Recovery Therapies

One-to-One – Therapeutic Relationships

Relationships are important. They can enrich our lives, give meaning to our existence and bring us both joy and pain. Sometimes they go wrong and we may not understand why.

When we embark on recovery we have the opportunity to reflect on our relationships in a different way. This is where therapeutic relationships can be most useful.

What is a therapeutic relationship?

It is a relationship with a specific focus on helping you to understand yourself, to recognise what you need to change and provide you with the opportunity to put those changes into practice.

Usually it will be with a therapist or other healthcare professional.

In a therapeutic relationship you can rely on the other person to be focussed on your needs. You will not have to worry about them. Their priority will be to help you have a different experience of relationships where you can be authentic. It may be that you need help to understand what that means.

What does this mean in practise?

It certainly doesn’t mean that they will simply agree with everything you say or avoid commenting on your attitudes and behaviours that may be self-defeating or self-destructive. However, they will address these issues with compassion, sensitivity and empathy.

Because the relationship is with a professional who is bound by a strict ethical code of conduct you can safely place your trust in them. They will have the necessary support to ensure that they can provide you with what is needed.

Although this is a very different kind of relationship, what you learn about yourself will have the potential to be carried into your relationships outside of the therapeutic setting in your everyday life.

For the therapeutic relationship to be effective you will need to be willing to participate and take responsibility for your thoughts and behaviours.

If you can do this there is much to be gained.

Art Therapy – Creativity of Recovery

Creativity is an important part of recovery. You could say that recovery is itself a creative process, taking us from the rigid and circular patterns of addiction into the potential of the unknown.

As with the creation of a piece of art or music we may draw on our past experience to create a framework but ultimately we are making something new that has not existed before.

Recovery is about change and it requires that we do things differently.

Think about what is involved in creating a piece of artwork or creative writing. The blank page or canvas can invoke feelings of anxiety or fear about not knowing exactly what the process will involve and how things will turn out.

This is an intrinsic part of creativity and tolerating these feelings is the price we must pay in order to access the benefits.

We will need to move away from the familiar, letting go of our preconceptions and embracing our fears and anxieties. For us to be successful in making something new we will need courage, imagination and commitment.

Where do we start?

In treatment we can engage in creative activities such as art therapy and creative writing. These enable us to access thoughts and feelings which otherwise may remain out of our awareness.

The creative process can be a liberating experience of exploration and discovery and being able to reflect on what we have created allows us to gain new insight and understanding.

The process of creative thinking can be incorporated into our recovery, our relationships and our wider approach to life. It can help us to solve problems, seize new opportunities and become who we want to be.

Being able to use our imagination and vision in this way can take us closer to achieving our aims and feeling good about who we are.

If we are willing to take the risks inherent in being creative we will open ourselves to a world of hope and opportunity.

Group therapy

Anyone considering group therapy will want to know what it has to offer and how it can enhance recovery. However, it is not unusual to feel anxious about engaging with group. Trepidation, or even fear, can be viewed as the “normal” response to participating in an activity with the potential for us to feel exposed within a group of strangers. It may be tempting to dismiss group as merely a talking shop for other people’s distress and whilst it may be reasonable to be sceptical, it is worth thinking about what group therapy has to offer the recovering person.

Addiction

Addiction has a powerfully destructive effect on relationships, changing the way we understand ourselves, the way we relate to others and ultimately, our capacity to experience intimacy. As addiction becomes our most important relationship, our ability to engage with others in an authentic and spontaneous way is curtailed and replaced by an insular and isolated view of our place in the world. We can end up playing out relationships in our head, imagining what others might be thinking and responding to them on that basis. This can leave others feeling confused, rejected and hurt. Ultimately they may become disinterested or rejecting, leaving us feeling isolated and rejected.

Why are relationships important?

We all have a relationship with ourselves, an inner dialogue between different parts or aspects of our self. These can be soothing, encouraging, reassuring and loving but can also be negative, critical, shaming and rejecting.

These internal conversations are shaped by our early experience of relationships. We receive messages from others about who we are and who we should be. The distance between these views can be the source of self-doubt and emotional pain. Feeling that we are somehow not what we should be can become the base from which we relate to others. It can be difficult to maintain healthy relationships from this position.

As addiction is established and our relationships become more dysfunctional, we are more likely to want to hide our perceived inadequacies from others.

We arrive at a place where it may feel too risky to reveal our authentic self and we may attempt to construct a false self, one that we think more acceptable or attractive to others. Over time we may become adept and successful at projecting this false self. However, the more successful we are and the more convincing it is to others, the more we are trapped into maintaining the façade, feeling anxious about being exposed as inadequate, weak or un-loveable.

Why are relationships in recovery important?

Addiction corrupts the relationship we have with ourselves, replacing self-honesty with self-delusion. It is not to be trusted, for it will always serve it’s own purpose rather than what is best for us. Its message is extremely seductive and powerful, promising a way of avoiding all that we find difficult or painful in relationships. Like our most trusted and reliable confidante, we come to rely on its direction and guidance.

But addiction is self-serving and does not have our best interests at heart. What we need are relationships with others who understand how addiction works and with whom we can be authentic.

How it works

Thankfully it’s quite simple. All that is needed is a willingness to attend and participate in the group sessions. If we can be open and honest with our fellow group members and be respectful of their feedback, all well and good.

However, if we are not comfortable with this we are likely to fall back on our familiar ways of behaving which keep us stuck. This is not a problem because group therapy can help us understand the relationship problems we experience in the “outside world” which have the potential to be recreated within the group.

These are often defensive in nature, intended to keep us safe from what we fear. These defences may have at some time served the purpose of keeping us safe. However, over time they may have lost their effectiveness or relevance and become redundant. In group therapy they can be recognised as self-defeating and self-destructive ways of relating that are no longer effective or necessary. Letting go of a defensive behaviour that doesn’t work is the precursor to being able to have intimate relationships.

“But how can others possibly understand the complexity of my life and all of my relationships?”

There are two answers to this question.

One is that regardless of our differences, there are common aspects of being human that we all share. We have all experienced emotional pain, have dreams and aspirations and want to love and be loved (even if we find that difficult to acknowledge).

The other is that as addicts, we are subject to the self-delusion that addiction brings and in recovery we need to trust others who understand the problem.

Group therapy offers a dynamic opportunity to identify and change the way we are in relationships. We can find a way to be authentic, without the need for a false self, able to remove the obstacles keeping us from achieving our goal of a satisfying and sustainable recovery.

The transformational power of group therapy lies in the experience. It may be tempting to view group as separate from “real life” that is not relevant to what we face in the outside world. The reality is that it is likely to be the most “real” experience of relating to others that we have had in a long time, if ever.

What we are able to learn in group therapy is available for us to use in recovery, in all our relationships beyond the group.

12-Step Recovery from Addiction

It is likely that you will have heard something about the 12 Steps, the 12- Step programme or the 12-Step meetings of Alcoholics Anonymous or Narcotics Anonymous or perhaps many of the other anonymous fellowships.

It may have been through your own experience, media articles, references made to it in films, television programmes or from personal contact with someone in recovery.

Some of it may have been positive, some of it not.

Or you may know little or nothing about it.

The aim of this overview is to provide you with some information that will help you to evaluate (or re-evaluate) the potential benefits for you of a 12- Step approach to recovery.

Background

The principles of self-help, mutual aid and recovery from addiction formed the basis of the 12-Step recovery programme developed by the originators of Alcoholics Anonymous (AA) in 1930’s America.

In the intervening years it has spawned a worldwide fellowship of men and women, with over two million members, whose shared aim is to support each other in maintaining recovery.

Starting with the idea of one addict helping another addict, it grew into a network of support for those seeking sustainable recovery.

The 12 Step programme of Alcoholics Anonymous has been further developed to address addiction in its many and varied forms, leading to the creation of many other fellowships focussing on different substances and addictive behaviours.

Although from a wide variety of backgrounds, they are a collection of like-minded people with the common aim and commitment of recovering from addiction. Their aim is to be collectively more powerful than addiction.

Here is an overview of the 12-Step approach to recovery from addiction and some of its guiding principles.

Anonymity

Members use only their first names and there is no record of who attends fellowship meetings. This provides a safe environment, where members can be confident that who they are and what they may reveal remains confidential. It can also help to reduce the stigma and feelings of shame associated with suffering from addiction.

Another important aspect of anonymity is the idea that irrespective of status or position in the world, in the fellowship everyone is equal.

Whether you come from the highest echelons of society or from the lowest of positions, everyone has an equal right to be there and an equal responsibility to participate and contribute to the process.

Abstinence

The idea of abstinence from all addictive activity is central to the 12-Step approach. It is based on the experience of addicted people finding themselves unable to control their use of substances or behaviours; often when attempts to try “controlled use” following a period of abstinence lead to relapse.

For those who have lost control, abstinence is probably the only viable option. In 12-Step recovery, addiction is not seen as “cured” or “removed” but an ever present risk.

Relapse is a very real threat for addicts without a strategy for sustaining recovery.

Higher Power

Recovery is about finding a way to live without the need for addictive behaviour and the experience of the 12-Step fellowships is that it cannot be achieved alone. This is linked to the idea of needing help from outside of oneself. That is what is meant by a “higher power”.

Some of the 12 Steps and related texts specifically refer to this higher power as “God”. It is acknowledged in the fellowships that this was very much a reflection of the context in which the programme was created in 1930’s America.

Nowadays it is widely accepted that each member finds their own personal interpretation of their higher power.

For some it may be God but for others it will be however they wish to conceptualise a benign power that has their best interests at heart. For many this power lies in the collective membership and wisdom of the fellowship.

Fellowship meetings

There are thousands of regular 12-Step meetings around the world. They are free, with the only requirement for attendance being a desire to stop drinking, using or acting out addictively.

The primary aim of these meetings is to provide support and guidance for those addicted people seeking recovery.

The meetings will differ in format; sometimes focussing on specific steps or themes or involving a speaker talking about recovery. However, there will always be time allocated for members to talk and hear others.

It is important for those members who have already established recovery to be able to help newcomers and to share their experience of being able to overcome challenges and problems without resorting to addictive behaviour. It offers a valuable way of staying in touch with the reality of addiction and its consequences, guarding against complacency and the danger of relapse.

Whilst initially for the newcomer it may be about receiving help and support, in time they will be also able to offer their help and support to others.

For many addicts who enter recovery with low levels of self-esteem, feeling that they have nothing to offer, this opportunity to help others can be the source of new feelings of being useful and worthwhile, and assisting in building self-esteem.

Evidence shows that being connected with others who are supportive of recovery increases the likelihood of success.

In addition to attendance at scheduled fellowship meetings there is an opportunity to build a supportive social network with other members. This can be invaluable for those who have been isolated or whose social network is not supportive of recovery.

Sponsorship

The fellowships have devised a system of individual support and guidance through sponsorship. This involves an established member with a significant period of recovery making themselves available as a resource to newer members outside of formal meetings. This will involve helping them with day-to-day problems and to guide them through the individual steps of the programme.

The 12 Steps

The steps are designed to address all aspects of addiction and to support the recovery process.

Steps one and two are focussed on recognising the power of addiction, understanding it’s impact on oneself and others and recognising the need for help.

Step three is about being able to let go of control and utilise help from outside of oneself.

Steps four, five, six and seven are about fully understanding who you are, freeing yourself from negative thoughts and behaviours and embracing and utilising your strengths.

Steps eight and nine are about recognising how you may have harmed others and where appropriate making amends.

Steps ten and eleven are about maintaining the work of the programme on a daily basis and developing a spiritual approach to life.

Step twelve is about being able to pass on what you have learned to others seeking recovery.

A second part of this document offers the presentation of the steps in more up-to-date language.

Families

We have characterised addiction as an all-consuming relationship with a substance or behaviour that is driven by a conscious or unconscious urge to feel something different which becomes self-perpetuating despite a range of harmful consequences.

It is clear that you do not have to be addicted to a substance or behaviour to suffer from addiction.

As a family or family member you can find yourself in a similarly consuming relationship. This too is based on an urge to experience something different. In this case it is to be achieved by somehow getting the addicted person to change; to stop their addictive behaviour and therefore all the harm associated with it.

Families can live on what has been called “hopium”; the belief that they can find that one thing which will bring about change in the other.

As with an addiction to a substance or behaviour life can begin to reduce to obsessive, consuming preoccupation with what is happening with the addicted person. This is a struggle. It is the family version of trying to control the uncontrollable.

Families come to feel disempowered but rather than facing up to this and what it means, very often the struggle is intensified. This may be borne of desperation – understandable in many ways given the nature of addiction and its potential fatality.

Families and family members experience chronic stress with a measurable effect on their psychological and physical health.

They may experience anxiety, depression, emotional volatility and low self-esteem. They may experience a loss of mental capacity, be distracted and be involved in conflict. There may be physical manifestations such as aches and pains, nervous tension, energy loss, stomach upset, injuries and the immune system may be compromised.

Families and family members find ways of coping either as individuals or as a system. Very often the ways of coping are counterproductive. Addiction becomes the organising dynamic, re-setting and determining the norms of behaviour within the family.

“Coping” may include denial, cover up and even collusion. Families can experience shame much as the addicted person especially given the hold that stigma still has over addiction in the public mind. It may also include twisting out of shape to accommodate the demands of addiction with an increasing inattention to the family’s own needs, individually and collectively.

At Clinic Les Alpes we recognise the needs of families and individual family members. They will have an important part to play in the treatment of their family member and, subject to the agreement of the patient, will be invited to participate in the treatment process. This will include Family Conferences where the members of the family get a chance to explore and understand how addiction has emerged and taken hold and how they might help each other and the family system as a whole to recover.

Also we recognise the need for families and family members to be offered help in their own right rather than simply in relation to the patient with the addiction. It is usually the case that so much focus has been placed on the family member with the addiction and often in a counterproductive way that the needs of others become neglected. They suffer as a consequence. We help them to retrieve and recover themselves from addiction, restoring their health and wellbeing in the process.

Clinic Les Alpes has a Family Therapist available to the family members and the Clinic offers a specially designed six or ten day programme for family members, including a residential option.

Interestingly when family members begin to turn their attention to looking after themselves, the addicted person often benefits. They may find the space they need to take responsibility for their own recovery.