LOVE ADDICTION: A Consumer's Guide to Psychological Treatment
In the following section, we discuss some of the more prevenient forms of psychotherapy. After a description of the unique goals an methods of particular therapies, we turn to an examination of the kinds If problems that are best solved by one or another treatment.
Although not an encyclopedic guide to all existing therapies for love addiction and codependency, this overview will provide familiarity with the issues to consider when a choice must be made.
SPECIFIC vs. GLOBAL THERAPIES
It is rare that clients enter psychotherapy solely to explore themselves. More
likely, clients are brought to treatment by one or more painful problems
with which they are unable to cope. Loneliness, anxiety, vague or specific
fears, addictions, consuming anger, these and other problems drive people
to seek therapeutic help. All therapies share the goal of ridding the client of
distress. But all therapies do not share the belief that ridding the client of immediate distress is the exclusive, or even primary, goal of treatment.
Therapies may be divided into two broad categories: those that are designed
to treat specific problems and those that seek to encourage personal
insight. Specific therapies attempt to resolve psychological problems without
altering underlying personality problems. Insight therapies are quite
different. They treat presenting problems as the symptoms of underlying
personality distress and therefore seek to change those deeper personality
patterns. Obviously, there is often overlap between these approaches. The
insight therapist who ignores the concrete problems that brought the client
into therapy is likely to fail because the client will be impatient and dissatisfied
(Haley, 1969). Similarly, the behavioral or cognitive therapist who ignores
an underlying problem that spawns a host of behavioral difficulties
reduces his or her chances of therapeutic success.
We have discussed the details of many global and specific therapies in earlier
materials. But in order to make our therapeutic recommendations clear
and meaningful, it is useful to review the kinds of treatment that are available
and useful. We will not describe all of the treatments that are presently
offered; that would require a book in itself. Rather, we will restrict ourselves
to those that have proven useful or are very popular.
SPECIFIC THERAPIES
Specific therapies deal with specific problems. Those problems can often be
defined quite narrowly and precisely, such as a fear of heights. Or the specific
problem may be a broad one, such as depression which, as discussed in
Chapter 13, encompasses a heterogeneous group of symptoms, among them
fatigue, loss of appetite, somatic concerns, and the like. The important thing about specific therapies is that they take one or more target problems and
seek to resolve them without going deeply into other aspects of personality
or unconscious processes.
There are two classes of specific therapies: biological treatments and Specific Psychological Therapies.
Biological Therapies
Among the biological therapies, drug treatments are by far the most popular.
Psychoactive drugs are more often prescribed than others; among these,
Valium is the second most commonly prescribed drug in the United States.
Drug therapies have been successful with a variety of common disorders,
including anxiety, unipolar and bipolar depression, and schizophrenia.
They can often have quite specific effects. For example, certain drugs may
affect schizophrenic thought, while others may influence schizophrenic emotion.
Another form of biological therapy is electroconvulsive shock therapy, or
ECT. It consists of sending a pulse of electricity through the brain, thereby
producing a minor convulsion. The treatment may be repeated six to ten
times. As mentioned before, ECT is a fast and effective treatment for
unipolar depression but it can have serious side effects.
Like all therapies, biological treatments are most effective with willing
and cooperative clients. But unlike psychological treatments, many biological
ones can be administered against the client's will and still have moderate
effects. One of the major sources of failure in drug treatment, however, resides
in the client's failure or refusal to take, the prescribed medications.
That failure often arises from the fact that the client is unwilling to take the
treatment, fails to understand how it will help, or has not developed the cooperative relationship with the therapist that is necessary for successful
treatment.
Biological therapies are designed to provide immediate relief for immediate
problems. They cannot teach clients to alter their behaviors, to avoid
stressful difficulties, or to cope better in the future. Nor do they try to bring
about greater insight or understanding into the causes of personal difficulties.
They affect biology, not learning. But in so doing, their effects are not at
all trivial, for problems tend to breed further problems. In reducing current
anxiety or depression, biological treatments prevent additional troubles from arising.
Specific Psychological Therapies
Like biological therapies, the specific psychological therapies seek specific
solutions to specifiable problems. These therapies, too, fall into two classes:
behavioral treatment and cognitive restructuring.
BEHAVIORAL TREATMENT
The behavioral treatments see the roots of clients' distress, not in physiological processes gone awry, but in behavior itself. Distressing behavior is learned, and what is learned can be unlearned and replaced by more constructive modes of coping and adaptation. Behavior therapists therefore deal directly with the problem. Although behavioral treatments have become popular only in the past quarter century, many of them have their roots in an ageless folk wisdom.
Consider the child who fears darkness. At first, parents will naturally accede
to the child's demand that the bedroom remain lit. Over time, however, the
overhead light will be replaced by a low-wattage night-light. And finally, that
too will be extinguished. Used therapeutically, that process is one form of in
vivo systematic desensitization. Introduced by Joseph
Wolpe in 1958, it is used primarily to treat phobias and specific anxieties.
The client is first reassured and relaxed, and then exposed to stimuli
that are minimally anxiety producing. Because one cannot be relaxed and
tense simultaneously, the anxiety dissipates, and gradually, the client is
trained to remain relaxed in the presence of stimuli that were formerly associated
with increasing anxiety. Over time and training, stimuli that formerly
induced panic are now greeted with calm.
Flooding treats anxiety in quite the opposite manner. Instead of gradually approaching the anxiety-provoking stimulus,
clients arc encouraged to experience the full force of the anxiety storm. Be cause by definition phobias are irrational fears, they are unlikely to elicit reinforcement,
Consequently, like any unreinforced behavior, they will
extinguish. Someone who is agoraphobic and afraid to leave home, for example,
would be encouraged to ~pend an hour in the park, and thus be
flooded with anxiety. Gradually, through the process of extinction, that anxiety
would abate.
Modeling is yet another form of behavioral treatment that has helped
clients to overcome fears and acquire new standards for their behaviors. Here, for example, a client who is painfully shy might observe and gradually imitate the behavior of a model who both enjoys being outgoing and is rewarded for it. Combined with graded rehearsal and practice, modeling treatments are quite effective in overcoming fears and inhibitions (Bandura, 1969a).
Aversion therapy aims to rid a client of undesired behavior by pairing that
behavior with aversive consequences. If alcohol is
paired with a nausea-inducing drug, or a sexually deviant impulse is paired
with electric shock, the expected result is that the client will avoid the undesired
behavior.
Behavioral treatments often can be very effective in speedily eliminating
sources of distress. As we will shortly see, they have been used quite successfully
for a variety of psychological troubles. But their virtues are also their
limitations, for they often fail to deal with the thoughts and feelings that
promote irrational behaviors in the first place. For these thoughts and feelings,
cognitive therapies are quite useful.
COGNITIVE RESTRUCTURING
Treatments that involve cognitive restructuring
are predicated on the assumption that irrational thoughts breed
irrational behaviors. Such thoughts are by no means rare, for they commonly
arise from the fundamental attribution errors that people make
about their own behaviors (Nisbett and Ross, 1980). Consider the person
who says “I have nor friends because I’m boring. That would be irrational thought on the part of a young man newly arrived at a college campus, irrational because insufficient time had passed for him to meet people
and test that belief. It would also be an irrational thought, but a different
sort, by a rude and critical member of a typing pool. Cognitive therapies
seek to illuminate these thoughts, to make clear their irrational basis, and
thereby, to change them.
Rational-emotive therapy is one of the more effective and popular cognitive
therapies. Developed by Albert Ellis (1962), it attacks
the faulty philosophical assumptions that are made by individuals and that
generate irrational behaviors. The notion, for example, that it is absolutely
necessary for an adult to be loved by each and every significant person in his
or her community, is a widely held irrational assumption. So, too, is the assumption that in order to consider oneself worthwhile, one needs to be
thoroughly competent, adequate, and fully achieving in all possible respects.
These and other assumptions are vigorously challenged and attacked
in rational-emotive therapy, with the aim of laying bare and ultimately
changing these cognitions and the behaviors they promote.
Cognitive therapy is quite similar to rational-emotive therapy and is used
primarily in the treatment of depression (Beck, 1976). Beck emphasizes
such negative cognitions as self-devaluation, a negative view of life experience, and a pessimistic view of the future as leading to depression. He gently encourages clients to examine these views and change them. As will shortly be seen, this approach has been very successful in treating depression.
Acquiring and maintaining realistic cognitions is no easy task. Cognitive
restructuring therapies use graded tasks, often done as "homework" outside
of the therapy session, to yield a succession of mastery and success experiences.
Like biological and behavioral therapies, cognitive therapies seek to
eliminate a specific problem, and to eliminate it quickly. They differ from
those treatments, however, in the requirement that, in order to alleviate a
particular problem, one needs to understand and change the thoughts that
promote it. And they differ from the global therapies, to which we now turn,
both in their insistence on staying "close" to the client's presenting problem,
and because they find it unnecessary to explore why the relevant cognitions
were distorted in the first place.
Although not an encyclopedic guide to all existing therapies for love addiction and codependency, this overview will provide familiarity with the issues to consider when a choice must be made.
SPECIFIC vs. GLOBAL THERAPIES
It is rare that clients enter psychotherapy solely to explore themselves. More
likely, clients are brought to treatment by one or more painful problems
with which they are unable to cope. Loneliness, anxiety, vague or specific
fears, addictions, consuming anger, these and other problems drive people
to seek therapeutic help. All therapies share the goal of ridding the client of
distress. But all therapies do not share the belief that ridding the client of immediate distress is the exclusive, or even primary, goal of treatment.
Therapies may be divided into two broad categories: those that are designed
to treat specific problems and those that seek to encourage personal
insight. Specific therapies attempt to resolve psychological problems without
altering underlying personality problems. Insight therapies are quite
different. They treat presenting problems as the symptoms of underlying
personality distress and therefore seek to change those deeper personality
patterns. Obviously, there is often overlap between these approaches. The
insight therapist who ignores the concrete problems that brought the client
into therapy is likely to fail because the client will be impatient and dissatisfied
(Haley, 1969). Similarly, the behavioral or cognitive therapist who ignores
an underlying problem that spawns a host of behavioral difficulties
reduces his or her chances of therapeutic success.
We have discussed the details of many global and specific therapies in earlier
materials. But in order to make our therapeutic recommendations clear
and meaningful, it is useful to review the kinds of treatment that are available
and useful. We will not describe all of the treatments that are presently
offered; that would require a book in itself. Rather, we will restrict ourselves
to those that have proven useful or are very popular.
SPECIFIC THERAPIES
Specific therapies deal with specific problems. Those problems can often be
defined quite narrowly and precisely, such as a fear of heights. Or the specific
problem may be a broad one, such as depression which, as discussed in
Chapter 13, encompasses a heterogeneous group of symptoms, among them
fatigue, loss of appetite, somatic concerns, and the like. The important thing about specific therapies is that they take one or more target problems and
seek to resolve them without going deeply into other aspects of personality
or unconscious processes.
There are two classes of specific therapies: biological treatments and Specific Psychological Therapies.
Biological Therapies
Among the biological therapies, drug treatments are by far the most popular.
Psychoactive drugs are more often prescribed than others; among these,
Valium is the second most commonly prescribed drug in the United States.
Drug therapies have been successful with a variety of common disorders,
including anxiety, unipolar and bipolar depression, and schizophrenia.
They can often have quite specific effects. For example, certain drugs may
affect schizophrenic thought, while others may influence schizophrenic emotion.
Another form of biological therapy is electroconvulsive shock therapy, or
ECT. It consists of sending a pulse of electricity through the brain, thereby
producing a minor convulsion. The treatment may be repeated six to ten
times. As mentioned before, ECT is a fast and effective treatment for
unipolar depression but it can have serious side effects.
Like all therapies, biological treatments are most effective with willing
and cooperative clients. But unlike psychological treatments, many biological
ones can be administered against the client's will and still have moderate
effects. One of the major sources of failure in drug treatment, however, resides
in the client's failure or refusal to take, the prescribed medications.
That failure often arises from the fact that the client is unwilling to take the
treatment, fails to understand how it will help, or has not developed the cooperative relationship with the therapist that is necessary for successful
treatment.
Biological therapies are designed to provide immediate relief for immediate
problems. They cannot teach clients to alter their behaviors, to avoid
stressful difficulties, or to cope better in the future. Nor do they try to bring
about greater insight or understanding into the causes of personal difficulties.
They affect biology, not learning. But in so doing, their effects are not at
all trivial, for problems tend to breed further problems. In reducing current
anxiety or depression, biological treatments prevent additional troubles from arising.
Specific Psychological Therapies
Like biological therapies, the specific psychological therapies seek specific
solutions to specifiable problems. These therapies, too, fall into two classes:
behavioral treatment and cognitive restructuring.
BEHAVIORAL TREATMENT
The behavioral treatments see the roots of clients' distress, not in physiological processes gone awry, but in behavior itself. Distressing behavior is learned, and what is learned can be unlearned and replaced by more constructive modes of coping and adaptation. Behavior therapists therefore deal directly with the problem. Although behavioral treatments have become popular only in the past quarter century, many of them have their roots in an ageless folk wisdom.
Consider the child who fears darkness. At first, parents will naturally accede
to the child's demand that the bedroom remain lit. Over time, however, the
overhead light will be replaced by a low-wattage night-light. And finally, that
too will be extinguished. Used therapeutically, that process is one form of in
vivo systematic desensitization. Introduced by Joseph
Wolpe in 1958, it is used primarily to treat phobias and specific anxieties.
The client is first reassured and relaxed, and then exposed to stimuli
that are minimally anxiety producing. Because one cannot be relaxed and
tense simultaneously, the anxiety dissipates, and gradually, the client is
trained to remain relaxed in the presence of stimuli that were formerly associated
with increasing anxiety. Over time and training, stimuli that formerly
induced panic are now greeted with calm.
Flooding treats anxiety in quite the opposite manner. Instead of gradually approaching the anxiety-provoking stimulus,
clients arc encouraged to experience the full force of the anxiety storm. Be cause by definition phobias are irrational fears, they are unlikely to elicit reinforcement,
Consequently, like any unreinforced behavior, they will
extinguish. Someone who is agoraphobic and afraid to leave home, for example,
would be encouraged to ~pend an hour in the park, and thus be
flooded with anxiety. Gradually, through the process of extinction, that anxiety
would abate.
Modeling is yet another form of behavioral treatment that has helped
clients to overcome fears and acquire new standards for their behaviors. Here, for example, a client who is painfully shy might observe and gradually imitate the behavior of a model who both enjoys being outgoing and is rewarded for it. Combined with graded rehearsal and practice, modeling treatments are quite effective in overcoming fears and inhibitions (Bandura, 1969a).
Aversion therapy aims to rid a client of undesired behavior by pairing that
behavior with aversive consequences. If alcohol is
paired with a nausea-inducing drug, or a sexually deviant impulse is paired
with electric shock, the expected result is that the client will avoid the undesired
behavior.
Behavioral treatments often can be very effective in speedily eliminating
sources of distress. As we will shortly see, they have been used quite successfully
for a variety of psychological troubles. But their virtues are also their
limitations, for they often fail to deal with the thoughts and feelings that
promote irrational behaviors in the first place. For these thoughts and feelings,
cognitive therapies are quite useful.
COGNITIVE RESTRUCTURING
Treatments that involve cognitive restructuring
are predicated on the assumption that irrational thoughts breed
irrational behaviors. Such thoughts are by no means rare, for they commonly
arise from the fundamental attribution errors that people make
about their own behaviors (Nisbett and Ross, 1980). Consider the person
who says “I have nor friends because I’m boring. That would be irrational thought on the part of a young man newly arrived at a college campus, irrational because insufficient time had passed for him to meet people
and test that belief. It would also be an irrational thought, but a different
sort, by a rude and critical member of a typing pool. Cognitive therapies
seek to illuminate these thoughts, to make clear their irrational basis, and
thereby, to change them.
Rational-emotive therapy is one of the more effective and popular cognitive
therapies. Developed by Albert Ellis (1962), it attacks
the faulty philosophical assumptions that are made by individuals and that
generate irrational behaviors. The notion, for example, that it is absolutely
necessary for an adult to be loved by each and every significant person in his
or her community, is a widely held irrational assumption. So, too, is the assumption that in order to consider oneself worthwhile, one needs to be
thoroughly competent, adequate, and fully achieving in all possible respects.
These and other assumptions are vigorously challenged and attacked
in rational-emotive therapy, with the aim of laying bare and ultimately
changing these cognitions and the behaviors they promote.
Cognitive therapy is quite similar to rational-emotive therapy and is used
primarily in the treatment of depression (Beck, 1976). Beck emphasizes
such negative cognitions as self-devaluation, a negative view of life experience, and a pessimistic view of the future as leading to depression. He gently encourages clients to examine these views and change them. As will shortly be seen, this approach has been very successful in treating depression.
Acquiring and maintaining realistic cognitions is no easy task. Cognitive
restructuring therapies use graded tasks, often done as "homework" outside
of the therapy session, to yield a succession of mastery and success experiences.
Like biological and behavioral therapies, cognitive therapies seek to
eliminate a specific problem, and to eliminate it quickly. They differ from
those treatments, however, in the requirement that, in order to alleviate a
particular problem, one needs to understand and change the thoughts that
promote it. And they differ from the global therapies, to which we now turn,
both in their insistence on staying "close" to the client's presenting problem,
and because they find it unnecessary to explore why the relevant cognitions
were distorted in the first place.
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