Category: Psychotherapy

What’s the matter? (Diagnosis)

Based on persistent distress and so on, people ask about themselves or others ‘What’s the matter?’

Over the past 31 years (that is, since the 1980 publication of the American Psychiatric Association’s third edition of its Diagnostic and Statistical Manual, the DSM for short), American psychiatry has trained not only the mental health industry but also the public at large to think and speak in the language of DSM disorder categories. Read more

Addiction as a Marker of the problem

The title refers to a perennial disagreement among people who treat addictions of all sorts, namely whether to think of addiction (to alcohol or sex or anything else) as the problem (disease, disorder’) itself, or whether to think of addiction as one sign (and not the only one) of a problem that actually generates the addiction (as well as other signs, if one looks carefully).
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What Stands Out about Addicts

First the usual caveat about ‘addiction’: It does not lend itself to precise definition. It is really is a term indicating use (substance or activity) on the part of someone that has come to stand out to others or the user him/herself as damaging well-being and which resists efforts to eliminate or modulate. It is consequential for treatment if the person using does not really (as opposed to lip service) see his/her use as ‘over the line’ in terms of self-harm.
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Why is Change so Difficult?

Perhaps therapists see a biased sample. Perhaps there are people who recognize a need to change something important about the way they live and execute change in a timely manner. But I must admit that what stands out to me as a therapist as well as through informal (non-therapy) relationships is how hard most people find it to change any well-entrenched aspect of how they face the world or live in the world day to day, regardless of how desirable it might seem to let us say ‘upgrade’ how they go about living life. Read more

The Importance of Desire for Change and Therapy

The issue of how therapy can help a person move away from excessive, self-harming use of a substance or activity cannot be discussed meaningfully without attention to the actual intention of the person entering therapy. To use learning a foreign language as an adult as a useful analogy, if the person being instructed does not actually want to learn the language and does not make a real effort to pay attention, concentrate, study, practice, etc., he/she is unlikely to benefit much from instruction. The degree to which the person genuinely opens to the subject matter and the instruction cannot realistically be overlooked (I draw upon my own foreign language instruction experience in high school and college, in which I engaged minimally, resentfully, and inattentively, with predictable results).

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How Does Change Occur in Psychotherapy?

I think it will be helpful to me and to prospective and beginning clients to try to provide an overview of how I think about …

Make-Believe in the Addiction Treatment Industry

Therapists shouldn’t be in the business of make-believe. There is a great deal of make-believe in the addiction treatment …

Magical Thinking About Drinking

Most of the people I see who have serious drinking problems express the hope that they can over time acquire the ability …