Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in...

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Toward a Humanistic Addiction Psychotherapy Scott Kellogg, PhD Diana Calvario

Transcript of Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in...

Page 1: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Toward a Humanistic

Addiction Psychotherapy

Scott Kellogg, PhD

Diana Calvario

Page 2: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Mechanisms of Change

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Leonardo Da Vinci

Page 3: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Drug Use is Meaningful

Page 4: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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)

Page 5: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Multiplicity of Self

Dancing of the Selves

By Brenda Clews

Page 6: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Id, Ego, and Superego

Page 7: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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Page 8: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Schema Mode Therapy

Page 9: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 10: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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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http://ideaswar.com/wp-content/uploads/2012/05/Goals.jpg

Page 12: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Greater Internal Freedom

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Freedom

By Louis Parsons

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Increased Personal Complexity

13

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Page 14: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Gradualism

Crossing

Infinity

Diana

Calvario

Page 15: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Gradualism

Embrace and Work with Complexity

Harm Reduction as a Method

Not a Goal in Itself

Small Steps

Page 16: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Substance Use Goals

Page 17: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Short-Term

Monitoring Use

Harm Reduction

Moderation

Cessation

Page 18: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Long-Term

Abstinence

Moderation

“Non-addictive” Use

Page 19: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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/

Page 20: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Therapeutic Relationship

Page 21: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Therapeutic Relationship

Love

Empathic Listening

Authenticity and Optimism

Courage and Determination

Page 22: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Heroic Self

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Margaret Mark and Carol Pearson

Page 23: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 24: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 25: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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”

Page 26: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Horizontal and Vertical

Interventions

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Page 27: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 28: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Horizontal Interventions

Page 29: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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Decisional Balance

Page 30: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 31: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 32: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Relapse Prevention

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Page 33: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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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

Page 34: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Substance-Use Management

34

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Page 35: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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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

Page 36: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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)

Page 37: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Contingency Management

Page 38: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Contingency Management

Uses positive reinforcement principles to:

Improve retention

Decrease substance use

Encourage harm-reducing and recovery-

related behaviors

Page 39: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 40: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Vertical Interventions

Page 41: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Anthony Papa

“The Heart of Addictive Disorders is Suffering”

– Edward J. Khantzian, MD

Page 42: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Healing the Past

Page 43: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Grief and Loss

43http://www.southbaytreatment.com/wp-content/uploads/2011/03/grief-pic-1.jpg

Page 44: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Interpersonal Trauma

44

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Page 45: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Claiming the Present

Page 46: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Inner Critic

Your Harsh Inner

Critic…

Methanie Dempsay Binder

Page 47: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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Page 48: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Creating the Future

Page 49: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Voice Work/Assertiveness

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

Helping Patients Develop and Strengthen their

Voice of Respectful Desire

Page 50: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 51: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 52: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Identity Theory

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The Case of N

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Page 54: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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)

Page 55: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Identities are a Way for the

Heroic Self to Create a New

Future

Page 56: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

The War on Drugs interferes with Identity Creation;

Therefore the War on Drugs interferes with

Healing and Recovery

Page 57: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Jane Uitti – Two Chairs

(www.janeuitti.com)

Dialogues and Encounters

Page 58: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 59: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Basic Motivational Dialogue

Desire to

Stop, Reduce, Or

Change The Pattern

Desire to

Continue Using

Substances

Page 60: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Strategic Guidelines

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Page 61: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

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

Page 62: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

Diana Calvario

Page 63: Integrative Addiction Psychotherapy€¦ · Drug Use is Meaningful People use substances in problematic ways for a range of reasons Reasons that need to be respected In many cases,

[email protected]

http://gradualismandaddiction.org/

http://transformationalchairwork.com/