This book is based on the experience the authors had
while working with heroin addicts during the years 1983-1990. It is also
based on experience with other types of addictions we dealt with in our
clinical work and as supervisors. The book consists of thoughts, ideas,
perspectives and techniques that we found useful when treating different
kinds of addictions in out-patient treatment (alcohol, drugs, food,
gambling etc.).
The book deals very much with client's lives outside of
the "addiction", and their relationships with family and friends
and in what ways these people can be helpful to the addict so that he can
do other things than use drugs.
For us and the colleagues we worked with, this way of
seeing people, the techniques and the way of working has been very useful
in our work with other types of addictions, in marital therapy, in general
psychiatry and in child and adolescent psychiatry, and also in our work
when it is connected to the social welfare system.
The book is for you who work in an out-patient setting,
which essentially means that you work with clients who live somewhere else
than at your workplace. You work either in an out-patient drug-treatment center, psychiatry, social welfare system, the church, the penitentiary
system or in a number of other contexts.
We have limited experience in using this way of
thinking in in-patient-settings. Others have successfully used it in
in-patient and day-units and have found what is presented here to be
extremely useful. We recommend that the model should be tried in many
different settings. If it works, it will be noticed quickly. If it doesn't
work - do something different.
One shortcoming of this approach is that it makes it
impossible to diagnose people and human systems outside the therapy room.
Therapists working this way do not gather information concerning symptoms,
pathology or family structure in a systematic way. This may lead to
problems for therapists in their contact with systems where information
about pathology and diagnosis are important, like courts, mental hospitals
etc.
The information gathered deals with:
- What the "therapeutic system" looks like
- The ressources people
— have — have had,
or — will have in the future
- Ideas about what life will be when the problem is
no longer there
- What needs to be done by whom, for the problem to
no longer exist.
The approach is easy to learn but difficult to apply
and it demands a lot of self-discipline.
Clients come to us and tell us about their lives and
situations and we assume that what is told at least in some ways mirrors
what goes on in their life.
We also assume an effect in the opposite direction. It
is not enough that "reality" affects what goes on in therapy. We
also believe that what goes on in therapy has effects on people's reality
outside the therapy-room.
(If you don't believe this, you don't believe that
people influence each others "realities" or at least you don't
believe that therapists can influence the reality of clients and you have
probably chosen the wrong profession, or at least you have chosen the
wrong book to read.)
We believe that there are many different ways to
describe a situation. It is possible to view and describe behaviours and
sequences of behaviour from many possible perspectives and therapists/social
workers/psychoanalysts/family therapists/men and women actively or
passively choose to pay attention to certain things and ignore other. The
choices made by the therapist/listener are important in that these choices
determine the description of "reality" that is made.
It is these choices that make therapists responsible
for the "reality" created in the therapy room, and therefore
also partly responsible for the reality that clients' live outside of the
therapy-room.
Expressed differently we mean that we "co-create"
reality together with our client in the therapy-room and what we construct
together is important because it can determine when and if the client will
develop a solution.
Expressed in another way, we claim that you as a
therapist have a responsibility for what you talk about and how you
participate in creating the client's description of his reality, and
whether it becomes a description that makes it possible to do something
about it or if the client is to continue in the same way as before he came
to you.
Magdalena 26 years old, has
abused amphetamines intravenously since she was 21. For 7 years and
since her mother's death she has an eating disorder problem alternating
between self starvation and bingeing. Using drugs is not a problem for
her. She tells us that her only concern is her being so tired that for
the last 6 years she hasn't been able to hold a job or "do
anything what so ever". Her father blames everything on the
drug problem so in later years she has withdrawn from contact with him
and now sees him only once or twice a week (she used to see him every
day).
It's difficult to talk to her. Her voice is thin, almost inaudible and she uses very few words. 10 minutes into the
interview she mentions that she is energetic the days when she will take
amphetamines. She knows in advance when this will happen. She rises
early, cleans her apartment, buys her groceries, pays her bills,
telephones her father and puts on the answering machine. We go through
these days in great detail and let ourselves become fascinated by the
fact that it is expecting amphetamines that makes her energetic, not the
amphetamines! We joke about how she could arrange so that she would have
energetic days more often. Again and again we come back to the fact that
it is the expectation of amphetamine – a thought – and not the
amphetamines that make her energetic. What is her explanation for this?
She tries but cannot find a reasonable explanation.
We continue to be amazed by how competent she is on these energetic days
when she in no time does things that take other people days or weeks to
accomplish. Can she explain how this idea that she will take
amphetamines in the evening makes her energetic the whole day before?
Couldn't she ask welfare to pay her every day, since these days are
energetic days.
She still cannot explain, but smiles cautiously and
talks a little bit louder and becomes a little more articulate. We talk about
her father and her brother and the rest of her life that has become very
impoverished in the last few years, as she sees it because of her
fatigue, as they see it because of the drugs. Eventually we come back to
our astonishment over what makes her energetic on the days that she will
take amphetamines and that she takes amphetamines on her energetic days.
The feed-back at the end of the session is not
complicated. "Everyone blames the drugs and it is difficult to
disagree with one's family". She immediately answers "They
are the only one I've got" and we nod and continue; "until
we meet next time we want you to pay attention to what goes on in your
life when you have energetic moments".
When she comes back a fortnight later, she has had 11
energetic days in a row, starting when she left the session. The last
three she has again run out of energy. But she has not used any drugs.
Three years later she still had not returned to drugs.
Certain patterns (descriptions that connect events)
will attract our attention and our attention will become part of a pattern
of events that starts to live a life of its own. The description is part
of creating what is described.
Co-operation is one of the primary metaphors we use as
we try to describe what we are doing. Co-operation with the addict, the
family and professional networks.
Co-operation is concrete. Sitting down with the
addict's family, the addict and the professional network and talking about
co-operation is not co-operation. Co-operation is not to say that we shall
co-operate. Co-operating is possible without ever mentioning that it is
what you are doing.
On a concrete level, co-operation means sharing
information, respecting and listening to each other's point of views even
if they are different, and using other people's knowledge.
When meeting with clients, families, and networks we
always assume that everyone is making an effort to co-operate. The clients
and the family-members are making efforts to have a better life or at
least to do the best out of more or less impossible situations and the
professionals are trying to do their job. The responsibility for making
co-operation work consequently falls upon us. As everyone else is always
trying and co-operation is a mutual endeavor, it is we who must make
efforts to find forms of co-operation that fit with the persons we meet
and with their unique situations.
We must listen for and adjust our encounter, and what
we suggest, to the motives people have for coming to us and to the
possibilities that arise from the relationship we develop with them. |
