Download
1 / 18
180 likes | 282 Views
Heart of Addiction. Displacement. Lance Dodes. Lance Dodes, M.D. is a Training and Supervising Analyst with the Boston Psychoanalytic Society and Institute and assistant clinical professor of psychiatry at Harvard Medical School.
E N D
Heart of Addiction • Displacement
Lance Dodes • Lance Dodes, M.D. is a Training and Supervising Analyst with the Boston Psychoanalytic Society and Institute and assistant clinical professor of psychiatry at Harvard Medical School. • He has been the Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the Alcoholism Treatment Unit at Spaulding Rehabilitation Hospital (now part of Massachusetts General Hospital) and Director of the Boston Center for Problem Gambling. • He annually chairs the discussion group The Patient witih Addiction in Psychotherapy and Psychoanalysis at the fall meeting of the American Psychoanalytic Association.
Reversing Helplessness: Factor 1 • Take an action that we know will make us feel better • It’s an understanding approach • Making the unconscious / conscious and then doing something about it • I make sense of my behavior
Addiction • Virtually every addictive act is preceded by a feeling of helplessness or powerlessness. • Addictive behavior functions to repair this underlying feeling of helplessness. • It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, or regaining control-over one’s emotional experience and one’s life.
Paradox • Addictive behavior behavior is out of control, but addiction serves a deeper purpose of regaining control - at least internally • But off course - you eventually create more out of controlness • Dodes believes that helplessness is common, but everyone experiences it a bit differently, it affects us differently, and the circumstances that makes become helplessness and the dynamics behind them are psychodynamically unique.
Explaining the Drive Behind Addiction: Factor 2 • Helplessness leads to a feeling of anger / rage • These feelings come in subsidiary forms • Identify what things make us feel intolerably helplessness • Root these out, have them expressed
Displacement: 3rd Factor • Addiction results from a redirection of energy to a substitute or displaced action because another more direct, action is not considered permissible. • Key is to find that displacement - what is being displaced? • When actions are taken directly to deal with helplessness, there is no addiction.
The Man Who Had No Time Intro: • Frequented Tony’s Bar most days • Recent Visit to Doc shook him up - You’re drinking every day again - • Given Dodes # • Ted did not drink for two days afterwards - but returned to drinking for two days afterwards.
Ted Meets with Dodes • Ted - been to a lot of treatment “I Know that I am an alcoholic” • Comes down to will power / stick with the program don’t drink • Lost 12 year marriage as a result of drinking (painful) • Lost job as an financial advisor • Arrested for DUI’s • Considered suicide on a few occasions
Ted Meets With Dodes: Psychodynamic History • Still drinking when sessions began (wasn’t causing crisis) • Only child (father computer programmer mother was research assistant / medical lab) • Ted done well in school (straight A’s elementary through high-school and in sports (football team) • Pushed himself to achieve “I had to accomplish things...Uphold something for the family” • Impressive achievement in college gave him wide selection to schools • Went to a college that fit his Dad’s standards - doing the right thing • Began to drink there “heavily” for the first time
Ted and Dodes (cont.) • College was when alcohol really started to interfere... In a way, the problem was really time”... If I’d taken even a quarter of the time I spent drinking to do the studying I should have done (shaking head in disgust)... And after College, just drank more”. • Taking about marriage, fights, spoiled special occasions, failed career as a financial advisor, accounts he’d let slide... • He kept returning to the time he had lost. “If only I could have that time back”
Psychodynamic Insights • Instead of talking about time lost to drinking, Dodes began to learn that Ted regretted other kinds of “time” losses • There’s never enough time to do things- things I really want to do...Never time for myself, time to do stuff that’s really mine • Insight 1) Realization that Ted was not in control of his own life. • Insight 2) Further sessions revealed just how burdened Ted had become (i.e., taking work home) • Insight 3) Pressure coming from the inside “I always should be doing more” • Insight 4) Work hard as an “adult” and “be good” pattern lived out as a child
A Core Insight • Pressure to perform at work = VALIDATION • Getting caught in head • Takes on new project >>> Feel stressed at work • “When I am going to have my time” • I started slapping around papers - then said “F - IT” Drinking Displaced Anger and Made Up For Freedom
TED IN A NUTSHELL • Choice to drink gave him control over his past feelings of helplessness • Ted started to feel better about his helplessness the “moment” he decided he was going to drink • His rage drove the behavior... Dodes states... “Qualities of rage at helplessness - an intense, narrowed focus, a loss of usual judgement, and a temporary blindness to consequences - are precisely the characteristics that describe addiction...
Summing Up Displacement • Addictive behavior at its core has an element of emotional health • We all fight against helplessness - it is psychologically essential - • Suffering with an addiction then, does not make you psychologically sicker or less mature than people with a wide variety of other problems • We can learn to use addictive drive as a signal that something emotionally wants to be heard, felt, and metabolized
