 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is the therapy show behind closed doors podcast with Bob Cook and Jackie Jones. I'll do an introduction. Welcome back to the next episode of the therapy show behind closed doors with myself, Jackie Jones and the wonderful Bob Cook and we're going to follow on. We've got a heat load of stuff coming up over the next few weeks, but this week's episode is going to be all around working with addictions in the therapy room. Correct. And first of all, I'd like to thank you for your kind words because at the last podcast you were saying that you always started with the first, you know, this phrase wonderful Bob Cook and I thought about that. Yes, it's a good way to start. It is. So you have against that's very nice of your kind terminology. I can't think of a better way of describing you, Bob. You're just wonderful. I'm not sure whether it was in that last episode that I said literally, I get so much from these podcasts myself. It's like an evolving thing going back to my training. Well, carry on with the wonderful, wonderful terminology. That's absolutely fine. So this podcast is working with addictions, people that come with addictions. So let's start there. So when we talk about addictions, there's many varied forms of addictions. So we could think of alcohol addiction. Yeah, you could think of drugs addiction. We can think of gambling addiction. We can think of sex addiction. Yeah. So there's, there's, you know, when we talk about addictions, there's many forms of addictions. So when I'm going to talk about addictions, it covers a wide, a wide sphere, if you like. But all addictions in my head are very much about really their coping mechanisms to survive. Yeah. Would you put habitual behaviour in the same category as addictions? Or are you talking substance addictions? So give me an example of what you're talking about when you say habitual behaviours, did you say? I don't know, kind of fear of something, you know, when we come up against a block, whether that's in therapy or in our personal life, limiting beliefs, all those sorts of things, just general habitual behaviour. I don't see those as addictions. Okay. Now I see them as learned behaviours or defence systems against actually feelings. Okay. So we're talking more substance. We're really talking about substance abuse. Okay. Okay. Yeah. Whether it be eating addictions, whether it be, so that's substance abuse, really. Yeah. And as I say, whether we're talking about alcohol eating or, or many of these different substance abuses, then they're all ways of coping and surviving rather than usually feeling. Yeah. So, you know, the big addictions like alcohol, gambling, they are really very, very destructive addictions, but they are a way of coping rather than feeling the original trauma, I think. Yeah. Is that how you see addictions? Yeah. I kind of talk with clients about, usually it's a lot of self-medication, you know, not necessarily going to the GP and getting, you know, medication or over the counter. It's kind of self-medicating through various means. Yeah. And it's a way of coping. Yes. Yeah, definitely. Unfortunately, the way they choose to cope brings often physical addiction. Yes. So, anybody comes say with, let's start with alcohol, for example, they will have a physical addiction as well and they'll get physically addicted to the, to the chemical. Yeah. Which is the alcohol in a sense. Yeah. And I suppose, you know, it sounds awful and I don't want to stereotype, but, you know, there's an awful lot of high functioning alcoholics out there that it's kind of like the norm to, to have a day's work and come home and, you know, have a few glasses of wine every night of the week. Yeah, absolutely. And most of these addictions, as I say, whether it's, whether it's gambling, whether it's sex addictions, whether it's eating addictions, um, you get, again, a continuum of people who, from high functioning, if you like, to the other end of the continuum. So you're quite correct. So you get high functioning, I don't know, alcohol, you know, alcoholics or people who drink problems, that's correct. Yeah. And they, and if we take alcohol, alcohol particularly, of course, as I say, there's a physical addiction as well. So coming off alcohol, going to rehab and coming off alcohol, the first thing you would have to deal with is the physical addiction and physical withdrawal, which is very, very difficult. Yeah. Yeah. I can remember when I was in my training and, you know, we did a session. You probably don't remember it. I'm an ex smoker. I used to be a smoker. When I did my training, I was a smoker. And I think it was kind of a bit of a, an eye opener when you referred to it as an addiction. And I didn't really equate the two together. So I see it, you know, because it's a way of taking the person away, usually from feelings again. But again, with smoking, of course, there's a, with physical part to it again. Yes. Yeah. So I don't know if you still are smoking, but if you, if you were or if you are, somebody attempts to stop smoking, you know, they have a physical withdrawal from the nicotine, which is why you've got the move to vaporing. Yes. Yeah. And I think that was probably what I was saying about, you know, habitual behavior. I'm an ex smoker now. I don't smoke. But it was, it was the habit that was harder for me to overcome rather than the nicotine addiction. I found that bit quite easy, which shocked me. Which, which did you find easy? Getting over the nicotine addiction was the easy part, breaking the habit of when I smoked, you know, and things like that. I found more difficult. Yeah. And my interesting, I mean, about this, because of course, with smoking, and of course, if we think of drugs, think of weed, if we think of cannabis, if we think of heroin, many, many books, there's a social habit that goes with it. Yeah. If we think of smoking, but I say you could put the other other medications in the same bracket, there's a social part to it. Yeah. What you're talking about with your smoking is the habit that's linked to the social companionship. Yeah. Yeah. Yeah. Yeah. But even lesser than that, yeah, I suppose, you know, with the, the alcohol, I don't, I don't particularly like drinking, but, you know, the, the connections we make to certain things that it helps me relax. It helps me sleep better. The kind of stories that we, we say to ourselves around certain substances. Helps us switch off. Yeah. Yeah. You might say to yourself. Yeah. And of course, alcohol does have that effect of knocking you out. Yeah. Yeah, particularly knocking out the parent part and often the critical narratives to go with that. Interesting. So transaction analysis, of course, we're going to use that model, which I often refer to. Yeah. Alcohol and many of, and many of the other medications I was thinking of knocks out or will knock out the internal, often critical toxic narratives and gives the person some relief from those internal narratives were so internalised. Yeah. Interesting. And of course, therapeutically, once you've dealt with the physical part of this, which I was just talking to, you would probably move next to help and desensitize or at least look at the parental toxic narratives that they, that they deal with, which is usually actioned under stress. So under stress, they usually very hard on themselves. And when you actually do the therapeutic work, you get down to the internalised critical parents, which they've internalised, which then gives them such a hard time, which is why they turn to medication to knock out the parental voices, if you like. Yeah. Yeah. And maybe once you start to understand the process of that, that it is the, you know, the internal self-taught, the internal dialogue that's, you know, perpetuating the cycle, so to speak. So what would you kind of say to a client? Would you encourage self-compassion? And because I would imagine if it's a critical parent that's talking, then we're probably going to be more in our rebellious child when we're succumbing to that possibly. I know for smoking, I was definitely in my rebellious child. Yeah. So in classical treatment, whether it be alcohol, whether it's smoking, whether it's gambling or all these different things, we would be looking at what was often called in transaction analysis, hungers. And one of the hungers, of course, is a hunger for stimulus. Now, to a normal level, we all have a derived stimulus. However, you know, the, if the stimulus is the negative critical parent, then the younger part of ourselves goes into hiding and certainly wants to knock out the critical parent. So in transaction analysis therapy, once you've actually identified that process that the person's attempting to knock out through drugs or whatever it is, then you can start to help the client get in touch with the dialogue in their head. And once you can help the client understand or take ownership, that it's not actually them that's giving themselves a hard time. It's actually the critical parent or critical other that they've internalized. Then you can help the younger part of themselves or the different part of themselves empower themselves to be able to turn up, if you like, or turn down the voices in their head. So they don't have to turn to drink or medication or drugs to do that. They can take power themselves or to find a less destructive coping mechanism. So in other words, you know, going for walks or going to the gym or, or whatever we're talking about here, but not so destructive as the original coping mechanism. Yeah. Yeah. So would you recommend a substitution for it then? Like that going for walk, meditation, going to an article by people who was listening to the podcast as an article by something called Jody Marjula. She's a TA therapist and she writes an article, which I quite like called appetite paths. And what she's talking about is the TA therapist with the client identifies the destructive coping mechanisms that they've actually using, whatever it is, to help them, in this sense, desensitize the parental toxic critical narratives and then substitutes them with less destructive ones. So if, if, for example, is, you know, getting drunk or taking heroin or whatever it is that they actually do, which is so destructive, of course, if they can find a less destructive one, which is, you know, perhaps a little bit more healthy, it doesn't mean it's actually all, you know, completely. Yeah. At least it's a substitute. Yeah. Vibing mechanism. Then she would advocate that. Yeah. Which makes sense, really, because, you know, what one of the things when, again, I'm only talking about smoking, but when we stop doing certain things, it's kind of like there's a big hole there. You know, one of my things was that whenever I was on the phone, I would smoke a cigarette and suddenly it was kind of like, well, what do I do now? Correct. So you need a different stimulus. Yes. Yeah. I talked about stimulus hunger. Yeah. Earlier on. And you need a stimulus which isn't so dramatic. Yes. Stimulus is not so unhealthy. A stimulus which is that you can take ownership of in a less destructive way. So I don't know which, well, Cobra mechanism you chose, but that would be the work of a therapist to actually discover a less destructive Cobra mechanism or a different habit, which is a habit, which is less harmful. Yeah. So that might be, I mean, I said go walking, but that might be going to this, that might be going to the cinema, that might be finding ways to distract yourself, which isn't so harmful. But that will be an inquiry with your therapist to start in a going left to a left instead of right. In other words, not going right to the health, to the unhealthy destructive patterns, but going left to a, you know, a different type of substitute behavior, which isn't so harmful. Yeah. Do you think it links in somewhere, you know, whatever the addiction with, I'm not sure the best way of saying it, whether it's a lack of self-esteem or self-worth or self-care that the person doesn't put great importance on themselves to give them as much incentive to stop the, you know, destructive behavior. Does that make sense? Makes complete sense. And this can also be a, the addiction can be a scape, can be an escape from visiting the earlier trauma. It doesn't have to be necessarily linked to pure self-esteem or worthlessness or, or, or, or what we're talking about here, but we could be a escape from feeling whatever feeling, whatever the trauma was. So I was just thinking people who suffer from post-traumatic stress will often turn to addictions, drinking, gambling, all the things that we talked about instead of revisiting the trauma. Yeah. Or a day, or a way of dealing with flashbacks or a way of dealing with revisiting the very traumatic times. So that's one avenue. Yeah. The other, the other avenue, of course, I was talking early on about, if you've got, if you're very hard on yourself by continuing to tell yourself off, which really comes from an internalized parent figure, I believe, then it's a way of escaping from those voices. Isn't it? Yes. So if you've always got those voices bearing down on you, then your self-confidence and self-esteem will, will be very high. You know, you will think very little of yourself because you've always got these voices telling you how worthless you are and how terrible person you are or whatever it is. So in that sense, self-confidence will be very low. Yeah. And you know, again, I think it was probably something that you pointed out to me in my training, that the alcohol, the smoking, you know, maybe unhealthy eating habits, things like that. It's, it's a quite a subtle form of self-harm as well. Yes, it is. And I had a, I did an assessment with somebody the other day and she was quite sophisticated in some sense. And in other words, she reflected on herself and she, she came in and talked about her addiction and she talked about it as a way of dealing with the neglect, with neglect from her childhood, which she saw as very traumatic. What she meant by that was, you know, by eating, eating the neglect away. In other words, that's the way she talked. By eating and purging, she was actually eating those feelings and she didn't have to go near the trauma. Yeah. Most eating issues or eating problems, whether it's bulimia or anorexia, is a way of dealing with feelings. Yeah. Anorexia particularly is to do with a parent child in TA terms, again, battle over food. And it's a way of keeping someone very young and infantilised and the parents taking control. The food becomes the battleground. Yeah. Yeah. And I think we've done a podcast on eating. We did, we did quite a few back. But it's kind of the addiction side of it, you know, can be seen as, as self-harm. There's a lot of young people now that are, you know, cutting and those sort of things, which is the obvious. It is self-harm, Jackie. I'm not disagreeing with you at all in the sense of, you know, what we're talking about in very unhealthy, destructive patterns. Yeah. And it's a way of coping and not, so they don't have to feel or visit their highly traumatic past. So, yes, it is self-harming. And at another level, yeah, it's, it's a defense system, so they don't have to visit those traumatic, you know, how it plays. Now, of course, the destructive patterns, they may knock out the traumatic experiences that they may knock out those horrendous voices, horrendous voices, or they may knock out having to visit the neglect or whatever it is. And the destructive patterns themselves can cause horrendous problems. Yeah. And then they feel unable, you know, to be able to stop the addictions or they have to then go to another level of different addictions. And so those behaviors become so extremely, you know, difficult in the present that they become, I wouldn't say worse than the original trauma, but they become a difficult process to handle in the present. But they start off as a way to cope with, you know, difficult times and difficult traumas and how parental voices in the heads and goodness knows what, is that self-harm? Well, it starts off in the world of protection, I think, might end up to be seen as self-harm. Yeah. But it's a desperate attempt to cope in a world which has often been so horrendous that they don't know how to cope. So in other words, they are survival mechanisms which turn into what people might see as self-harm. They don't start off like that. Yeah. And again, I suppose touching on the hungers and the need for stimulation, you know, with younger people nowadays, the peer pressure to do certain things also plays a part potentially in future addiction. You know, that with Maslow's hierarchy of need, the need to belong when we're, you know, talking about maybe younger kids smoking weed or smoking or vaping and all those sorts of things. Yeah. So absolutely. And I could agree more with you. I've seen an increasing amount of children and parents where that is one of the main concerns that the parent is having is that the child is experimenting with certain substances. And what do you see as a psychotherapist? What do you see as the treatment then? Well, you know, luckily, unfortunately for me, the conversations that we're having with the parents is very open. And I think it's that, you know, with young people, that's one of the main things is that they're open, you know, avenues of communication and exploring the reasons why, you know, is it peer pressure? Are they feeling under pressure? Is there something going on? You know, so not necessarily focusing on the substance, but more what's surrounding the child at the moment, whether, you know, it is a way of avoiding something for them. Yeah, that's what I think parents going to fear mode. Oh my God, you know, they've just had a joint or something. And that's where the focus is rather than looking a bigger picture, maybe. Yes, I agree with you. And in the world of reality TV, and the search for that narcissistic culture, I think, which is promoted by the present social media, unfortunately, we see more and more of this. I mean, what's good is what is positive is that the people who are parents, if you want to put it in that way, are seek help more. Yes, yeah, helps more accessible. Yeah. Yeah, I think I think completely what you're saying, you know, the world of reality TV and social media and things like that, it's what we were seeing behind closed doors a lot more than what we used to be, you know, my children have a completely different lifestyle to what I did. You know, everything's in full view now. Well, much more than our generations. I still think a lot hams behind closed doors. Definitely, but, you know, if I made a mistake, not a lot of people knew about it. If somebody else makes a mistake now, it's pretty much all over Facebook instantly. Yeah, well, it can be. I was just thinking about the highest rate of suicide, believe it or not, is with young men under 35, which I think is very indicative of what we're talking about here in terms of the culture and things like this. And, you know, the turn to medication to addictions to alcohol or whatever this we're talking about here, I just want to reiterate, is a way to knock out on this huge despair, a huge attempt to not have to visit their traumatic past. Yeah. I was thinking of, you know, the suicide rates, you know, and people who desperately turn to means many levels of addictions, so they don't have to visit their traumatic past. And the therapy is about actually helping them have an awareness of this and an understanding of this and helping them actually understand how the past affects the present and finding different ways of handling this. And this is why my colleague, Jodi Marjulu, wrote that article, Aptide Paths, when she talks about, she ran addiction sentence, by the way, she talked about helping people understand that and helping them find substitute coping mechanisms, which weren't so unhealthy as the destructive ones, which we were talking about earlier on. From that, it's like going down layers of onions until they find mechanisms at a far less unhealthy way. Yeah. So that's her treatment. And alongside that, looking at what I was just talking about, the internalised negative critical voices, which often run the show and how they can be empowered to have more self confidence to desensitise these voices so they can live a healthy life. Yeah. Which can all be done in the therapy room? Yes. And, you know, sometimes the people are so addicted, as I said, with the physical addiction as well, that there isn't enough resources. So in other words, the therapist can only offer them the most, probably two hours a week or maybe one. So you might have to recommend them to go into rehab or a process where they can actually be in a community or somewhere where there's a lot more resources around than the private therapist that can only offer one or two hours a week. Yeah. Yeah. Do you think there is an added bonus to being in a group with addiction? You know, alcoholics, anonymous, or things like that? You know, community, especially rehab, if you can afford it. Or if you can, I mean, the government, you know, I was thinking the local government rehab, especially around alcohol and especially around drugs, if you can get into a rehab where there's 24 hours of resources or there's access to resources around one hour a week, absolutely. Yeah. Absolutely. Because then they've got tapped to a lot of resources, which, you know, the therapist is really limited, aren't they, Jackie, to one hour a week? Well, at one level, it's better than nothing. But certainly, if you can get into what I would call rehab, all the better. Yeah. Yeah. And in a supportive group as well. Oh, yeah. I mean, if, yes, it's another scale, very much a supportive group. I mean, the wonderful thing about AA, for example, or even the groups that have started off for codependency and things like this, is that all their processes will actually be offering groups as well. In AA, you have to, you know, you go to a group. Yeah. Yeah. You do the 12 steps with the group. Yeah. It's not enough just individually. Yeah. So just to finish up on this, is there any kind of overall advice that you would give to therapists working with addictions? Would it be to offer, you know, one or two sessions a week? Would it be to have them within a group setting? Well, number one, I think, is to see these addictions as a way to cope, not to see it around self-harm, to see them as desperate coping mechanisms to get by. And so that's, if you start from that place, you're starting from a compassionate approach. Yeah. Okay. If you're starting from that, then you need to help the person take ownership of their own narrative, their own story. And I think then you help them look for more healthy coping mechanisms, and then you help them look at, you know, what is, what's happened in their history? This has been so traumatic and so difficult. And if that's going to take a rehab, if that's going to take two or three sessions, if that's going to take resources that you haven't got, you refer on. Yeah. If that means they go to AA, where there's much more resources and there's groups and there's 12-step programs, refer them on. Yeah. Because most psychotherapists, they haven't got, it's a first step, but they haven't got the resources. They've only got an hour or two hours a week. Now, that's better than nothing. And if a person won't go to rehab, if they won't go to Google, if they won't go to a 12-step program, then it's certainly better than nothing, but I would be encouraging them all the time to look for more resources as well. Yeah. Yeah. And it might be worth just mentioning on this, which I know we did way, way, way back on earlier podcasts about contracting. Maybe they're not under the influence of anything when they come and attend therapy. Absolutely. Which again, you know, might be a weekly contract that you do every week that they're going to, you know, not touch the substance between sessions if that's, you've seen them twice a week. Yeah. It's a difficult one. Many therapists won't see people who have severe drink problems until they're at least six months clean. Wow. For example, with drugs as well. So different therapists have different frameworks. Yeah. And you can't work with somebody who's under the influence, whether it be alcohol or drugs. And why some people won't work with people you know, life has to be six months clean. Because that will show motivation, number one. It will show a willingness to change. It would show, you know, the therapy has a chance from an adult to adult perspective. So different therapists have different thought processes around this. I believe if we were talking about deep addiction, whether it be alcohol or medication, it'd be better if you can get them into some process, whether there's a group and whether there's more resources. It's very difficult for an individual therapist to offer the resources needed to help with somebody who's a, you know, a well-functioning alcoholic or somebody who's a well-functioning drug addict. I mean, it's a difficult story actually. There are lots of layers to this. And, you know, and I suppose, again, you know, because I am a, you know, a single person that works from home, you need to prioritise your own self-care as well if you are working with people that potentially could be under the influence of something when they come to see you. Absolutely. And I think that's different from dealing with smoking addiction, for example. Yeah. Now, on my YouTube channel, Bob Cook, you will see a video of me working with somebody to help them therapeutically, to help them with their smoking addiction. And an example of what we do. And I think that's a different level for somebody who's a, you know, a raging alcoholic or somebody who is hooked onto heroin at levels. Definitely. Yeah. And like you said, there's a spectrum. There's a sliding scale with a lot of this. Yeah. And so therapists should have a list of resources and organisations to be able to send these people to. Yeah. Yeah. And again, working within your own skillset and knowing what your limitations are as a, you know, a practising therapist. And to agree more. Brilliant. So what are we going to do the next episode of? Are we doing working with challenging clients next? Yeah, that's the next one. So I look forward to talking about that. Okay. See you on the next episode. See you on the next one.