Understanding Psychotherapy

Using psychotherapy for addiction treatment is common because its many variations make them easier to tailor to fit a patient’s particular needs. In fact, psychotherapy in addiction treatment has proven successful in providing patients with skills to deal with triggers and in expressing their emotions. In addition, psychotherapy for substance abuse is sometimes used in conjunction with medications. It can be offered on a one-on-one basis or in group. Indeed, an especially successful form of psychotherapy, commonly called “talk therapy,” involves contingency management. It offers people with substance use disorder the immediate gratification drugs and alcohol once gave them — and in a much safer way. If you want to learn more about  psychotherapy for addiction and what rehab treatment facilities can offer, please call us today at 405-583-4390.

Psychotherapy Overview

Psychotherapy, or “talk therapy,” is actually a variety of techniques psychiatrists or therapists use. The aim is to help a person identify, understand and change troubling emotions and thoughts, as well as behavior — in this case drug and alcohol addiction. And in the field of psychology, psychotherapy for addiction modifies specific thoughts, feelings and behaviors in order to help people function better in life. Also, most psychotherapy in addiction treatment takes place with a licensed and trained mental health care professional. Patients will meet one-on-one with the therapist or with other patients in a group setting. 

Someone might seek out psychotherapy for different reasons, such as: 

  • severe or long-term stress from a job or family situation
  • loss of a loved one, or relationship or other family issues
  • symptoms with no physical explanation
  • changes in sleep or appetite
  • low energy
  • a lack of interest or pleasure in activities that you once enjoyed
  • persistent irritability, or sense of hopelessness that won’t go away

A mix of various types of psychotherapy techniques prove effective for different disorders. Consequently, depending on their training, the condition being treated and the patient, therapists could  use one primary approach, or incorporate different elements into the therapy.

For example, let’s say a person has a low opinion of himself. That way of thinking has become automatic and is increasingly harmful to the person. The therapist helps the person find ways to question these thoughts and understand how they affect emotions and behavior. The therapist then tries ways to change these self-defeating patterns. This approach is central to Cognitive Behavioral Therapy (CBT). 

Psychotherapy Versus Psychoanalysis

When thinking about psychotherapy do you imagine yourself lying  on a couch while a therapist says, “And how does that make you feel?” Actually, what you’re really imagining is psychoanalysis as largely developed by Dr. Sigmund Freud in the first half of the 20th century.

Psychoanalysis, though now mostly relegated to the social sciences, is an intense form of therapy that can take years. On the other hand, psychotherapy for addiction focuses on one or two issues that currently are affecting the mental state of a patient. In a comparatively brief time, therapists can provide patients with the skills to cope and move forward with their lives.

Although the theory of the conscious and unconscious mind dates back to ancient times, Freud’s three-pronged description caught fire with the public. And so there is the id, the unconscious, impulsive part of the mind; the superego, the conscience and the moral imperative; and the ego, the rational mind trying to find a balance between instincts, impulses and conscience.

The popularity of Freud’s theory began to wane mid-century as science began learning more about the brain and how it works. Consequently, the actions of the id, the ego and the superego are now identified as functions of the different parts of the brain. Thus, the frontal lobes are the seat of thinking and judgment, the limbic areas facilitate emotion and various other parts of the brain handle basic drives or instincts. As biological psychiatry took hold, the real knee-capper for Freud and psychoanalysis was the rise in psychopharmacology.

Psychopharmacology and Psychotherapy

Australian psychiatrist John Cade’s discovery of lithium carbonate as an effective treatment for bipolar disorder in 1948 is seen as the start of a new kind of psychiatry — psychopharmacology. As a result, within a few years effective drug treatments for schizophrenia and major depression followed. And by the early 1960s, benzodiazepines were being used to treat anxiety disorders.

Today, many psychiatrists use the pharmacological approach to treat mental illness. What might take years to accomplish with psychoanalysis can now be effectively treated within a matter of days or weeks with medication therapy. That’s not to say talking treatments have fallen by the wayside. In fact, psychoanalysis may be a relic, but therapists and psychiatrists find that a combination of talking therapy and medication treatment works best.

Therapists use a variety of techniques based on the best available research. In addition, they consider each person’s values, characteristics, goals and circumstances. Feeling depressed, angry, or anxious for a long time are reasons why some people may talk to a therapist. Or they may want help for a chronic condition that is interfering with their lives or physical health. While medication may treat major depression, talk therapy can help a person rebuild relationships damaged by this chronic condition.

Therapists can conduct tests and assessments to diagnose a condition or tell more about the way a person thinks, feels and behaves. Furthermore, these tests cover intellectual skills, cognitive strengths and weaknesses, personality characteristics and neuropsychological functioning. And while there are many different styles of talking therapy, a therapist works with individuals to find the one that is most effective.

Psychotherapy for Addiction Treatment

If you want to begin recovering from substance use disorder, your addiction specialist will help you figure out the best treatment options. There are many options that have been successful in treating drug addiction, including:

  • behavioral counseling
  • medication
  • medical devices and applications used to treat withdrawal symptoms or deliver skills training
  • evaluation and treatment for co-occurring mental health issues such as depression and anxiety
  • long-term follow-up to prevent relapse

Some of these treatments require a psychiatrist, while therapists are appropriate for others. Initially, you get your first experience with psychotherapy for addiction at outpatient behavioral treatment. This includes a wide variety of programs for patients who visit a behavioral health counselor or therapist on a regular schedule. And most of the psychotherapy for substance abuse programs involve individual or group drug counseling, or both.

Inpatient or residential treatment is also very effective. In fact, this is especially true for those with more severe problems, including co-occurring disorders. Licensed residential treatment facilities offer 24-hour structured and intensive care, including medical attention. Furthermore, residential treatment facilities may use a variety of therapeutic approaches that require the expertise of a psychiatrist.

Psychiatrists play a key role in medically assisted treatment. That’s because they are the type of addiction specialists that can write prescriptions for medication. But therapists work in different aspects of treatment, such as individual therapy and group sessions.

Types of Psychotherapy

Psychiatrists and other mental health professionals use several types of therapy. The choice of therapy type depends on the patient’s particular illness and circumstances and his preference. Therapists may combine elements from different approaches to best meet the needs of the person receiving treatment. These are some of the most commonly used therapies:

Cognitive-behavioral therapy (CBT) helps people identify and change harmful thinking and behavior patterns. They are replaced with more appropriate thoughts and  behaviors. For psychotherapy for addiction, CBT can help a patient avoid situations that can cause a relapse. It also provides the patient with the tools to handle triggers that cannot be avoided. Coping skills in the “real world” can help a person focus on current problems and how to solve them. CBT can be helpful in treating a variety of other disorders, including depression, anxiety and eating disorders.  

Interpersonal therapy is a short-term form of treatment. It helps patients understand underlying interpersonal issues like changes in social or work roles, conflicts with significant others and problems relating to others. It can help people learn healthy ways to express emotions and improve communication. Most often, it is used to treat depression. 

Dialectical behavior therapy is a specific type of CBT that helps regulate emotions. Often used to treat people with chronic suicidal thoughts and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility to change unhealthy or disruptive behavior. It involves both individual and group therapy. 


Additional Therapies

Psychodynamic therapy is based on the idea that behavior and mental well-being are influenced by childhood experiences and inappropriate repetitive thoughts or feelings. A person works with the therapist to improve self-awareness and to change old patterns so he can take charge of his life. 

Supportive therapy uses guidance and encouragement to help patients develop their own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. 

Additional therapies sometimes used in combination with psychotherapy in addiction treatment include: 

  • Animal-assisted therapy — working with animals to bring comfort, help with communication and cope with trauma
  • Creative arts therapy — art, dance, drama, music and poetry therapies
  • Play therapy — helps children identify and talk about their emotions and feelings

Contingency Management

Contingency management therapy takes into account the immediate positive reinforcement people get from taking drugs and moves it in another direction. The theory is that drug users are more interested in immediate gratification. Meanwhile, they overlook delayed rewards.

Under contingency management therapy, the drug high is replaced with small, immediate rewards. As the addicted person progresses in his ability to resist drugs, the rewards become greater, although not as immediate. It’s important to remember, however, that the prizes are part of the overall psychotherapy for substance abuse treatment.

There are two main contingency management reward systems used for drug and alcohol rehab patients. The first is Voucher-Based Reinforcement. VBR augments other community-based treatments for adults who primarily abuse opioids, especially heroin, or stimulants, such as meth. In VBR, the patient receives a voucher for every drug-free urine sample he or she provides. The voucher can be exchanged for food items, movie passes, “or other goods or services that are consistent with a drug-free lifestyle.”

At first, the voucher values are low. But they increase as the number of consecutive drug-free urine samples rises. Get a positive urine sample and the value of the vouchers drop to the initial low value. VBR has been shown to be effective in promoting abstinence from meth and for patients undergoing methadone detoxification.


Prize Incentives

The second reward system is prize incentives contingency management. The prize incentives apply similar principles as VBR, but it becomes a game of chance to win cash prizes. Over the course of at least a three-month program, patients who supply drug-negative urine or breath tests draw from a bowl for a chance to win a cash prize worth between $1 and $100. Patients may also get the chance to enter the drawing for attending counseling sessions and completing weekly goal-related activities.

Some practitioners are concerned that the prize incentive option could promote gambling addiction. However, studies looking into this concern found that the prize incentives did not promote gambling behavior. As you can see, there are many forms of psychotherapy for addiction. The experts at the Oklahoma Addiction Treatment Network can help guide you through the various treatments. When you enter rehab, a specific psychotherapy treatment for substance abuse will be tailored to your needs. If you contact us, we can refer you to professionals who can answer more questions about how therapy can help you. To learn more, call 405-583-4390 today.


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