Monthly Archives: October 2010

Whitaker on “Social Therapy”

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I’m reading Whitaker and Malone’s 1951 book The Roots of Psychotherapy, an early attempt at a general theory of therapy. Whitaker was a psychiatrist who started working with families in the very early days of the family therapy field. It’s a good book, though not an easy read.

My favorite of his ideas so far is that of the social therapist. He says that since everyone has troubles, and everyone has some capacity to help others through troubles, everyone is a potential “patient” (therapists still called their clients “patients” back then), everyone is a potential “social therapist,” and every interaction between people has the potential to be therapeutic.

What causes a potential “patient” to become an actual “patient,” and go ask a professional therapist for help is a failure of that person’s social-therapy community to help with their troubles. That, and the “patient’s” overcoming their own fear of change and their fear of the stigma our culture places on getting therapy.

Whitaker also tackles the sticky question, “What is a cured patient?” and concludes, “In short, the patient gets access to other human beings and, incidentally, enters the community as an adequate social therapist, no longer so concerned with himself that he cannot get and give therapy to others in a social setting.” (p. 79)

[First published on Nathen’s Miraculous Escape, October 30, 2010.]

Five Fears About Emotions

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I’m studying Emotionally Focused Couples Therapy, or EFT, this term in my Couples and Family Therapy master’s program. In her book for therapists, Susan Johnson writes that many people, especially those with histories of trauma, have strong fears about expressing strong emotions. She gives five common examples. These are directly quoted from her book, Emotionally Focused Couples Therapy, p. 73:

We may fear that if emotions are unleashed, they will go on forever.

We may fear that we will be taken over by such emotions and our ability to organize our experience, our very sense of self, will disappear.

We fear that we will lose control and be slaves to the impulses inherent in these emotions, and so we may make things worse or actively harm ourselves or others.

We fear we will not be able to tolerate these emotions and will go “crazy.”

We fear that if we express certain emotions, others will see us as strange and/or unacceptable.

[First published on Nathen’s Miraculous Escape, October 22, 2010.]

Diagnostic Criteria for Substance Abuse and Dependence

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I’m taking a class called Contemporary Issues in Addiction. One of the things we’re learning about is how different clinicians think about addiction. Here are the official diagnostic criteria for substance abuse and dependence, word-for-word from the DSM-IV-TR:

Criteria for Substance Abuse

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) withdrawal, as manifested by either of the following:

(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

(b) the same (or a closely related substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance of withdrawal (i.e., either Item 1 or 2 is present)

Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)

Course specifiers (see text [below] for definitions)

Early Full Remission

Early Partial Remission

Sustained Full Remission

Sustained Partial Remission

On Agonist Therapy

In a Controlled Environment

Here are those definitions, from pp. 196-7:

Early Full Remission. This specifier is used it, for at least 1 month, but for less than 12 months, no criteria for Dependence or Abuse have been met.

Early Partial Remission. This specifier is used it, for at least 1 month, but less than 12 months, one or more criteria for Dependence or Abuse have been met (but the full criteria for Dependence have not been met).

Sustained Full Remission. This specifier is used if none of the criteria for Dependence of Abuse have been met at any time during a period of 12 months or longer.

Sustained Partial Remission. This specifier is used if full criteria for Dependence have not been met for a period of 12 months or longer; however, one or more criteria for Dependence or Abuse have been met.

On Agonist Therapy. This specifier is used if the individual is on a prescribed agonist medication such as methadone and no criteria for Dependence or Abuse have been met for that class of medication for at least the past month (except tolerance to, or withdrawal from, the agonist). This category also applies to those being treated for Dependence using a partial agonist or an agonist/antagonist.

In a Controlled Environment. This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance-free jails, therapeutic communities, or locked hospital units.

[Post first published on Nathen’s Miraculous Escape, October 4, 2010.]

“Gaming”

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This quote came after a shocking first-person description of what it’s like to work at a casino, mostly ripping off the Social Security and pensions of elderly folks with gambling problems:

“In this politically correct decade, the most horrific politically correct term ever created is the one that the gambling industry has made into an everyday word: Gaming. There is no game here. You pay and you lose; that is the game.”

–Addiction Treatment, Van Wormer & Davis, p. 7

[First published on Nathen’s Miraculous Escape, October 20, 2010.]