Toward a Humanistic

Addiction Psychotherapy

Scott Kellogg, PhD

Diana Calvario

Mechanisms of Change

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Leonardo Da Vinci

Drug Use is Meaningful

Drug Use is Meaningful

People use substances in problematic ways for a

range of reasons

Reasons that need to be respected

In many cases, they will need to be addressed

directly

Sometimes before the person is ready to

decrease or cease their use of substances

(Tatarsky)

Multiplicity of Self

Dancing of the Selves

By Brenda Clews

Id, Ego, and Superego

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Schema Mode Therapy

Multiplicity of Self

The internal world of patients is conceived of as

containing different parts, selves, modes, or

identities –

Many of which may not only play a role in a

patient’s suffering and drug use,

But also in his or her healing and recovery

Gestalt Chairwork

http://www.atpweb.org/grof/slideshow2/image-

pages/pix.asp?cp=148&pp=1

Taken by

Stanislav Grof,

MD, PhD

Frederick “Fritz” Perls, MD Developed

Chairwork into a Psychotherapeutic Art Form

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Greater Internal Freedom

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Freedom

By Louis Parsons

Increased Personal Complexity

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Gradualism

Crossing

Infinity

Diana

Calvario

Gradualism

Embrace and Work with Complexity

Harm Reduction as a Method

Not a Goal in Itself

Small Steps

Substance Use Goals

Short-Term

Monitoring Use

Harm Reduction

Moderation

Cessation

Long-Term

Abstinence

Moderation

“Non-addictive” Use

Methods of Healing

Wide Rothko (2008) by Joao Vasco Paiva

http://www.siusoon.com/dat/2010/07/31/hong-kong-contemporary-art-biennial-awards-2009/

Therapeutic Relationship

Therapeutic Relationship

Love

Empathic Listening

Authenticity and Optimism

Courage and Determination

Heroic Self

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Margaret Mark and Carol Pearson

Heroic

Self/

Healthy

Adult

Difficult

External

Realities

Social

Oppression

No Future

Orientaton

Anxiety and

Internal

Suffering

Physical

Pain

Self-

Soothing

Drug Use

Self-

Stimulation

Drug Use

Inner Critic

Attack

Before Treatment

Trauma and

Loss

Heroic

Self/

Healthy

Adult

Claiming the

Future

Facing

Fear

Confronting

Self-Hatred

Taking

Action

Self-Directed

Choices

Resisting

Pressure

Controlling

Drug Use

Reducing

Harm

During and After Treatment

Self-

Compassion

Existential Language

This is the Language of the Heroic Self

“I want”

“I am deciding to”

“I am choosing to”

“I will”

“I will not”

Horizontal and Vertical

Interventions

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Interventions

Horizontal Interventions

Those focused on controlling and/or

discontinuing drug use

Vertical Interventions

Those that are used to address and treat the

underlying issues and co-occurring

psychopathology

Horizontal Interventions

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Decisional Balance

Positives of Drug Use

Immediate physical pleasure

(10)

Escape/Feeling more “there”

(10)

Feels more emotion (10)

Reduces social anxiety (6)

Shuts out critic (7)

People will know “real” self (7)

Positives of Change

Feel a greater sense self

discipline (9)

Would be more productive (10)

Help him be more comfortable

with self (8)

Greater confidence (6)

Negatives of Drug Use

Feels guilty (7)

Others are concerned (6)

Not as productive (10)

Feels like it a crutch (10)

Feels bad (7)

Health Problems (7)

Negatives of Change

Would not enjoy life as much (9)

Would be ignoring a part of

himself (10)

Breaking up with something he

loves – a hard breakup (9)

Decisional Balance

Motivational Forces

Self- Stimulation:

Using To Feel Alive,

Powerful, Good,

and Joyful

Self Medication:

Using To Reduce Pain

and Suffering;

Using To Feel

More Comfortable

Existential Issues:

Desire For a Better Future

Fear: Health and

Life Concerns

Relapse Prevention

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33

Relapse Prevention

Involves working with patients to:

Understand triggers and cues

Identify high-risk situations

Develop such coping skills as:

Cognitive Restructuring,

Assertiveness – Drink and Drug Refusal

Urge Surfing

Substance-Use Management

34

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35

Substance Use Management

Helping people use drugs in ways that are safer

Including

Reducing the amount consumed

Changing methods of use

Reducing the time of involvement

Changing the context of use

Drug substitution (Dan Bigg, 2008)

Overdose Prevention/Naloxone

Ideal Use Plan

“If you were to use drugs or alcohol in such a

way as to maximize the pleasure and benefit you

gain from them while minimizing the pain and

danger involved, what would that look like?”

Can they implement this?

What interferes or stops this from happening? (Tatarsky & Kellogg, 2010)

Contingency Management

Contingency Management

Uses positive reinforcement principles to:

Improve retention

Decrease substance use

Encourage harm-reducing and recovery-

related behaviors

Contingency Management

Harm Reduction, Moderation or Abstinence

Patient Choice

Set Weekly Goal

Decrease the Fee if They Achieve Goal

Increase the Fee if They Do Not Achieve the

Goal

Profoundly Empowering

Increasing Control – Small Steps

Vertical Interventions

41http://feralhouse.com/press/15tolife/press/socialist_worker_1203.html

Anthony Papa

“The Heart of Addictive Disorders is Suffering”

– Edward J. Khantzian, MD

Healing the Past

Grief and Loss

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Interpersonal Trauma

44

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Claiming the Present

Inner Critic

Your Harsh Inner

Critic…

Methanie Dempsay Binder

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Creating the Future

Voice Work/Assertiveness

49http://buildyourbridges.com/wp-content/uploads/2013/08/AssertiveVennDiagram-300x197.jpg

Helping Patients Develop and Strengthen their

Voice of Respectful Desire

Heroic Existentialism

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Dr. William James President Theodore Roosevelt Dr. Albert Schweitzer

“We like to be reminded that our central calling,

our main task on this planet, is the heroic.”

– Dr. Ernest Becker

Heroic Existentialism

An Injustice to be Remedied and Corrected

A Suffering to be Healed and Relieved

Something of Beauty to be Protected and

Preserved

Someone or Something that is Loved to be

Nurtured and Developed

Identity Theory

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The Case of N

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Identity and Recovery

The core idea:

Drug use will decrease and eventually cease or moderate as:

Nondrug-using identities become more central, reinforcing, and important to individuals

And as they compete with and replace the Drug-Using Identity

(Anderson, 1998; Biernacki, 1986; Granfield & Cloud, 1996; Kellogg, 1993)

Identities are a Way for the

Heroic Self to Create a New

Future

The War on Drugs interferes with Identity Creation;

Therefore the War on Drugs interferes with

Healing and Recovery

Jane Uitti – Two Chairs

(www.janeuitti.com)

Dialogues and Encounters

Positives of Drug Use

Immediate physical pleasure

(10)

Escape/Feeling more “there”

(10)

Feels more emotion (10)

Reduces social anxiety (6)

Shuts out critic (7)

People will know “real” self (7)

Positives of Change

Feel a greater sense self

discipline (9)

Would be more productive (10)

Help him be more comfortable

with self (8)

Greater confidence (6)

Negatives of Drug Use

Feels guilty (7)

Others are concerned (6)

Not as productive (10)

Feels like it a crutch (10)

Feels bad (7)

Health Problems (7)

Negatives of Change

Would not enjoy life as much (9)

Would be ignoring a part of

himself (10)

Breaking up with something he

loves – a hard breakup (9)

Decisional Balance

Basic Motivational Dialogue

Desire to

Stop, Reduce, Or

Change The Pattern

Desire to

Continue Using

Substances

Strategic Guidelines

http://revolutionarydesire.files.wordpress.com/2010/01/11.jpg?w=223&h=300

Strategic Guidelines

“Superego-Based Change says: “I should…”;

however,

“Ego-Based” Change says: “I want…”

Patients heal and recover by:

Strengthening the part that wants to change

Not by persuading the part that wants to use

to desire recovery

Desire Engages with Desire

Diana Calvario

scott.kellogg@nyu.edu

http://gradualismandaddiction.org/

http://transformationalchairwork.com/