The Psychological View
This view of recovery states that addiction is only a symptom of an underlying psychological disorder. In the years since the development of psychoanalysis, many psychological theories have been formed and promoted, each with its own view of the nature of the psychological causes of addictions. The theories range from Freud’s assertion that the alcoholic is expressing latent homosexual tendencies, to the Family Systems Theory concept of the addict as an actor of a role in a dysfunctional family system. Many of these theories, as they have each come into fashion, have had some impact on the Twelve Steps.
Currently, the psychological agreement seems to be that the addict is someone who uses to cope with some kind of pain. This pain might be the result of early child hood trauma, sexual abuse, a dysfunctional family system, low self-esteem, etc. The pain could also be produced by an existing mental disorder, such as Post Traumatic Stress, Bipolar Disorder, Schizophrenia, depression, etc. Addicts of this second kind are called “dual diagnosis,” because they are diagnosed with their mental disorder and addiction. Because addicts are seen as using to cope with pain, addiction is sometimes called “self-medicating.”
Recovery in the Psychological View is the process by which an addict learns appropriate methods of self-care. Treatment focuses on treating the source of the addict’s pain, and teaching the addict new ways to cope with pain. There is much talk about “feeling feelings,” and overcoming fears and shame. Sobriety is seen as a time of self-discovery, because feelings surface that were suppressed by using. Because most of these feelings are uncomfortable, the Psychological View attempts to help people in recovery to manage life while processing difficult emotions. Often, addicts are encouraged to use self-affirmations to build a positive self-image and increase self-esteem. Recovering people are instructed in the basics of self-care: hygiene, nutrition, sleep, and healthy social interaction. Sometimes, the word “H.A.L.T.” is used to remind people in recovery to stop and take care of themselves when they feel “Hungry, Angry, Lonely, or Tired.” The Psychological View encourages proper medication for people who have a dual diagnosis, and regular talk therapy, with emphasis on processing the pain of childhood and difficult personal relationships.
Working the Twelve Steps is not central to the Psychological View of recovery. When the Steps are worked in this View, they tend to be an extension of the type of therapy mentioned above. One realizes one’s powerlessness and turns one’s life over to professional treatment. Inventory is usually “balanced,” meaning that for every negative aspect of self, there is a positive one as well. Inventory also tends to explore things like family dynamics, early child hood trauma, instances where the recovering person feels that he/she has been victimized, etc. Amends are not emphasized in the Psychological View. In fact, most Twelve-Step rehabs will only utilize the first five Steps. Twelfth Step work is almost non-existent in the Psychological View, as professional treatment is seen as filling the role of ‘sponsor.’
Meetings in this View are seen as important to the recovery process. The Psychological View understands meetings in nearly the same manner as does the Re-Socialization View. For the Psychological View, meetings are important not for mutual-aid as much as for group therapy. The emphasis is not on “we help one another out,” but “we each get our turn to process feelings.” Often, addicts exiting treatment will be instructed to attend “90 meetings in 90 days,” and meeting attendance is often part of the routine at rehab. However, in many cases, the Psychological View feels that meeting attendance is not enough for the recovering person. Regular visits to a councilor are encouraged.
The Psychological View’s expectations for recovering people are equal to or less than those of the Re-Socialization View. Addicts are expected to struggle greatly with mental obsession and difficult feelings for the rest of their lives. One figure in the Psychological View, Terrence Gorski, has defined what he calls Post Acute Withdrawal Syndrome. PAWS predicts that people in recovery will not be able to get better through meeting attendance and Stepwork. Instead, the addict needs to see a PAWS trained therapist, or they will have severe symptoms of Post Acute Withdrawal Syndrome that will likely cause them to relapse. These symptoms can never be eliminated, only managed.
Stories of people recovering in the Psychological View often reflect their experiences in therapy. They speak of learning to feel their feelings, coming to grips with early childhood trauma, becoming better at taking care of themselves, or similar topics. Sometimes stories will include mention of Stepwork, but it is usually clear that this is Psychological and not Conversion Experience style Stepwork. Stories include much Psychological language, and will often focus on the emotional accomplishments of the speaker. The process of self-discovery and learning to love oneself feature strongly in Psychological View stories.
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