Changing Addictive Behaviour by Dr Elizabeth McCardell, M. Couns., PhD

 

May 2024

Addictions are gripping but are not necessarily permanent fixtures. We can change our behaviour. We have choices.

 James Prochaska and Carlo Di Clemente, in the 1970s studied the processes of change and came up with what is known as an integrative theory of therapy. This assesses a person’s readiness to act on a new healthier behaviour and provides strategies, or processes of change as well as that person’s decision making capacities. They identified the stages of change in this way:

 Precontemplation (an unreadiness for change) where people are not intending to take action to change and don’t see their behaviour as problematic but may be required to attend therapy to please the courts or families or employers. In this case, exercises in self awareness as well as realizing addictive behaviour is risky to health and relationships. Alcoholism and drug taking, gambling, porn addiction, digital media addiction, etc have dramatically negative consequences on good health, work, and maintaining healthy relationships.   Addiction makes it hard to maintain trust, respect and open communication with others and the life of addicts revolves around obtaining and using the drug of choice. This may lead to neglecting responsibilities or the needs of significant others and burning themselves out.

 Addiction saturates the brain with dopamine and people become dopamine junkies. Dopamine is less about giving us pleasure per se, rather it motivates us to do things we think will bring pleasure. We experience a hike in dopamine in anticipation of doing something as well as when we do the thing itself, which makes us want to continue doing it. As soon as it’s finished, we experience a comedown or dopamine dip. That’s because the brain operates via a self-regulating process called homeostasis, meaning that for every high, there is a low. Interestingly though, if a person can do something else interesting enough for 12 minutes, the addictive craving subsides.

 Contemplation (preparing for change) where people are starting to recognize that their behaviour is problematic and are starting to look at the pros and cons of their continued actions. They are also ambivalent about change. On the one hand they may be hoping to change their behaviour, but can also be unwilling to actually take action to make those changes. This is when they are likely to be the most influenced by prompts from others.

 Preparation (ready for change): here people are intending to act to make changes in their lives and are starting to take small steps towards this. This period typically lasts about  30 days. In this time they are telling friends and family about what they plan to do, which is great because it’s then that support is critical. They are  realizing that the better prepared they are, the more likely they will succeed in life long change.

 Action: people have made specific overt modifications in their behaviour. This is when they are most receptive to learning techniques for keeping their commitment to change. They are also realizing that they have to avoid certain people and situations that perpetuate the unhealthy behaviours of their old behaviour (for example, not going to the pub and drinking with friends when trying to stay sober). 

 Maintenance: people are able to sustain these new behaviours for at least six months and are working to prevent relapse. During this phase, it’s recommended that people spend time with others who engage in healthy activities such as exercise particularly during times of stress. Group meetings of former addicts are helpful for many.

 Completion (termination): people are no longer tempted to return to their old behaviours. If relapses occur, the process of change is likely to be easier than previously.

Change is possible. We don’t have to be chained to old behaviours. When we stop doing what we have habitually done, we find ourselves living in the world quite differently. We can obtain pleasure in less destructive ways and we can live life abundantly.

 

Preparing others for a lifetime of change is what counsellors do best. We help people through the first phases of addictive behaviour, for instance, and give them tools for maintaining and strengthening what they have learned and gained. It’s beautiful work.

 

The Snowdrop by Dr Elizabeth McCardell, M. Couns., PhD

 August 2022

 

     One of my favourite plants is the snowdrop. It spends most of the year as nothing more than a small swollen bulb underneath the dark earth. Time moves on, day to night to day… seasons change from hot to cooler to cold, rains come and go and come again, and nothing much seems to happen around that patch of ground. Where did I plant the snowdrop bulb again?

      Life goes on, new decisions are arrived at, new choices made, old stuff is left behind, new plans initiated. Change is constantly with us: some we fear, some welcomed, some just thrust upon us and we are forced into making new choices.

      Why, when transformation is happening within us/ for us, do we try and hold it back, to contain it, to try and continue the same old, same old? Why, so often, are we just afraid of change?  Why do we attempt to hold back the inner juices of inevitable shift in our being?

      The little bulb lying silently underneath the dark earth follows its own apparent inchoate primordial process, doing its own thing: growing roots, and preparing an upward thrust through granules of soil out to the sky beyond; much of which we don’t see until little green leaves appear.

      Are we actually any different? Does change in our own life go unnoticed until we find ourselves seemingly suddenly facing unfamiliar new things? Is meeting the sky unfamiliar to the little bulbed one, or is this new stage already known in the fabric of the cells of its being, in its memory of existence itself?

     My feeling is that we, like the little plant, have a deep knowing of the nature of transformation and a deep reverence for it. The stuff of religious ideas is emergent from it. The Christ rising from the dead, the miracles of lamas who transmogrify into rainbows, the mysteries of manifestations are all implicit in our ordinary processes of change.

      What then, the fear? Much of our lives is spent in trying to hold still the unstoppable. Do we not have faith in natural processes? In the Tao of life?

      I like to watch the making of sand mandalas by Tibetan Buddhist monks. Utmost attention is put to each grain of sand rubbed down by vibrations to the patterns forming below. The mandalas are of heavenly architectural buildings representing the dimensions of ourselves. When the “buildings” are made, they are sung over, and then scraped up into a vase and walked down to a river or the sea to be scattered to the beyond. Each act is the letting go of any idea of holding to the unchanged, for all is change, all is flux.

      There is something very beautiful in change. The little plant, now growing strongly, forms buds and then, in the miracle of silence, exquisite white flowers come forth: white blossoms with spots of green and a faint perfume. It is a pretty flower, the snowdrop, but so are we as revelations of beings in the process of becoming.

    Let’s not be frightened of change. We cannot control every aspect of our lives, and neither is there any benefit in attempting to do so. We can simply acknowledge that the changes that we become aware of have been happening anyway outside our consciousness. It is implicit in the nature of being itself. We cannot control the essence of life because it pulses through us. We are like snowdrop bulbs making flowers in the making of new futures.

 

“What we perceive depends on how we direct our attention.” (Milton Erickson) by Dr Elizabeth McCardell, M. Couns., PhD

January 2019

     Perception is an interesting thing. Most of the time we see our world as we have become accustomed to seeing it. This is generally useful as it means we are not having to work hard at living life, but can assume a lot of things and then get on with making sense of the novel. 

     Our responses to what we perceive can largely become part of a well-oiled machine, which is not to say that this is necessarily good. In families, old patterns of behaviour in interactions between members and beyond that to interactions with other people who simply remind us of a family member, can be practically set in stone in a destructive manner. For example, a little girl is bossed around by her older sister who has been given the care of the younger one because mother is ill. The older sister has always been angry at having to be “mother” to her sister and forced, more or less, to give up her own childhood. The younger one doesn’t really know any difference. Mum is sort of there, but not as a comforter when she is hurt. “Mother-sister” is unreliable (she’s angry, after all), but who else is there? Father works away, and there is no other family nearby, and so the little one has to depend on this person who feels good/not good. When she grows up, she meets a man who is good and not good. He is familiar, but still not quite known. He behaves unpredictably and erratically, he is there and then he disappears and returns to surprise her, and then goes, and then comes.  Every time the woman meets with her older sister, she feels attacked and sort of depleted. She notices that afterward seeing her sister she eats a lot of sweets even though she isn’t hungry and even though she is now pre-diabetic. She attends psychotherapy sessions and starts to notice the patterns of behaviour in her own life as well as that in the man she’s with. She breaks up with him and at the same time, builds an understanding her sister more. She starts to notice that as her perceptions of that woman’s behaviour change, so are her reactions changing. She doesn’t feel the same imploded feelings so much and doesn’t consume massive amount of  ice cream in the way she used to.

     The process of psychotherapy interrupts not only tired old modes of interaction that are not working, but brings insights that create an ongoing capacity to change how we respond to others in the world. This, though, doesn’t mean everything is hunky-dory. As anyone who has experienced how it is to stop reacting as one has traditionally done within families and other groups, one’s non-reactions disturb the machinery of the family system and certain others can become belligerent and nasty. My suggestion when such things happen is to walk away and leave the antagonist to fight their own shadows. I’m reminded of the martial artist who, when the opponent lunges aggressively at them, simply steps aside. The opponent topples over. Neat.

     In time, the perceptions of other people in response to us change as we change and how they behave towards us changes too. Family and other social systems are not immutable, but fluid and flexible. What once was, doesn’t have to be forever. Our perceptions change according to how we direct our attention, and that changes practically everything.

Seeing consciousness as a rolling ball by Dr Elizabeth McCardell, M. of Counselling, PhD

Dec 2012 

      Imagine a beach ball rolling around in a swimming pool, or in the ocean. The top surface of the ball rolls to below the surface of the water and then rolls right over so that what was previously on top returns there. The ball rocks a bit in relation to small waves, rolling again, rocking once more. Maybe you are imagining you are the rocking ball in the water, maybe you are not. Maybe you can sense the water around you; maybe you cannot sense the water. Maybe…, maybe not? Whether or not you are the ball or are watching the imaginary ball, its rocking and rolling motion in water has a nice calming quality to it. It’s hard to resist.

      This scenario could well be part of a hypnotic induction process where relaxation and yet concentration and focus allow for some profound changes to take  place at a holistic level in the person being hypnotised, but it also serves to illustrate how non-psychodynamic, non-psychoanalytic theorists  are thinking about consciousness. The rolling  ball image contrasts with the image of the iceberg where the conscious mind is illustrated as being the small bit above the surface of the water with the unconscious mind the huge iceberg below. Psychoanalysts, following Freud, think of consciousness in terms of an iceberg; non-psychoanalysts view consciousness more like a ball in water. I much prefer the rolling ball metaphor. There is fluidity here, fluidity and flexibility, and endless shifting change. 

      There are implications for therapy according to how we see consciousness and unconsciousness. For iceberg theorists and therapists, the work is always about ameliorating suffering at an unconscious level, as what is viewed as the conscious mind is only the “tip of the iceberg”, and a symptom is seen as coming out of  “the unconscious”.   “The unconscious” according to those following psychoanalytic thought is an actual place;  a cauldron of psychic energy which fizzes out in uncontrolled bursts in neurotics. I realize I have lots of mixed metaphors here, but they are only metaphors, which we can make up however we please and according to how we see the world.  The cauldron of psychic energy metaphor was that described by Freud (1856-1939), following his interest in the new technology of steam engines. Neurologically, there isn’t an unconscious mind nor a conscious one, but of course, the mind isn’t well accounted for in neurology. That aside, I want to promote consciousness in terms of the rolling ball analogy because I believe it is a very useful one.

     A rolling ball theorist/therapist has a view of consciousness that sees consciousness as that which is visible now and invisible next and visible again. Notice how this analogy does not talk of an unconscious as an entity. Here is a view of consciousness that is visible sometimes and invisible sometimes as well. This is a consciousness of awareness and unawareness that is always relational to actual contexts, memories, and ideas. There is no storage place of  unthought thoughts, but emergent or forgotten thoughts and emotions that under the right circumstances are remembered. These remembered thoughts and emotions and experiences may or may not be objectively or forensically verifiable, but have a veracity for the person involved. It is this sense of truthfulness that matters and can be brought into therapy, or not.

      My work is with what is and what next emerges in my conversation with my client at that time. There is only what presents itself  in our interaction. Insights arise on both sides, for me and for her. These are insights that enrich and expand my client’s awareness, as well as my own. This contrasts with a psychoanalytic approach where the therapist sits in a position of power and decision working with what they decide is important. The client’s input is restricted to what the therapist considers important, just as the image of a solid iceberg (clearly not one melting under the impact of climate change) restricts an understanding of what consciousness is actually capable of: in this view, fixed and inflexible.

      The rolling ball view of consciousness has changed how therapy is done substantially and it has also changed how clinical hypnosis is practiced, just as a matter of interest. No longer a swinging watch on a chain, no longer a “look into my eyes,” no longer “you are going deeper and deeper,” no longer a maestro controlling a patient; instead there is now a gentle collaborative process with a recognition that the client will hear what is important to them and make meaning according to their own experience, that a good hypnotist and therapist will change the course of a therapeutic session according to what is reported by the client and what is observed as present by the therapist. Hypnosis and other forms of  non-psychoanalytic psychotherapy becomes a nurturing and change making process. 

     What emerges in therapy and hypnosis can be extraordinary and a powerful generator of change at  a habit reducing level, the level of psychological and physical pain, for managing obsessive behaviours, for lack of self confidence, and a number of other debilitating issues, as well as bringing a greater number of choices to every day life. The beauty of the rolling, rocking ball in water analogy is that we can choose, or not choose, what we want to change.

Copyright @ 3013 Dr Elizabeth McCardell