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.

 

Using what is already there

Using what is already there   by Dr Elizabeth McCardell, M. of Couns., PhD, Dip Clinical Hypnotherapy

June 2013

     I was doing the initial assessment before a hypnotherapy session with a client recently, for work on his difficulty sleeping. Among other things, I wanted to know if he had had any prior experience with hypnotherapy. He said he had, but what he described was creative visualization, which is only one technique of hypnotherapy. He said it was kind of useful, but it didn’t have an enduring effect. He also said he had a relaxation cd that sort of worked, but he found it difficult to stay focussed.

     Creative visualization can be very effective, but only if the imagery is sufficiently pertinent to the person using or receiving it. This point is one I wish to develop here. It follows the principles I use, and have described previously, of using what is already within the ordinary experience of a client in therapy, for it is this unique and personal resource that aids in the process of recovery.

      There is an elegance in doing this that is very Taoist. The word “Tao” is difficult to translate and is usually described as the “way”, which doesn’t really tell you much. I like the description of the Tao as the watercourse way, the way of simplicity, the way things happen when water finds its path naturally, from where it is at now to where it becomes and how it changes its way in a simple process of becoming. The Taoist way is not forced and doesn’t impose things that are not already present in some form.

     So I inquired of my client with the sleeping problems what imagery was used by the previous practitioner. He said he had to visualize a waterfall in a forest and imagine the sound of water tumbling down. I asked if he had any particular liking for waterfalls and he responded that he didn’t particularly. He said it was an image he had to work at conjuring up. I then asked him what his favourite pastime is, and he replied fishing offshore in his boat. It is an activity he doesn’t get to do much, but when he does it, it relaxes him profoundly. This was the way of Tao for him and thus became the image I used in my session with him: sitting in a gently rocking boat, throwing a line overboard and waiting for a fish to nibble. Fishing from a boat is something he knows and it is something that he does already for relaxation. What a better resource than a imagining with difficulty a waterfall prior to drifting off to sleep!

      The fundamental of good therapeutic practice in general is to start with their lived experience, their phenomenology, not an alien idea taken from a text book. This is why taking a case history really matters, and why intelligent questioning and conversation is needed throughout the sessions of working together. What happens in a psychotherapeutic and a clinical hypnotherapy session is thus shaped around the client’s experience, and the resources they already have, albeit ones they may not be aware of. Change happens from this starting point, in a very concrete way and not in any abstract sense.

     Hypnotherapy has come an incredibly long way from the traditional method of the hypnotist requiring the patient to gaze at a candle or swinging pendulum and then to go into a deep trance and receive suggestions without an opportunity to respond to them during a session.  By contrast, in modern  hypnotherapy developed from the wonderful work of Milton Erickson (1901-1980), the client might be invited to speak about what’s happening for them as the therapist works. They may be invited to comment on the direction the session is going, or to speak about their experience at that particular time, or amplify or clarify some aspect that the therapist doesn’t fully understand, or they themselves need further explanation. This invitation is a hallmark of an approach that isn’t top-heavy, like traditional hypnosis tended to be; it is, instead, collaborative. The client can choose, and express it aloud, whether to take up suggestions made during the session. In other words the client is active in the process. Things are not being done to him against his will. His own experience, matters and this is what is employed in the sessions with the therapist. Change happens through choiceful engagement in a process, not because somebody else dictates it.

     In other words, modern clinical hypnosis, is less dependent upon the development of a trance state (though this remains part of it) and more on bringing focus through awareness of other ways of seeing things and of shifting an emphasis that is getting in the way of ordinary life. Problems like smoking, insomnia, pain, hoarding, low self confidence, compulsive behaviours, panic attacks, and depression are all helped by hypnotherapy sessions. I emphasize, though, the collaborative aspect of this kind of therapy. Hypnosis isn’t a magic pill that cures without the person wanting change. Change happens because the person wants it. The sessions are deeply nurturing and the person generally expresses feeling wonderfully relaxed

     Therapeutic change has a similar feel to the way water courses through a landscape, organically transforming everything it meets, for it uses the already present yet tangibly shifting blockages and stagnations and problems that used to go round and round and round one’s head, to a new fluidity, a lightness of being, and an a delight in something young and new and very exciting. This therapy is deeply transformative.