Does Talk Therapy Work for Everyone in Addiction Recovery?
“Talk Therapy Isn’t Working” … Truth or Misconception?
For clients receiving treatment for addiction, one-on-one sessions with a therapist can be extremely valuable in helping them get in touch with and understand the underlying feelings and motivations that drove them to drink or use drugs. Clients coming into residential drug treatment have been self-medicating and numbing their feelings for differing lengths of time. Clients may experience challenges at the beginning of treatment as a result of beginning to feel their feelings for the first time in a long time. It’s uncomfortable. Individuals struggling with addiction are challenged with how to feel uncomfortable without turning to substances.
Facing memories and feelings that had previously been numbed or suppressed through substance abuse can be tough, prompting some clients to make the statement that “talk therapy isn’t working for me,” or possibly stating “I feel worse.”
Each individual’s perception of “worse” is subjective, of course. Clients can decompensate at different times in the therapeutic process for different reasons. As a therapist, I come from a person-centered perspective, meaning that I meet the client where they’re at. I encourage their progress, but never push them to keep going if it causes them to feel unsafe in the client-therapist relationship.
Creating a Safe Environment
One technique I teach clients who are newly sober is “I.C.E.” This stands for Identifying feelings; Clarifying feelings; Expressing feelings. This process aids in managing the new feelings that come up. I encourage clients to journal their feelings, and remind them that it’s normal for their initial feelings to be negative. It’s especially important to honor and process those feelings.
Difficult memories are also important to process when the time is right, which simply means when the client feels ready. Creating a non-judgmental, empathetic therapeutic environment allows clients to bring shameful, deeply painful and uncomfortable memories into the room.
“When Should I Start Feeling Better?” Helping Clients Manage Their Expectations
I try not to use the word “should” in my work with clients. It sets up unrealistic expectations. There is no magic timeframe for when a client should expect to start feeling better. This kind of therapy is more about working collaboratively with the client to set manageable short-term goals, as well as longer term goals, and adjusting interventions when a client is feeling like they aren’t making progress. Just like “worse” is subjective, so is “feeling better.”
A client can have a week where they are feeling more optimistic and hopeful, and then something may happen the following week that causes them to feel sad, hopeless or angry. The goal is to be able to identify the feelings, explore the source or trigger for those feelings, and process them as they come up. In residential addiction treatment we teach clients to use healthy coping skills such as journaling, reaching out to others and mindfulness, among other tools.
Alternative Therapy Options
Working through difficult memories and feelings is an important part of the therapeutic process. Throughout the process the therapist and client should always be assessing the progress the client is making. Ideally, the therapist-client relationship is a collaborative one. For example, once a client and therapist have established a therapeutic bond and the client feels safe, thoughts and feelings may come up surrounding past traumatic events. They may decide together that a general “talk therapy” format does not adequately address the trauma.
If a client and I mutually agree that an alternative type of therapy might be needed, I might refer them to another professional; for example, a trained trauma therapist who uses specific protocols for processing traumatic memories. It’s important for therapists to have many “tools” in their respective “toolboxes.”
I utilize an eclectic group of therapeutic modalities so I can adjust approaches as needed, whether it’s cognitive behavioral therapy, dialectical behavior therapy or a narrative approach, for example. I also wouldn’t hesitate to refer a client to an art or music therapist if that approach might be helpful.
Checking in with Clients at Each Step of the Therapy Process
At Promises treatment center in Malibu, I meet with my clients three times weekly. At the start of each therapy session I assess the client employing the Subjective Units of Distress Scale, or SUDS, asking the client where their particular symptoms (e.g., anxiety, depression, anger, distress) are on a scale from 1 to 10. This “checking in” system helps me understand how a client is progressing through therapy, or where they are in the process. Checking in helps me determine how well therapy is “working” for them at each step, and what adjustments we can make.