In my psychotherapy (and chats, consultations, etc) with people in addiction, I combine skills I’ve picked up over 35 years studying clinical psychology, developmental psychology, psychoanalysis, and neuroscience. But it’s not enough. I need retooling.
I’ve developed some good intuitions about how to do psychotherapy…mostly by doing it, putting theory into practice. And I can be effective with people in addiction partly because I’ve been there myself. I know I’ve helped people transform their addictive habits. I’ve had clients who’ve quit, cut down substantially, or who continue to use or drink without a sense of desperation or compulsion. I’ve helped people discover or rediscover how to like themselves, forgive themselves, even love 
themselves, sometimes despite vast challenges (including abuse of one kind or another) during childhood and/or adolescence. And I’ve helped people devise cognitive tricks to shunt their trajectory away from substance use and toward more satisfying habits.
But I’ve failed a lot too. I’ve had clients I haven’t been able to help, for whom my best instincts amount to little more than a shot in the dark. With drug addiction, every failure is potentially lethal. So I figure I need to retool.
So what’s the best way to do that?
Like so many other “experts” working with people in addiction, I’m still looking for the silver bullet. Or bullets — because I can name ten schools of psychology, psychotherapy and mindfulness training off the top of my head (and some pharmaceutical approaches as well) — most of which aim to help people recover from addiction (as well as other mental health goals). And most of them do help. Some people. Sometimes.
But there seems to be a black hole in the centre of the addiction galaxy that sucks in techniques of every sort and laughingly squishes them to nothing, tosses them back down some wormhole to some parallel universe. And surely that’s because addiction boils down to a unique “thing” which is totally psychological, totally biological, and totally social. A habit in the workings of our cells, our minds, and our interpersonal relations.
(And by the way, when people ask whether addiction is psychological OR biological OR social, they’re asking the wrong question.)
But besides that, the very unique thing about addiction is that when you start to beat it, when you actually start to succeed in your recovery, then instead of a radiant glow of achievement and satisfaction (that may come 
later) you’re often left with an aching emptiness. And what the hell are we humans supposed to do with that?! (Mindfulness/meditation has some answers, but let’s face it, the solution isn’t obvious.)
So, I want to spend the next few posts examining some of the therapeutic techniques that are potentially effective with addiction, and try to figure out what works best, what works for whom, and how we might nudge some of these techniques so they’ll work even better. I also want to address this issue of “emptiness” head-on. It’s a biggie.
I’ll start by sharing my own plans for retooling.
Acceptance & Commitment Therapy (ACT)
ACT combines techniques from cognitive-behavioural therapy (CBT) with techniques from mindfulness/meditation. It’s oriented toward people’s basic deep-down needs — and the incredible things they do to avoid them, deny them, or satisfy them in ways that just don’t work. It’s also strategic, in that the therapist serves as a coach to try different approaches to recurring negative experiences. ACT is explicitly geared toward conscious change in how we interact with ourselves and with others.
I’ve used some ACT themes in my own work with clients. They help. But I want to get to the details. So I’ve recently enrolled in an online intensive training course. The course is taught by Steven Hayes, the founder, a guy who somehow resembles a martian, totally bald, with sea-shell ears that rise at an odd angle, but who radiates wisdom, compassion and skill. ACT is partly devised to help people with addictions. And other addiction workers (like Matt and Peter Sheath who’ve posted on this blog) see it as effective. So what’s the secret? I’ll tell you what I’m learning as I learn more.
Internal Family Systems (IFS)
IFS is a school of psychotherapy that identifies and listens to the internal voices in our heads — most obvious in addiction through the (sometimes horrendous) conversations or shouting matches between the taking-care self, the addict self, and the internal critic (how they’re often recognized and identified). The founder, a guy named Richard Schwartz, studied family systems therapy back in the 70s and began to realize that all the shit that goes on between family members is actually going on in our own heads. Sometimes almost constantly.
IFS is well-designed for dealing with addiction because addicts so frequently say “there’s a part of me that just says fuck it, I want to use” and ignores the arguments of other “parts” of the self. This division of one part of oneself from other parts just begs to be dealt with head-on. I sometimes focus on clients’ internal dialogue in my own therapy practice, though I’ve never studied IFS seriously. But now I’m reading up on IFS…to get ready. I’ll be attending a 5-day intensive workshop on IFS for people in addiction this March. I’ll let you know what I learn.
I hope visits to these and other psychotherapeutic approaches will be useful for readers who are devoted to helping people in addiction. But I also think they’ll be important for those who are struggling with their own addiction — because they can highlight what’s available from different forms of therapy and introduce powerful techniques you can use on your own.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Really looking forward to reading about what you learn, Marc. Also look into Open Dialogue therapy too, at some point, although you clearly have a lot planned right now!
For me, connecting with people (those in recovery and regular people), organising social events for people in recovery and sharing our stories is what heals and fills the void. It’s an ancient thing, this yearning for stories, so I aim to fill myself up 2 or more times a week. I can see myself sitting beside a camp fire, listening to others, as we breathe in and out and tell our stories. We are messy AND we are human. Namaste.
Hi Annette. Yes, a lot on my plate. But I’m interested in Open Dialogue Therapy…and check this out for a decent review: https://www.psychologytoday.com/us/blog/hide-and-seek/201507/open-dialogue-new-approach-mental-healthcare.
My impression is that Open Dialogue is mostly targeted to people in psychosis, often schizophrenia. For that reason it may be less relevant for dealing with “garden variety” addiction issues. But maybe I’m off base here. Do you want to suggest how it might work specifically for people in addiction?
Hi Marc, Open Dialogue is for everyone experiencing acute AND long-running mental health issues. Psychosis isn’t needed, just an awareness that we’re not aligned with who we are deep down: fragmented and finding life utterly overwhelming.
In the UK, people can be referred by their GP (free to patients) to Dialogue First, who use Open Dialogue. The patient has to be willing to travel to their offices in east London, but after a few visits, they can Skype.
Importantly, all practitioners practise daily mindfulness and many have a faith. They don’t label – an important distinction – but sit with patients and listen carefully, to help them birth their distress and the stories behind the NATURAL reaction to unnatural events. Patients always have the same team, btw: no need to keep repeating painful events …..
It helped me get to the deep reasons of why I drank the way I did, and I began to write a new narrative for my life. It will work for all addicts in this way. I combined it with service in the recovery community, which gave me a sense of where I was on the addiction spiral, and the best healing for me has been organising sober socials in London and the west of England: 4 years now.
I prioritise daily self-care every day. My ‘void’ is filled with service, nature and some writing (daily) along with yoga, walking and gratitude. It is a healing daily discipline of the kind that Anne Lamott writes so brilliantly. It is an Eastern/African/Latin American way of living, rather than the West’s cruel and alienating individualism.
I focus very little on what’s happening in the world, which is often dark and hopeless, instead what I can DO locally to mitigate it. Life is extraordinary away from rampant consumerism, of which addiction is a symptom.
Sometimes I wonder if we’d be able to negotiate life better if we talked about the gift of failure and what we learn in the process, rather than the “Success” bandwagon which screams at us, day in, day out. We’d be gentler people for sure……
I recommend Russell Razzaque’s new book “Dialogical Psychiatry” to you. An easy read, just over 120 pages, which explains exactly how OD works. And if you’re in the UK at the end of March, do come to our London conference on the 28th, at UCL, central London. Namaste, Marc.
So agree, thank you for sharing. Breathe, see the story and see it is not real. The therapy component has been so important to me too. Looking to do an inquiry on what is mine to shift and walk with compassion. Namaste. Kelly
Nice blog, Marc. Looking foward to more of your reflections. I particularly like:
‘…the very unique thing about addiction is that when you start to beat it, when you actually start to succeed in your recovery, then instead of a radiant glow of achievement and satisfaction (that may come later) you’re often left with an aching emptiness. And what the hell are we humans supposed to do with that?!’
Thanks, David. Yes the emptiness issue…it can be a serious deal-breaker. Hope you stay tuned and offer your own thoughts and insights.
By the way, I’ve been listening to this talk by Sam Harris (I admit I’m a fan): https://www.youtube.com/watch?v=ITTxTCz4Ums The topic is the inevitability and senselessness of death — nice bedtime reading — but he approaches it with such warmth, understanding and rationality… Gotta love the guy…and at least consider the message.
Hi Marc and David-
Marc, you also say in “The Biology of Desire”:
“When desire is ready to arc from the goal of immediate relief to the goal of a valued future, treatment can begin.”
There has to be a reason why I’m doing this…a personally meaningful reason, that aligns the relevant biopsychosocial elements that are key. The neuroscience literature as well as most “addiction” studies seem to agree on this. It is not just about stopping an unhelpful, now negatively consequential behavior. It’s about what am I going to replace it with, and recognizing my level of readiness and motivation to do so– to embark on this difficult habit change. These levels of readiness, motivation, confidence, desire to change, etc.. come at different times for everyone and they eventually have to align. The problem is the readiness is not just some light switch you flip on. It’s fleeting. It’s a “window of opportunity” or a “reachable moment”…”a moment of clarity,” if you will. I think all these methods CBT, ACT, DBT, MET, REBT are great if you know what they are and are able to access them. Even though it’s improved, there are education and access issues that limit availability. If I’m ready to change and I have to wait month for an appointment or a bed, that motivational window closes pretty fast.
Hi Matt. I agree with you (and with myself?) that timing can be a dodgy factor, and waiting lists can sabotage the recovery readiness window. And yes, specifically, those moments of clarity really are important, basically wormholes from one galaxy to another.
It’s also true that non-professionals can have a hard time accessing therapeutic tools like online courses. Yet the therapies I mentioned and many others do have inexpensive resources, so this shouldn’t be a deal-breaker. Both ACT and IFS have exercise manuals as well as weightier tomes to introduce the approach at a starter level or something more involved. The IFS website in particular shows many available books and manuals for addressing a wide spectrum of problems…from incest to addiction.
Yes, the IFT sounds fascinating, Keep us posted! I’d love to hear your thoughts on polyvagal theory and how that might be integrated into therapeutic practices, perhaps it’s already been covered. Thanks for your awesome consideration of as many perspectives and perceptions of addiction/recovery as possible. It’s quite validating.
Thanks, Wicked. I’ve been learning a bit about polyvagal theory as well…mostly in relation to trauma. And since trauma and addiction are so frequently overlapping, I agree that it’s highly relevant.
Hey Marc, been following your blog for a while but never contributed.
I am a social worker now, but used to be a heroin addict. Went to rehab twice / NA / diet changes / acupuncture / therapy / healing / etc etc – nothing ever worked for me … until I fell pregnant and decided to keep the baby. The thought that somebody depended on me gave me something to live for and I detoxed myself and I’m still ‘clean’ a decade later (I don’t subscribe to complete abstinence – I drink occasionally) …
My take on addiction and who stops when is complex. As addiction is complex and as you know is a transactional model that takes into account social / biological factors. I did my undergrad literature review on neuroscience of addiction and its possible relevance to social work and my conclusions support this view.
Over the years I found some people you thought had all the signs of getting ‘clean’ couldn’t stay clean. Others you thought would be dead by the end of year are thriving now (my ex being a perfect example of this). There is no sliver bullet. I think the best hope is to try a combination of things and let the client guide you in the things that they think will be helpful. A personal therapy cocktail perhaps – to use a slightly inappropriate metaphor. And yes harm reduction strategies are key – abstinence is not for everyone!
For me I think it boiled down to identity and self esteem. I traded my ‘junkie’ identify with a ‘mother’ identity and just built myself up from there. It was actually easy to quit when I had real motivation. As time went on my brain healed and I made new social connections with people who were outside my former circles. So new identity = space and time to heal my body + new social group = improved self esteem + being accountable to people = lasting change.
I could go on and on … my thoughts are vast on this subject. But I will leave it there.
This is a fantastic summary of “what worked for you” and the identity piece seems so very critical. Really resonates for me. Thanks for sharing, Maenon.
Thanks for your story, Maenon. I couldn’t agree with you more. I’ve been using the “cocktail” strategy in my therapy for years. (and the metaphor isn’t so bad if we agree that total abstinence from everything isn’t necessary) Different clients really are remarkably different, and they need you to be flexible, to try whatever works and toss whatever doesn’t work. For example, some will take off with the “internal voices” angle; others put it in the same league as the Tooth Fairy. And what you said about identity — that is so important. Identity is the leading edge of personality, behaviour habits, and interpersonal connections. So changing one’s identity can pull everything else into place. Great contribution. Thanks.
I’m on the edge of my seat, Marc! Love this next direction you’re taking us.
Im on the edge of my seat also, interested in where your going next Marc. I have not been here before to write although have been reading a lot and enjoy and learn more than thought I could. I love Addiction, as it is intense, as it killed 5 family members. Rather, they killed themselves using drugs and alcohol to excess or incorrectly. That’s why I went to school to try to understand this thing called addiction. I noticed Marc You Tube a year ago and since then, I have been hooked. I truly love how he thinks and his approach to things. All that to say, I intend on writing more, and will learn and share. Thank you Marc, you have made an impact on my thinking and my business.
I would love to know what you think of the Ho’oponopono approach. It’s caught my interest. It proposes an entirely different role for the therapist.
The story that draws most people to explore it is of Dr. Hew Len, who cured every patient in the criminally insane ward of a Hawaii`i State Hospital — without ever seeing a single patient.
I have no idea. I googled it out of interest. Strikes me as a chanting-based meditation practice, a bit like Transcendental Meditation, but arising within an aboriginal (Hawaiian) context.
I am really looking forward to hearing more about these different approaches. I am a retired clinical social worker and stopped drinking (and smoking) over six years ago.
Over the years, I have been intrigued with how different people approach addiction and what works for them.
I certainly experienced a “moment of clarity” when I knew I needed to stop drinking. It was a very painful moment and I was acutely aware that I would then have to face the emptiness. I still struggle with how to address that but have found therapy, connection with others ( a secular women’s group), lots of reading, podcasts etc. to be very helpful. Now, I would like to focus on meditation, yoga and nutrition.
Richard Schwartz’s work is fascinating–I used to be uncomfortable when watching his technique–it is very intense. I wonder how I would respond now.
Thank-you for your blog and I really am looking forward to hearing more about your discoveries.
Great to hear, Diana. For me, the “contemplative” practices like mindfulness/meditation are the single most powerful means for inserting meaning into the “emptiness” we know so well. Psychedelic experiences (whether in the Amazonian jungle or the shrink’s office) and other means for achieving altered states (like holotropic breath work) can provide a similar sort of infusion for many people.
I sometimes try to remind my clients and myself that the emptiness is a different way of being conscious: it’s not really empty, it’s just open, still, and not goal-directed.
Interesting project and look foward to more. And thoughts about being ?” in addiction” – a new one to me
Thing is no one thing is going to work for every one – and like cancer in a few nothing works and the patient dies
So the therapist ( which Im not ) or the compassionate helper ( which I am ) tries to helf the person find that which is best for them. Thereby self empowerment of choice .
We all seem to agree that diversity in approaches is the golden road to helping people “in addiction” …because they and their problems are so unique. By the way, I use that phrase because I really don’t know what else to use. It seems the word “addict” is uncool because it implies denunciation or at least boxing/labelling….and I can see how that’s valid. So…..what are we left with?
Marc
Thanks for working on the deeper learning needed inside of recovery. In my own experience the emptiness is always what moves us. Its just how it moves us that is the issue… I have tried to learn the boundaries and feel the edges of it, I have tried to fill it with other things. But most of all I have learned to treasure it as it is part of my journey. To where…. I am not sure yet… The most important thing I have learned about my emptiness is that it is spawned out of want, which springs from my basic needs, which when left unmet seem to surface in the language or form created by my life’s patters, traumas. But it seems basic needs being left unmet are the cause for me.
I would like to know your opinion as a Neuroscientist regarding psychedelics and their efficacy in recovery? Namely the likes of psilocybins, and ayahuasca. I understand that there is some study happening with these drugs or medicines (depending on the camp one is in).
As for talk therapy I found great benefit in healing the self betrayal of falling back into or into for the first time addictive patterns that crossed my moral boundaries. Traumatic Incident Reduction was a great tool for going deep, and connecting the feeling to the thought. Left me more whole and able to make decisions that kept me more whole. If that makes sense.
Talk therapy is my main gig of course. Even working with people online, it’s possible to get very close, to tune into each other’s humanity, yet retain that analytical edge that let’s you see the way developmental-historical events, traumas, and current problems are interconnected. As for psychedelics, please look back two posts. I cover some of my thoughts in detail. I don’t know anything from neuroscience that suggests that psychdedelics are harmful. What brain scans actually reveal are brain changes — more communication among cortical networks — that look very similar to those gained from years (!) of meditation practice. Intriguing!
As for the relation between unmet needs and emptiness…that seems a broad and complex issue. Emptiness can be peaceful, but it can also be disorienting, vertiginous, painful, even agonizing. Maybe emptiness is just the sign on the door….leading down corridors that go in very diverse directions. The achy kind of emptiness you describe seems to be similar to what children feel when they lose contact with an attachment figure….and we know people get very attached to their substances of choice.
Thank you so much for another insightful and welcomed partnership for expanding the universe of learning. I look forward to your posts because I gain more than new knowlege, I grow personally and professionally hearing from all who reply and I am grateful to a community that keeps an open mind to solutions we may be just at the edge of discovering.
do humans need addictions ? – are we forever looking down the wrong path here trying to remove addictions – drug use, the spiritual realm and humanity have been entwined since the dawn of humanity – humans are attracted to mind altering for many reasons and purposes – and to habitual behavior of all sorts – and we bust our gut trying to get people to be – sober or straight or clean or whatever – and with glee count our success, while as you say Mark those we ‘help’ are then miserable in many ways and lost in a sober world of hypocrisy as humanity finds ever more ways to be ‘legitimately’ addicted (think Stock Market & licit pharmacology as examples) – the whole mobile phone thing is a classic example of how the free market economy deliberately exploits the human frailty and creates addiction in the guise of ‘connection’ – we’ve been barking up the wrong tree for years and like you Mark many of us are asking – what am i doing here, where is my work going when what i mostly see is the failure of individuals to do what we say they should and recover like good recovering addicts should do – with glee and gratitude ……………
It’s true that, in a free-market economy, the human urge to accumulate resources can easily amplify itself into horrendous trajectories, leading to all kinds of dead-ends, addictions, blankness, despair… like the products you mention and so many others. It’s a culture of amplification, and we’ve got the know-how. But that doesn’t mean that people who try to make money are evil. It does mean that they get lost in the impulse to stockpile resources (wealth, power, imagined invulnerability from loss and death)…and thereby lose their awareness for how others might suffer as a result of their attempts to get ahead.
What to do?
Remain addicted, to one thing or the other? Or wake up and pay attention to what’s happening in the here and now?
i guess in some respect its about an individuals ability to wake up and pay attention – there are many too troubled by trauma’s and disconnections to sit still and listen to themselves, but many others do – in some ways we need our addiction until such time as we ‘naturally’ wake up or mature out of the chaotic behaviors into more manageable habits
Really interested in this particular topic…I tend to believe that the roots of addiction are rooted in in Shame that in many cases is Toxic. It was John Bradshaw, in his book, “Healing The Shame That Binds Us”, referred to this “Toxic-Shame”. So! if a person can move from this sense of toxic shame to a sense of guilt, in many respects they have moved miles. The difference between the two is that “shame” I am a mistake versus guilt, I made a mistake.
It’s a lot harder to deal with the idea that “I am a mistake” (shame) compared to I made a mistake (Guilt). If an addict feels shame they may experience deep anger, fear, isolation, depression and feels there is an absence of choice but to continue to “self-medicate”. In fact, self medicating, in many cases, is salvific compared to other detrimental alternatives. In my own experience self medicating was the answer not the problem.
So! in terms of shame, guilt, and/or other deep rooted emotions, “Belief” itself in terms of our story keeps us going despite the consequences…self-perpetuating.
However, through it all, I came to realize that “change” is an “inside-job” and until or unless I came to this realization my life would never change. The lens I was looking through was one of blaming others, my situation and/or the whole world for my problems which in turn was justification for my behavior. The old Poor Me, Poor Me, pour me a drink syndrome.
In my life, shame, guilt and just feeling my life was always “unmanageable” was a catalyst for change. In examining my own family upbringing, all of what I thought was “non-sense” , transformed. I suddenly realized every single part made perfect sense given all the pieces involved. I stopped blaming but understood that dysfunctional family systems create, in many cases, dysfunctional individuals and are usually generational.
It was only through “looking” without blaming that I was able to understand the dynamics and gained the ability to change my own narrative recreating my whole life.
For me, this wasn’t a “recovery-process” as much as it was a “Discovery Process”.
Hi Marc
I’ll be highly interested to follow your thoughts on this. I struggle with alcohol. and the question of the effectiveness of various methods is often on my mind. It does seem, despite the confidence and dogmatism of various practitioners, that there is no really agreed and effective treatment. I often feel that with regard to addiction we are still in the age of leeches, ice baths, and purging to adjust out-of-balance humours. Part of the trouble seems to be that there is no real consensus as to the nature and causes of addiction, or even what a satisfactory explanation would look like. Some people favour favour what might be called a psychological explanation – some one like Lance Dodes will confidently assert that addiction is always caused by a feeling of powerlessness, and other people favour an explanation in terms of neurobiology, such as the incentive sensitisation theory you discuss in your book. Presumably these two types of explanation are related in some way, but I get the impression that we don’t yet know enough to have much of a clue as to how. Even sticking to neurobiology, there is a bewildering variety of theories – a recent paper I was looking at discussed seven different theories put forward in the 21st century alone.
As things are, it seems as if the best way thing to do is just to find a pragmatic approach that suits you. Myself, I find the AA approach completely useless because of the higher power thing – it’s not so much that I don’t believe in one, it’s that I can make no sense at all of the concept, so “as I understand it” is not applicable at all. I’m currently finding that reading about neurobiology is strangely helpful – it feels as if there must be something right about incentive sensitisation based on my own experience, and understanding what I’m feeling in terms of what may be going on in my brain seems to help me resist temptation – although my personal feelings are no basis on which to found a scientific theory. Obviously other people find a variety of other approaches helpful. I’ll be very interested to hear your thoughts on ACT & IFS when you get to grips with them.
I just recently discovered IFS therapy while researching MDMA therapy for treating PTSD. I read something by Richard Schwartz in which he mentioned flow states he enjoyed while playing basketball. I’m guessing people are deprived of those experiences that get them centered in the capital S self, aka the ‘spark of the Divine’. It’s painful to be chronically disconnected from my so-called divinity so a part of me yearns for oblivion or numbness.
When I was learning to surf my friend and I would smoke a joint before paddling out. Every time as I was struggling to paddle through the breakers it would occur to me that being stoned while trying to negotiate the chaotic energy of the ocean made the whole endeavor exponentially more difficult. Then once having had that realization I often would gel into a flow state in which my body just knew how to surf and I’d be amazed and theilled by my seemingly spontaneous new skill. Then after a little while I would fall out of the flow state and start floundering, getting completely pummeled by the waves.
I’d spend a good part of the session in an on again, off again cycle, until the pot wore off enough that my surfing was more consistent. Once I got pretty good at surfing I realized I enjoyed it more without having to go through that cycle of on and off so I eventually just chose not to get stoned before surfing. The feeling I get after a couple of hours bobbing in the waves waiting for a good one, going through the rinse cycles of wipeouts, and a few luminous seconds of actually riding waves and flowing with their incredible energy, is similar to a narcotic.
Anyway, I’m not sure how that relates to the need for oblivion but I appreciate the opportunity to share that little anecdote. I don’t get to surf as much as I would like anymore and I’m searching for other ways to experience those flow states. I composed this with a glass of wine on board and the process of trying to convey all that felt good while feeling just slightly enebriated. I don’t feel compelled to keep drinking until I’m drunk and I’m aware that the alcohol buzz is a cheap substitute for the relaxation that comes after a few hours of having mind, body, and Spirit, working as a whole.
Marc, I am very excited to be a part of your exploration into these theories and approaches. As you know (once you place who I am), I, too, work professionally with clients on these issues and find that what works is as varied as the individuals with whom I work. And simultaneously, there is a shared humanity that threads its way through all of my clients, those who struggle with addiction or not. As I’ve mentioned to you privately, I see human pathology as stemming from the ultimate struggle between vulnerability and protection. The further the chasm between these states, the more room for what we call pathology to fill in. Addiction is a common way that we deal with the discomfort and isolation that emotional protection inevitably creates. The point being that I am always looking for the best individual way for each of my clients to find their way toward their own vulnerability, and that is where I run into the same problems that you do. With some clients we find our way to this healing quickly, with others it is very difficult or seemingly impossible. I have been finding myself drawn to my own professional expansion, lately, so I can’t wait to hear from you about what you find valuable, in this regard. Incidentally, I will be training in EMDR as soon as I get the chance. I can’t wait to hear the follow up, and am so glad that you are sharing this with us.
Hi Marc
Excited to see ACT as one of your retooling tools. I have attended many ACT workshops and read widely. Will be interested in what you think. Certainly both ACT and Voice Dialogue ( which sounds somewhat similar to IFS) have given me insights into how minds work. Sometimes I wonder how anyone is walking around not knowing this information. It makes life and relationships easier BUT it didn’t stop me getting addicted to cigarettes again after a 20 year absence. The way I stopped smoking this time was a complex two year negotiation between my ‘selves’ and my values. In the end common sense won. I think all parts of me eventually believed
smoking was most assuredly NOT the antidote to emptiness it had promised to be. Once I believed that my ACT training helped me set off in a more meaningful direction.
These are great discussions, great for the mind! thank you all and especially Marc for keeping this going, its a “fix” I look forward to and must have.
I’ve been doing therapy for years, and I was taught by the people I helped. This is what they showed me worked: 1) genuine listening, 2) fostering self-empowerment and 3) kindness.
I’m not trying to simplify the field of counseling theories and approaches, so I don’t mean to offend. It’s important for a counselor to always be a learner, and have tons of ideas and approaches. Books like Marcs and others are crucial.
But take Genuine listening. It’s a hard skill to perfect. We think we do it , but we don’t. Took me years to nail it. As well as be motivated to do it….you must have a clear mind and you can’t be thinking about your own problems/addictions or focused on generating solutions for the person… (as counselors we have good intentions and are always thinking: what will help this person? what counseling theory or approach?).
And genuine listening doesn’t judge, or reinforce labels, or pathologize. I interface with tons of providers and I see genuine listening is a missing element. I see counselors making judgements to the client, like….” well, you better stop or you’re going to die, go back to jail, lose your family, ect, “…Most people I work with know this, and fear is not empowering, nor helping the person get to the source of the problem.
And genuine listening feeds into fostering Self-Empowerment. Most people seek help because they want to get better. But do they believe they can get better is the important question? Many don’t. That’s why they came to you, the counselor. They are looking for “you the expert” to find a solution or approach to their life problems.
This is where I redirect people, “you are the expert and you have the answers to your life.” Many look at me oddly at first, especially those that have been drown in the AA philosophy they are powerless. But in time, they believe, and then they start telling me what they think will help them get “unstuck”.
I admit as a young counselor I thought I needed to be and was trained to be the “expert” but now, as a old counselor I don’t want that coat. lol. Now I listen, and listen, and reflect back to the person what they say. And wait. And wait, and wait….. and believe in the person I’m helping, even when everyone has given up on them, most importantly themselves. Kindness and encouragement. Even at the most bleakest moments, as we know addiction can bring that crap on.
But see sometimes we try many approaches that fail, searching in vain for another possible solution that will help this person and ‘nothing works”. So we give up hope, believe we just can’t help that person. It’s in those time you must be steadfast with hope and kindness. Encouraging the person, if they are still willing, that they can find the truths they need.
Kindness. So overlooked. A psychiatrist, Dr. Jerry Motto use to write letters to his patients because he believed genuine caring and kindness healed people. Imagine letters not scripts. When he was in WW II, he said that the genuine letters he got kept him going in the dark times of war. When he returned home from war he got the idea to start writing letters with genuine caring and kindness.
As for human emptiness, I love that existential topic. I think human emptiness is desire that’s never satisfied and always hungry. Till death do us part…
But as humans we distract ourselves from the emptiness, with unhealthy and healthy coping skills, rather than accepting it’s always there. And we will sink or swim depending on the coping skill we use to ride the tide of emptiness. A tide that always comes in and out. Ugh.
What does the research say?
Link to a table from Chapter 2, “What works? A summary of alcohol treatment research” in R. K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon.
https://checkupandchoices.com/what-works/
Hi there, I too have spent a lifetime searching and testing approaches to pysychological growth. I’m a psychologist, psychotherapist, hypnotherapist – you name it I’ve got the badge. I’ve also struggled / struggle with addiction. Your work has been so helpful – thank you. Yoga has filled a massive black hole for me and many clients. More recently psychedelics have connected me further, not sure what to, but I’m it’s a feeling of connection beyond my self. Somehow this has helped me to sit in stillness and find peace in what used to feel like emptiness. I’m still working on it but at least I feel like the future might just be ok 🤍
Hi Marc,
I always look forward to hearing your unique perspective.
I myself have been an addictions counselor for over 15 years and still feel like sometimes I have ‘it’ only to be proven wrong the next.
I am interested to hear your perspective on ACT – I have used it myself in practice and personally. Steven Hays has the best course I have seen and a way of explaining things that you may enjoy – even as a seasoned professor! I personally have a background in Applied Positive Psychology – but I follow the Cognitive Behavioural Science area closely.
I am currently writing a research proposal for my final dissertation for an MSc in Psychology and Neuroscience of Mental health at King’s College London – largely inspired by your work and in particular your talk at the Royal Institution.
I am always grateful for your perspective and hope one day to be able to contribute to the field in a meaningful way.
Just testing, Jaime. Let me know if you get an alert in your email….and then let’s see if this comment shows up. As you know, I’m having tech problems at the moment.
I did get the email – and I can see this comment – but the link to reply in the email did not work.
The emptiness is brutal. I have stopped my addictive behaviors (after 12 years of numbing out and missing many opportunities), but I am struggling to actually believe that I’ll find the degree of genuine, effortless fulfillment and connections I experienced for the first 18 years of life. I lost it at college, developed an addiction to cope, and now that I’ve let that go, I’m very worried it’s back, in an updated way.
What exacerbates the hopelessness is this: The most common advice out there to remedy this condition is to volunteer, do things for others, go to a meetup or participate in activities I enjoy.
When I spend a morning volunteering or attend a meetup, I typically am present and engaged in the activity, but when I get home, I actually feel worse—more alone, more hopeless…I think because the interactions and activity I was participating in, while pleasant, didn’t deliver what they were selling. And I KNOW these things are all about repetition, consistency, but it’s tough to achieve the amount of face-time required to cultivate real connection. As an adult, I’ve only experienced this slow development into closeness with co-workers, due to the sheer number of hours spend together.
I just feel like asking the internet to PLEASE stop saying that volunteering/meetups/hobbies IS the solution to remedying this emptiness.
You seem to be the only voice addressing the struggle with this specific type of emptiness. Please, keep going, say more.
I’m away from home. Can’t write much. Try Sam Harris. His Waking Up guided meditation app. I find it not only centering but also strangely comforting. I think he’s a very wise man who cares deeply. The app is free for those who can’t afford it.
Thanks for the response. He’s actually a favorite of mine, his podcast and the app. I subscribed to it when it first came out, but couldn’t make it a daily habit. Now that I’ve stopped my addiction, I picked it up again and made it through the 50 day intro course.
You’re right, it’s better than other apps I’ve tried. I recently asked him this question after he tweeted a request for pod topics:
“Theres something that bugs me about how dismissive of emotion mindfulness advocates can be. The emotional experience of being alive seems more profound, valid, direct or innate, than the experience of being DETACHED from emotion, observing it. Can you say something on this?”
Sort of relevant. I hope he picks it!
I feel your pain. A cliche I just realized. But it’s true. Mine isn’t much different. I think that’s important in all of this.
That’s amazing. I’m in France now tryin to type on my phone. I also sent in a comment/request, also about emotion. Guess he gets lots. His Waking Up app inslikte meditation on steroids. Not easy. I like Tara Brach for easier feelgood med. Take care. I feel your pain. I find the only effective solution is to be friendly with myself. Sometimes out loud. I found an expression recently. Spanish. Tranqillo Pappy. With a certain intonation I heard in Costa Rica.