The first week of the New Year! How exciting, promising, tantalizing, and glad that we could end the previous year surrounded by the many family members including many grandchildren. It was truly exhilarating to have young and old together as we celebrated Christmas the German way with real candles on the tree, singing, praying, and enjoying the annual performance by our grandchildren of the story of Christmas (which by now is depicted with more humor than serious intentions) and of course eating traditional German Christmas delicacies. Now it’s over and we all are recovering slowly, day by day.

Now, as is also usual, I am in my office going through much of my work in an attempt to sort out what I want to keep (which is most of it), and which I can discard. It’s quite an undertaking. It’s actually quite relaxing, because I can revisit the many newsletters and good wishes from my providers and my clients. I take the time to really savor these intimate writings that fill my heart and for which I provide a permanent place to resource when I am in need of support or validation. Oh yes, I do get down sometimes which really makes me feel human and part of the rhythm of life. Invariably I feel recharged and connected with all.

One other activity I engage in is to go through the many books on my shelves – recently purchased ones and older ones and simply pick one out that suits my mood. It’s quite interesting to me that when I find myself in this reflective mood I usually choose a book that without realizing initially resonates with me once I stick my nose in it. This time was no different. I chose The Pleasure Prescription by Paul Pearsall (1996) which I had read more than once, judging from my various comments on the sides of the pages. The Subtitle reads: To Love, to Work, to Play – Life in the Balance. Ah, my first thoughts were, yes, I relate very much to the first three – but – Life in the Balance? No, I am really not good at it. While I genuinely love people, life, and my work, I forget to balance. You know the old saying “Don’t do as I do” – have you ever felt this way? And isn’t it great to know that your teacher, coach and/or therapist is imperfect?

While I re-read the whole book, I particularly enjoyed Chapter 6. Wouldn’t you know, it’s about addictions – where I spend many hours reading, researching, writing programs and working with my clients? Here is what Dr. Pearsall reminded me of – that addiction is natural – yes, natural and the active use of our endorphins are necessary to keep us happy and strong. How on earth? Because it is adaptive, it assists us in learning what is good for us. Dr. Pearsall an Psychoneuroimmunologist (goodness, this word is almost as long as German words tend to be) has joined other researchers to unravel the bias of brain over mind (see references below). Let it suffice that feeling good is essential and positive and a natural internal stimulant provided by our Endorphins located in the limbic system of the brain. No doubt you all are already acquainted with that. The penalty for trying to create experiences that provide us with an ongoing high we unfortunately manage to create our own crash soon after as every “unhealthily” addicted person can attest. Sylvan Tomkins has demonstrated that no emotion can stay for very long be it happy or feeling low, we human beings are wired to provide relief for ourselves without having to extend much effort. So what is the solution? Pearsall suggests developing our 7th sense which means we can learn what is sufficient and savor the process, linger in the comfort of feeling good and become comfortable and at peace with fluctuations in mood.

Those of you who have studied with me have learned that the answer to our own tendencies is to savor our experiences, to lean into them, may they seem happy-making or painful; savor getting up in the morning and appreciably breathe deeply. Take note of what is missing and give it space in your life to resolve without pressure of immediacy, but don’t stress out over it if you don’t have an instantaneous resolution. Our 7th sense enables us to moderate our feelings and thinking, to synthesize what is and above all savor the process. Upon closer examination we can discover that “being” is precious, that we need little more than feeling “sufficient” with whom we are and what we have. Being addicted to more doesn’t bring peace of mind, rather it disallows us to learn who we are and can be and learn to embrace all aspects of ourselves.

Pearsall provides some suggestions for what is healthy and unhealthy, what a mild dose of natural stimulant will provide versus a large dose of internal stimulant. If we seek increased thrills to get high, we’ll only crash because more isn’t ever quite enough again (Pearsall, pg. 83). So when you are attempting to Gestalt Your Day, consider the following:

Healthy:                                            Unhealthy:

Slow, controlled                                fast, uncontrolled
No build-up of tolerance               build-up of tolerance
Enough is enough                             need more and more
Feels “Just right”                              gets “too high” and “too low”
Life energizing                                   all-consuming
Enhance relationships                   destroys relationships
Mind-controlled                               brain-controlled

I wish you well throughout this coming year, learn to enjoy a healthy, biologically available addiction and keep in mind what Pearsall suggests, namely that we don’t get killed by stress but by too little joy in our lives. And those of you, who want some assistance in turning your life into the right direction, I have much to offer you to resolve your difficulties and become all you can be, at peace with yourself and in appreciation of your learning, growing, struggling Self.

Resources for Your Reading Pleasure:

Emotional Intelligence – Daniel Goleman

The Feeling of What Happens – Antonio Damasio

The Developing Mind – Daniel Siegel

Affect, Imagery and Consciousness – Sylvan Tomkin

Western society dictates a “mission accomplished” point of view. In spite of poor recovery statistics, this sense of urgency remains stubbornly in the addiction/mental health treatment field, sometimes even when giving lip-service to available contemporary, more relevant treatment practices. Spending a moment experiencing and relishing a sense of a job well-done, taking time to savor one’s hard work and accomplishments – are highly undervalued in our society and practiced much too infrequently in the treatment field. The ramifications of such a let’s get this done now, get sober and stay that way attitude are enormously negative. They create and maintain fear, stress, and create discouragement that may well contribute to, and maintain the very addiction or mental health conditions, that the individual wants to alleviate.

Life is an ongoing process of living and changing; there is no permanent cure for pain and problems, and there is no Nirvana. Nevertheless, the individual desiring recovery can adjust to and reduce the frenzy inherent in treatment and in contemporary life on his very own. Below are some simple suggestions that can make life a little easier until the client feels whole and self-assured in full recovery.

Some simple suggestions to ease a stress-filled life:

1. Slow down long enough to stimulate courage and feel emerging excitement and interest in living beyond meeting dictated needs.
2. Experience a feeling of satisfaction - of self-discovery over completing a task successfully without submitting to someone else’s prescribed dictates for recovery and other life style changes.
3. Complete a day reflecting when deeply felt values and beliefs guided you to do something unexpected rather than attend a meeting to which you may not have related. This decision can take as little as a moment of I did it, taking a deep breath, or treating one’s self to a quiet moment of self-appreciation and peace.
4. Acknowledge satisfaction when sharing a self-initiated experience with a good friend, or experimenting with new activities even if initially self-conscious.
5. Savor a job well done, having been in a flow experience, losing track of time in the process.
6. Learn to count blessings – the awareness of discovering something novel – making someone smile, getting a wave of thanks from a motorist whom you gave permission to turn before you. It means simply recognizing pleasant small moments which would have been out of awareness earlier.
7. Evaluate how you co-created this pleasant moment. Accumulating these positive self-discoveries hold the additional promise of gaining self-worth and awareness of how a person can make many little steps that may lead eventually to accomplish larger individual goals – like full recovery.

Life becomes joyful when one recognizes the ability to co-create good moments. They make life worth while. After all, would anyone want to go through the rigors of recovering, were it not for the hope of a more satisfying existence?

The above is certainly not an outline for a treatment approach; yet it serves coaching very well. Chances are that a person in the process of recovery will be much more successful if he is introduced to himself, his strengths, vulnerabilities, and values that made it possible for him to courageously arrive at your office at this very moment willing to entrust himself to you, a dedicated, non-judgmental clinician who realizes that the client is always the authority and ultimately the change-agent in this dialogical, completely client-centered I-Thou process. All one needs is encouragement, compassion and belief in human nature imbued with a desire for self-actualization.

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

?

When I began working in the field of addiction 30 years ago, most clients were automatically labeled addicts, (yes, shocking but true) just as most clinicians were either recovered individuals or members of addiction-troubled families. Of course, the field has evolved and what was once held to be gospel truth has been modified and re-labeled. The purpose of this brief paper serves to highlight the confusion and complexities inherent when assigning the label “Addiction”.

Addiction may be:

• Disease/illness; Disorder DSM-IV-TR, (insurance reimbursement)
• Not illness but can create lots of physical illnesses
• Myth of Alcoholism (Herbert Fingarette; scientific data)
• Concept, not illness (Jellinek)
• Spiritual depravity, character defects – AA fellowship only salvation (AA)
• Hedonism – following the pleasure principle – feels good (our limbic system)
• Everyone is addicted (Andrew Weil, Harvard Conference presentation)
• Genetically programmed (unproven, research not universally validated)
• Big multi-billion dollar business
• Treatment and discomfort depends on the healthcare providers’ projection (Ellen Langer, Harvard)
• Resulting from abuse and trauma
• Life-style issues
• Once an addict – always an addict vs. once a human being – always a human being
• Organismic self-regulation, creative adjustment to what is
• My theory is better than yours philosophy !

The above bullet points are not inclusive and perhaps none speak to each reader. My heart goes out to clients and clinicians for both are, one might say forced, to give a diagnosis that pretty much will stay with an individual for life i.e. failed attempts to purchase life or health insurance etc. Are any of our noble attempts really helpful? Statistics vary hugely; it all depends on who provides them – each program is the best on the web.  The questions really become: Can a label alone define anything? Who is the client? What is his/her experience; a good question because some will say addicted individuals can’t think clear enough for recall or have warped perceptions. Others will claim that there is no cure; what does that mean? Why bother? Who is the individual who has learned to overuse substances? Are they embodied in their drinking, drug-using activities?

In conclusion, my professional belief is that what is, is and whatever works, works. I see each individual as a wonderful, complex, highly unique individual who trusts or learns to trust me that s/he is deserving. Kierkegaard wrote that “if you label me you negate me”; a powerful statement that invites all professionals to have an open mind, an open heart, to see and experience the client/professional relationship not as two separate, isolated human beings but in an I/Thou co-created dialogical relationship. This is how we both experience our working together. Believe me, it isn’t always easy. You may see it differently and I would really love to hear your experience and position on the issue of “Addiction.”

You may find more information on my website www.GestaltRI.com; LinkedIn and Facebook.

References:

Alcoholics Anonymous (2001) Alcoholics Anonymous World Services. Fourth edition. Inc. New York City.

Diagnostic and Statistical Manual of Mental Disorders (2000). Fourth edition. American Psychiatric Association.

Fingerette, Herbert (1988) Heavy Drinking. The Myth of Alcoholism as a Disease. University of California press.

Jellinek E.M. (1960). The Disease Concept of Alcoholism. College and University Press. New Haven, Ct.

Langer Ellen J. (1989) Mindfulness. A Merloyd Lawrence Book. Lifelong Books. Da Capo Press.

Vaillant M.D. George E. (2008). Spiritual Evolution. A Scientific Defense of Faith. Broadway Books, New york.

The above is a very limited selection of references that contributed to the shaping of my philosophy. For more information and my own publications, please visit my website www.GestaltRI.com