Addiction Counselling Theory
Eamonn Keogh
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In this paper we will take a brief look at addiction. Following that we will examine the different counselling approaches and how they are integrated in addiction counselling. The strengths/challenges of these perspectives will be explained. In doing so the approaches being used in this paper are Humanist, Cognitive Behavioural and psychodynamic perspectives. Having discussed the different approaches and their relationship with addiction the next area to be covered in the paper is answering this question is the pathology of addiction to be found in the object drug or the subject who is using the drug?
According to the American Society of Addiction Medicine addiction is defined as
‘A primary chronic disease of brain reward, motivation, memory and related circuitry’ and ‘is characterised by inability to constantly abstain, impairment in behavioural control, cravings, diminished recognition of significant problems with ones behaviours and interpersonal relationships and a dysfunctional emotional response’
From this definition it is easy pick out three different standpoints. Firstly that addiction is a ‘chronic disease’ this points out the lifelong battle that some clients have experienced. Secondly by referring to brain reward, motivation, memory and related circuitry one would thing that addiction has a large neurobiological component. Finally by naming some of the consequences of addiction this definition associates addiction with significant individual and relation impairment and distress. Each of these standpoints has a different approach to tackle the issue of addiction. The choice of which approach to use can come down to a number of different factors such as length of treatment needed/wanted, what the client is looking for, which approach the counsellor tends to lean towards but whichever is needed or used a large number of issues can be covered using such approach as named below.
The first approach to be looked at is the humanist person-centred approach. This approach was devised by Carl Rodgers. One form of the person centred approach is motivational interviewing (M.I.). What is unique about this approach is that it focusses on the client’s experience of themselves as opposed to the counsellor being the expert and telling the client what to do or what is wrong with them. The relationship between the client and counsellor is very important in this approach. It starts to form when the counsellor demonstrates what is known as the core conditions. As pointed out by Rodgers (2003) these core conditions are as follow the first is empathy and here the counsellor is trying to understand the thoughts and feelings the client may have as they are going through them. Secondly congruence is used to build up a trusting relationship between the client and counsellor and is a very important condition if this approach is to work. Congruence also has another use. It can be used to help defeat negative attitudes or conditions of worth that other may have placed on the client. The final condition is unconditional positive regard. This benefits the client in allowing them to talk about their problem without getting the response “Do you think that was a good idea”, “Why did you do that”. It also gives the client the space to talk about their problems without a fear of being judged or criticised. As pointed out by Kelly (2014) humanist theory would situate addiction from the standpoint of the persons own ability to realise his/her potential. This model works when the counsellor has established the core conditions in order to remedy thee blocks that are impeding the client from realising his/her growth.
The next approach to be looked at is cognitive behaviour therapy (CBT). CBT is a directive time limited treatment. According to Kelly (2014) some characterises CBT holds are that a person’s belief system may be distorted with the result of the client having negative taught about themselves and the world around them which leads them towards low self-esteem, anxiety or depression or continued drug use. The central focus of CBT is the client’s beliefs and taught patterns and how these link with self-defeating behaviour. As pointed out by Beck et el (2012) the client gains a perspective that their addictive behaviour is the primary pathway by which they experience pleasure or they get relief for distress. The client also learns that unhelpful beliefs just add fuel to their addictive behaviour. Furthermore CBT uses strategies to cope and deal with cravings helping the client to build up their inner controls which it turns bring down the chances of relapse. CBT also helps the client tackle any negative emotions like depression, anxiety and guilt. Kelly points out that the cognitive approach considers such problems to not only come from the event itself but also be the way that the client interprets and creates meaning for them.
The final approach to be discussed will be from the psychodynamic school of counselling. The basic concepts of this approach are that personality consists of three elements Id, Ego and the Super-Ego. Drives such as chaotic, irrational and striving to gratify instinctual needs are to be found in the Id. The Id works off the pleasure principle. As Kelly (2014) explains through socialisation a part of the Id is modified by the real world. The Ego works off the reality principal. The Ego is changing back and forth from the Id to the real world. Some of the Ego’s functions are problem solving, perception and repression. The Super-Ego is the product of the roles played out by other people and the effect they have on the client such as parents, law and culture. The Super-Ego develops from an early age and is internalised by the client as a sense of should/musts and ought to. We also work from three different levels of consciousness the unconscious, preconscious and the conscious. There are two different stand points here one the humanistic school who would think the human is good. They have the potential to be good. It promotes a positive self-actualization integration and wholeness. Conflict is played down and if it does exist it is a chance for further growth. Whereas on the other hand the analytic school would belief, it to be a site or agency that is divorced from any consciousness, called the unconsciousness. This determines how we think, feel, and behave. We are not masters in our own house even if we think we are. We are divided between consciousness and unconsciousness. Language can divides us in the same way. The psychodynamic approach can be characterised by a number of features and traits. Firstly what are the differences between a symptom and a structure? Freud would argue that the symptom is not the problem. The symptom is on the surface while the structure is to be found in the depth. A symptom is the manifestation of the unconscious conflict and is a product of the subjects own history. On the other hand structures are the building blocks of our personality formed from our earliest relationships and influences. The next stage is ego deficits. All ego deficits are profound dependant needs. They are played out in powerful social-interaction. In addiction they can only see the other as an object this is a deficit in the self-concept. Following on from here the next area to be covered is defence mechanisms. These defences are in place to help the client to protect themselves from their own ego deficits. These defences can keep a person trapped in their addiction and stop any growth or personal development. Some examples of these defences are as follows denial, projection and conflict avoidance. The fourth stage is secondary gains. This is an important stage to understand as it works for both the client and the counsellor. It works for the clients who have a history of trauma they use their addiction as an unconscious way of seeking out love or security. Secondary grains keep the clients repetition compulsion in place. As for the counsellor it gives the client the space to look more deeply into their addiction and view it as a chance of growth. The final feature of this perspective is transference and counter transference. As pointed out by Kelly (2014) transference refers to the relationship between the client and the counsellor as it develops as the treatment moves forward. The client relates to the counsellor in the same way as they did with pervious relationships particularly that of the parents. Counter transference refers to the counsellor’s unconscious feelings towards the client. I can be a positive tool when accessing the state of mind of the client but it can be negative when it highlights areas in the counsellor life that are still unresolved. The psychodynamic perspective views addiction as the use of drugs allows for the expression of otherwise repressed tendencies. In other words drug use relieves unconscious conflicts that the client cannot deal with on a conscious level.
When thinking of weather the pathology of addiction is found in the object drug or in the subject that used the drug it is hard to answer this without first looking at how the client experiences/ experiences and how they represent themselves to themselves. Kelly points out what meant by this is, that it depends on what if any difficulties the client may have had in the quality of their upbringing and the effect it has on them in the here and now. Many different aspects add to this which includes social, relationships with family members, peers and educational aspects received by the client. All of the above and many more contribute to how the client is going to experience / experience and how they represent themselves to themselves. If one was to think as how the object drugs works for the client on the pleasure economy. The pathology of addiction from this perspective lies with the subject that uses the drug rather than the object drug. It could be argued that from this addiction stems for the specific effect of that drug have on the individual. On the other hand as Loose (2002) points out that drugs produce distinct pleasure effects which are not uniform, and it is this non-uniform that hooks the subject. Both perspectives can be addressed with the use of the talk therapies. As Loose (2002) points out the aim of the counsellor is to move the client from a real solution of toxicity to the symbolic solution of speech and language.
In this paper I have tried to explain addiction and the different talk therapy approaches to dealing with the complex issue of addiction. The three prominent talk therapy approach used were as follows the humanist perspective, cognitive behavioural theory and finally the psychodynamic positions. Each approach has a different and unique style of its own ranging from the humanist viewpoint that the client is the masters of their own house to the standpoint of the psychodynamic approach where the counsellor is the expert. I have also highlighted that the pathology of addiction can be found in both the object and the subject depending on the individual drug and the individual the uses the drug. Having looking at all the different theories and the inner working of them throughout this module I feel that my skills are best suited to the style of motivational interviewing. That’s not saying that I’ll be solely working form a M.I standpoint. When needed ill draw in some CBT and some solution-focused brief therapy. I feel I’ve pointed out in this paper that addiction is a very complex issue and can be tackled in a number of ways that best fits the situation.
BIBLOGRAPHY
Kelly (2014) Class Notes: Reality Theory.
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