18 Oct How to Get the Most Out of Psychotherapy in Treatment
Going for treatment to overcome problems with substance abuse or other dependencies involves a number of different phases, one of which usually includes psychotherapy. For many individuals beginning the active treatment stage, this is a big unknown and a process that may fill the person with trepidation. It shouldn’t. In fact, this is the time when you’ll be coming to grips with a great many aspects of your life, past and present, that may have strongly influenced your current substance abuse behavior. Don’t let fear of psychotherapy get in the way of healing. Here’s how to get the most out of psychotherapy in treatment.
Who Needs Psychotherapy, Anyway?
Let’s face it. We’re not the best judge of what’s appropriate for us most of the time, especially when we want to change our behavior relative to abuse of substances or engaging in process addictions (such as compulsive gambling, overwork, compulsive spending, compulsive sex, and so on). Whether it’s abuse or dependence on alcohol, drugs, alcohol and drugs, illicit street or prescription drugs used nonmedically, it’s tough to follow our own counsel. We’re not only frequently wrong, we’re often ill-informed, and we certainly don’t recognize or take heed of warning signs.
In short, we’re clouded by our own set of beliefs, attitudes, and past history of substance abuse. For some individuals entering treatment for long-term addiction to certain drugs (heroin and methamphetamine, for example), their brains have been rewired to such an extent that intensive therapy will be necessary in order to quell the overwhelming urges and learn new behaviors.
Even those with a single substance abuse problem, say it’s alcohol, need therapy to help unravel the underlying causes or contributing factors to continuing use. This is the first step before the bad behavior can be unlearned and healthier behavior substituted.
Who needs psychotherapy, anyway? The answer is that psychotherapy is generally a part of most recognized treatment programs for substance abuse. It’s also one of the most effective aspects of treatment – given the full participation of the patient or client.
How Does Psychotherapy Work?
There’s no great mystery about psychotherapy, which is a general term to cover a number of different treatment modalities. In its simplest form, psychotherapy is talking therapy. A person – you – talks with a psychiatrist on a one-on-one and/or group basis for a certain period of time as recommended in your overall treatment plan.
Sessions are scheduled according to the type of substance abuse or addiction (or co-occurring substance abuse and mental health disorder, multiple disorders, substance abuse and compulsive sexual behavior, and so on), length of time you have been using or engaged in the addictive behavior, any other medical or psychological factors, and a number of other considerations. You may, for example, have an individual therapy session every day, along with a group session. There may be other types of treatment modalities during a week’s time – again, depending on your overall treatment plan and your progress (or lack of) during the course of your treatment.
Speaking of your progress, this is regularly monitored and adjustments are made to your overall treatment plan to either step up efforts in a certain area or move on to cover different aspects of addiction/recovery that you may be ready for.
You will be assigned a primary therapist who will stay with your case until you complete treatment. As for additional treatment modalities, these are other professionals that you may see during the course of your treatment who specialize in those therapeutic techniques.
Types of Psychotherapy Interventions
In addition to psychotherapy, there are also social (psychosocial) strategies for treating drug and alcohol and other dependence. Each offers a different level and type of support to persons who are recovering from dependence on alcohol or drugs and other addictive behavior. Treatments are usually mixed and matched to fit the individual’s needs. Some are resource constrained (patient’s lack of insurance coverage and/or financial ability to pay).
There are four basic types of psychotherapy interventions or agendas. In a broad-based view, here’s what they are and what they attempt to do:
• Supportive – In supportive psychotherapy, the aim is to provide patients with a safe and trustworthy environment where they feel free to discuss various aspects of their lives that may be troublesome or that are holding them back. The role of the therapist is as follows:
o to listen to the patient, and to provide encouragement to him or her to share their feelings and emotions
o to act as an authority or guide, as necessary, outlining things the patient either should be doing or should not be doing
Supportive therapy doesn’t dig into the patient’s past history. Therefore, it is not exploratory psychotherapy. Supportive psychotherapy is most useful for patients who are emotionally and interpersonally fragile. It is also helpful for patients who may become disorganized when they are confronted with stressful memories and situations.
• Exploratory – As the name implies, exploratory psychotherapy aims to help people discover the links between what happened in the past and their current behavior. Such past experience could include trauma, violence, abuse, and many other situations. It should be mentioned that recalling painful past events may prove disorganizing for some patients, and is not recommended for dual-diagnosis patients with psychotic or other severe symptoms. Many individuals can benefit from other types of psychotherapy and don’t need an exhaustive examination of past events – and can heal just fine with coping-based psychotherapy, for example. On the other hand, a form of exploratory psychotherapy called exposure therapy is useful in treating individuals with anxiety and trauma-based disorders. As long as the individual has demonstrated stable sobriety, this type of psychotherapy should not be ruled out.
• Coping-Based Psychotherapy – This type of psychotherapy is focused on the present and in teaching patients practical and specific ways to cope with problems such as anxiety, depression, panic, and substance abuse relapse prevention. The most effective forms of coping-based psychotherapy are those that are evidence-based – that is, they are based on the latest scientific research which shows they work. While there are several forms of Cognitive-Behavioral Therapy (CBT), almost any one of them are highly recommended. Another type of coping-based psychotherapy that is generally part of a treatment program is relapse prevention.
A recently-concluded (2009) interventional study sponsored by the Department of Veterans Affairs (http://clinicaltrials.gov/ct2/show/NCT00108407) compared two types of therapy – integrated CBT and 12-step facilitation therapy – for treatment of dually-diagnosed veterans with major depressive and substance abuse disorders (alcohol, cannabis, and/or stimulant abuse/dependence). The reason for the study is that a great number of adults with substance use disorders also suffer from depression. Although there is a tremendous need for effective programs to treat dual-diagnosis patients, there have been few studies to do so. As part of the study, symptoms and substance use were compared during 24 weeks of the active treatment phase, and one year following the end of active treatment.
• Social Skills/Interpersonal Growth Psychotherapy – Many individuals who are in treatment for substance or other abuse lack effective social or communications skills. Such patients often resort to dealing with emotions in self-destructive ways. They need help learning how to become more socially and emotionally secure in their dealings with others. Social skills and interpersonal and growth psychotherapy usually occurs in a group therapy context. During sessions, patients learn and practice (in the group and amongst themselves) how to communicate with others in healthy ways.
Tips to Help you Get the Most Out of Psychotherapy
There’s no manual to go to that provides a step-by-step approach to dealing with psychotherapy in treatment. The best you can hope for is a schedule of your therapy appointments and a thorough discussion one-on-one with your therapist about the types and purposes of the different treatment modalities that have been recommended for your situation. This doesn’t mean that you can’t benefit from such discussions. On the contrary, it’s only through establishing trust with your therapist that you’ll be able to make great progress.
But you do need some tips or suggestions as to how you can maximize your benefits from psychotherapy. Use what works for you and either modify or discard the others. Perhaps a combination of several will prove the best solution. At least you’ll have something that you can call your own that will help you start fresh in therapy and pave the way for quicker healing.
• Be clear about your goals – As simple as this sounds, it’s amazing how often we throw our purported goals out the window when we encounter something new – especially if we’re fearful about the process and outcomes. To the extent that you can, be clear about your goals. If you’re in treatment for substance abuse, one goal is to overcome your abuse/dependence and learn to live a life that’s healthy and substance free. If you suffer from major depression, are anxious, unable to function with others, unable to follow-through on your commitments and job or household responsibilities, mention these specific goals during your first meeting with your therapist. This is the getting-to-know-each-other meeting, and it’s critically important that you be as direct as possible. If you only have a vague notion of what you want, you can say that, too. It’s at least a good place to start – and many people in therapy do just that.
• Ask how therapy will work – You may have been given a schedule, but you need to know just exactly what to expect during the therapy sessions. Ask your therapist how long they will last, what specifically you’ll be doing, and what the expected outcome will be. Your therapist expects this and the questions are typically what is covered during the first session. Mention that you want to feel free to ask questions at any time during the therapy if there’s something you don’t understand, don’t like, or feel isn’t working to your benefit. Remember that this is a collaborative effort: you and your
therapist are working together to achieve your goals.
• Be active in treatment – In order to be effective, you as the patient need to be active in all aspects of the treatment. You can’t just sit passively and clam up. If you’re asked a question by your therapist, it’s designed to draw you out, to have you open up and talk about certain difficulties you may have been having since your last session in dealing with cravings and urges, for example, or being able to sleep through the night, or how to avoid blurting out hurtful things to others when you feel stressed or frightened. The psychotherapist isn’t a mind reader. He or she can only help and guide you with your active participation. You’ll progress faster if you can put yourself in the mindset that you want this to work, and your therapist is your guide to helping you get where you want to go.
• Be ready to learn – Some of what you’ll be exposed to during psychotherapy or psychosocial strategies involves learning a lot of new behaviors. You may need to do a deep-dive into your particular type of substance abuse or dependence during educational lectures and discussions outside of your regular therapy sessions. Don’t think that these are dumb-school sessions. Learning about the disease of addiction is critical to being able to overcome it. This means that you need to be ready to learn, to anticipate being introduced to some strange terms and a lot of facts, as well as some very practical strategies and techniques for dealing with your problems – with substance abuse, depression, anxiety, and communicating with others, just to name a few.
• Be willing to change – Nothing will happen if you remain adamant that you aren’t going to change your behavior. Why are you even in treatment if you won’t give therapy a chance? After all, you’re here. You might as well get all the benefit you can out of psychotherapy. Millions of others have gone through similar programs – and most of them have been able to benefit greatly from them. Even if they relapse at some point after leaving treatment, they can’t help but absorb some information that will eventually sink in. The best way to get the most out of psychotherapy during treatment is to accept that things will change and commit to your willingness to change.
• Establish trust – Although it’s mentioned here, it really is one of the first things that you need to do with your therapist in order for you to make maximum progress. But establishing trust takes time. It won’t happen overnight – or even after the first session. That’s fine, and normal. You need to feel comfortable discussing fears and challenges and impediments as well as how to become more self-confident, capable, and begin to restore or build hope. Trust is a two-way street, and although the therapist is practiced at communicating with patients, you may not feel as fluid in this situation. Give yourself and your therapist the benefit of the doubt and build your rapport slowly. Don’t hold things back, but do be willing to open up a bit more each session. Don’t worry too much about this trust-building process. It will occur naturally in whatever time it takes.
• Be ready to change your perception – Creating a transformational shift in your way of thinking about a problem is the goal of problem-focused and emotional-focused strategies of CBT. Guided by your therapist, you will learn how to gradually change your perceptions of problems and emotions and how to best deal with them. Sometimes we feel that long-held beliefs and attitudes can’t be changed – but they can. Be ready to change your perception in order to heal and grow.
Take Part in Aftercare Counseling
Once treatment is complete, if it is part of your overall treatment program, take part in aftercare or continuing care. This service provides continuing access to counseling as well as other assistance that proves invaluable following completion of treatment. If you don’t have this as part of your overall treatment program, inquire before you leave treatment where you can get additional counseling. Ask about federal, state, or local programs or organizations that provide such counseling at a reasonable or reduced-fee basis.
Go to 12-Step Meetings
Although it isn’t therapy in the traditional sense – 12-step groups do not treat anyone – you will benefit from continuing participation in 12-step meetings. It’s really a strong recommendation of most of the established treatment programs in this country, and there are 12-step groups that are available in all 50 states and many foreign countries. You can easily find a location near you by doing an Internet search using the 12-step group name (Alcoholics Anonymous, Narcotics Anonymous, Marijuana Anonymous, Cocaine Anonymous, Gamblers Anonymous, Sexaholics Anonymous, and so on). Many offer online or telephone sessions as well. There are no fees and everyone remains anonymous (first-name basis). Next to your family, your 12-step group is the most important support network you have in recovery.
Bottom line: How to get the most out of psychotherapy in treatment depends on you. Follow some of the suggestions and discover some new ones that work for you. If you set your mind to it, you can achieve great things in recovery. Your therapist can be your guide, but in the end, it’s all up to you.
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