Here is my approach to addiction treatment based on years of personal development, intensive psychotherapy training and extensive work with out-of-control sexual behaviors, as well as substance use issues. Simply put, I work to understand the problem from a person’s experience, develop a collaborative relationship and co-create an individualized treatment plan. I then use a variety of therapeutic skills, concepts and tactics to achieve the desired goals, relying on client feedback to the only question that matters: is the problem getting resolved? Here’s a preview of what to expect.
The first step in any therapy is to identify and assess the problem. Two useful questions to determine if there's a problem are:
Have you made repeated efforts to stop or modify your use without success?
Are you continuing to engage in the behavior despite negative consequences?
This can then lay the groundwork for exploring what kind of attempts have been made to address the problem. What kind of attempts failed and why? But in addition to finding out what hasn’t worked, I want to identify experiences of success and build on them. What, if anything, has helped in the past? If so, how? We want to pay careful attention to exceptions to the rule and learn from successes even if they appear small.
Traditional treatment approaches emphasize abstinence-only goals and use confrontational techniques to achieve those goals. Because I consider myself a harm-reduction therapist, I take a collaborative approach to identifying goals. For some people, that may involve trying to quit drinking or drugging completely. For others, that might mean learning to moderate their use. Some people want to stop looking at porn and others just want to learn how to do it less. What the actual goal is not as important to me. What’s important is that I respect clients’ autonomy and customize treatment to support them in reaching their stated goals.
Each client is unique. So this means that every intervention will be unique. But in general I use a psychotherapy approach that utilizes techniques from experiential dynamic therapies, motivational enhancement, cognitive-behavioral therapy, mindfulness and hard-won lessons I've acquired from working with people struggling with porn, sex and substances over the years. Frequently used interventions include: assigning homework to develop one’s capacity to respond rather than react to difficult emotions, deconstructing recent slips to incorporate important lessons moving forward, assigning reading or videos to improve one’s understanding of the problem, increasing awareness and acceptance of one's various self-states, brainstorming how to get one’s needs met in healthier ways, highlighting the role of one’s particular environment (time of day, situational cues, etc.), developing a deeper shared understanding of the problem, and facilitating access to blocked emotions to gain mastery over one's inner life.
The Client's Role
Unfortunately, therapists don't often spell out what clients are supposed to do, resulting in unnecessary confusion. What I expect from clients is simple, but not easy. Probably the most important thing I expect from clients is to say in the moment whatever they’re thinking or feeling. Adam Phillips wrote, “…talking is different to thinking; and surprising oneself in the presence of another person is of value.” Although this seems pretty straightforward, saying what one is thinking and feeling (especially about one’s therapist) without self-editing is a skill that is developed over time. But talking without censorship illuminates unconscious parts of ourselves, give us an opportunity to get to know these parts and ultimately leads to greater self-acceptance: perhaps the most profound goal of therapy itself.
Second, it’s necessary to do the homework. Although emotions can be viewed as the engine of our behavior, it is our cognitions that steer the car. Homework helps raise awareness of and distinguish between helpful and unhelpful cognitions that guide our behavior. It is also a useful to way to apply what's learned in psychotherapy to one’s actual life. Understanding the nature, function and meaning of a problem is a necessary, but not sufficient requirement for change. Actually putting this understanding to work so that it results in behavior change is the name of the game.
Length of Treatment
Honestly, it depends on each person. Sometimes the enormous relief of finally getting to talk to someone about secretive behavior in that first session is all that's needed to change course. For the vast majority, it takes longer. But my goal is to help clients resolve their problem as soon as possible. I really have no interest in making the treatment longer than it needs to be. In my experience, it can take anywhere from one session, to six months, to one to two years and everything in between. Frankly, it also depends on how hard clients work. The more clients roll up their sleeves, face uncomfortable feelings, and try something different, the faster it tends to go.
In some cases, if financially viable, meeting multiple times a week can speed up the process considerably. Why is this the case? Because when clients meet with me multiple times a week, there is less “catching up” to do, which enables us to build exponentially on the previous session. In the end, Nick Cummings and Mike Sayama in their book Focused Psychotherapy sum up my view nicely: "Our contract with the patient should be: I shall never abandon you as long as you need me, and I shall never ask you to do anything until you’re ready. In return for this, you’ll be joining me in a partnership to make me obsolete as soon as possible.”