The Field of Treatment

Dictionary definition of word psychotherapy | up close
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What is Psychotherapy

What is Psychotherapy?

Psychotherapy, also known as Talk Therapy, is the treatment of disorders using psychological techniques rather than medical intervention. The general intention of psychotherapy is the promotion of communication to aid in recovery from a variety of ailments. PT is used to improve conditions of emotional stress, anxiety, and substance abuse. By communicating with trained psychotherapy professionals, the patient can work towards a solution to their problems, usually by learning how to modify their thinking and behavior. The wide variety of approaches used in PT means it can prove successful for those of any age, gender, and personality type.

 

Types of Psychotherapy

Cognitive Behavioral Therapy, often referred to as just CBT, falls under the category of a psychotherapy. The psychotherapist’s aim with CBT is to aid the patient in altering their own behavior and thought. Commonly used for anxiety and depression, Cognitive Behavioral Therapy is a type of talk therapy where the therapist focuses on specific solutions to the patient’s problems. The Purpose of CBT is to get the patient thinking and acting more appropriately for their situation.

 

Psychodynamic/Relational

Psychodynamic Therapy is sometimes known as Relational Therapy and involves in-depth psychoanalysis conducted by a specifically trained psychotherapist. This unique technique in psychotherapy attempts to help both the therapist and the patient understand where their problems are coming from. Be it from emotional distress or deeply rooted fears or behaviors, the goal of the therapist is to develop the establish and enrich the patient’s self-awareness. Psychodynamic Therapy hopes to connect previous experiences to current behaviors.

 

Somatic Experiencing

Somatic Experiencing is a psychotherapy approach concerned directly with body awareness. Its principal intent is to heal trauma that is often the result from what has become known as post-traumatic stress disorder (PTSD). The focus of the treatment is on the patient’s somatic sensations; their perceived body sensations. The theory behind SE is that negative symptoms of trauma, like shame, anxiety, and embarrassment occur because we do not fully process the trauma. During treatment, the therapist will introduce minute amounts of stressful trauma and make observations on the patient’s response. From this, the Somatic Experiencing therapist can begin developing with the patient, strategies to regulate their stress responses.SE is one of the more recently developed psychotherapy treatments and has been successful for a variety of stress disorders.

 

EMDR

It’s a long one! EMDR stands for Eye Movement Desensitization and Reprocessing Therapy. What could that possibly entail? This psychotherapy approach has been very well researched and has consistently shown to produce positive results with respect to trauma recovery. During the treatment, the therapist will dig into the patient’s history to determine the root-cause of the trauma. The patient will then be trained in a few stress reduction techniques to be used during the therapy sessions. Visualization of the trauma, identification of self-negativity, and emotional responses and body sensations are all key aspects of the treatment. The actual EMDR techniques are a bit difficult to envision but include eye movements, taps, and tones. The inclusion of these stimuli is what has shown in research to bring success to the therapy.

TRM

The goal of this psychotherapy approach is for the patient to be able to manage their nervous system by controlling the sensations they experience with respect to their traumas. Our bodies have automatic responses to perceived threats; think fight, flight, and freeze. Trauma Resiliency Model uses several approaches to help the patient understand their natural responses to trauma and stress. Titration, tracking, and pendulation are some of the technique you’ll come across if you choose to undergo this psychotherapy. The uniqueness of TRM is that the body’s innate responses provide the foundation to work from. In other words, the patient already has everything needed to be successful in this approach to psychotherapy.

Motivational Interviewing

Motivational Interviewing is a fairly straightforward psychotherapy approach that works on facilitating and engaging intrinsic motivation within the client by focusing counseling session more on specific goals rather than self-expression from the patient. In MI the aim of the therapist is to influence the patient directly in hopes of accomplishing specific goals geared towards improving the patient’s state of mind and behavior. The presence of ambivalence is commonly very high in those suffering from addictions and trauma. The focused and direct approach of motivational interviewing sessions is designed to help the patient omit conflicting and contradictory feelings and thoughts which impede progress and eventual success in psychotherapy.

 

Group Therapy

This is one of the more well-known types of psychotherapy. Most often involving 6-12 patients and a single therapist, group therapy is a very open strategy that can integrate other psychotherapy techniques like cognitive behavioral therapy and motivational interviewing, in a group format. In this approach, the group itself is the key strategy. Group therapy leverages the group setting as an instrument for change by relying on the dynamics of interpersonal relationships. In groups, patients can lean on each other for support while learning from one another’s strengths and skillsets. For this reason, group therapy is one of the more command preferred psychotherapy approaches.

 

Interpersonal

Interpersonal psychotherapy is as the name implies, personal. Differing from group therapy as a one on one approach, IPT is highly structured and follows a strict timeframe usually of 12-16 weeks. Originally developed to treat depression, this psychotherapy approach is now utilized to treat many more types of issues, including substance abuse. There are 2 principal techniques in IPT, attachment theory, and interpersonal theory. The ultimate goal of interpersonal psychotherapy is to develop the patient’s communication abilities and therefore improve their ability to enter and maintain relationships with others.

What to Expect

 

There is no general expectation one could have for psychotherapy. The variety of approaches means the patient won’t know what to expect until they speak with a professional. Also varying is the length of treatment. Again, until the patient meets with a psychotherapy provider it is hard to say exactly how frequently and for how long they will receive treatment. When deciding to contact a PT provider it is key to keep in mind that these types of treatments for addiction have a long-standing record of success. Discuss your goals and define key indicators of successful psychotherapy with your provider.

 

Who Can Benefit

 

So, who can benefit from psychotherapy? In a nutshell, everyone. While psychotherapy comes in many different approaches and strategies there is more or less something for everyone. The benefits of PT to those suffering from addiction are well documented and widely utilized. However, it should be noted that a patient undergoing psychotherapy for addition can frequently make improvements in other aspects of life including mood, anxiety, and personality disorders.

 

How to Find a Provider

 

Google, of course! When searching for a provider in your area consider all the traits you would for most services. A local, well-established psychotherapy provider will have a better understanding of the local community and the common issues with substance abuse and addiction in that area. Ensure your providers is certified with reviews and has long-standing experience with your specific needs.

 

Interventionit Leading drug abuse intervention
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How to Stage an Intervention

What is an Intervention

 

An intervention is often the very first step taken by loved ones in helping someone with addiction. Whether it be an alcohol intervention, or a drug abuse intervention, there is an organized, planned approach for success. The purpose of the intervention is to confront the addict in hopes of promoting acceptance of the addiction and to show comforting support for the rehabilitation process to come.

 

How to Stage an Intervention

 

Gather a team

This is the foundation of an intervention, the team. Family interventions are most common however friends and colleagues of the addict can also be present. The ideal size for an intervention team is typically between 3-5 people the addict has a close relationship with. 3-5 team members are large enough to show the addict that there is an obvious addiction, but small enough to not overwhelm them and allow for easy communication amongst the group.

Intervention professional

Selecting the right interventionist is key to a successful intervention. Make sure the professional you choose is certified, and they should hold some sort of counseling degree or license. Experience counts too! The number of interventions they’ve conducted and their approach to interventions is also highly important. Have they had much experience with family interventions?     

Planning an intervention

Interventions can be highly stressful for everyone involved and are crucial to beginning the drug rehabilitation process. It is, of course, most important to identify exactly what the issue is and the reasons why an intervention is needed. Given the dramatic and emotional nature of interventions, thought must be given in selecting your intervention team. Decide who the addict is closest to and with whom they have comfort and trust.

Rehearse

Not too many of us have interventions as commonplace in our lives. For this reason, rehearsing and practicing the intervention with your team, and your chosen interventional professional is a must. Go over the initial approach, discuss and prepare exactly how the intervention should go. Perhaps most importantly, prepare yourself and your intervention team for the likely refusal or resistance from the addict to participate.

Define consequences

Accepting that one has an addiction is a very difficult thing. There is a very good chance the addict will deny the issue, or refuse to participate in the intervention and planned follow up care. Situations like these are why the intervention team should have planned some consequences to the addict if they refuse help. The consequences, of course, are dependent on the situation but oftentimes a proposed consequence may be taking away a vehicle, denial of visitation rights to children, or loss of employment. Your interventionist will be able to discuss these with you.

Choose a location

Remember that when choosing your intervention team, you must consider how comfortable and trusting the addict will be with the team members. The same consideration should be taken when deciding on where to conduct the intervention. Family interventions are personal and can be very emotionally charged. For that reason, public venues should be avoided. Consider where the addict is likely to be comfortable. Make sure the venue is a commonly visited place by the addict but not somewhere that may have a negative association. Perhaps some dramatic events related to the addiction have occurred at the addict’s home; choose a more neutral location for the intervention.

Be prepared for anything

Anything can happen during an intervention. This is one major reason why a professional interventionist should be present. Consider the viewpoint from the addict. Will they be defensive, offended, confused? There is an added element of unpredictability when dealing with those suffering from drug or alcohol addictions. Give some thought to the addict’s personality, the type of addiction they suffer from, and recent behaviors. Consider the possible reactions during the intervention and use that when considering your team members. A professional interventionist will be well versed in a variety of possible scenarios.

 

What Happens After an Intervention?

 

Detox

Time is of the essence post-intervention. It is imperative that the intervention team be ready for the addict’s acceptance for help and have a follow-up plan in place. The team should have a treatment facility chosen and registered. There needs to be an immediate transfer of the addict to their treatment facility following acceptance of the intervention and agreement to therapy. Have necessary items ready to go for the addict so no distraction can occur with packing. Have what they need ready, and ensure them everything is planned.

Extended care

Also known as Aftercare, extended care is the step following Detox. Here the addict may enter an inpatient care facility or an outpatient care center that allows the patient to return to some normal life activities. More information on Extended Care can be found at this link:

Sober living

A version of Extended Care where the addict can live in a designated housing community amongst other recovering addicts. This type of aftercare allows for a sense of normal life while still maintaining recovery strategies like group therapy, counseling, and structured behavior. This type of care may or may not suit all recovering addicts but should definitely be considered as a type of aftercare.

 

What if your Drug Intervention Fails?

 

What to do

Convincing an addict to seek treatment isn’t usually easy. Staging a successful intervention is tough and even if you do everything right there is a chance the addict may resist treatment. Don’t be discouraged if the first intervention attempt fails; plan, and try again. However, your post-intervention behavior is crucial to future success. Whatever ultimatums you made during the initial intervention should be maintained. This means you may have to move out of the house, cut off money supplies, or even make the addict leave the home. However difficult, you must stand firm on promises made during your intervention. Again, the most important thing you must do after a failed intervention is – try again.

What not to do

The things you shouldn’t do following a failed intervention fall in line with what you should do. Firstly, do not give up. It could very well take several tries before your attempt at intervention is successful. Secondly, do not make compromises. Remember the promises you made during the intervention; to leave, to file for divorce, to take away child visitation rights; this may be difficult but it is an absolute must for future success.

Why might your intervention fail?

Interventions are tough. They are tough to plan, tough to initiate, tough to go through, and tough to accomplish. Many will fail and if your intervention fails it is important to consider why. Perhaps the planning fell short. Maybe the flow of conversation wasn’t there or maybe the addict wasn’t comfortable with the group or location. Perhaps the intervention went in too many directions. Were there solid ultimatums given? Were those ultimatums committed to? Another reason interventions fail is because no clear solution to the addiction was presented. If too much focus is placed on the problem and not the solution, the intervention may stall. Focus on the solution!

 
 

Things I don’t like about contemporary treatment: A meditation from the inside

Dr. Erich Fromm, one of my teachers, inspires the title, and much of the content here.

There is a huge shift transpiring in the field of drug and alcohol treatment, it is happening rapidly and systemically, it will be for the worst and difficult to reverse. Warning: the field of treatment is being infiltrated by people who are emotionally disconnected and un-empathetic towards the plight of the people they claim to serve.

What the treatment industry used to look like: A group of people who had an experience of transformation becoming missionaries and willing to do whatever it took to help addicts and alcoholics. Twelve step, spirituality, new clinical techniques, whatever helped people recover it was done with spirit, intention and legitimacy. I am not idealizing the past, there were always unscrupulous operators, but they were the exception rather than the rule (with some large scale exceptions in the 80’s treatment bubble).

What’s happening now is something different: salesmen, hustlers, and young wealthy kids who want to show their parents they can be successful, open treatment programs, for the wrong reasons and with no experience. Many Drs. And psychiatrists enter into the field as consultants or hired employees and get tempted by money and use their degrees as cache to become owners and operators of there own centers, these too tend not to be missionary healers, but more business savvy narcissists. What’s happening now in treatment is systemic, a result of the breakdown of ethics and spirit in the treatment field. All of this has come together in a near perfect storm to create an industry that seems to have lost its way. The new breed of treatment centers is looking at how to maximize profits, buy and sell addicts care, and become as large and efficient as possible. It is the wrong approach.

One of the contributing factors to this shift is the influx of narcissistic and egoistic personalities that own and operate treatment programs. Every day I hear about the shenanigans of the owners of large “successful” treatment programs. It is clear many of the owners of private rehabs have not done their own spiritual work. Many of these owners are pathological. They tend to have the psychological profile of compulsive gamblers: Mildly (or majorly) anti-social, grandiose, charismatic, addicted to the cycle of winning and loosing, self sabotaging, self-absorbed and lacking in empathy.

What makes this situation deeply troubling, as opposed to another unfortunate by-product of profit-centered capitalism, is that recovery once was a sacred field, largely due to Alcoholics Anonymous.

We have reached a moment in the field of treatment where events and industries have conspired to create the perfect storm. The issue is greed.

Treatment, when done correctly can be a profitable business, and treatment with a focus on profit (over care) can be insanely profitable. Treatment has now become an attractive field for those looking to make a quick buck. On some level what is happening is no different than what happened in the mortgage industry in the early 2000’s. The treatment bubble began to attract these characters (en masse) with the introduction of mental health coverage from insurance in conjunction with the capacity for huge online marketing efforts on Google.

How has this happened? There is a lot more money in the field than there was ten years ago. There is also, unfortunately, a growing customer base, as our country is in the midst of the worst heroin epidemic it has ever seen, and it is an epidemic affecting not only the lower, but also the middle and upper class that can afford to spend more on treatment. This has not gone unnoticed by venture capitalists, real estate investors, huge multinational corporations; they all see treatment as an industry they can capitalize on.

One of the reasons this works is that when families or clients choose to come to treatment all they know is the marketing, not the treatment itself. Unlike a restaurant, customers cannot just try the product and decide if they like it and go somewhere else. Rehab is a big investment. From the outside (or the website) there seems to be no difference between genuine experience legitimate treatment, and large commercial insurance farms. Financial success in this industry has little to do the quality of treatment and everything to do with marketing. The more one can focus their resources on marketing the more clients one will get. It has become a marketing game to fill beds. As a result you see the greediest operators achieving enormous success, putting marketing first (over care). The clients who don’t get the care they need don’t have a voice because they disappear back to where they came from, or sometimes, tragically, die. No one takes responsibility, and the most vulnerable among us are being exploited.

And, we now have the recovering community itself getting involved. Which in many ways is a great thing, but when a recovering person in the first couple years of recovery without much experience or know how opens a treatment center, the core of the treatment matches the core of the founder: shaky, compromised and not yet fully integrated.

So what does good treatment look like? A good treatment center is one that exemplifies healthy living, strong ethics, strong boundaries, expertise (through experience) and lots of love. The men and women in the trenches of their recovery, with an interest in transitioning into the field of recovery, become counselors, therapists, techs; they go back to school learn their crafts and 10 years later they have worked their way to positions of power, legitimately.

The best of us in the field are those who feel an obligation to our fellow person, see ourselves in the people we help, recognize our own limitations, can empathize deeply with suffering, and have the strength to help create a safe and sacred place for those in need to recover.

The other day I was visiting with a young man who just opened a new treatment center. I was speaking with him and the clinical director for longer than I had anticipated.   It was clear he was excited about his new business and also clear that he was excited to be helping those who need it. We talked about ethics, spirit and fighting the trends of our industry. Treatment programs like his and mine, are becoming the exception. We are people first, we’ve done our own work, we have experience, we are small, smart, and we are values based. I am having these conversations more and more (with colleagues, with parents, with clients, with peers); there is a small underground group of us forming, perhaps a specter is haunting the treatment field: the specter of integrity!

#recoverintegrity

The Human Side of Treatment Behind the Opioid Epidemic: Ryan’s Story

I was working in residential treatment a few years back; one Friday night, a new resident, Ryan, approached me. He was a teenager, 5’6” with big, kind eyes, natural dark circles, and a face that turned red at every feeling or change in temperature. He asked, vulnerably, if he could speak with me. I took him to my office, we sat down and I asked, “What’s up?

I got out of Heroin detox two days ago. I’m 8 days sober. And I’m craving shooting heroin again.”

I could see that he was quite sincere and on the razors edge of going this way or that. I looked him in his eyes and asked him: “How are you going to use?” This question surprised him; I think he thought I was going to talk him out of it.

I’ll smoke it,” he said dryly.

“Do you have Heroin on you now?”

No,” he said.

I asked, “How will you get Heroin?”

“From my dealer” he responded, clearly getting impatient and annoyed.

I proceeded, “Do you have money?”

“Ten bucks” he answered.

I said “Give it to me,” and he did, and I put it in my pocket. “Do you have a cellphone?” I asked.

“No,” he was beginning to catch on to our game.

“How are you going to call him?” I pressed.

With some finality he said, “I’ll panhandle, get the money, I’ll call him from a payphone at the gas station, and get high.”

“So he will come drop it off and you’ll get high at the gas station?”

No.” Ryan said,  “my dealer doesn’t deliver, I’d have to take the bus to Inglewood and meet him.”

I continued, “After you meet him and get the dope where will you get high?”

“I’ll get some tinfoil and a straw from burger King and smoke it in the bathroom there.”

“And then what?” I asked accusingly.

“I’d be high,” he replied.

“And then what?” I asked.

“I’d go home,” he answered.

To your parents?” I asked.

“ No, they kicked me out. I’d come back here,” he admitted.

“To rehab?” I asked, “and then what?”

“I’d get sober,” he answered.

“You’d get sober? But you’re sober now!” I replied, too loud, revealing my inner judgement.

Yes but when I am High I really want to be sober,” he said.

Aha. “So let me get this right, in order for you to stay sober you have to get high?”

 

Two days later, Ryan was on the street getting high. Ryan wanted to be sober. But he wanted to be high, also. By the eighth day in treatment and sober, he had run out of motivation to stay sober. Why did Ryan need to get high in order to stay sober? When he went into his memory he realized that when he was high, he found the motivation to get sober; the crisis of addiction created an energy, a desire in him to get well. Ryan was cutoff, he was stuck in his own thinking, and his thinking was cut off from the world. He was stuck in a narcissistic bubble of addiction. Ryan was rational, but his reasoning was driven by an unconscious craving to get high. He didn’t want to get high, that’s why he asked to talk to me, but it was almost as if once he engaged me he was sleep talking, unable to wake up and stay where it was safe and welcoming. Underneath the mechanics of Ryan’s thinking there was something else going on. Ryan was numb, and underneath his numbness was pain, fear and sadness.

I wonder if I had been able to break out of my role in that moment: warm and clever counselor and instead become loving and vulnerable with him, would the effect have been different? If I had held his hand, been there with him 2 or 3 hours or however long was necessary, listened to his pain, given him a hug, could I have broken through to a different part of him and changed his trajectory? As it was, I believe we were both stuck in our roles at the time, him the out-of-control addict in need of saving and me the young-smart-(slightly)-distant counselor. Ryan recovered from his condition; I am still working on mine.

Ryan ended up in treatment two weeks later and has been sober ever since. So it turns out he was right, he had to get high in order to get sober.