phenomenological world.

The first three steps stress the personal decision/choice processes by examining our contribution to our problems, and work toward an examination of our lifestyle and the re-discovery of our long-abandoned internal and external supports.  Steps four and five allow us to examine our problem development as part of a process in connection with others at a particular time and place.  In addition, it stresses that we should examine our coping skills as strengths that help us to survive.

Steps five and six encourage individuals to look at how they keep unfinished business from the past alive and how it interferes with healthy living.  Relationships become particularly important here as sources of information and strength, because most of our unfinished business is lived out in relationships.

Accepting ourselves

In steps seven and eight, we accept our own and others’ inherent strengths and weaknesses and a healthy interdependency results.  The phenomenological world of individuals becomes enlarged with steps nine and ten, as we fully accept our strengths as weaknesses, pains and joys, as part of the human condition.

Source: Helga M. Matzko, MA, CAGS, CCMHC, ACDP, Gestalt Institute, www.gestaltri.com.

The Addiction Letter: A Resource Exchange for Professionals on Preventing and Treating Alcoholism and Drug Abuse

Vol. 9, No. 11

November 1993

ISSN 8756 405X

Is addiction of any kind a disease or does overusing substances, food etc. cause diseases? Is a disease of addiction a mere concept as Jellinek suggested in the Foreword of his book The Disease Concept of Alcoholism(1960) because he was himself reluctant to call this addiction a disease? Or is it a life style issue as some suggest; a character flaw and the result of spiritual depravation? Certainly there are many such views and more in this hotly debated topic.

Having worked, taught, and written about this thing called addiction for 30 years, I have gained a totally different view. And who taught me? None other than every one of my clients. Kierkegaard wrote that “If you label me you negate me” and labeling, my clients taught me, diminishes their being. Consequently, I no longer see addiction as a disease as it is commonly described, but rather a courageous search for meaning and an ultimate quest toward wholeness.

Here are some of my insights I have gained from my clients:

1. The foundation for addictions was laid in early childhood prior to the actual onset of addictive habits, and in the context of the family and social mores. From the beginning the child and care takers co-created behaviors and relationships.

2. Yet, there existed support and use of internal strengths for the child to live long enough to survive and become sober. Strengths in the life of an addict? Absolutely, yes! Consider, surviving a difficult childhood, using one’s own creativity to modulate and survive experiences while simultaneously evolving into full-blown overuse of substances in an effort to assert a self and attempt to make sense out of a senseless life. Then embracing sobriety,  with or without treatment or self-help programs, they still have stamina and drive to want more, fulfill unmet needs,  and design a life to make unrealized dreams become a reality. That demonstrates strengths of perseverance, resilience, creativity, and hope par exemplar.

3. Contributing factors to the onset of addiction:

In addition to the possibility of genetic vulnerability (at this point unproven, however, possible), most people who develop addictive habits come from an environment that disallows for the natural flowering of a child’s developmental potential. Without detailing all possibilities, many children grew up in dysfunctional families and many have experienced to various degrees trauma, familial mental illness i.e. depression, violence, physical – emotional – mental abuse, or poverty. Minimally, the impact of these toxic experiences on the developing child limited their healthy progressive developmental phases. Similarly, at the opposite extreme, are families who overindulge their children without ever-setting limits and teaching age-appropriate responsibility.

Sounds dismal? At first glance, yes, until individual innate human strengths and creativity in action is stressed, surface, and evidenced when making changes.

4. Creative use of options: barrowing from Gestalt Therapy, a creative adjustments is what one does and how one responds to situations and people. It is a creative response, because one chooses from among the possible options available developmentally and in doing so changes the situation in some way and makes it personally manageable. For example, a child may be sensitive and cry easily, rather than being reassured, she is yelled at and told that if ‘you don’t stop immediately, I’ll give you something to cry about’. That little one may hold its breath, not cry, withdraw or start smiling when hurt. Another may be curious, energetic, and enjoy exploring –and – may break a new toy someone just gave him. He is yelled at for being bad and hit, told that he is a terror and hopeless. That little kid may learn to fight back throwing temper tantrums, hit and kick or begin acting and feeling exactly what he internalized and become a loser.

Most of us have memories of some experiences of ‘injustices’ during our childhood. Luckily, human beings from infancy on are wired and capable of experiencing a lot before we actually internalize a distorted self-image. Yet, when these insults are heaped upon the child incessantly, the once adaptive and age-appropriate modulations become automatic and eventually deeply anchored in the child’s reality, behavioral repertoire, and belief system.

When a larger social system like school requires an expanded repertoire of behaving and responding, the children we are describing lack the experience of flexibility and response-ability other youngsters may have or easily learn. Most likely, the school age child will simply intensify what already exists and ironically recreate experiences that are familiar from at home and ironically reinforce what s/he already know and believes about the world and themselves in it.

Adolescence, while difficult for most teenagers regardless of mental health, paradoxically holds the potential for bringing some relief to the troubled kids because they find a cohort of similar kids – lost, distraught, violent, and depressed. Together, they introduce each other to alcohol and substances, form a tight group or gang where they are accepted, experience a sense of belonging, and identity. The shy, quiet child may find alcohol and realize she is funny and desirable and has a ball. The wild kid may become a powerful gang leader, use uppers and or smoke pot to calm down and feel one with the universe. Still others began addictive habits to numb their bodies, or to eliminate boredom, anger, depression. When this population reaches twenty-something, many will become troubled by addictive habits, wind up in AA or other self-help or treatment groups, either self-referred or court-mandated.

Final Thoughts: This all sounds simple, very pat and unrealistic when it definitely is not. A book could not do the topic justice. I intended briefly to demonstrate the complexity and co-created inevitability, almost natural evolution of a path to use and abuse addictive behaviors within the context of family/environment. Throughout this process I wanted to stress the presence of many, albeit unaware strengths of creativity, perseverance, courage, determination and awesome resilience that will assist the client to discover a clean and good life fulfilling his wants and dreams.

Let’s go: A life of freedom from compulsion is ready and waiting to be realized!