Healing Alcoholism

BOOK THREE: Healing Alcoholism 

Return to home? 

 In this section I aim to provide psychotherapists with a set of guidelines for the therapy of alcoholism. These guidelines will also be of interest to the spouses, relatives, and friends of alcoholics, since they can be used, with a few modifications, by anyone who wants to relate to an alcoholic in a helpful way. Let me summarize.  

Alcoholism is not a disease; therefore, the best solutions to alcoholism are not medical.

 

Alcoholism is not incurable. It is an acquired condition different from person to person, based partly on innate, biochemical responses to alcohol, partly on social pressure to drink, and partly on the emotional, thinking, and nutritional habits of the alcoholic. 

Alcoholism can be healed, and a few former alcoholics (about 10%) are evidently able to return to normal drinking though the majority either can't or choose not to. 

The physical factor responsible for alcoholism is the addictive properties of alcohol. This is treated by maintaining sobriety for at least a year.

The social factors responsible for alcoholism are the intense social pressures to drink, and the participation of alcoholics and their circle in the Alcoholic game with its three roles: Victim, Rescuer, Persecutor. These roles must be avoided by anyone who wishes to help the alcoholic 

The psychological factors responsible for alcoholism reside in the Enemy. The Enemy is a collection of harmful messages that have been adopted by the person and that interfere with thinking, feeling, getting strokes, and being aware of one's bodily states. This is treated by confronting and neutralizing the messages and emotional patterns which the Enemy promotes. One very effective method to achieve this goal is emotional literacy training.

AA should be enlisted whenever possible. The therapistís job is to encourage the client to take action against the alcoholism and to provide protection as the alcoholic changes his or her life. 

 

Chapter 12. Myths of Alcoholism. 

 There are many theories about what causes alcoholism but precious few specific approaches to the problem. Alcoholics Anonymous remains the best choice for people who find themselves in difficulties with alcohol. The professional literature, on the other hand, is filled shot through with big words like compulsion, regression, passivity, dependency, character disorder, psychosis and so on. These terms humiliate alcoholics and do not seem to answer the main question: what do we do to help the alcoholics? 

As a result of this poverty of approaches, it is very difficult for an alcoholic to obtain reasonably competent treatment. Many therapists feel afraid and uncomfortable with alcoholics and are therefore reluctant to get into therapy with them. The more experienced therapists will happily refer alcoholics to other therapists while they keep the more pleasant clients for their own comfortable practices. 

Let us briefly explore certain myths about alcohol and alcoholism. These myths have served to obscure the obvious in a field that has been riddled with contradictory opinions and points of view. Disposing of these myths can clear the way for a sensible and objective approach. 

1. Alcoholism is just an illness  

As we have seen, the notion of alcoholism as an illness (in the sense that the medical profession defines it) is an obstacle to its proper treatment. It is important not to confuse the illness, which is a consequence of excessive drinking with excessive drinking itself, which is not an illness at all. Saying that alcoholism is an illness (because of the different illnesses that are associated with it, like delirium tremens, heart disease, or liver or brain disease) is like saying that driving recklessly is an illness because it often leads to broken bones and concussions, which are treatable only by physicians. 

 On the other hand alcoholism is a health disturbance in a more general sense. Modern holistic medicine, regards disease in a completely different light from Western allopathic, (drug-and-surgery-centered) medicine. In the holistic view any disturbance of healthy bodily functioning is a health disturbance. 

The approach outlined in this book, and even its title, are strongly influenced by holistic health ideas. Holistic medicine's specific treatment of alcoholism bears little resemblance to what has been the traditional medical approach. Above all, sedatives and tranquilizers are not used. Instead, diet and life-style changes are recommended, together with an expectation of the alcoholic's active participation in the healing process. 

Attempts to treat alcoholism with drugs have failed even though at certain points of a drinking episode it appears that certain drugs can be of some help. However, at this moment, there are no drugs that specifically treat alcoholism, nor are there or have there ever been any drugs that show any promise. In my opinion drugs for alcoholics should be avoided altogether-except for medical emergencies. It is important that alcoholics and their therapists abandon the notion that alcoholism and medicine are necessarily related in any way except in the terminal stages of alcoholism when it has become intimately associated with bodily tissue damage. 

The sense that the alcoholic is progressively, incurably ill and that therefore nothing can be done about the illness, except to keep the cork on the bottle, is as much a myth as the other extreme of thinking, which states that alcoholism is strictly a matter of choice. 

2. Alcoholism is just a choice 

This myth lies beneath the notion that the alcoholic chooses to be an alcoholic and that the remedy is simply a matter of choosing differently. According to this view, the alcoholic or any other addict doesn't need therapy, A.A., or any help at all. All she needs to do is make her mind to stop, "just say no" and "do it." This view is all the more prevalent since it is clear that some alcoholics do just that; they quit and even return to social drinking.

But for the majority of alcoholics who are not able to just stop, this approach overlooks the many pressures to drink that the alcoholic finds herself under and how those pressures are, at times, irresistible. It is an approach that leads to callousness on the part of the helper; nothing but the alcoholic's will to drink or not to drink is considered of any importance. 

Only someone who has never been under the compulsion of drug or other substance abuse can understand how humiliating and persecutory such a point of view can be. Some alcoholics are so browbeaten by this view that they will accept and defend it themselves. "I am just a weak-willed person." "All I have to do is stop drinking-then Iíll stop being an alcoholic" or "I have to do it myself-that's all there is to it'" are the kinds of things alcoholics who have been thus indoctrinated will say about themselves.  

 These views are not very useful, they sound brave and responsible, but they don't help because they are unrealistically simple and almost never work. Most frequently they result in nothing more than guilt and further feelings of powerlessness because they ignore the powerful factors other than choice that are the causes of alcoholism (addictions habit, social pressures, the inner Enemy, etc.) They interfere with a realistic view of people's responsibility in their own life. 

3. Alcoholism is just a symptom. 

This point of view, though less and less prevalent, is that drinking is merely a symptom of a deeper psychological or social problem. As a consequence, these therapists will choose not to discuss the drinking (because it is merely a symptom) but will attempt to investigate its "dynamics" and origins (childhood traumas, social environments, script injunctions and attributions, early family constellations, emotional conflicts, or repressed primal screams) through a variety of techniques such as psychoanalysis, gestalt therapy or psychodrama-all of which ignore the everyday realities of the alcoholic's drug use.

Since these views consider drinking just a symptom of a deeper problem these therapists do not typically seek complete cessation of drinking and will have to deal with clients who are almost always under the influence of alcohol, (or between binges) and cannot realistically exercise enough common sense and Adult control to deal with whatever they must do from day to day to make their lives work. 

From the Transactional Analysis point of view, the therapist who chooses to ignore the client's drinking in favor of dealing with his more "basic" conflicts is playing the role of Rescuer (Patsy variety) in the game of Alcoholic and is contributing to the continuation of the problem. Regardless of whether drinking is a symptom or not, it is necessary and desirable that the alcoholic take some realistic action. Regarding alcoholism as only a symptom can be a major mistake comparable to forgetting to bail out a sinking boat while looking for leaks. 

To stop drinking is the very first step. Stopping the drinking may not be a cure, but it does stop the progression of the script and is thus an indispensable move. Only a reliably sober person can find the energy and clarity of mind necessary to deal with the "underlying" causes of alcoholism. Changing life styles, friendships and social circles follows.

Allied with the misconception that alcoholism is just a symptom of deep underlying emotional conflicts is the assumption that only "deep" one-to-one individual psychotherapy can be effective in dealing with it. In fact, group psychotherapy has proved to be every bit as effective as one-to-one therapy-especially in the treatment of alcoholics. In groups, alcoholics seem more capable of ridding themselves of the problem permanently than in deep" one-to-one analysis. In my experience alcoholism does not require "deep" or heroic methods of therapy. It does require a relaxed, patient, nurturing, well-informed, experienced, demanding, persistent and optimistic approach.

 

In summary: alcoholism isn't any one single problem. Instead, it is the result of a combination of physical, personal, and social factors which exist in different people at different times in their lives. When the 'right" combination occurs-and it occurs in about twenty million people in this country at this time-alcoholism results. Alcoholism can be healed and what can be done to heal it will be discussed in the rest of this book. 

 

 

Chapter 13. Can Alcoholism Be Healed?

 

Some argue that alcoholism is incurable. Can Alcoholism really be healed? This is a good question that deserves a serious answer. The short answer is "Yes!" and that natureís healing powers are on our side.

In Transactional Analysis we believe that children are born OK, with an innate potential for spontaneity, awareness, and intimacy-or, as Eric Berne put it: "People are born princes and princesses (and their parents turn them into frogs.)" Depending on what kind of a household or situations we are delivered into by fate, our development to full potential may be fully allowed, or we may be "turned into frogs" when our potential is nipped in the bud or barely permitted to muddle along.

 

Another way of saying this is that human beings are imbued with a life force for health and survival which, if give the opportunity, will heal the body and soul from most damage. This force, Natureís helping hand named Vis Medicaterix Naturae by Hippocrates, is present in all the living and is the greatest ally of the client and therapist in the struggle against alcoholism.

The cynics are convinced that people don't change, not really. The optimists believe that everyone can, given the proper motivation and help. As usual the answer is somewhere in between; of course people can change. A donkey will never be a mule but change is the essence of life. The question is how much and how fast.

Change is inevitable but three things promote or stimulate it. The first is intense need. That is what alcoholics call "hitting bottom," the point at which the consequences of excess finally become unacceptable or unbearable. One day the alcoholic wakes up facing financial, personal, social or health disaster and he says to himself: "This has to change I have to do something about my drinking!"

 

The second major requirement is the capacity to manipulate oneís behavior through symbolic thinking or what we in TA call "Adult control" Neither of the two aloneódesire or control--is sufficient but together they are capable of shaping behavior in a permanent way.

Thirdly, radical change requires action. The significant changes that healing alcoholism requires are unlikely to happen without concerted action on the part of the alcoholic.

Change, as I said, is an inevitable aspect of life. Healing change is generated from within and we can either help it along or interfere with it. As long as there is life, the struggle to change for the better usually continues and the therapist can help. Sometimes, for a while, a person may not want to improve his or her life but that too is liable to change.

A recent study by Timko et al published in the Journal of Alcohol Studies (July 2000) supports these views. 466 alcoholics who participated in a detoxification program, indicating that they had hit some sort of bottom were studied for eight years. Some received no treatment, others had some sort of psychotherapy some went to AA and some had both treatment and AA. After eight years it was shown that all improved. Those who had both forms of intervention did best, AA and psychotherapy separately had a lesser but roughly equivalent improvement and of those who had no treatment 25% improved anyway. It is a feature of living things that they have self-healing mechanisms independent of any healing administered by any intentional healer.

There are many recorded cases of extreme alcoholism that was healed without healing intervention of any sort. Still a good therapist can be very helpful. A competent, honest therapist works for a living and is mindful of her job. She is humble as to what, in the end, helps the client: a combination of nature's healing power, the clients efforts to take responsibility and bring about changes and the therapist's direction and skills. Every session she reviews what progress is being made, openly rejoices or regrets the client's changes and is ruthlessly analytic about the process using the most advanced knowledge to inform her work. She recognizes the unique individuality of each client and applies her creativity to the client's specific difficulty. She is tuned into and respectful of the clientís perceptions and opinions. She provides permission to change. She provides protection against the demons that beset the client in uncharted, healing waters and she devotes constant, potent attention to the whole process. Her love of truth keeps her honest about the effects of the therapy; positive, negative or neutral.

A jungle healer

Here I would like to tell a brief, apocryphal story: A physician was called to visit a village in the jungle because of epidemic of dysentery that affected 8 out of 10 of the people. After a brief tour of the town he called a meeting of the elders: "I noticed that your latrines are next to the river. Here is what you must do right away. Always take your drinking water upstream of the latrines and your problem will be solved.

The villagers followed this basic, generic, public health principle and the epidemic abated. Still 20% of the villagers continued to be ill. Later measures such as boiling the water, moving the latrines away from the river, antibiotics, etc reduced disease by another 15%

With alcoholism, stopping the drinking, like stopping the drinking of polluted water is an essential aspect of the process of healing. In addition most psychotherapies share a number of mental health principles which will be beneficial to the sober alcoholic. A good therapist will be nurturing and will endeavor to be attuned, thoughtful and soothing while the client is encouraged to talk about problems and vent feelings.

But every personís problems are different and the basic methods described above are often not sufficient; a higher level of expertise is needed to combat the Critical Parent, deal with unruly emotions, handle emotional complications and nutritional and other health issues. The various factors that are important in the healing of alcoholism will be explored in the next chapters.

 

 

 

Chapter 14: Personal Responsibility

 

 How does it happen that in spite of having the capacity for choosing any kind of life, we wind up with the particular enslaving scripts that we live?

Even North America where people have an unusual range of choices and reasonable freedom to choose between them, approximately 10 percent will become slaves to alcohol and suffer the devastating horrors of alcoholism. One-fourth will be addicted to cigarettes and (this is my guess) as many as one-third will let themselves be dominated by some form of addiction: caffeine, sugar, fattening foods, prescription or over-the-counter drugs or narcotics.

 

Does the alcoholic simply lack will power and insists in making bad choices? Or is the alcoholic a victim of his heredity childhood experiences and family? Heredity matters and childhood experiences matter but no one is willing to claim that they are the reason why alcoholics are alcoholics. We assume that the alcoholic has choices, yet he feels powerless.

 

Powerlessness 

One experience is common to all addictions, and that is the feeling of powerlessness. If there is an innate healing positive force within all of us why is alcohol so powerful and alcoholism so difficult to overcome?  

Being unable to control one's behavior is a devastating experience. Not having the power to stop the use of cigarettes, sleeping pills, coffee alcohol, amphetamines, heroin, marihuana or prescription drugs, gambling or sexual compulsion when we know they are harmful, is most damaging to self-esteem. When we experience the humiliation of powerlessness, it poisons our daily life, makes us feel worthless, contemptible, and ashamed. We look around and see other people who appear to be in control of their lives, doing what they must do, avoiding what they must not. Yet we see ourselves chained to our habits, powerless to control our own actions. 

Many people manage to avoid confronting their powerlessness over substance abuse by telling themselves and others that the amount of harmful substances they consume is reasonable, that there is no problem, that they are in fact consuming these substances voluntarily, because they enjoy it and don't see anything wrong with it. Still many of those people secretly would like to stop.

The terror that comes with the realization of how helpless we really are is one of the greatest obstacles to people's success. Discovering that we are powerless to stop doing things we don't want to do is an experience we wish to avoid. Many who know and believe that it would be desirable to do something about their harmful habits simply do not attempt it because they believe they will fail, and, quite understandably, do not want to face the humiliation of their impotence. That is why acknowledging oneís helplessness vis-ŗ-vis alcohol is the first step in AA recovery.

We are brought up to believe that anybody who is anybody can do whatever he needs to do by himself, without any help. To seek advice, to request nurturing, are taboo. This is especially true for men in our culture, who believe that doing it alone, without help, without discussion, is how it really should be done. It is true that some people manage by themselves. But addictions are very powerful; help is needed, and trying to do it alone is unnecessary, foolish, and prideful while seeking help is intelligent, human, and effective.

 

By ignoring the realities of addiction and blaming ourselves for lacking willpower we make ourselves more powerless than we really are. Addictions are difficult to overcome but with help it can be done.

 

According to some, people choose what they do and are completely responsible for what occurs in their lives. If their lives aren't working satisfactorily it is because they are choosing them to be so. People can choose to be poor, and people can choose to be rich. People who are not loved have a need not to be loved and could find a faithful lover merely by looking. People who are ill can choose health; people who are persecuted can choose to be free.

If we are to believe this view, we have no one but ourselves to blame for the quandaries in which we find ourselves, life is exactly as we want it to be and if we wanted it to be otherwise we could simply change it. There is no point in blaming our parents or teachers, advertising, our government or the media, the multinational corporations or globalization the quality of our lives; we are free to choose whether we want to be happy or unhappy, employed or unemployed, healthy or sick.

Those holding this view, remind me of the finger who, because it could move this way and that, every time it wanted to, developed the delusion that at was separate from the other fingers and in complete charge of its own destiny.

 

The Greek word idiotes means separate individual. Hence this fingerís delusion can be justly called idiotic. It is plain to the observer that the finger is attached to a hand and that its everyday life and destiny is intimately tied to factors beyond its control. The absurd notion of total personal responsibility was successfully sold to people through millions of copies of best-selling pop-psychology books in the late 20th century.

A further, equally mistaken, corollary of the idiotic view of total responsibility is that since we are completely responsible for what happens to us we canít be made to do things or to feel emotions by others. We are not responsible for what happens to other people nor are they responsible for what happens to us. This especially true in the area of emotions where the notion is that "I canít make you feel and you canít make me feel." This latter fallacy is thoroughly explored in my book: Emotional Literacy; Intelligence with a Heart.

 

Let us, however, look further into this notion and ask ourselves why the myth of total personal responsibility is so appealing to people. The idea does have a substantial grain of truth. We do choose just how we are going to live our lives. However, the choices we have, especially as children, are usually very limited. If we looked realistically at the tens of thousands of children who are born every day, we would see that only a few lucky ones will be given true freedom to choose. Many face starvation from the first day on, many will never have the basic human right to speak freely or to express their emotions-let alone to choose for or against in matters of importance to their lives.

Many are not much freer in the "land of the free." We smoke, drink coffee and alcohol and sodas, eat Macburgers and French fries and then we get fat and develop back trouble, diabetes or cardiac disease. It could be said that we chose all that from our free will. But how many of us can work eight hours and commute two hours a day, cook a healthy meal, do the dishes, take care of the kids and the dog and then jog or exercise for an hour at the end of the day?  Sure, we choose to drink, drink, drink from sun up to bedtime. But we are pressured to drink by friends, coworkers, employers and constant advertisements. We aren't allowed any other avenue for the expression of our needs, for fun, love or human contact. We are also addicted and don't know it.

Most script choices are made in the distant past, and they have consequences not so easily changed. It is as if life was a walk through a thick forest. If, early in the day we choose a certain fork on the path and decide by noontime that we made a mistake, the right path can be found again but not all that simply. So, yes, we choose, but we choose among the alternatives available to us at the time, and we choose before we know much about what our choice means or leads to. That can hardly be translated into the claim that we are fully responsible for the shape our lives have taken.

Another reason that people adopt the view of total responsibility may be because it gives them a feeling of power over their lives "If I didn't believe that I have power over my life, I could become completely discouraged, I'd want to give up and kill myself!" a patient once told me.

Psychotherapists who espouse the idiotic view seem to be convinced that anything short of taking complete responsibility would cause their patients to give up all efforts to change and settle into a mire of irresponsible blaming. My experience with this matter is different. I believe that people's lives are the result of a combination of external and internal factors; an alcoholic is an alcoholic because she has a genetic predisposition to it, because her father and grandmother were alcoholic and because she decided to sneak drinks when she was a teenager. She is surrounded by people and advertising which encourage her to drink. She is overworked and exhausted from an ill-paying and monotonous job and she doesn't eat or sleep properly. Her choices are combined with external influences to shape her life. It is a fifty-fifty proposition.

 

Some therapists think that this is yet another dangerous idea that encourages people to blame other people and bad conditions, rather than themselves, for their alcoholism. However, when I explain this to my patients, they don't respond by giving up and blaming the world for their problems. They simply come to see more clearly why their lives are what they are and why, at times, they feel powerless over them. So far as I can see, this realization only leads to renewed efforts and power rather than to giving up. 

 

 

 

 

Chapter 15: How to Help Without Rescuing  

People often ask me, "What is the secret of good psychotherapy?" My answer often is, "One-third not Rescuing, one-third transactional analysis, and one-third hasn't been figured out yet." 

In a reasonable helping situation, we are able to make as much of a contribution as we want to make for as long as we want to. We remain free to withdraw and let the person help himself or find others to help him. 

 Not so in a Rescue. A Rescue is like a fishhook; once we take the bait, it is very hard to let go. We cannot stop the Rescue because we develop the impression that our Victim will drown, fall apart, die, or kill himself if we do. We are stuck because we do not want to be responsible for the tragic end of another. Somehow, in the process, our victim has shifted the responsibility for his condition entirely onto our shoulders and because we are reasonable, humane, human beings, we cannot simply dump him-so we unwilling carry the load sometimes through extraordinarily long and arduous periods of time. 

In this connection it is helpful to distinguish between a small "r" rescuer and a capital "R" Rescuer. The rescuer is someone who as part of his vocation or avocation helps people in distress. Among such are lifeguards, firefighters police, physicians, nurses, social workers, alcohol psychotherapists and so on. It is quite possible to be effective as a rescuer and truly benefit other people in need. On the other hand, rescuers can also be Rescuers, people who get caught in the Rescue triangle game with a victim. 

When a rescuer becomes a Rescuer, he steps into the merry-go-round of the Drama Triangle. He becomes an actor in a play and loses his potency as a healer. Specifically with alcoholism his behavior will cease to be therapeutic; his words will become lines read from the alcoholic's script which serve only to promote the alcoholic's tragedy through to the final curtain. 

The basic difference between a genuine "rescuer" and a game "Rescuer" is relatively easy to detect. If you are doing more than 50 percent of the work or investing more than half the effort in a situation in which you are helping someone you are Rescuing. Even God in his infinite mercy won't help those who don't help themselves-or so the saying goes. It doesn't make any sense to try to help those who don't participate in the effort; it is important to only go halfway in any situation in which we are trying to be helpful. That means, first and foremost, that we do not help someone who is not asking for help. Diving head first into situations where the victim hasn't even asked to be saved is the most blatant example of a Rescue. Alcoholics are expert at presenting us with a situation which is in need of repair. They may not want to commit themselves to working on it, but they're quite willing to let us try if we want to.

Characteristically, the alcoholic's Rescuer does most of the talking, cooking, traveling, staying awake, planning, or thinking while the alcoholic simply does most of the drinking. A good contract, faithfully followed, is the best insurance against that sort of outcome. (As discussed in Chapter 16) 

 This may come as a shock to you, but if you are helping an alcoholic and really don't want to do it anymore, and don't stop soon, you will be Rescuing. If you are Rescuing, you are not only not helping the alcoholic, you are actually harming her. This is true for anyone-whether she works in an agency dealing with alcoholics or is in a relationship with an alcoholic-as a child, spouse, or parent. If you are helping without the desire to help, or if you are doing more than your share of the work you are not only not big helpful, you are making the problem worse. 

 This is difficult for people who may be totally immersed in Rescuing an alcoholic to believe, but it is true. I have witnessed scores of situations in which, after forcefully pointing this out to a Rescuer and encouraging that he stop the Rescue, the alcoholic did not go under, die, or commit suicide, but in fact pulled himself together and made some improvement in his life. Alanon the self help organization was designed to help the persons close to alcoholics to avoid just such a situation.  

Everyone, sooner or later has had the experience of being sucked deeper and deeper into doing more and more with and for a deeply troubled person who seems to be getting nowhere fast. Each renewed effort starts with hope and ends in disappointment. Or we may have experienced the anger and dismay of seeing months of support and involvement in seeming success dissolve into a binge or a similar breakdown. Yet it seems that turning away from someone else's need would be heartless and selfish.  

 These are traumatic experiences for the Rescuer; but, as I have said repeatedly, they are also harmful to the Victim and they must be avoided for the sake of everyone involved. 

Again, Rescuing is simply a matter of: 

 (1) Doing more than your share of the work in a relationship, and/or

 (2) doing something you don't want to do. 

But what about compassion? The Good Samaritan? The duty to help? Can we let these intellectualizations guide our behavior when we come across a life and death situation and the Rescuing guidelines recommend that we stay aloof and refuse to help?

Please donít confuse these words with hard heartedness or cruelty. Of course we stop and help a person who is injured or dying. Of course we extend a helping hand to the sick or needy. I am speaking here of helping a person over time when that person is not matching our efforts with theirs.

 How do we know when we are doing more than our share in helping another person? This is not always clear. In an attempt to develop Rescue-free relationships, some people have carried this concept to extremes. Rescue avoidance has been misunderstood by some to mean being distant and noncommittal, avoiding a warm, nurturing attitude with anyone who needs help, being suspicious of any situation, which seems to pull at our sympathies. This is not what I mean; when not Rescuing is carried to that extreme, it is a subtle (or not so subtle) form of Persecution.

Doing your share in a relationship is a much more subtle process than merely staying aloof. Consider the following telephone conversation I once had with a man who eventually joined one of my groups: 

CS: "Hello." 

Mr A: (Surprised at hearing a male voice rather than an answering-service operator) "Hello, may I speak with Dr. Steiner?"

 CS: "This in Dr. Steiner." 

Mr A: (Seems disappointed). "Oh, I didn't expect to get you on the phone. "

CS: "Well, here I am, how can I help you?" 

Mr A: "(Somewhat hesitant) I'm calling because my sister thought I should speak to you."

CS: "About what?" 

Mr. A: "Well, she says I'm an alcoholic." 

CS: (Cheerfully) Well, good, thanks for calling. What do you say?" 

Mr. A: (Startled) "About what?"

CS: "About being an alcoholic." 

Mr. A: Well, to be perfectly honest, I'm not sure I know. I guess I am an alcoholic. 

CS: Okay. What can I do for you? 

Mr. A: Well, I really don't know. 

CS: (Nicely): I'm sure I don't know if you don't know. Why don't you call me back when you know what you want from me? I'm usually easy to reach, and you can... 

Mr. A: (Anxious) "She said that you have classes for alcoholics." 

CS: "That's right. Actually, they're not classes, they are therapy sessions."

Mr. A: "I guess I should come to one of the sessions."

CS: "What for?" 

Mr A: "Well, to try 'em." 

CS: "That would be okay, but I don't think you really want to come. (Silence-no reaction from Mr A.) Why don't you tell your sister that you spoke to me and tell her that we agreed that it probably wouldn't work. That way she will be satisfied, and I will be able to go back to what I was doing before you called."

Mr. A: (Relieved) "You don't think it would work? Why not?" 

CS: "Well, because you really don't want to do it, and therapy never works for people who don't want it."

 Mr. A: "I can see that, and I really don't want to do it right now."

 CS: "Well, if you don't want to do it, I don't want to do it either. Thank you for calling. You didn't tell me your name."

 Mr. A: "The name is Amble. Karl Amble." 

CS: "Okay, Mr. Amble, nice talking to you." 

Mr. A: "Well, maybe I should try it." 

CS: "You should think about it. I'm always here-you don't have to decide right now I have group therapy once a week, and if you want to know more about me you can read my book Healing Alcoholism, or you can call me again. Okay?" 

Mr. A: "Okay, Good-bye." 

 With Mr. A's example, I have tried to illustrate the process of starting therapy with one who needs help, without Rescuing.

In order to avoid Rescuing in a group setting it helps to visualize the situation between the people involved in terms of a space in which negotiation take place. Two or more people are sitting around an initially empty space. As the conversation proceeds, everyone puts something into the common central space. The people in the helping role, whether they be therapist, friends, or group members, ask questions, put in suggestion, or offer nurturing. The person who has taken the role of being helped (let's call him Karl) examines the offerings and chooses what he wants. If he likes a suggestion or accepts a criticism, he picks it up and acts on it. If he doesn't, he leaves it alone. 

 If Karl wants the nurturing he is offered, he accepts it. The helpers are keenly aware of Karl and what he takes and what he rejects. If he is eager, then the helpers become eager as well. If he is reluctant, the helpers sit back; the helpers and Karl maintains a balance of activity. If Karl rejects a number of ideas, then the helpers stop making suggestions.

I have a personal rule that I call "three strikes and you're out" as in baseball. I keep track of the suggestions I make. And when three of them are rejected, I stop. I may even say, out loud, "strike three" I might explain that I've made three suggestions that must not have been very good and have therefore struck out. This may sound disingenuous but it really isn't, because I truly believe that any suggestion that is rejected probably was not a good one. It was either not put in the proper words, so the person could understand it, or it was poorly timed, or perhaps-wonder of wonders-it was really a poor suggesting.

 I am of the opinion that a valid, properly worded and timed suggestion will be accepted, and that when a suggestion is rejected, there was probably something wrong with it 

 Not Rescuing helps because it rejects the Victim role. To the alcoholic's plea, "Help me! I can't do it!" the response of the effective helper is, "I am interested in helping you if I can see what you are doing on your own behalf. What are you doing for yourself? What else can you do? What will you do if I help you? What would you like me to do? Let's make a deal: I'll do X if you do Y."  

 It is also necessary to be able to say, "I understand that you would like me to help you, but I don't have the desire (or time) (or energy)." 

 Not Rescuing additionally avoids Persecution. Persecution is the inevitable result of Rescues, and for every minute that a person spends rescuing another, it is inevitable that another minute will be spent Persecuting. Yet, since no one is perfect and no one can really avoid Rescues every once in a while (as I keep noticing myself), it is important to know how to deal with one's Persecution tendencies as well as one's Rescue tendencies.

First, it is important to recognize that Persecution is a harmful transaction and that when we feel angry at others because they're not working hard, or because they're rejecting all of our moves, or because they are not getting better, that this anger is our responsibility and should not be foisted on them. When, for one reason or another, after having Rescued an angry feeling of persecution emerges, it is important to say so and to take the responsibility for it. 

 "Karl, I am getting angry at you because you are not accepting my suggestions (or because what I do doesn't seem to help). I realize that I shouldn't be angry and that my anger has to do with trying too hard. I apologize for having Rescued you and I will try not to be angry. I hope you will understand if I pull back a bit and stop trying so hard."

 Having spoken so strongly against Rescues, I feel I need to say a few words to prevent too strong a reaction in the opposite direction. I call this reaction an anti-Rescue and believe it to be a subtle form of Persecution in which our present fear of helping is a reaction to mistakes of the past. An effective therapist is willing to stick her neck out a little to start the ball rolling. Being initially eager, helpful, friendly, and active does not mean that one is Rescuing.

 One other assumption is that to simply nurture someone who is hurt or feels powerless or in distress is to Rescue. I think it is very important to distinguish between Rescue and nurturing. When someone is upset and is showing his feelings freely, I see it as a very substantial contribution toward improvement. I feel no qualms about responding with some feelings of my own. Most of the times when a person cries, the tears are a genuine expression of feelings of despair and powerlessness. People's anger reflects their frustration. I will assume that these are honest feelings and will respond in kind, with my own honest feelings. Only if this becomes a pattern, where the person gets angry or cries or engages in emotional outbursts repeatedly, without any visible progress or change, will I then consider the possibility that I should not respond lovingly and that perhaps, as some T.A. therapists say, "I am stroking a Ďracketí or game." 

Nurturing someone is not automatically a Rescue, it is a legitimate aspect of helping people. Not nurturing someone who is genuinely upset is, once again, a subtle form of Persecution. Some people who become therapists and who have problems being loving and nurturing will use the concept of not Rescuing or Tough Love to justify their lack of warmth, but this use of the concept is nothing more than an easy copout. 

Ten Rules to Avoid Rescues:

Although there are many ways of Rescuing an alcoholic, some ways are typical. Here are ten of them: 

1. When three or more suggestions to an alcoholic have been rejects you are Rescuing. Instead, offer one or two, and wait to see whether they are acceptable. If they are not, stop making suggestions. Don't play "Why don't youÖ Yes, butÖ" 

2. It's O.K. to investigate possible therapists for an alcoholic, but never make an appointment for him or her. Any therapist who is willing to make an appointment with an alcoholic through a third arson is probably a potential Rescuer and eventual Persecutor.  

3. Do not remove liquor, pour liquor down the drain, or look for hidden stashes of liquor in an alcoholic's house, unless you're asked to do so by the alcoholic. Conversely, do not ever buy, serve, mix for, or offer alcohol to an alcoholic. 

4. Do not engage in lengthy conversations about alcoholism or a person's alcoholic problem while the person is drunk or drinking; that will be a waste of time and energy, and will be completely forgotten by him in most cases when he sobers up. 

 5. Never lend money to a drinking alcoholic. Do not allow a drunk alcoholic to come to your house, or, worse, drink in your house. Instead, in as loving and nurturing a way as possible, ask to see her again when she is sober. 

 6. Do not get involved in errands repair jobs, cleanups, long drives, pickups, or deliveries for an alcoholic who is not actively participating in fighting his alcoholism. 

 7. When you are relating to an alcoholic, do not commit the common error of seeing only the good and justifying the bad. "He's so wonderful when he's sober" is a common mistake people make with respect to alcoholics. The alcoholic is a whole person, and his personality includes both his good and bad parts. They cannot be separated from each other. Either take the whole person or none at all. If the balance comes out consistently in the red, it is foolish to look only on the credit side. 

8. Do not remain silent on the subject of another's alcoholism. Don't hesitate to express yourself freely on the subject, what you don't like, what you won't stand for, what you think about it, what you want or how it makes you feel. But don't do it with the expectation of being thanked or creating a change; itís not likely to happen. Do it just to be on the record. Often your outspoken attitude will be taken seriously and appreciated, though it may not bring about any immediate changes. Just as often it will unleash a barrage of defensiveness and even anger which you should staunchly absorb without weakening. 

9. Be aware of not doing anything that you don't want to do for the alcoholic. It is bad enough if you commit any of the above mistakes willingly. But when you add to them the complications of doing them when you would prefer not to, you are compounding your mistake and fostering an eventual Persecution. 

10. Never believe that an alcoholic is hopeless. Keep your willingness to help ready, offer it often, and make it available whenever you detect a genuine interest and effort on the alcoholics part. When that happens, don't overreact, but help cautiously and without Rescuing; doing only what you want to do, and no more than your share. 

Remembering these guidelines about Rescuing will be helpful regardless of what else is done. 

Let us now look at the first important thing to do to help the alcoholic; making a contract. 

 

 

Chapter 16. The First Step: Contract 

 

 Most of us have a healthy desire to nurture and take care of people who need us. Many of us have also had the experience of starting out as helpers and rescuers-and winding up the victims of the very person we are trying to help. The classic example is the innocent bystander who is walking on the beach and sees someone drowning. He jumps in, swims up to the victim, and in the process of rescuing him, drowns right along with him-though at times, ironically, survives.

Many of the techniques lifeguards learn are designed precisely to prevent their being drowned by a drowning swimmer. Similarly, a person who is interested in helping others needs to develop effective techniques for helping. These techniques which need to include safeguards against being dragged down and destroyed by the very ones she aims to help.

 Alcoholics, especially, seem to have the knack of attracting the good graces of people who start out feeling that they can help and wind up totally swamped. Very often we began a helping relationship with love in our hearts and a true desire to help. In certain situations, this desire remains part of our motivation and we continue to want to help. Very often, however, our desire to help diminishes and eventually disappears while it suddenly appears that we are now compelled to go on helping whether we like it or not. 

 Drawing up a contract is the indispensable first step in avoiding the game of alcoholism and its roles; Rescuer Persecutor and Victim. Transactional Analysis is a contractual form of group treatment which must be distinguished from other activities that may be of therapeutic value. A person may do all sorts of things alone or in groups which could presumably be helpful. Going to a football game or a dance, joining an encounter group, spending a weekend in the wood meditating or beginning psychoanalysis are all activities that might be helpful. The basic difference between these activities and a Transactional Analysis group is the contract. 

Therapeutic contracts-contracts between a person who holds herself out to be a competent therapist and a client-should be regarded with as much respect as legal contracts in a court of law. Two aspects of legal contracts are fully applicable to therapeutic contracts (1) informed mutual consent, (2) consideration. These requirements were developed over hundreds of years, so it is reasonable to accept them as pragmatically effective as well as socially desirable in the establishment of a therapeutic contract. 

Informed Mutual Consent 

Mutual consent implies that both of the parties in a contract are consciously and sincerely agreeing to the terms of the contract. Therapeutic consent implies the request, offer and acceptance of therapy. Presumably the client has come to the therapist to get help for her condition. Presumably also, the therapist understands the situation and is willing to make a contribution to the improvement of that condition.

In order to make an informed, intelligent offer, the therapist should clearly understand the client's specific situation and what the client wants to accomplish. In order for the acceptance to be informed consent the client needs to understand what the therapist requires as conditions for the therapy. Consequently, the therapeutic offer should contain a clear description of what the therapist considers essential for the process to be successful and how success will be defined. 

Establishing mutual consent as part of the contract is particularly relevant to the therapy of alcoholics, since alcoholics are accustomed to enter into a therapeutic relationship without any contract at all.

For example: It is common for alcoholics to get into therapy as a result of pressures applied by family or by the courts. A therapist may mistakenly assume that there is mutual consent in the ensuing relationship when, in fact the client is not willingly involved but instead feels coerced and even victimized in the situation, a situation which places the therapist inauspiciously in the Persecutor role. On the other hand it is also typical in the therapy of alcoholics that a willing client blindly agrees to entering the situation without any understanding of what its requirements are-only to find out later that the requirements are far different and more complicated than expected. 

My experience is that the minimum requirements for successful therapy with alcoholics are as follows.

 1. Complete sobriety for a minimum of a year during which

 2. The client attends group therapy regularly every week for two hours and

 3. Involves himself in specific homework including diet and other life-style changes addressed to his specific problems including, perhaps, attendance in AA and

 4. Attends my monthly body-work sessions.

The establishment of a mutual informed-consent relationship involves three transactions.

 1. The request for treatment from the client,

 2. An offer of treatment by the therapist and

 3. An acceptance of treatment by the client. 

 It is not unusual in the relationships between therapist and client for them to enter into therapy without these three elements having been fulfilled.

Consider the following conversation between Jonas. an alcoholic, and Jill, a therapist 

Jill: "What can I do for you, Jonas? 

Jonas: "I'm here to get therapy. "

Jill: "Fine I have an opening available for you on Tuesday at six o'clock. Can you make it? "

Jonas: "Yes, I can. I guess Iíll see you on Tuesday. "

Jill: "Good."

This conversation may seem to achieve mutual informed consent. If examined closely, however, it may turn out that the client's request was really only as follows. 

Jil1: What can I do for you, Jonas? 

Jonas: (My wife is leaving me and I was arrested for drunk driving and my mother, the judge, and my wife say that I need to get into therapy, so) "I am here to get therapy."

 This is not really a request for therapy, and it is definitely the opening move in a Rescue game. It would be a great mistake for a therapist to agree to work with a person under the above circumstances. 

 Let's try again. 

Jill: "What can I do for you?" 

Jonas: "I'm here to get therapy." 

Jill: "Why do you want therapy? "

Jonas: "Well, I guess I need it." 

Jill: "Maybe you don't need it. What makes you think you do? "

Jonas: "Well. I'm drinking too much, and I'm getting sick. My wife is going to leave me, and l may have to go to jail for drunk driving. I want to stop drinking because it is ruining my life. Do you think you can help me? "

Jill: "Yes, I think I can. I have an opening available on Tuesday at six o'clock. Can you make it? "

Jonas: "Yes, I can. Iíll see you on Tuesday."

This example involves a request for therapy, but it doesn't involve a proper offer because the therapist has not stated what she intends to do or what she hopes to accomplish. She hasn't really got the information to understand whether she can actually help and she has not stated her conditions for help. 

 In fact they are both still considerably in the dark with respect to informed mutual consent. The therapeutic offer by the therapist implies that she understands the problem, that she is willing to deal with it, and that she has reasonable expectations to be successful in the process. 

In order for informed mutual consent to occur, the therapist needs to have certain information. In my experience, the following facts must be investigated before a therapist can enter into a therapeutic contract with a client. 

Does the person recognize himself to be an alcoholic? Does the person feel that has drinking is out of control and/or that it is harming him? 

Jonas has indicated that he recognizes both: he feels that his drinking is out of control and that it is harming him. If a person with a drinking problem asks for therapy but does not see his drinking as being out of control or harmful, it is important to examine the extent of the drinking. The following questions are useful. 

What kind of alcohol and in what quantities does the person drink? This question needs to be answered in detail. No ambiguity should be allowed. If the amount the person drinks varies, an average for a typical week should be obtained. A person who drinks more than two ounces a day regularly or who drinks more than five ounces within a period of two hours more than once every three months can be considered a problem drinker. 

When does the drinking occur? Anyone who drinks before lunch and everyone who drinks regularly in the evening can be considered a problem drinker. On the other hand, a person may drink what seem imprudent amounts at times and not really have an alcoholic problem though he may be in danger of developing one.

For instance, a person may regularly drink before going to sleep. She may be using alcohol as a sleeping medication. It is a reasonable substitute for some other form of drug. While this is definitely a problem, it isn't necessarily a problem of alcoholism, but it may be a problem of insomnia. When a drug is taken just for its purely physical biochemical effects, it lacks the social and psychological aspects of alcoholism. It will be easier to deal with and will require a different approach than the usual alcoholic problem. 

 If the therapist has adequate information about the client's drinking she can now involve herself in mutual, informed consent. If the client shows signs of alcoholism and sees himself as having an alcoholic problem, she is now in a position to make an offer. Consider the following: 

Jill: "What can I do for you, Jonas? "

Jonas: "I am drinking too much and I am getting sick. My wife is going to leave me, and I may have to go to jail for drunk driving. I want to stop drinking because it is ruling my life. Do you think you can help me? "

Jill: Okay, Jonas, I think I can help you. Let me tell you what is involved if you get into therapy with me, I have certain expectations of you. In order for it to work, you need to come to group meetings every week for a two-hour session and to body-work meetings once a month. You need to attend regularly and on time and not have had a drink for 24 hours previously. This kind of therapy doesn't work while you are drinking so it is necessary that you stop drinking altogether as soon as possible and that you don't drink at all for at least one year. During that year, in addition to attending group regularly, I expect you to be actively involved in working to solve your problem and that will include doing homework on diet and life-style changes between meetings, and perhaps attending AA. So if you come to group regularly, don't drink for a year and we work together on your problem, I expect that you will be cured of your alcoholism. If you are willing to agree to this we can proceed. I have an opening available for you on Tuesdays at six o'clock." 

Jonas: "I understand, I will see you on Tuesday."

This highly condensed example contains three requirements for mutual informed consent: a request, an offer, and an acceptance. It is a model for a successful beginning contract, which is likely to result in satisfactory work to both of the parties (client and therapist) as well as the other members of the group. 

On occasion, an individual seeking therapy is clearly an alcoholic, but wants to work on some other difficulty.

For example, Jonas may want to work on his relationship with his wife but may wish to leave his drinking alone. Making an offer to treat a disturbance such as marital troubles without dealing with his alcoholism, is a mistake that will surely lead to difficulties. It can be compared to being willing to perform plastic surgery on a terminal patient and should be declined on the ground that the alcoholism is so disruptive in itself that it will defeat any efforts to deal with some other lesser problem. Unless the therapist wants to face unending frustration and difficulties, such a request should be politely denied with a frank explanation. 

On occasion a person may come to therapy with a drinking problem that is not severe enough to be called alcoholism. Under those circumstances, it is best to take a "wait-and-see" attitude. It is possible to make a temporary, short-term contract to deal with some minor difficulty and pursue the alcohol situation to see whether the drinking is serious enough to require a primary contract dealing with alcoholism. 

On occasion drinking troubles are really minor and fade away as other problems are dealt with. I am always willing to give clients the benefit of the doubt and take some time to see how severe their alcoholism really is. 

The Consideration 

The consideration is the second (after informed consent) requirement of the contract.

A helper gives of himself. To avoid a Rescue, the person helped needs to give sometime in return. In legal terms, this is called the consideration.

Every contract must be based upon a valid consideration. Valid consideration refers to benefits that pass between the therapist and the client. These benefits may be bargained for and eventually agreed upon. The benefit conferred by the therapist should always be a competent attempt to remedy the problem. In exchange, the client will usually pay the therapist money. But money is not the only kind of benefit a client can confer upon the therapist. Let us look at the consideration in some detail. 

As stated above, the benefit conferred by the therapist should be a remedy of the problem. That is why it is important that the client clearly states the way her life is unsatisfactory and what would be required for satisfaction. The client needs to state specifically what is making her unhappy. Is she drinking too much? Is she unable to sleep? Does she cry all the time? Does she fail to have good relationships? Is she shunned by her friends? Is she unable to keep a job? and so on. She should also be able to state what would make her life satisfactory. Getting a job and keeping it, being in a reasonably happy love relationship, being able to sleep and wake up refreshed and happy, making friends, getting rid of headaches or stopping drinking. The therapist has delivered his consideration in the contract when the person, the therapist, and the majority of the members in the group agree that the problem described in the beginning of therapy is no longer present. That is why, at the beginning of therapy, problems need to be stated in clear, behavioral, simple, observable terms, understandable to an ten-year-old. Without this initial statement it is impossible to determine whether the problem has been solved.  

On the other hand the consideration given by the client can vary. The most common consideration in the therapeutic contract is money, but in the absence of a full fee it is also possible to accept a partial fee temporarily with the understanding that the full fee will be expected when the client is able to pay it.

 

People who wish to help an alcoholic as friends rather than as therapists need to be equally scrupulous about mutual consent and consideration involved in the relationship. In addition to making it clear that the alcoholic wants our help and is willing to work at least as hard as we are on his problem, it is also important that we get something in return (not necessarily of a material sort) for our effort. If you are my friend, and if I am willing to speak to you on the phone for an hour about your problem then I expect you will be willing to listen to me for an hour at some future date should I need it.

If I come to your house and help you clean up a mess you made, then I expect you to do a similar favor for me should the need arise. I will make an effort to ask you for your help so that we keep the balance of energy devoted to each other more or less even. If I lend you money, I expect you not only to return it but to lend me money or something that I need when I need it. If I give my help to you freely I expect you to give help equally elsewhere. The equation of energy-in/energy-out has to maintain some semblance of balance between us or we will slip into a Rescue game and I will inevitably become angry with you, cease to have an interests in helping you, and may eventually Persecute you.

 People who "selflessly" help others while expecting nothing in return are weakening the effectiveness of their help. At the very least, a helper can expect an energetic effort to change, a willingness to work hard, and an eagerness to learn. To many helpers, this type of positive attitude is sufficient consideration for their work. If so, well and good-it is the very least that should be expected. To expect more is reasonable. In any case the consideration must be made fully clear and should be negotiated for maximum success 

The Alcoholism Treatment Contract 

As I have mentioned earlier, every alcoholic's first task is to stop drinking. Therefore this is also the first contract. However, it does not need to be the only contract. As long as the is drinking it is foremost in importance; but obviously, when the drinking ceases, other matters will have to be attended to in his personal life, his work, recreation, health habits, nutrition. Consequently, an alcoholic in therapy will have additional contracts, such as:

Finding a better job 

Getting strokes 

Stop eating sugar (or drinking coffee) (or smoking) (or all three) 

Make friends 

Improve sex life 

Fight the Enemy 

Stop Rescuing 

Develop an Ally 

Give more strokes 

Be truthful 

Show feelings 

And so on. 

For some people, completing a contract such as "showing my feelings" can represent a couple of years' work which results in a change of life-style that includes giving up alcoholism. Other contracts, such as "Find a better job" can be one of a series of contracts which the client chooses during her therapy. 

For effective therapy, a client needs to have a contract throughout. As each contract gets worked through, the question becomes: "Is therapy complete, or should we start on another contract?" The answer to this question is up to the client rather than the therapist. Any new contract should be made with the same scrupulous attention to mutual involvement as the last. Therapists need to look out for that common tendency in our profession which compels us to tell our clients what they should (or shouldn't) do. This is essential to ensure that any contracts arrived at are based on the needs and desires of the client rather than the therapists. This is not to say that the therapist should not freely express his opinions on this or any other matter-only that these opinions should take a back seat to the client's needs and opinions. 

In addition to the specific personal contract that each client works on there is another universal contract in my groups which involves all the group members, including the therapist: the Cooperative Contract. 

This contract specifies that there shall be no power plays among the participants, specifically "No Rescues and no lies."

 Rescues have been amply covered so far; let me briefly explain what is meant by no lies and no power plays.

 No power plays; A power play is a transaction designed to manipulate another person into doing something she or he would not otherwise do. Accordingly, people cannot intimidate, bully, threaten, or yell at each other to get desired results. Nor can they try to get the same result by sulking, guilt-tripping, or withdrawing from the group. Especially important is the application of this rule to the therapist's behavior; many of the "motivating'' tricks that therapists feel free to use are not allowed in a cooperative problem solving group. For example, according to the cooperative contract, it is not permissible to pretend to be angry and to insult someone in order to help him get angry and express his feelings. That would be both a lie and a power play to boot. 

No lies : Alcohol loves lies. Everyone in the group agrees to complete truthfulness. This means no deliberate untruths or lies of commission are told, and that includes secrets or lies of omission as well. If a group member who has been drinking is asked about it and denies it, this is a lie of commission. But if she is not asked and fails to mention it, she is lying as well. According to the definition, a lie is the deliberate act of hiding what someone else wants to know. Clearly, in a group therapy situation, everyone at the very least wants to know whether an alcoholic member is drinking. The same is true in the social circle of the alcoholic; therefore the same commitment to truthfulness should be extended to friends and family.

This rule applies also to the hiding of feelings, desires, or opinions. If a person has angry or loving feelings for someone else in the group, not expressing these feelings is keeping a secret. Similarly, not expressing desires or critical opinions is a form of lying as well. Truthfulness involves asking for 100 percent of what one wants 100 percent of the time.

This contract is especially useful to stimulate the full expression of feelings. It encourages the honest expression of opinions and feedback. It is an ideal testing ground for asking for what one wants and for not Rescuing. It provides the necessary trust and feelings of safety that are essential for the open and honest discussion of all the facets of one's life right down to the most embarrassing.

Cooperative contracts, together with each member's individual contract, are a powerful social structure within which people can radically improve their lives.

   

 Chapter 17; Sobriety  

After making a contract, a person who has decided to deal with her alcoholism must concentrate on stopping the use of alcohol altogether. Most people who are alcoholic realize that they have become powerless over alcohol and that the best approach to their problem is to stop drinking entirely. This realization is arrived at through an honest evaluation of the lack of success of previous attempts to deal with their drinking. Many people with drinking problems have also had contact with Alcoholics Anonymous and have come to see the one universally accepted truth in alcoholism work: You can't fight alcoholism while you are drinking.

People who have come to accept this commonsense fact are at a distinct advantage over those who still hope that they can deal with their alcoholism without giving up alcohol. Nevertheless, there will be people who will want to cut down their drinking instead of stopping altogether. They may have not seriously tried to stop drinking and imagine themselves still in control.

When a person insists that he wants to try to deal with his alcoholism without abstaining entirely, it is very important for the therapist to respond effectively to this understandable desire. The most effective response is one which succeeds in communicating the very important facts of "cutting back" while drinking and at the same time avoid the parental, persecutory, uptight authoritarianism which alcohol workers usually fall into in that situation.

This is a good place to discuss the concept of "loving confrontation" the ideal combination of therapeutic transactions which are most effective in working with alcoholics and, indeed, in any interpersonal working situation. 

Loving confrontation

A client who seeks therapeutic help chooses a certain therapist presumably became he thanks that the therapist knows what he is doing. Thus it makes sense that the client wants to be presented with the facts as the therapist sees them.

Loving confrontation, is an attitude that shares some components with "tough love" a more recent concept that has become popular in the "helping professions." Tough love is associated with "Just do it!" another attitude applied to people who people who "need help." Both are attempts to avoid co-dependency; to help without Rescuing. Their effectiveness depends on the level of sympathy and empathy that is included in the help given.

If the therapist thinks that it is very difficult-if not impossible-to stop alcoholism by just cutting down then presumably the client would like to hear that, along with whatever other useful information the therapist has

However, alcoholic clients are often reluctant to accept that they must stop drinking completely in order to succeed. That reluctance may have more to do with the way the information is transmitted than with the information itself.

Granted, alcoholics usually secretly hope to hear that it is possible to have one's drink and beat alcoholism at the same time, but they don't mind being confronted with the facts as long as the information is presented in an acceptable manner. Nobody likes to have facts-no matter how correct-shoved down one's throat, unfortunately, therapists often give clients their opinions in a supercilious, parental, and generally obnoxious manner. It is possible to present information from a strictly Adult, scientific perspective, backed up by a Nurturing Parent emotional attitude. Accordingly the therapist might say:

"As you probably know the largest majority of the people who have attempted to deal with their alcoholism without stopping entirely have failed. It would seem that your chances are not much better."

 This is a "Confrontation'' statement coming from the Adult of the therapist. It is certainly an improvement over the following statement, which comes from the Critical Parent.

 "It is ridiculous for you to think that you can stop being alcoholic without stopping drinking entirely. I have never seen it done, and I don't expect you to be the first do it. You'd better do it the way everybody else does it. You can't afford to be special at this point in your life. Stop feeling sorry for yourself and just do it!" 

This approach is liable to antagonize the client-and rightfully so, since it comes from the therapist's Critical Parent. Its wording and tone are going to stimulate the client's anger, guilt, shame, rebelliousness, or some other negative emotion, which can only lead to confusion and lack of success.

However, the proper mixture of factual confrontation with a nurturing emphasis and tone is the most effective in this situation: 

"Look I can understand that you would like to continue to drink on occasion while you are trying to overcome your problem. Unfortunately, I don't believe it can be done. (Nurturing) My experience shows that only a very small percentage of people have been able to do it (Confrontation) and while I am not necessarily sure that you can't, I just think it would be a lot easier if you stopped drinking altogether. (Nurturing) What do you think? Do you think you can cut down? I don't" (Confrontational.) 

Another approach might be:

"Listen, you may not realize this, but you are powerfully addicted to alcohol (Factual Confrontation) You probably wish that this wasn't so, and that you could feel more powerful in the situation and cut down gradually. I can understand that very well, (Nurturing) but the fact is that it is virtually impossible to do that. (Confrontation) Why don't you make it easy on yourself and just stop altogether? I'd hate to see you spend the next three months in all that useless agony. (Nurturing) And frankly it will make my life a lot easier too" (Confrontation)

 For anyone who is addicted, the notion of having to stop completely is usually quite frightening. After all, the drug offers some pleasure or relief, and life is hard enough without giving up what seems to be its major pleasures. More important, though, someone who is addicted fears that stopping completely and abruptly might be extremely difficult and could become a horrifying struggle, ending ultimately, in failure. The need for complete sobriety reminds alcoholics of their helplessness, their fear of failure, the dread of being powerless and being shown up to other group members, friends, family and the therapist as lacking in will and self-control.

In addition, alcoholics don't often comprehend the magnitude of their addiction. Hence they blame themselves for their incapacity to stop, and they feel weak and gutless. Instead, they should realize that they are in the jaws of a veritable steel trap. That is why a nurturing, understanding approach is essential.

Therapists should not sit in judgment. They need to be sympathetic to the plight of the addicted person, and that sympathy is shown by avoiding a supercilious parental attitude as well as a cold and unemotional Adult attitude which simply serves up the facts without any feeling. Information is important, but information alone does not constitute the most elective form of therapy. On the other hand, love is not enough either. Information and love (Adult and Nurturing Parent) are both powerful aspects of therapy, but they are most powerful when they are offered to the person together in loving confrontation.

After mentioning the unlikelihood of success unless complete sobriety is achieved for at least one year, it is important to negotiate the agreement between the therapist and the client. If the client insists that she wants to "cut back" then I am usually willing to give it a try with the understanding that her effort will be evaluated after a few weeks. If it is not successful, I warn her, I will insist that she stop completely.

"Mary, I have not seen this approach work with someone as addicted as you, even though a lot of people want to try it to begin with. But I'm not going to stand here and tell you that you can't do it because you may be one of the few people who can.  If some people have stopped being alcoholics by just cutting back, I have never experienced it. I'd rather you didn't but, if you insist, let's give it a try."

"Work at it for the next month. Let's say that you will restrict yourself to a total of seven ounces of alcohol per week for the next week, one a day maximum. We will talk about how you are doing at the next meeting, and I hope you succeed. Let's try it, but I want you to agree that if your drinking gets out of control you will let me know and proceed to try to stop drinking completely."

The client may want to drink a different quantity over a different period of time, that can be negotiated as long as the amount that is consumed clearly qualifies as social drinking. What is important: an attempt is being made to cooperatively negotiate on the basis of the therapist's and the client's points of view. This mutually respectful, cooperative approach may seem inefficient but, in the end, because it avoids power plays, it is the one that builds the kind of trust and mutual respect that is essential for good results.

Loving confrontation avoids Persecution on one hand and Rescues on the other. It is loving without being mindless, and it is and confronting (or tough, if you will) without persecuting. It cultivates mutual love and respect. And it works.

 Antabuse

 Clients who recognize the importance of stopping drinking entirely and who expect difficulty can be helped with disulfiram (Antabuse). Many people accept this offer without hesitation. Antabuse is a drug which in combination with even small quantities of alcohol, produces extremely uncomfortable symptoms with a susceptible person; if a lot of alcohol is taken, the alcohol/Antabuse combination can even lead to death.

Antabuse should be taken every day. Because it remains in the body for as long as seven days, it is an effective deterrent against the impulse to drink since drinkers have to plan days in advance if they wish to start drinking again.

Antabuse can be used in a number of ways, some of which are completely ineffective-if not harmful-in helping people overcome alcoholism. Most ineffective is forcing the alcoholic to take Antabuse eider by putting it in his food or through a more subtle form of power play. This approach may work as long as the therapist or his agents are capable of forcing the drug into the client's body, but inevitably it will create antagonism and resentment. As soon as an opportunity presents itself, the client will be compelled, due to justifiable pride-if for no other reason-to go on a bender with all possible speed.

To illustrate the total ineffectiveness of this type of coercive approach to drug abuse, let's look at Nick a borderline alcoholic who got into serious alcohol-related trouble with the law. To his great shock, he ended in jail with a nine-month suspended sentence. Nick is a reasonable man who understands that he has a drinking problem. He feels he needs to do something about it. During the nine months of his sentence which was seen by the authorities as a period of "rehabilitation'' he was forced to attend AA meetings and to take Antabuse. He took his Antabuse and attended AA meetings without protest. Nick is a D&P player, and I expect him to eventually deal with the problem and stop drinking excessively. But throughout the nine months he said that the very first thing he would do once the sentence was completed, was stop taking Antabuse and get drunk. When I asked him why he would plan such a thing, since alcohol was a problem for him and that this might be a very bad way of using his reprieve, he pointed out to me that it was a matter of simple red-blooded American pride. He would deal with his alcoholism later-but the first thing he would do as soon as he could was to get drunk, and there was no two ways about it.

Nick spent the nine months that were supposed to serve as rehabilitation designed to launch him on a drug-free way of life, planning day by day and hour by hour how drunk he would get, what he would drink, and whom he would drink it with. 

Forcing Antabuse (or any therapy) on people does not help, but Antabuse can be extremely helpful to a habitual drinker who wants to be rid of the constant, nagging temptation to drink which is so characteristic of the beginning stages of sobriety. Antabuse has no direct effect on the desire to drink, but because the possibility of drinking is completely excluded, it basically frees the alcoholic's consciousness from the ongoing struggle between his desire to drink, and his decision to stop drinking. For some people, the elimination of this constant internal struggle can be a blessing; their minds can be occupied with other matters, and drinking becomes a much less dominant thought, which has to be dealt with only on occasion and which gradually recedes in its power to flood consciousness without warning or control. 

If over the first few months of sobriety whenever the alcoholic thinks, "I want to have a drink" there is another, automatic thought that says, "Forget it-you'll get sick" the frequency and intensity of the desire to drink will be dramatically reduced. That does not mean that there will not be periods of time in which the alcoholic will have intense conflicts dealing with drinking and at which time he may consider stopping Antabuse so he can have a drink a few days later. But it can be clearly seen how this is a large improvement over the situation in which relief is only a swallow away. 

 This is how Antabuse was administered at the Center for Special Problems, a public health clinic in San Francisco where I worked as a psychologist in the 1970ís. With very few exceptions, any person who wanted Antabuse was prescribed the drug. People were refused if they had a recent history of its misuse or a medical condition that makes an Antabuse reaction threatening-more threatening than alcoholism itself. After appropriate warnings, the drug was dispensed. No attempt was made to produce the Antabuse reaction in the clinic. The initial dosage was 5|mg. (1 tablet) per day for seven days, which was then cut down to 2 mg. per day. With this approach there were no known deaths or severe reactions

A few patients on Antabuse will experiment by drinking a small quantity of alcohol just to see if the can. Most of them are quickly convinced of the drug's effectiveness and stop experimenting. On occasion, a patient reports such a small effect that he was able to continue drinking on top of Antabuse. In such cases, Antabuse therapy should be discontinued. Antabuse has a few unpleasant side effects, such as a strong garlicky breath, and this is another reason why people resist its use. These side effects can usually be eliminated by taking the daily dose just before going to sleep, at night, and by reducing the dosage to 1 mg (1/4 tablet) Usually the people who have strong reactions to the side effects also have strong reactions to the drug itself and do not need the larger dosage. 

Men more often resist taking Antabuse than women. Men-more than women-feel that it is embarrassing and shameful to be out of control. I will always respond in an understanding manner to these feelings. But I will also explain that a person need not be ashamed of needing help, and that the best way to work on problems of this sort is by using as much help from as many sources as possible.

I also explain how sex-role scripting forces men to go it alone, without help, and how it is important to reject those expectations to profit from group therapy. But if an alcoholic insists that he wants to try to stop drinking without Antabuse, I would avoid arguing and would steer clear of the persecutory stance implied. I try to come up with a cooperative, negotiated agreement.

If sobriety cannot be achieved without the Antabuse within a reasonable period of time, however, I will insist that Antabuse be taken. This discussion could seem puzzling or even nebulous to some therapists who may say to themselves, "This approach is based on having an alcoholic who is willing to stop drinking. But the very nature of alcoholism is that the person cannot or does not want to stop drinking. It wouldn't work with somebody who is a real alcoholic. This approach is of limited value and doesn't deal with the real problem of alcoholism."

Of course. Only those who want to stop being an alcoholic will stop being an alcoholic. But there are many alcoholics who would like to and simply do not believe that they can. They have tried and failed. They have had violent withdrawal symptoms, they have given up over and over, and they have gone back to Devil Alcohol. They know that alcohol is destroying them, but they have developed a fatalistic, defeated attitude. This attitude may include arguments defending their right to drink on occasion or arguments minimizing the severity of their problem. But these are rationalizations which easily give way under the pressure of loving therapeutic confrontation. This approach brings to the surface the alcoholic's desire to stop drinking if it exists, and it exists in the great majority of alcoholics. 

Most people who come for help will stop drinking completely within a month or two of attending therapy sessions. There is always a smaller group who agree to the contract but do not stop drinking, and they fall into two categories. One group continues to drink more or less continuously and attends meetings under the influence of alcohol. The other group reduces its drinking input and confined it to weekends or between sessions, they are sober during group meetings but drink in between. 

The client who continues to drink steadily and attends therapy session under the influence of alcohol should be told that it is impossible to do psychotherapy under those conditions. Still, I always insist that he attend whether drunk or sober, and when he does, I make it a point to be friendly and nurturing, to ask how he feels, what his week has been like, and the extent and quantity of his drinking during the week. I will encourage him to speak about how he feels, since a person who is drunk is often in touch with emotions that are hidden when he is sober. This material can become important information for future therapy. However, I will not give advice or engage in discussions dealing with the reasons for drinking or any of the debates that alcoholics are fond of getting into-especially when they are drunk. I make sure that the inebriated client does not monopolize the session or take more than his fair share of time, and limit myself to being friendly, nurturing, concerned, and clearly insistent that the client come to group sober next time. I refuse to do Adult, "rational" work with a drunk alcoholic because it won't have any lasting effect; his Adult is out of commission. I do, however, try to convey a message of empathy and support which will penetrate that alcoholic fog and make an impression on his Child 

The alcoholic who drinks between meetings presents a different problem, since he drinks and keeps the therapist in the dark about it. This type of alcoholic usually plays D&P and puts the therapist in the role of the Victim/Patsy. By concealing the facts of his drinking, he finds out whether the therapist is experienced enough to pursue the matter and confront him; the therapist who doesn't will probably be completely ineffective. 

While working with an alcoholic who is still drinking, the therapist should make sure that she remains aware of the quantity and extent of the drinking. This is accomplished by uninhibited questioning and by being open to whatever information may be volunteered by employers friends and relatives. Because awareness is the best defense against becoming a Victim/Patsy, employers, friends and family are encouraged to communicate with the therapist. This is done openly, with the understanding that information will, not be divulged without the alcoholic's permission. 

In this manner, confidence is preserved while awareness is maximized. Many therapists treat their client's relatives with aloofness verging on contempt. This attitude is usually rationalized as necessary to preserve confidentiality and trust, but it is really persecutory and wholly unnecessary. Instead, it is best to accept information as offered with the proviso that it mast be evaluated and used with caution.

 When the therapist refuses to play Victim/Patsy and continues to focus on the client's drinking he plays the antithesis to the Alcoholic game and thereby makes it possible for the alcoholic to choose an alterative to game playing. Eventually the alcoholic will either cease drinking entirely within three months or will frankly admit that she is not interested in changing her drinking behavior and will discontinue treatment. To date, a very small portion approximately 10 percent) of alcoholics who have joined one of my groups realize that they don't want to quit drinking, openly say so and discontinue treatment. 

Chapter 18 The Newly Abstaining Alcoholic 

Once an alcoholic has stopped drinking, treatment takes a dramatic turn since, until then all efforts are addressed primarily to the problem of helping him to stop. The first consequence of completely stopping drinking is the physical withdrawal period. The withdrawal can take the form of severe withdrawal sickness or mild discomfort depending on a number of factors that affect how toxic the alcoholic body has become.

The end of the withdrawal detoxification period is normally followed by a lull lasting about two weeks-sometimes less-during which the alcoholic feels very strong and confident. He is sure he will never drink again is in good spirits; this is the well-known period when the alcoholic is "on the wagon" and feeling "on top of the world." From the point of view of script theory this period could be the beginning of a true script change or merely the "counterscript" within the script. The distinction is explained later in this chapter.

If sobriety continues a profound change in the quality of the person's consciousness will occur which can cause what I call "withdrawal panic." This withdrawal panic is particularly pronounced in people who have had a long history of uninterrupted drinking. Withdrawal panic should be distinguished from withdrawal sickness.

Both of these crises result from alcohol withdrawal, but the withdrawal sickness is mostly physiological: a bona-fide medical condition (especially in the extreme case of delirium tremens or D.T.'s, which is potentially fatal and may require hospitalization). The withdrawal panic comes two or three weeks later; and while it may have a subtle physical basis, it is primarily a psychological phenomenon. 

Withdrawal panic may occur with or without withdrawal sickness and not all persons who stop drinking undergo a severe withdrawal panic. People who do-and who are not on Antabuse-are likely to drink at this time. If they do not drink, they may become obsessed by thoughts of drinking and constantly struggle against these thoughts. This struggle can completely flood consciousness and obscure the subtle mental changes that result from an alcohol-free nervous system.

Interestingly, people who take Antabuse and are therefore usually free of the desire to drink are more likely to become aware of the change caused by the absence of alcohol in their bodies. As an example of these subtle changes, one patient reported waking up in the middle of the night with uncontrolled thoughts racing through his mind, which somehow threatened to cause a mental explosion or breakdown similar to a short circuit in a computer. He felt extremely aware of minute bits of his wife's behavior, or of having special insights into motives and conversations, or of seeing things such as trees and flowers in an alarmingly sharp and vivid way. Because of their newness and unfamiliarity all of these symptoms created great anxiety he interpreted them in malignant terms; he felt as if he were about to lose his mind. 

Some therapists analyze these reactions as evidence that alcoholism is a defense against the breakthrough of an "underlying psychosis." The theory that alcoholism often serves to protect the alcoholic from a preexisting psychoses is based on the observation that some alcoholics exhibit alarming psychotic-like symptoms such as auditory hallucinations or paranoid states even after the withdrawal sickness is over. A finding that further supports this theory is that it seems that some alcoholics are helped to maintain sobriety with the help of phenothiazine, "antipsychotic" drugs.

These alcoholics are thus thought to be basically psychotic and only incidentally alcoholic. This determination may have several outcomes, the patient may be henceforth ignored as incurable, maintained on drugs, but otherwise ignored, or he may even be "allowed" to go back to drinking, since, it is argued, alcoholism is the lesser of the two evils. 

I believe that any diagnoses of an underlying psychoses is not to be made lightly. I always assume that such symptoms are temporary and will subside, usually within six weeks.

This was the case with the person described earlier and for many others who have gone through similar symptoms under my care. The vast majority of patients who go through symptoms of this sort are in the grip of a withdrawal panic and are not psychotic at all. They are experiencing an alcohol-free state which is so unfamiliar that it is frightening and difficult to comprehend. If the symptoms persist after three months of sobriety, considerations of underlying psychosis become reasonable.

From the point of view of his script, a man who stops drinking is going against the parental injunction that he not use his Adult, and that he not think. While he is drinking, he is in a Child ego state, which is going along with the injunctions of his Parent. The withdrawal sickness and consequent feeling of well-being are a period in which the Parent ego state runs the show and during which the Child willingly stays out of the picture. Withdrawal panic represents a gradual return of the fully functioning Adult ego state; this clear-thinking state of mind is unfamiliar and is a frightening development. It is a mode of functioning which was strongly enjoined against and disapproved of by the alcoholic's parents. He may never have experienced it until now. At this point the patient needs protection and strong reassurances that he is OK and not going crazy and that he is experiencing an Adult ego state free of alcohol, Within a month or two, he will become accustomed to it and will be able to assimilate this new view of his world. Such reassurances are usually quite effective in countering the panic. Accordingly, the use of medication is strongly discouraged unless it is absolutely necessary. Instead, in addition to reassurance, soothing teas, hot baths, massages, and other relaxing activities are recommended. 

Other symptoms observed during the withdrawal panic are dizziness, loss of balance, insomnia, mental anguish, nightmares, extreme colds extreme hunger, pain, blurred vision, and feelings of being clairvoyant or telepathic. Whether these symptoms are low-level remains of withdrawal sickness or whether they are purely psychological in nature is unclear. In any case they are reasonable sequels to withdrawal from long-term alcohol abuse. Similar combinations of physical and psychological symptoms characterize withdrawal from psychiatric drugs like SSRI antidepressants and especially benzodiazapines (Librium, Valium, Xanax, Halcion, etc ) which can last as long as one year and involve pain and severely disorienting neurological symptoms. These withdrawal symptoms need to be patiently endured; the good news is that natureís helping hand will eventually bring the body into healthy drug free equilibrium.

Alcohol alone has a relatively short period (weeks rather than months) of withdrawal symptoms. Following the period of withdrawal panic (if the patient does not escape from it into renewed drinking) there is usually a "honeymoon" in which the patient becomes accustomed to the drug-free Adult ego state and during which he feels genuine relief and well-being. The honeymoon tends to include freedom from games and intense script behavior, and may last as long as three months. However, it can be expected to subside, and even though the patient may remain sober, the games which are linked to his specific game of Alcoholic and script-whatever it is-will begin to manifest themselves.

Many alcoholics find that when they stop drinking and choose to remove themselves from their alcoholic circle they become isolated and lose the important sources of strokes that they had when they were drinking. The depression resulting from this loss of strokes is a very common problem at this point and action needs to be taken to generate new stroke sources. Everyone who has been an alcoholic and has stopped drinking will be faced (as is anyone who gives up a major game) with an existential vacuum relating to the many hours each day that need to be structured and which cannot be structured as they were when they were drinking. Alcoholics who stop drinking often attempt to continue structuring time in familiar ways by going to a bar after work and drinking soda water. Others who are aware of the problems associated with structuring time in old alcoholic ways, may find themselves completely at a loss and unable to find satisfactory new methods.

A therapist who proposes to help must aid in finding ways to structure time as part of the sober alcoholicís homework. For one patient, a schedule of activities was constructed to cover every waking hour, a week at a time. Another patient whose drinking started as a way of overcoming painful shyness was afraid and reluctant to contact friends and was encouraged to make several phone calls during the group meeting to arrange various activities and dates.

For married people with children, there is usually an increased positive interaction corresponding with the "honeymoon" period after withdrawal. This eventually yields to a period in which it seems that the members of the family not only expect-but almost seem to wish-that the alcoholic would resume dinking. This phenomenon is easily understood when we remember that alcoholism is a game that requires several players; the wife and children of the alcoholic are usually full participants in the game and feel a vacuum in their own lives when the alcoholic stops drinking similar to what is felt by the alcoholic himself. Thus, the alcoholic in a family might feel an even stronger urge to drink than a person who can leave his "game" social circle behind. In addition to his own internal compulsion to drink, he will feel the pressures applied by his family.

Because the healing of a married alcoholic requires simultaneous changes in two or more people in his or her circle, it almost seems at times that the single alcoholic has a better prognosis. However, the very real difficulty which is added for the alcoholic by the presence of a family is usually overshadowed by the positive support that families are able to provide. I have sometimes thought that a certain alcoholic might profit by a separation or divorce from her spouse because of the difficulties mentioned above, only to find, if the problems are worked through with the family, that the family is a great adjunct to the person's health as a source of strokes and as a basis for existential meaning. Sometimes, however, the family really pushes the alcoholic to return to drinking and a cure may require a separation between the two partners.

People who achieve sobriety by taking Antabuse generally want to stop taking it within six months. After six months of sobriety without a desire to drink most feel that it should no longer be necessary to take Antabuse. They yearn for the feelings of autonomy and self-determination that are implicit in not having to rely on the drug.

This desire should be regarded with caution and even suspicion. As soon as Antabuse is discontinued, alcoholics will almost always return to think about drinking, which may start them drinking again. I will weigh in on the side of caution and suggest that they extend the Antabuse use for another six months to insure the indispensable year of sobriety.

 

However it has been my experience that every alcoholic drinks again after some months of sobriety, regardless of my opinion. In the context of ongoing group therapy, this episode need not be disastrous, but may actually refresh the patient's memory about the realities of drinking. Except for the alcoholic who goes on an extremely self-destructive binge, one or perhaps two such relapses can have some positive educational aspects. The nature and extent of the drinking episode is usually a good indication of whether the therapy is having any effect. Generally, these episodes are shorter and less severe than the previous episodes, and this represents improvement In Adult control. A binge which is as bad or worse than previous ones indicates that therapy has not been effective and that the patient is only making superficial "progress" with no real changes in Adult control. People who are improving will emerge from the episode considerably wiser; they will have had a chance to review the different aspect of their drinking in a situation of improved Adult awareness and control; an experience that invariably proves to be sobering. However, for effective healing a full year of sobriety needs to follow after the alcoholic has anything to drink.  

Two important events in the sober alcoholicís life; deciding to discontinue Antabuse and/or having the first "social" drink after a long period of sobriety,(even against the therapistís advice) are regarded as a public declaration by the alcoholic that he is no longer an alcoholic and is now O.K. Because it flies in the face of his Enemy (who says he is not-O.K.) as well as the beliefs of many recovered alcoholics and of AA (who say it isn't possible), these events are always potential trouble spots.

The therapist has to treat such landmarks with finesse, since he is neither a Patsy who blandly accepts renewing drinking as a harmless act, nor a Persecutor who predicts certain doom. The best attitude is the Adult wait-and-see, backed up by a promise of Protection no matter what happens. In any case I much prefer to be informed by the alcoholic about his intentions to have a drink or to stop Antabuse than to find out that he did when he gets drunk and calls me in the early morning hours to tell me.

The counterscript 

As we know, people operate under the compulsion of scripts. Alcoholism as a script compels the alcoholic to uncontrollable drinking and self-damaging behavior. But there always are periods in the life of the alcoholic when she is not drinking or being self-destructive. 

These periods are interesting because they bring up the question of cure. Between alcoholic bouts no one really knows whether the person has really changed into a nonalcoholic. Only time can tell whether the script is just dormant, waiting to re-emerge in full bloom, or whether it has been abandoned. 

The counterscript is that period within a script during which the person is temporarily not following the most obviously damaging requirements of the script. During this period, the alcoholic is sober, content, and productive, but has not given up the script, which will return inevitably unless it has been truly been given up. 

AA's point of view would argue that the alcoholic can never give up the script and that any periods of sobriety are merely a temporary counterscript. But my observations of alcoholics indicate that people who were once excessive drinkers who are no longer drinking come in two categories; some people give up the script; some are merely in a counterscript phase of the alcoholic script. 

Berne pointed out that the most convincing evidence of script change for an alcoholic is a protracted period of moderate, social drinking. However, since many cured alcoholics lose interest in alcohol, this criterion is not always available. In general, the loss of preoccupation with alcohol--the alcoholic pastimes, or the game in any of its roles--is a good criterion as well. A radical change in time structuring and the development of avenues of stroke procurement and enjoyment without alcohol are crucial indicators of a script change. In addition, an often subtle change in the physical appearance of the alcoholic is a reliable index though difficult to assess. The alcoholic in a counterscript is tense, anxious, "up-tight" even when smiling and enjoying himself, as if constantly on the brink of relaxing and letting go, which he feels he can't do for fear that the script will take over. The cured alcoholic lacks this "on the brink" quality and therefore looks and feels quite different (relaxed, comfortable around alcohol) from the alcoholic in a counterscript. 

However, I must warn the reader not to take this section too seriously--especially if it means that he or she is going to use the information to try to diagnose any one person's sobriety as being a real script change or merely a temporary counterscript. That type of analysts of other people's lives is presumptuous and meddlesome. Aside from the fact that it can lead to the wrong answer, it is also of very little use. This is why I mention it only as an afterthought. Sobriety is the first step for an alcoholic and it is clear that it is hardly ever enough. Many changes have to follow sobriety for alcoholism to be completely cured. These change are what we are interests in; whether a person is really cured is nobody's business but his own. Only he can answer the question, and then only to himself. 

 

 

 

Chapter 19. Fighting The Enemy 

 * In a lively class discussion, Marge is asked a question by the professor. She is convinced that everyone is smarter and better read than she. She fears that her teacher will find out that she is a fraud and her mind becomes a blank as her whole body is frozen with panic. 

 * Doug hears voices in his head every time that he has an interaction at work: "Can't you see how weird and awkward you are? Every one else does!" 

 * Whenever Charlotte makes phone calls to sell customers her company's services, her heart beats wildly and she is filled with dread. Yet she has developed a system with which she manages to appear calm and self-assured. She suffers of constant stress-related headaches. 

 * When he approaches a woman he likes, Jacob has overwhelming emotional responses and expectations of ridicule. On the other hand he is unable to be affectionate and ask for the affection he wants when he is in a relationship. 

 * Hillary is in constant fear of danger; danger of bad food, bad air, dangerous people and risk of being stalked and raped. She performs complicated, extremely time consuming steps to keep her safe and has to limit her activities radically. 

 * Almost every night Daniel wakes up and spends long periods of sleepless time tossing in his bed while plagued by fantasies of bad things that could happen next day. He is unable to control his doom-ridden thoughts even though his fears fail to materialize. He is often tired and sleepy in the middle of the day at his high-tech, high achievement job. 

 * Sally lives under a cloud of sadness. Every so often she cries uncontrollably and for no reason and is convinced that she is doomed to a life of unhappiness. She puts up a workable front and on occasion she has a short period of well-being and that gives her hope. 

 * Drew regularly compares her appearance with other women's. She ignores people who she decides are not as attractive as her and focuses on those who are "better" than her. She is plagued by continual feelings of inferiority and competition about her body; her weight, breasts, hips, legs, hair, skin, and she obsessively reads fashion magazines. 

 * Jane is terrified of social situations because she is sure that people will evaluate her and find her awkward, ridiculous and needy. This fear is so strong that she has become completely socially isolated and depressed. 

Pleased to Meet You; Can You Guess my Name?

 

This near universal phenomenon has been recognized and named by every psychotherapy system; that inner voice that tells us over and over, in good times and bad, in whispers or shouts, from childhood to old age, when we are doing well or when we are doing badly, that our life is mediocre, hopeless or doomed, that we are not OK, that we are stupid or bad or ugly or crazy or sick. 

It has as been called by as many names as the Devil himself. Self hatred, low self-esteem, negative self-talk, catastrophic expectations, the punitive protector, internalized oppression and the critical parent. The names go on and on but they all refer to the same experience.  

The voices in Doug's head would be called his harsh superego by a psychoanalyst, Jacob's predictions of doom would be called catastrophic expectations by a rational-emotive therapist, Marge's demeaning feelings about her worth would be called low self-esteem. Charlotte's panic attack would be called a phobic reaction. Daniel's mental conundrum would be called an obsession and Hillary's fears would be called negative self-talk or obsessive thinking by cognitive therapists. Sally would be diagnosed as having major depression and Jane as socially phobic. Drew's constant self put-downs have been called punitive alter by multiple personalities advocates and pathological self-criticism by academic psychologists; all of it has been called stinking thinking in AAís Twelve Step programs. 

I will call the particular demon that makes our lives miserable by sabotaging us, the Inner Enemy. I have called it other names in the past; the Pig Parent, the Critical Parent, the Vicious Judge or even the Enemy Alien; feel free to use my names or make up your own but do give it a name and lets talk about it. What the source of this common human ailment is called is not as important as calling it something, anything, and talking about it; these negative ideas working inside of us are normally not acknowledged and discussion of them is not welcome in polite company. 

Everyone of the real-life situations described above can be seen as the result of a set of ideas which has acquired a firm grip over each person's mental and emotional life. In Transactional Analysis we see it as a particular ego state; The Critical Parent. Its biological basis is probably a neural net of ideas and attitudes that operate in a coordinated pattern. When we give it a name it is a metaphor of a very familiar process of possession. When this possession is by a vicious, brutal entity it has been called the Pig Parent, when a relentless critical voice the Enemy, when a rational seeming constant nag the Critical Parent, when a silent depressing presence the Inner Critic.

The Enemy gets a start as an external influence imposed on us when we are children, by people with power. Primarily parents, but other relatives as well as teachers, neighbors and very importantly, other children, have that kind of power over us when we are young. Like hostages that come to love their kidnappersóthe Stockholm Syndromeólike inmates in a prison camp who do best when they submit to their jailers, children find that their comfort, and at times survival, depends on accepting what they are told, without protest.

When they do so they change from free ranging, autonomous humans to enslaved beings, from princes and princesses to frogs, governed by the outrageous rules of the Inner Enemy. Because accepting these rules is a condition of psychological survival when we are children, the Enemy presents itself as friend when we are grown up, claiming to do what it does only to help us. The truth is that its constant presence in our life effectively diminishes most of us, ruins many others and undercuts everyoneís capacity to succeed and be productive. 

The Enemy is principally the enemy of love. Its fundamental message is: "You will not be loved. You will be alone. You will be excluded from the tribe." This ultimate threat to survival which today is out to control us may have started untold generations ago as an attempt, perhaps, to protect us from the terrifying dangers that loomed beyond the safety of the ancestral cave. It is utterly frightening and I have found it to be at the bottom of virtually every instance of the Inner Enemyís argument whatever the age, national origin, gender, religion or class background of its victim: "You will not be loved," "You will be shunned."  

The Enemy starts in the past as other people apply their Enemy to us. Since it is acquired, we can delete it as an influence in our present. The most important obstacle in this project is that, without realizing it, most people believe that the Inner Enemy's mission is legitimate: to keep us on the right path, prevent us from making mistakes, guide us in our decisions, advise us of our flaws; in short that it is well informed and beneficial, worthy of being listened to and followed. The Enemy is also mistaken for our Conscience, that core aspect of our soul which reminds us of our legitimate obligations as human beings. 

But unlike our Conscience which is intended to build love of ourselves and our neighbors, the Inner Enemy's undermines the affectionate bond between people. To make sure that we listen to it and no one else, the Internal Enemy seems to be devoted to making sure that we not only don't love ourselves or others. When we don't love ourselves or others no one will love us. When human bonding and affection is reduced to a minimum we are impotent against the Enemy's influence and its control is complete.  

The Enemy is a reality in everyone's life. However, the extent to which this reality is perceived by people varies greatly from person to person. In one person's awareness the Enemy is simply a dark influence settling over the mind like a suffocating blanket which turns everything dismal without warning. To another person, it is a nagging, insistent voice. It can appear as a rational-sounding, sedate, moderate, occasional statement which undercuts every important effort The Enemy can operate in the form of nightmares, physical aches and pains, or white-hot flashes of anxiety and dread. 

No matter what particular form the Enemy takes, it is essential to its power that it not be challenged by the victim of its abuse. The Enemy continues to operate because the person is willing to countenance it and to accept it as a valid part of the world. As long as it is listened to, believed, and followed, the Enemy has power. We need to recognize that it is an arbitrary set of lies that has been internalized and is now being listened to as if true and important. To achieve this we must change three things: 1. change our thinking 2. change our emotional responses and 3. change the daily interactions with people who support that damaging entity in our minds. 

 

What follows is a practical guide to working with the uniquely alcoholic script and Enemy; helping people to get rid of the destructive internal dialogues that originate within them. It is written with the alcoholic in mind but to some extent it applies to everyone: we all take on internalized oppressive messages in the process of growing up. 

To eliminate the Enemy's power it is essential that several step are consecutively followed: 

Awareness: Stalking the Enemy.  Where is it? What form does it take? What feelings does it prey on? Guilt? Shame? Fear? Anger? 

Action. Separating the Self from the Enemy. How does the person remove his support of the Enemy so that it loses its potency and returns to its original external form? What specific techniques are effective to counteract the Enemy's influence? 

The steps outlined above will be explored below. 

Stalking the Enemy: The process of making the Enemy conscious; becoming aware of it and understanding the way it operates is analogous to the layers in an onion. The Enemy's messages are layered, as we become aware of and begin to discard one layer, another layer comes into view. Some people begin work on a totally unpeeled onion, while others have already discarded a number of layers. In any case I will describe several layers that a person might have to work through. 

The most obscure layer of the Enemy can be merely a repetitive negative emotion of some sort. The emotion can be a very subtle feeling of impending doom or it can be a sudden fright. It can be a persistent hatred, a creeping doubt, a dread of death or disease, free-floating anxiety or a claustrophobic feeling. The experience is often one that does not seem to be attached to anything concrete, yet is ever present. The person learns that the feeling can engulf her anytime. Often, whenever the person is feeling good, the fear that a negative emotion will make its appearance can be enough to bring on the Enemy. "Things are going too well-it must end soon" "Whenever I feel this good I inevitably feel bad later. "  

 An alcoholic might suddenly realize that he's had a few days of careless, happy days without a single thought about drinking and will suddenly be overcome with anxiety. The next stage of the attack is the familiar feeling of fear, dread, doubt, which is the specific favorite of that person's Enemy, and which in the alcoholic's mind can be dealt with only by drinking. Each personís Enemy has its own specific messages and its own specific techniques. In fact, each Enemy is just like a complex, real person, with strengths and weaknesses, tricks, and strategies of its own. 

 An Enemy attack can last for a few intense seconds and spoil a person's day, or it can start slowly and build up to a fierce pitch, which then subsides. A strong desire to drink can take a minute, a day a week, or even longer depending on the Enemy's power. One of the most familiar and feared experiences for alcoholics are those periods of time during which strong negative emotions combined with a strong desire to drink completely invade their consciousness. 

 It is important that the person learn to recognize the specific feeling that is characteristic of his Enemy. After having identified the feeling, the next step is to recognize that there is always a cause for its onset. This cause may be a verbal statement, or an image, or a series of images. There is always some sort of mental activity that accompanies the feelings. 

As an example, one person had sudden attacks of anxiety that came from nowhere, as far as she could tell. After focusing on the mental events surrounding the attack, she realized that they were always preceded by a wordless fantasy, a sort of private silent movie of the mind. It was merely an image of her standing in front of a large crowd of people who were jeering, pointing at her, laughing, and throwing stones as she stood terrified wondering what she had done so wrong. 

 Another man's Enemy approached him through a sudden fear of death, accompanied by an image of lying in a coffin with his eyes closed and being led somewhere, probably to his grave. Other pre-verbal Enemy attacks can be fantasies of being killed, raped, of failing miserably, starving to death, being hated by everyone around, being tortured, or getting cancer or some other dread disease. For alcoholics, sooner or later, these fantasies become attached reflexively to the desire to drink. This happens because alcohol has a very strong sedating effect which tends to wipe out strong negative emotions; a conditioned reflex develops and brings on a desire to drink. In the same way that the proverbial bell brought on salivation in Pavlov's dogs. 

The first defense against such an attack is to make that preconscious "movie of the mind" clearly conscious to discover its contents and to become aware every time that it intrudes into one's consciousness.  

Having discovered the fantasy which comes with the attack, the next step in stalking the Enemy is to find the verbal content or "score" which goes along with the movie. It is always possible to find a verbal message behind the attack. The words that are attached to the fantasy might be "You are going to die," or "Everybody hates you," or "you'll get a heart attack," or "you are rotten and no good" or "Have a drink-it's the only way to feel better" or "Its hopeless-you might never succeed" or "you are rotten you might as well give up and get drunk." These may be heard as clear, loud voices, or as ominous whispers. One woman saw them written under a picture of herself: "Drunk and alone." 

During the next stage of the battle with the Enemy, it helps to get a small notebook to keep an "attack diary." Each attack or bad feeling even if the person isn't sure of its source-is recorded, with the movie and score-the fantasy and verbal content behind it--whenever possible.  

This way the person starts to become conscious of the actual dimensions of the Enemy's offensives. Some people report that when the Enemy strikes, it totally blanks out every other mental activity for seconds, minutes or hours. Some people feel completely overwhelmed and others only feel a slight annoyance. In any case, documentation of the Enemy's activity and exact messages is important. 

 People who are quite willing to keep a record of their negative feelings may or may not be willing to accept that these experience represent Enemy attacks and that they are false ideas introduced to consciousness by an external source of the past which has now been internalized. People have a tendency to be willing to assume that the predictions and statements of the Enemy should be considered valid. "I may get cancer. All the people in my family have..." or "I may fail, I have failed all my life so far," or "I am no good, I have ruined three marriages, and my children are all in trouble." Or "I'm stupid. I can't even balance my checkbook" or "There is no hope. I might as well get drunk." These are all examples of the way in which people will actually take sides with their Enemy and defend its point of view. This brings us to the second stage in the battle: making conscious the external origin of the Enemy. 

Separating the Self from the Enemy

When the fantasy and the words associated with the Enemy are located, it is essential to reemphasize the external source of all the negative messages. The most difficult part of the struggle is making clear that the Enemy is always wrong. 

In order to succeed, it is necessary to differentiate between Enemy messages and Adult messages which may be critical in content. The critical messages coming from the Adult, such as: "If you do it this way, it won't work," or "there is a good chance that you will not get this job," or "if you continue to smoke, you are likely to get cancer" are not negative messages about ourselves, they are statements of unfavorable probabilities. Even though they are associated with negative outcomes, they are not Enemy messages. 

Enemy messages attack peopleís nature with negative adjectives and putdowns. If we accept transactional analysisís premise that every human being is OK; beautiful, smart, health-seeking and good, then we can also assume that any statement to the contrary (you are not-OK; bad, stupid, ugly, crazy, sick or doomed) is a falsehood. When a person tells himself such falsehoods, they need to be rejected.

One of the most effective ways of showing the basic falsehood of Enemy statements is that they are usually blatantly opportunistic. For example, one classic form of harassment is: "You are a failure. You never do anything right" One woman who was plagued by this type of statement also reported that whenever she succeeded in something she would tell herself: "You are trying too hard-most people could do this with no effort at all." When I pointed out that she could not win no matter what she did, she said "That's right. Come to think of it, when things come real easy, my Enemy says: "That doesn't count-it was too easyí." 

 Another favorite form of paradoxical opportunism the Enemy likes to use is illustrated by the following example. John reported extreme feelings of incompetence and stupidity, reinforced by constant voices in his head, saying, "You dumb bastard, you're retarded. How can you be so stupid?" A group member commented, "That's your Enemy!" and John answered, "I know, and I feel real stupid for having such a vicious one." 

During this phase, it is very hard for a person under the influence of the Enemy to see her separateness from it. For years she has taken the truth of these statements for granted. Moreover, there is no real evidence that anyone can muster to disprove these statements: everyone fails sooner or later, everyone makes mistakes, everyone commits occasional evil acts. So when a person hears "You are evil" or "You are wrong" or "You'll never succeed," it is hard to see that this is an Enemy strategy, rather than a true statement. The therapist has to continually point out the difference between an objective, calm statement of negative expectation ("You'll be late to work" or "That was a mistake" or "If you don't rest you'll get sick" or "People will be angry if you keep acting this way,") and an accusatory, damming emotional attack on the OKness of the person, which is characteristic of the Enemy. 

 Sometimes people will hotly argue in defense of their own Enemy. It needs to be pointed out at this time that the person's insistence in maintaining and defending the Enemy position is in itself part of the Enemy's hold on his consciousness. In time, the therapist may need to explain that this is an unfair situation, one in which the therapist is trying to fight both the client and the client's Enemy and getting no help; a classic Rescue situation. 

This process can take weeks-sometimes months-to accomplish, and the therapist needs to be patient and should under no circumstances overextend herself to the point of irritation. She needs to simply point out repeatedly and whenever relevant that the client is having an Enemy attack and that he is again siding with his Enemy against himself. 

It should be remembered that in a therapeutic contract which involves cooperation-and thus no Rescues-the therapist should never do more than half the work in the struggle. Therefore it is essential that the client do her part by actively fighting alongside the therapist. When the client sides with her Enemy, she is essentially embracing the Victim role. If the therapist indulges in a Rescue, he will eventually have to Persecute her. The process has to be engaged in slowly and patiently, always making sure that the client is equally involved and is taking equal responsibility in the struggle. 

Once this particular portion of the work is completed and the 1. emotional fantasy and verbal content (the movie and the score) of the Enemy is determinedas,2. the Enemy is recognized as an external influence which can be separated from the self and fought effectively, we come to the third stage of the struggle: the development of the specific strategies that will defeat the Enemy. 

Techniques 

Technique I. Exposure. One of the most effective techniques against the Enemy is exposing it to other people. Consider this: In the most tyrannical of political regimes people are prohibited from speaking their ruler's name. Why? Because if we can't talk about what is oppressing us we are limited in fighting it. In addition if we can't clarify how the tyrant works we can more easily be persuaded that we are the cause of our own troubles. Being able to talk about oppressors is the first step to overthrowing them. Likewise with our internal Enemy; it is important to be aware that it ruins our lives and to refer to it by name. 

 As long as we harbor the Enemyís operations its ideasóno matter how mistaken-- have power over our consciousness because they go unchallenged within our minds. In group therapy, with eight people listening, the act of stating openly what the Enemy says has a enormously cleansing effect. It is as if the Enemy is a creature which can live only in the murky shadows of our minds. As we overturn the rocks under which the Enemy lives and open it up to the group's perceptions, it tends to slink and die away almost by itself. Very often this approach is sufficient to defeat the Enemy, but in other cases, even when a person realizes what is going on there will be continued attacks. 

Technique II. Confrontation. Each attack must be analyzed in detail, and specific confrontations must be developed. Some people will try to turn deaf ears to the Enemy's statements, some people will shout back; some people will argue logically. And while each one of these techniques might work with one personís Enemy, it may not work with another. 

One personís Enemy may be a nagging, insistent presence which follows a person from room to room, constantly repeating its whispered accusation. This is not one you can easily turn a deaf ear to. Instead, it might be more effective to face it squarely and say calmly, "Get out of here. If I ever see you again, I'm going to kill you" That approach may not work with a brutal, bloodthirsty Enemy which shouts insults and threats which can be defeated only by pumping oneself up to a large size and staring it down I'll until it disappears. 

Each Enemy has its particular source of power and it is necessary to match its power with power parity. The clever, devious, mind-bending Enemy needs an equally clever response, the one that predicts illness and death requires healthy self-confidence, the one that lies deliberately requires truthfulness and knowledge about what is and isn't true. 

Technique III. Nurturing. The Nurturing Parent or Ally is the natural foe of the Enemy. When being attacked it is often very effective to get nurturing either from oneself or from another person. In this connection, it is important to be able to distinguish Nurturing (You are 0K) statements from Enemy (You are Not OK) statements. Usually the difference is obvious: 

 Ally: "I love you." Enemy: "I hate you." 

 Ally: "You are beautiful." Enemy: "You are ugly." 

 Ally: "Go on, you can do it." Enemy. "Youíll never do it." 

 Ally: "Go ahead enjoy yourself." Enemy: "You don't deserve it." 

 Ally: "That's a good idea." Enemy: "It won't work." 

 Ally: "That makes sense." Enemy: "You are crazy." 

 Ally: "You are a winner." Enemy: "You are a looser." 

At times, what seems to be a Nurturing statement is contaminated with Enemy ideas. 

 "You are very pretty (for someone who is as fat as you are)" "You are my favorite child" (Competitive-puts the other children down.) "I don't hate you." (Any negative word in the statement is suspect of being Enemy-originated.) 

And even, given a certain tone, a sentence like  "Go ahead, enjoy yourself" can have an Enemy undercurrent because it might really be a rejection, rather than an encouragement. 

One important form of contamination occurs when the Ally's statement is one of concern and nurturing which has as its core an assumption that the person is incompetent in some way. Often the nurturing of children has this aspect. It stifles the child's capacities to take care of itself. Specifically, in the case of eating habits the parent encourages the child to eat, eat, eat so that it won't get sick. Unfortunately, this attitude assumes that the child cannot judge what food it needs and interferes with learning what, how, and when to eat. What seems benign and helpful Nurturing turns out to be Enemy contaminated. 

The best way to decide whether a certain Nurturing statement is "clean" is to subject it to the scrutiny of the group. If no one in the group objects, it is probably "true-blue nurturing" 

Asking for (and getting) or giving oneself nurturing strokes is a most potent antidote against the Enemy. Strokes can be written down and hung in a prominent place like the bedroom or kitchen where they can easily be seen at strategic times. Strokes can also be tape-recorded and kept near the bed or in the car to be played back when needed. 

Whichever form the strokes take (from self or others, verbal, physical, written, spoken, or recorded) the person bas to be alert to the moment they are needed most-during an Enemy attack. 

The Nurturing ego state can be exercised and developed. We all have at least a small capacity for nurturing, but most of us do not have permission to nurture ourselves. Women are encouraged to be Nurturing and therefore tend to have strong Allies but their Nurturing is reserved for men and children-not for themselves. Men, on the other hand, are discouraged from being nurturing because it is considered "women's work" Men tend to have underdeveloped Allies. Because of their sexist training to be tough, men do not nurture themselves, or each other. As a result, neither men nor women are able to be their own best friends or allies and do not take care of themselves in time of need. But the Enemy is given plenty of support for its work and usually functions unopposed.  

Helping a person develop a strong Ally involves giving him permission to nurture and love himself. The person who wishes to learn nurturing behavior can observe other people's nurturing, copy it, and practice it whenever appropriate. Being deliberately nurturing instead of rational, seeking out situations in which to Nurture without Rescuing, practicing taking care of, serving, or nursing others are different ways of strengthening the Ally. As the person learns nurturing behavior, she also needs to nurture herself, which is an additional, separate task. When nurturing themselves, people can expect strong interference from the Enemy, who will argue loudly. "You are being selfish and ridiculous," "First you have to take care of others," "This will never work," "The only thing that'll make you feel better is a drink," "Go ahead, have one." 

 A person may choose to develop a strong Ally as a contract in the group. This has proven very effective since it is easy to practice nurturing in the group. The same can be done within a family or friendship circle, it works best if everyone is aware of the contract and supports the effort. Developing a strong Ally can take some time-often months but it never fails to be a rewarding activity. Nurturing people (especially men) are much appreciated. Even more important, a strong Ally is the best weapon against the Enemy. 

 Technique IV. Avoiding Enemy Collusions. Insulating oneself from people whose Enemy colludes with or agrees with our own is another important technique. This often involves a separation from relatives who hold the same opinions which are the original source of our Enemies or friends who were chosen in the past because they shared what later turned out to be Enemy points of view. 

Relating to someone who shares our Enemy's opinions can lead to collusions in which two or more people develop blind spots for certain points of view which they hold. Scapegoating is an example of such a collusion. Racism and other forms of prejudice such as sexism are mass collusions. One common collusion of alcoholics is the feeling that private matters should not be discussed openly. Alcoholics will agree with each other that "I'd rather drink than think," "I'd rather drink than talk about myself" or "I'd rather drink than work it out." It is necessary to avoid such collusions to effectively fight the Enemy. This can be done by mutual agreements to be critical of each other's Enemy-originated statements and attitudes. However, sometimes other people aren't willing to make such deals, especially if they don't agree that the statements and opinions in question are objectionable. Then it may be necessary to avoid contact with those people. This is especially important with alcoholics whose social circle is liable to be composed of other alcoholics with similar attitudes. 

Collusions are very important to detect and avoid since some people's Enemy self-attacks are exclusively the result of their contact with others whose Enemy agrees with and stimulates their own. The corner bar is a place where collusions are plentiful and always available; its best to avoid it altogether. Very often, newly sober alcoholics want to socialize and drink sodas at their old hangout. I have never seen that work for long. The alcoholic either gets sucked in or eventually avoids bars altogether. 

In one example of a collusion, a man after months of working on attacks that seemed to come on just before the group meeting on Mondays, realized that he had a standing telephone date with his parents on Sunday evenings. He hated the calls but was locked into them. He felt he could not get out of them. His parents always talked to him in veiled critical tones by asking questions about his work and his relationships. These questions came from their Enemy and stimulated an Enemy attack in him, ("Youí1l never amount to anything" "You'll never be loved.") When he realized that and decided not to call them for a month, he became free of attacks. Eventually he reopened communication with his parents, but this time with an understanding of what he was and wasn't willing to accept in his conversations with them. In fact--and this is rare with parents who are usually set in their ways--he was able to educate them about the Enemy; and they stopped "laying their Enemy on him" and presumably on each other and themselves as well. 

 Enemy collusion can come from anyone but tend to come from people who would like to control us and are angry at us because they can't-such as certain kinds of parents, spouses, or lovers, employers, teachers, preachers, and politicians. Drinkers are often annoyed at people who have quit and are liable to use all sorts of subtle and sometimes crude maneuvers to get them off the wagon. 

 This stage of the work is an intense period of analysis of the Enemy's tactics and techniques and the counter-tactics and techniques which neutralize it. After some of this work, we hit on the effective method that seems to suddenly deflate the Enemy. It must be used every time the Enemy rears its ugly head-and it will. The person needs to practice, to be alert to renewed attacks, which, incidentally, will become more subtle as the Enemy trees to find new avenues around effective defenses. When an effective strategy is found, the point in the struggle is clearly marked by a sudden release from the great anxieties caused by intense attacks, so that the person is now in a whole new phase of well-being and feelings of OKness, even though the attacks may continue at a much lower level of intensity or with less frequency. These feelings of well-being arise from having developed techniques against Enemy attacks which demonstrate that it is wrong, that it is not really part of us and that we can stop it from dominating our lives. 

Sometimes someone will come to the group after a week of unsuccessful struggle and despondently describe his powerlessness in confronting the Enemy. Nothing seems to work; the Enemy has dominated his life for days. What to do? 

 V. Confronting the Enemy. It is important to become very specific about the time, place, and details of the specific Enemy attacks as well as the strategies used to confront the Enemy. When did it happen? Where did it happen? What was the beginning of it? How did it proceed? And, especially, what was done to stop the Enemy? In doing this one finds what techniques are unsuccessful. The techniques need to be analyzed in order to understand the reason for their lack of success. Other techniques need to be developed to replace those that didn't work.

If turning a deaf ear didn't work, perhaps calling someone up and getting nurturing strokes will. If that doesn't work, maybe physical strokes are needed, and one needs to get a massage or to run around the block. If massage or running don't work, maybe starting a shouting match with the Enemy will work. If a shouting match doesn't work, then perhaps one can develop finely tuned arguments to defeat the Enemyís statements. If having a list of strokes written by the group doesn't work perhaps it didn't because the list was kept under the pillow instead of hanging next to the bed where it can easily be seen. If arguing against the Enemy didn't work, perhaps it was done in a pleading rather than angry tone of voice. Eventually a technique that works will be found if the person, the therapist and the group keep at it. The Enemy's hold will be weakened. 

Fighting the Enemy is at the core of healing alcoholism. Of course there are other important tasks to be accomplished. Developing a competent problem-solving Adult, helping the Child rediscover joy, developing satisfying stroke sources, finding a support subculture free of drug use in which loving confrontation is the rule and improving food and health habits are equally important.

  

Chapter 20; Emotional Literacy Training

Emotions exist; they are an essential aspect of human nature. All the emotions can be enormously helpful, positive and add to our personal power, or they can be destructive and render us powerless. Being emotionally literate means we have emotions, we know what they are and how strong, and we know what causes them. We learn how to express them and where and when to express them, and we learn how to control them. We learn how they affect other people and we take responsibility for their effects. When we are emotionally literate we are sophisticated, gourmet cognoscenti of the texture, flavor and after-taste of emotions, good and bad. We allow our rational skills to work hand-in-hand with our emotional skills to produce the changes that we desire in our lives.

Emotions have power. They have an impact that at times can be overwhelming to others. We are aware of the power of emotions when we hold them back so as not to upset their target. We abuse power when we unload them without warning on the unwary, unprepared, or unprotected. We further abuse our emotions' power when we use them in power plays that are a sort of emotional blackmail or racket, a tactic used to intimidate others into compliance. We abuse our feelings power when we couple them with judgments, accusations, exaggerations, and lies, and we wield them like clubs. 

Emotions are inborn, generated in the most primitive, reptilian, limbic portion of our brain, and are constant reminders of our irrepressible carnal nature. Still, emotions are highly modified by the experiences that we have, especially as children, and by the attitudes about emotions that surround us. Depending on those factors: innate emotional tendencies, early emotional experiences, our family's emotional environment and the emotional culture that we live in, we achieve a certain level of emotional literacy. Let me give two examples:

Shawn a young man, now 30 years old, was exposed by his father to endless cyclic episodes of drinking, violence and remorse. He regularly finds himself affected by irresistible and chaotic emotion, which he has to wrestle down endlessly. This is an exhausting task and, on occasion, his control breaks down and he lets go -- usually when he is drinking -- to inevitable cumulative bad effect; he has made several, unsuccessful starts in a variety of endeavors -- college, marriage, small business-- and is now learning the plumbing trade. He shows promise in each case but eventually defeats himself through badly timed emotional outbursts that leave everything in a shambles. He feels badly about himself, out of control in every way; he eats badly, he is overweight, he reads pornography, he drinks and uses TV to soothe himself, watches all evening, every evening and often wakes up next morning, on his couch with the set still on. He has several single male chums who he watches TV sports with, but no women friends and he is out of touch with his family. 

Matthew, age 45, grew up in an upwardly mobile working class home where father was a controlling and stern disciplinarian and mother carried the burden of the family's  emotional expression. In his twenties Matthew was a heavy drinker and eventually joined AA and is now a teetotaler. He finds himself unable to contact his feelings except as occasional self righteous-outbursts. As a policeman he is appreciated by his coolness under pressure.  On the job, when others become emotional he is able to understand and responds with reassurance and nurturing though he feels next to nothing in the process. At home, following his father's example, he is a severe disciplinarian feared and respected by his children and wife. He watches cops and lawyer shows and on Sundays, if he is off work, he watches mostly religious channels and sports on TV but shuns news programs which he believes are hopelessly liberally biased. On his way to and from work he listens to talk radio shows and he almost passionately loves Rush Limbaugh the right wing radio commentator. 

These are but two examples of emotional illiteracy and dysfunction; one, out of control, the other overly rigid.  

An Emotional Awareness Scale 

Let me introduce an emotional literacy scale in order to illustrate the concept. Figure 1. represents a hypothetical  continuum between two ideal, non-existent states; Zero to 100% emotional awareness.  

  100%  ? 

INTERACTIVITY 

EMPATHY 

CAUSALITY  

DIFFERENTIATION 

VERBAL BARRIER -----------------------------

CHAOTIC EXPERIENCE 

PHYSICAL SENSATIONS 

NUMBNESS 

0% 

An Emotional Awareness Scale 

  Figure 1 

The raw, unschooled, feral, inborn experience of emotions is probably undifferentiated and chaotic; from that state a person in her or his emotional development can regress toward numbness or move toward awareness and emotional literacy.  Placing emotional chaos at the approximate center of the scale, I postulate additional points on the continuum: Physical Sensations and Numbness below the verbal line and Differentiation, Causality, Empathy, and Interactivity above. 

Numbness: In this state of numbness and anesthesia, a person, even while under the influence of strong emotions is himself unable to experience anything which ha can label as a feeling. This, while others around him can see, (from facial  muscles and skin coloration) as well as literally feel, his  powerful emotions. When asked how he feels, this person is liable to be baffled or to report feeling only coldness or numbness. Emotions are literally freeze-dried and unavailable to awareness, the person is empty of any feeling though he may be under the influence of powerful emotions.  Occasionally, perhaps under the influence of alcohol or another drug, one major emotion irrepressibly breaks through and is vented in a sharp, brief outburst, which is quickly replaced by renewed anesthesia.  

Physical sensations: At this level of emotional awareness, emotions are experienced as the physical sensations that normally accompany them; the person will feel his quickened heart beat but not be aware of fear, a pressure in the chest but not identify it as depression, a hot flash, a chill, a knot in the stomach or ringing in the ears, tingling sensations,  shooting pains; the sensations of the emotion devoid of  awareness of the emotion itself. When people live in this state of emotional illiteracy they often will consume drugs (over the counter, under the counter or prescribed) that target the different sensations, but which unfortunately almost always have detrimental, if not addictive side effects. By eliminating the head and stomachaches, the jittery or tired feelings, drugs leave the person without any awareness of the emotional conflicts that cause them. The conflicts don't go away and while the unpleasant sensations may be temporarily improved the emotional issues remain unsolved while the body chemistry is thrown out of balance by the drugs, with potentially harmful long-term effects. 

 Chaotic experience: In this state of emotional illiteracy the emotions are conscious but they are felt as a heightened internal energy level that cannot be put into words and therefore feels like an undifferentiated but unfathomable emotional mass. This emotional state is especially troublesome because the person is very vulnerable and responsive to his or her emotions but unable to modulate, speak about or control them.  Consequently the person can be more troubled -- in more jeopardy from uncontrolled emotions -- than the person lower on the scale, whose emotions are completely frozen out of awareness. This illustrates how a person may function more effectively at an emotionally illiterate level than he might at a more advanced, albeit chaotic, awareness because of the anti emotional bias of our culture. Because of this some people conclude that emotional awareness and responsiveness is, in fact, a handicap. The evidence shows, however, that high emotional literacy skills and awareness of emotional information, once achieved, will lead to personal effectiveness and power even in our emotionally illiterate world. 

The Verbal Barrier. The application of verbal, information-based schemes and skills to human emotion is at the very foundation of this project. It is at the "verbal line" that the impact of language and the capability to exchange emotional feedback between people, makes it possible to develop awareness and sophistication about feelings, and a technique for their expression and management. In order to cross this linguistic barrier we have to be in a cooperative environment that is truthful and friendly to emotional information. Only when emotional discourse is welcome and encouraged can we discuss our emotions honestly with people who will honestly discuss theirs and only with free open discussion can we come to understand our and other people's feelings. Below the verbal line, before the person speaks about his or her feelings, no differentiation is likely or even possible.  

Differentiation: Differentiation is a step toward recognizing different emotions as well as their intensity, and learning how to speak about them to others, as well as how to think about them. From emotional chaos we are able to extract the anger, love, shame, joy or hatred that makes up our tangled experience. Perhaps the main feeling is one of love tinged by shame or it may be that it is made up of strong hate and equally strong fear. Or it may be just plain anger, fear or shame. 

Causality: The human potential movement has provided us with a great deal of positive information and technique. However it has also promoted the idea that people cannot cause feelings in others. According to this view we are responsible for what we feel and it is a fallacy to blame others for our emotional experiences. 

The conviction that people can't make each other feel, held by so many as a great, wise and liberating revelation is, in my opinion, the high point of emotional illiteracy. It is an obvious fact to feeling persons that we can indeed cause emotions in each other. I have noticed that this emotionally illiterate dictum is most passionately defended by white, middle aged, professional men. When I challenge this view in my groups it usually women who with a sigh of relief thank me for challenging this view and putting into words something they have long felt.

 

As we understand the exact composition of our feelings we also begin to understand the reasons for them; why the strong love or hate, whence the shame. It is here that emotional interconnections have to be understood; that we can indeed cause feelings in others and that they can cause feelings in us. We discover that most of our emotional responses are caused by interactions with other people and we learn the effect that people's actions have on us. In this way we become able to understand why we feel what we feel. 

Empathy: As we learn the different emotions that we feel, the various intensities in which we feel them and the reasons for them, and as the awareness of our own emotions becomes textured and subtle we begin to perceive as well as intuit similar texture and subtlety in the emotions of those around us.  This process is quite amazing to the novice, because it seems to depend on a sixth sense that, at times, feels dangerously like clairvoyance. We literally receive other peopleís emotional signals on a separate, emotional channel that goes directly to our awareness. When being empathic we donít figure out or think about, see or hear other peopleís emotions. Instead we feel them, just as we feel ours. Research suggests that empathy is actually a sixth sense organ with which we perceive emotional energies in the same manner in which the eye perceives light. Emotional illiteracy develops when we fail to develop that sense or even suppress it. 

At this level of emotional literacy we become aware of other people's feelings. But our awareness is of little value if we cant validate it; in a cooperative setting where people are willing to discuss their feeling truthfully, we can verify our intuitions by checking them out. This process of indispensable feedback greatly improves the accuracy of our emphatic perceptions; we learn to become aware of other peopleís feelings, how intensely and why they occur as clearly as we do our own, by continual perception, feedback and correction. Eventually our empathic perceptions become more accurate and reliable. 

 Interactivity: Interactivity, the reciprocal communication and feedback of information is a recognized, desirable goal of the information age. The same is true for emotions; emotional interactivity is an important skill in an emotionally literate person. 

Emotions are not static events; they are fluid, chemical and take time to run their course unlike thoughts and ideas, which are much more contained, electrical and instantaneous.  Emotions merge, fade, grow and shrink in each other's presence and over time. Accordingly, the awareness of how emotions interact with each other, within people and between people, affords an additional level of emotional sophistication.  

 

Emotional Literacy; Basic assumptions 

 Axiom 1. The healthy human being is emotionally responsive and responsible, both capable of being made to feel and responsible for how he or she makes others feel. 

 Axiom 2. Emotional information is absolutely essential for effective interpersonal communication, without it we have only half of the data in any set of transactions.  

 Axiom 3. Effective interpersonal communication is essential for human productivity and personal power. 

What We Feel and Why 

There is no convincing final word on precisely how many different emotions there are; an exact taxonomy remains to be developed. But it is fairly clear that there are about two handfuls of primary emotions--that is to say, emotions that are reasonably distinct from each other--including love, anger, fear, joy, shame, guilt, pride, sadness, hope. 

Emotions can be divided into positive and negative. We define emotions as positive or negative because most people tend to seek the former and avoid the latter. When two or more primary emotions occur simultaneously, they combine into secondary emotional hues.  Love can occur with shame or with anger or even with its counterpart, hate. When more emotions are added, they can create such a muddy experience that chaos and confusion are the consequence. Jealousy is often such a compost of emotions-- anger, fear, shame, love, sexual desire--that it is both incomprehensible and unmanageable. 

 Emotions can also be strong or weak. Each of the emotions mentioned above has powerful and weak manifestations. For instance, anger can go from minor irritation to blind rage. Shame can go from slight embarrassment to intense blush- provoking humiliation. People who are emotionally illiterate may recognize their emotions only at the very intense end of the spectrum. 

Men, for instance, are often either completely unaware of mild forms of anger and unable to speak about them. Yet, when they get angry enough, men will express their anger and know that they are feeling it. The same is true of men's awareness of and capacity to express their feelings of love. Men have a tendency to feel love only when it is at the very intense end of the spectrum, and to feel it very intensely but, when the feeling wanes, they suddenly find themselves utterly out of love. 

A person who cannot read often becomes afraid and defensive about his incapacity and fakes understanding out of embarrassment. Illiterate persons tend to invalidate the importance of reading and writing and often become anti-literate and discount the value of the written word. People who are illiterate often try to compensate in other ways; they try to live a normal life outside of the realm of letters. Or they will develop tricks that get them by, recognizing certain words without really reading them. Likewise, emotionally illiterate persons are often embarrassed by their incapacity and attempt to compensate for their handicap through logical and rational methods. They discount emotions as being meaningless and useless and are embarrassed and defensive when their incapacity is revealed.  They learn to respond to emotional situations in ways that appear that they understand what is going on. And throughout, since emotional illiteracy is the rule rather than the exception, the anti-emotional consensus acts as a powerful reinforcement of the illiterate condition. 

The consequences of emotional illiteracy are many. On one hand, when emotions are not acknowledged but suppressed, rationality and logic prevail at the overt public level.  Interactions seem "civilized" and "grown up." But barely hidden beneath the surface, emotions do continue to exist and create the effects of their presence. When suppressed, pent-up emotions distort thinking and communication, produce erratic behavior, and can create physical symptoms such as head, back, and stomach-aches and chronic conditions like asthma, arthritis, ulcers, colitis, and hypertension. 

When events hurt or sadden us and we cannot cry, that sadness can become the bedrock of our personality. When our impulse to embrace, love and kiss, and celebrate our loved ones is denied, our hearts shrink. On the other extreme, when emotions are out of control, life can become an unending war zone in which emotional traumas build on each other to the point of causing madness and despair. When the emotionally illiterate inhabit the corridors of power and dominate whole governments, they threaten the citizenry with apocalypse--war, death, hunger, and disease. 

Learning Emotional Literacy

Emotional Literacy requires more than emotional awareness. It requires action in a social context. To that end I have developed a set of training steps that will develop a personís emotional literacy. A detailed description of this process is the subject of my book Emotional Literacy; Intelligence with a Heart.

I. Cooperative Contract

The honest communication of feelings requires an atmosphere of trust and acceptance without which emotional literacy cannot be taught. The cooperative contract, explained in Chapter XX if held to, will provide such an environment and, because of its emphasis on how people feel and what they want, has the effect of advancing people from chaos toward interactivity while competition has the opposite effect, namely to move people from chaos to numbness. 

 

II. Strokes. Opening up the Heart. 

Learning to exchange wanted strokes

1. Giving others or ourselves positive strokes.  

2. Asking for and accepting strokes we want or rejecting unwanted strokes. 

 

III. Action/Feeling Statements. 

Developing emotional information by investigating the relationship between feelings and actions. 

1. Telling people, without judgment or accusations, the feelings that their actions have caused in us.  

2. Putting aside feelings of shame, guilt or anger and  accepting without defensiveness, that our actions have caused  certain feelings in another person. 

IV. Fears and suspicions  

Further developing emotional information by investigating peopleís motives for their actions.

1. Telling people, without accusations or judgments the fears and suspicions--paranoid fantasies--that their actions  have generated in us.  

2. Acknowledging these fears and suspicions without  defensiveness and seeking for the grain of truth in our actions  which could be their legitimate source. 

V. Taking Responsibility 

Correcting our emotional mistakes.

1. Acknowledging that we have acted in a manner that warrants apologizing and asking for forgiveness.  

2. Accepting or rejecting the apology and forgiving or refusing to forgive. 

VI. Betrayal, Repentance and Apology

Correcting major emotional misdeeds.  

The above examples regarding apologies are related to small, everyday, garden-variety errors. But frequently people's behavior is more seriously amiss when it takes the proportions of betrayal. Betrayal is not a concept easily dealt with in today's social climate where individuals are encouraged to choose and act for themselves and the possible victims of those acts or choices are expected to fend for themselves. Often, in the process of following a self-seeking we will betray others and accepted the betrayal as "just the way it goes." 

Betrayal can leave a profound, often festering, scar upon the soul. A person who has been betrayed, to be emotionally literate, cannot ignore the betrayal, bury her feelings and proceed as if nothing happened. The betrayal will poison her every transaction from then on. A person who betrayed another must not attempt to pretend that the betrayal did not occur; the guilt of the betrayer will cause endless defensiveness, psychological denial and blindness that will affect every future relationship as well. The betrayer will continue to betray and the betrayed will be poisoned by bitterness. Both will suffer if they ignore the facts of the betrayal even if they go on to other relationships or even if the betrayal is papered over and an apparently cordial relationship is rekindled.  

Alcoholics wanting to give up their scripts must deal with the almost inevitable betrayals that being an alcoholic generates. That is why AAís twelve steps include making amends. But what I am speaking of here goes far beyond what AA requires in its twelve steps; to deal with betrayal in a emotionally literate manner the alleged betrayer and the person who feels betrayed need to mutually and cooperatively explore and agree upon the nature of the trust that existed between them and the breach that was committed. The betrayer must go through the process of acknowledging the breach, feeling regret and repentance, making an apology or even begging for forgiveness. The betrayed has to be given the option to re-experience the grief, hurt, anger and other emotions that the betrayal caused, give vent to it, come to believe that her betrayer is truly repentant and willing to make amends and finally ask for what she wants, if anything, to be able to forgive. Only after that process is completed can the emotional damage of betrayal heal and the relationship eventually be whole again.  

 

The steps presented in this chapter will go a long way toward providing a positive environment for emotions to be expressed, whether between friends, lovers, co-workers or within a family. As people become skilled in the use of these techniques, they become second nature, and people lose their initial awkwardness. The techniques simply become part of everyday routine, similar to brushing one's teeth, raking the leaves, or walking the dog. Once assimilated, they contribute to a more well-ordered life in which emotions are acknowledged and integrated into our everyday existence. 

 

 

Chapter 21; Body Work

Body-work sessions are a place in which the innermost feelings and experiences of the person are encouraged to come to the surface. During the time that I conducted a full time psychotherapy practice I held about one body-work session a month, which was open to all of the people in all of my groups. Usually between eight and twelve people attended as well as one or more therapists in training to assist me. The body-work session lasted two or more hours. It took place in a large room where people could lie down on large gymnasium mats and have enough space to move around.

We start with a brief discussion of what each person wants to accomplish during the session and make a body-work contract for the session.

Typical contracts are:

Getting angry

Crying

Getting in touch with my feelings

Relaxing

Learning to scream

Getting over being ashamed of speaking up

Cursing without guilt

Making obscene bodily movements

and so forth.

When people come to a bodywork session, they know to dress comfortably and to bring a favorite blanket or comforter in case they get cold, which is often the case in the beginning part of the session. I start by asking everyone to lie down comfortably. After everyone is comfortable, I ask them to close their eyes and say: 

"The purpose of body work is to provide an opportunity for people to speak from and with their bodies. In group therapy we speak the language of the Adult, with words, mostly. The culture sanctions only that which comes from the rational part of ourselves and we have no permission to express the language of the body or the Child, if you will. 

"In this session it is O.K. to express what your body has to say. Doing this would probably create difficulties for you in the outside world but we provide a situation here where there is total safety. You will not be criticized or hurt for anything you do. You need feel no embarrassment or fear. The worst that could happen is that somebody else doing this work does not like whatever you are doing (shouting, crying, moaning), and as part of their work they may express that dislike. But you don't have to stop as long as you're not physically injuring anyone, and I and the people assisting me will make sure that you don't accidentally hit or hurt someone or yourself." 

"It doesn't matter what you do with your body, what posture you assume, what movement you make, whether you cry or scream or yell; it's all O.K. and, as I said, you won't get criticized. Remember the cooperative contract we have in our groups. One rule is that you'll keep no secrets. To keep back a feeling is actually keeping a secret, and so, really, you are expected to express whatever you feel. In addition, of course, keep in mind your own particular body-work contract for the session.

Remember, first and foremost, that this is a situation where you are to fully express what you feel, without any shame or holding back. In other words, I am saying you should feel safe, protected and with permission to do whatever you want to do." 

 These statements are designed to create a sense of trust and safety so the person can effectively deal with the strong messages that we all hear from our Enemy whenever we are about to express a strong feeling. Typically the Enemy will say things like "You are making a fool of yourself" or "This is childish and immature. Stop it!" or "People will hate you for being so crude." My reassuring statements, coming from my own Nurturing Parent, provide the participants with ammunition against these injunctions from the Enemy. 

 The knowledge that I and the people assisting me are all here to provide permission and protection for this work is essential to effective body-work. Having accomplished that purpose, I continue: 

"I want to explain to you that the whole business of becoming aware of bodily feelings is basically a retuning, a refocusing of your attention. The feelings are actually there all the time, but we tend not to pay attention. Subtle feelings such as slight irritation, sadness, embarrassment are squelched. We notice only strong feelings like anger, pain, cold or fear. I'd like you to start by simply focusing in on whatever it is that you're conscious of right now; pay attention to whatever is occupying your consciousness. Right now you might be in the past or in the future or in another galaxy. Pay attention to where you are right now. I will give you some time to get in touch with that. You will probably be aware of things like aches and pains. Or you might be preoccupied with an argument you had yesterday, or an examination tomorrow. Don't try to change what is going on in your mind; it will surely change by itself as we proceed. As you lie there and relax and notice what happens, you will discover there is a subtle shift in your consciousness. Slowly your thoughts will lose some of their primacy, the contents of your consciousness will change, and you'll start feeling other things."

"The focus of your attention is probably shifting down from somewhere in your head to somewhere lower in your body; your chest, abdomen, legs. And your consciousness is going to be less pictures, images, and words, and more feelings. The change is subtle; it doesn't happen instantly.  For instance, if you're walking down the street and you suddenly get a fright, your whole body is involved and it may take a half an hour to get over the effects of that. We aren't capable of beginning or ending our emotions the way we can begin and end thoughts. Our mind is like a computer-it can be turned on and off-but our emotions are different, they don't start or stop growing on command. It takes time to start that process, and it also takes time to terminate it. You will have all the time you need." 

"If we pay close attention to our feelings, we will notice what we think of peculiar things, feelings of floating, hollowness, or heaviness and different strange feelings like tingling or tight bands around some part of the body or energy fields, streaming sensations or what-have-you. These sensations can be alarming. People who feel them can get scared that they are losing their minds, which in a way is true." 

"You are being encouraged to lose your mind, but remember that it is perfectly safe. You can get it back anytime you want. You are not really losing it-just setting it aside for a while. If you get scared, however say so and if you want something ask for it. We will be here for anything you need. If you need a pillow to hit, or an extra blanket because you feel cold, or someone to hold your hand or hug or massage you-or if you need a tissue, a towel or something to spit or throw up into, just ask. We (give the names of assistants) are here to take care of your needs while you explore or abandon yourself to your feelings. If you want a specific person to assist you, you can ask for him/her by name." 

At this point it is not unusual for some people to begin to feel and express strong emotions. Someone might start crying or say that he is scared or worried. But most people don't enter the process as easily. Usually at this point people are feeling colds puzzled, worried, uneasy. In order to facilitate their work, I speak to them about breathing: 

"How we breathe has a lot to do with how much we feel and also perhaps how we feel. Not breathing deeply has the effect of constricting your feelings, and breathing deeply has the effect of fanning your feelings like embers in a fire. If you blow into them, the embers will glow and sometimes flames will break out into a roaring fire if the fuel conditions are right. It's the same with feelings; breathing will make them more vivid, and sometimes it will cut them loose into a roaring emotional fire." 

"I'm going to teach you a little bit about breathing and encourage you to breathe deeply in order to facilitate your contact with your bodily feelings." 

I follow with a brief exercise in thoracic and abdominal breathing, teaching the difference and then showing how to combine the two in order to maximize respiration. I make sure that people are inhaling and exhaling fully: 

"As you breathe more fully, you are going to inevitably have to make some noise. Don't control that noise. Don't hold it back. Let it out. Remember what a dog that is breathing heavily, sounds like. It makes noise. Open up your throat. Make any noise that naturally, normally accompanies that kind of breathing for you. Breathe deeply and well, opening up your throat as much as you can, breathing deeply, through your mouth, both ways, in and out." 

"Now I'd like you to exaggerate the sounds. We are very limited with our sounds. I'd like you to emphasize, dramatize it, say any thoughts or words that come into your minds. Don't worry about being foolish, say, express anything you feel with sounds, whether they are words or grunts or laughter or sighs or screams. Donít worry about obscenity, its OK." 

This is how the session begins. After this point I just encourage whatever expressions naturally happen, attend to people's needs, but mostly let them run through whatever flow of emotion or feeling that comes. On occasion I will make a suggestion for additional behavior; the assistants limit themselves to encourage and support what the client is doing.

Usually about one-third of the people have a powerful and meaningful emotional release which often leaves them with a feeling of liberation, rebirth or great joy. The rest go thorough a variety of lesser but mostly satisfying experiences of crying, anger leading to well-being, or relaxation. A few find themselves completely shut down, cut of, alienated. Some even leave the session. I do not do anything to change this, except to encourage whatever people feel they want to do. I let the flow of emotions take its own course, encourage it here and there, and let the combined effect of all the factors in the situation create each person's individual experience. 

People are strongly influenced by how safe they feel, by their own life situation of the moment, by who is assisting me, by what others in the room are doing and feeling, by their contracts, and I daresay by the weather and the phases of the moon. The body-work session facilitates emotional storm and release. As it proceeds, it feels like just that: a storm at sea. Feelings will come in waves of deep sadness, wild anger, uncontrollable laughter which will affect all of us in some way or another. The combined experience is cleansing and tends to have a strongly remembered effect that will be the basis for discussion at the next group session. After a period, which may vary between about forty five minutes and an hour and a half, the storm subsides. Everyone becomes quiet.

When that lull comes, I ask whoever is ready to sit up to do so, and when everyone feels complete and feels ready to sit up, we rearrange ourselves in a circle and each person spends some time sharing what she or he experienced. This aspect of bodywork is very important because without it the cognitive and emotional components of the experience can fade and fail to be integrated into a lasting change. One or more people will have profound insights or recollections and with the help of the group make sense of what they have experienced and how it applies to their difficulties and how to use that knowledge for positive change. Others will have to work on settling down and regaining their composure. The meeting may end with a group hug or a circle in which all hold hands. 

People will confront their emotional issues fully in a later session if not in the first one. Their tendencies to be afraid, or to Rescue, or to become bottled up and hopeless, their anger or sadness sooner or later come to the surface and become obvious. Some will never experience an emotional release, but most will, sooner or later. In any case, bodywork is an exceptionally valuable experience for alcoholics. When I have offered it regularly I have experienced greatly increased success in my work. 

Readers who perceive the power of this process will realize also that it is not available to most people in their everyday lives. It is hard to find a situation in which we can let go in safety and with full encouragement. Our society simply doesn't support that kind of behavior. Similar abandon can be found only in spectator sports, some very rare churches, or at wild parties which are usually stimulated by alcohol or other drugs. There is a situation in which it can be practiced and that is in one's car while driving on the freeway and I recommend this as a last resort for people who need emotional release. 

The expression of feeling can be legitimized in the alcoholic (or in all of us, for that matter) in a number of different ways. Bodywork is only the most effective and dramatic. Let us realize that the true expression of feeling is our birthright, that not to claim that birthright makes our lives joyless and susceptible to alcohol and other drug abuse. The liberation of our emotions is a basic task in healing alcoholism. 

 

Chapter 22: We Are What We Eat

In my professional training as a clinical psychologist, there was little suggestion that mental states could be affected by what was eaten in the recent or distant past. Of course we knew that alcohol and other drugs were intoxicating substances, but that is where the information ended. No further connection was made between various foods and substances and people's states of mind. I had been trained to believe that the mind and the body are separate and that while what we eat can make us physically ill, the mind is somehow exempt from what we do to our bodies. 

After working as a psychologist for years I realized that it was important to find out what so-called "psychotics" had been putting in their mouths recently. Working with people who had been using huge quantities of amphetamines brought me this awareness.

For me it was a surprise to realize that extended use or large doses of amphetamines can actually create a state of mind that looks every bit like those sometimes incurable psychoses which I had learned were caused by internal mental conflicts.

When I began to inquire closely into people's eating and sleeping habits prior to and during their emotional crises, I found that alcoholics tend to stop eating when they start drinking. They often smoke excessively, drink a lot of coffee and eat snacks and junk food almost exclusively. Their sleep patterns are often disturbed. I also began to realize that when a person drinks and manages to eat and sleep properly and is not especially addicted to cigarettes and coffee, the devastating health catastrophes that are so common to other alcoholics were often avoided; the drinking did not become as intense, and the recovery did not take as long. Something that should have been obvious to me and my coworkers and which should have been taught to me in my training began to become clear to me: much of the distress that alcoholics suffer has to do with what they consume, other than alcohol. An alcoholic's binge may have more to do with what he is putting in his mouth in addition to alcohol-than with any other thing whether allergy, incurable disease, heredity, or script. 

The most destructive drinking pattern that I've ever seen-one that is common with skid-row alcoholics-is the combination of cheap wine with little or no other for than the cheapest food available at the corner store: white bread, canned beans, jam or peanut butter, together with coffee, all of it laced with plenty of sugar and cigarettes. Sugar (cheap wine is loaded with it) suppresses appetite, and so do cigarettes and coffee. Alcohol makes you sleepy at first, but a few hours later, it interferes with sleep as does coffee.

 

The hardest time for an alcoholic is usually the evening. While he is drinking, he is smoking cigarettes. Sleeplessness and insomnia will be the natural outcome of this combination. The later at night it gets the more isolated and alone he will feel, the more fearful of his condition he becomes. Eventually he falls asleep at two or three o'clock in the morning after having overdosed with alcohol. He may wake up very early-way before anyone else does-shaky and sick, drink a cup of coffee, smoke some cigarettes, eat some junk food, overeat and throw up, and the drinking will start again. 

This pattern is typical of skid-row alcoholics, but it is also happening next door and down the streets of Middletown. The alcoholic who still has a job will start drinking after work. This will suppress his appetite. He will not eat a reasonable meal, especially if meals are not cooked for him and he has already lost his family milieu where regular meals are a routine. Instead he will eat a hot dog or a hamburger, a sweet roll, and a cup of coffee with lots of sugar.

All the elements are there: coffee, cigarettes, poor diet (including too much sugar and fats), sleeplessness, and usually, in addition, sleeping pills or other powerful tranquilizing medication. The effect can be just as devastating as living on skid row.

The physical effects of the kind of a diet combined with the sleeplessness that goes with it should be obvious to anyone who thinks about it. Yet people who work with alcoholics don't ordinarily pay much attention to eating habits. It seems extremely important, and I can't imagine being effective in helping alcoholic's without dealing with these problems in some way or another. 

As an example Mr. Q. came to me because he was concerned about his drinking. He had a full-time job and a family, and he had been drinking socially for years; but he had noticed that alcohol was becoming more and more important in his daily life. He was concerned and wanted to do something about it. I asked him a few routine questions about his diet. 

 CS: How do you eat? Do you have a reasonably good diet?  

 Q: Yes, I eat quite well. In fact, I eat too much. 

CS: Well, tell me what you had to eat yesterday, for instance. 

 Q: Okay, I had breakfasts lunch and dinner, like I do almost every day. 

 This would seem to be a clear enough answer but I persisted. 

 CS: Let's be more specific. What did you have for breakfast?  

 Q: I had some toast and cereal. 

 CS: Is that all? 

 Q: What do you mean? 

 CS: Well, did you have coffee? What did you have on your toast? 

 Q: Oh, yes, I always have coffee. I have one cup of coffee first thing in the morning. 

 CS: Sugar? 

Q: Yes. Three teaspoons. 

 CS: Cigarettes? 

 Q: Yes, a cigarette as soon as I get up. 

 CS: How many cigarettes by the time you leave for work?  

 Q: I'm trying to cut down to one, but I usually have two. Lately, I've been having more. They get me going. 

 CS: Okay. What kind of bread?  

 Q: Just regular white bread. 

 CS: Jam? Butter? What do you put on it'?  

 Q: I put margarine on it and I love jam, so I really pile it on. 

 CS: How many pieces of toast? 

 Q: Two or three slices. 

 CS: Sugar in your cereal?  

 Q: Yes, I like the sugar-frosted kind. 

 CS: Fruit? 

 Q: Yes, canned fruit cocktail. 

 CS: So what did you eat next? 

 Q: Lunch, I guess 

 CS: Any snacks at the office? 

 Q: Well, I usually have another cup of coffee.  

 CS: With sugar, of course? 

 Q: Yes, and I'll go to the vending machine around ten thirty in the morning and buy a donut. 

CS: Okay, let's talk about lunch. What did you have for lunch? 

 Q: I'm trying to stay on a diet, so I had a salad. 

 CS: Dressing? 

 Q: Yes, Thousand Islands. 

 CS: Is that all? 

 Q: Yes, except for some crackers. I also ate somebody else's crackers, and had more coffee. 

 CS: By now you must be really hungry. 

 Q: Yes, I'm usually starved at lunch, but I try to keep what I eat down because of my diet and also because I don't want to spend a lot of money.

 CS: Okay, what comes next? 

 Q: Another cup of coffee in the afternoon. This is around three-thirty, and at this time I feel very sleepy and tired and am usually dying to have a drink. This is why I am beginning to worry about my drinking. I have been thinking about drinking a lot just before work ends, and I can hardly wait to get out. I used to go home and have my first drink, but my wife has been nagging me about it, so I stop at a bar and I have a martini. 

 CS: Anything with it? 

 Q: Well, they usually have some snacks during Happy Hour-some deep-fried stuff or cheese-and I usually eat some of them. 

 CS: How many? 

 Q: As many as I can get. 

 CS: Okay. What did you have for dinner? 

Q: Pretty good. My wife cooks balanced meals. Often I really don't like what she cooks-it's mostly for the kids-but last night she had frankfurters mashed potatoes and salad. 

 CS: Mashed potatoes out of a box, or actually potatoes that are mashed? 

 Q: Oh, I don't know. I think they come from a box. They're instant potatoes. 

 CS: Anything on your potatoes? Sour cream? 

 Q: We can't afford sour cream. I put a lot of margarine on them 

 CS : How many frankfurters? 

 Q: Three. 

 CS: What dressing on your salad? 

 Q: Thousand Island. I know, you want to know if it was out of a bottle. Yes, out of a bottle. 

 CS: You're beginning to see the point of all these questions. Okay, any more the rest of the evening? 

 Q: No more food, but a lot of wine. 

 CS: Are you sure? No snacks? 

 Q: Let me see. I usually eat something around ten o'clock. Yes, I had some more toast and margarine and jam. 

 CS: How much did you drink? 

 Q: I think I drank a bottle of wine before I got to bed. I used to drink two glasses, but now I'm up to a bottle and that's worrying me. 

 Mr. Q.'s diet strikes me as a nightmare of malnutrition. If we total what he ate, it's about seven slices of white bread, a quarter stick of margarine, a cup and a half of sugar, a quarter of a head of lettuce, a handful of peas, four frankfurters, salad dressings, lots of fat, several deep-fried snacks and a generous assortment of the more than thousand different chemicals that are routinely added to our food. 

No wonder Mr. Q. Is hungry all the time. He thinks he eats too much. He does but in fact, he's starving himself. No wonder he craves a drink before work is over. Alcohol is a very quick, accessible source of carbohydrates that satisfy his hunger cravings. No wonder he can't sleep. No wonder, in fact, has drinking is gone out of control. He is overweight, saggy, tired, and devastated. One would assume that this has to do mostly with his drinking. In fact, it has to do with his overall diet-including his drinking. The coffee doesn't help, the cigarettes don't help either. 

In fact, when Mr. Q cleaned up his diet his drinking went back to the previous more acceptable levels. However, educating Mr Q. to the realities of food and diet was not easy. He was addicted to sugar, coffee and cigarettes-a powerful addictive combination. It took months for him to bring his sugar consumption down, his processed carbohydrates down, to replace coffee with tea and to bring his cigarettes and alcohol use down. 

 To have tried to ignore what he ate and to have worked only with his alcohol consumption would have been, I believe, dangerously ineffective. True, he immediately agreed to stop drinking altogether, and he eventually did; but his craving for alcohol continued for months and coincidentally decreased when he straightened out his diet 

 Alcoholics will complain of several symptoms their drinking makes better and will often blame their drinking on sleeplessness, nervousness, being cold, and not being able to warm up, hunger pangs and, of course, extreme cravings for alcohol. All of these symptoms can be caused by the alcoholic's diet, and all of them can be dealt with and reduced so that the desire for alcohol will be reduced as well. 

Sleep Problems.  

Sleep problems are the major reason that people drink late at night, and night drinking is the royal road to alcoholism. In order to understand insomnia, we have to look at the whole day preceding it. 

Naturally, drinking coffee will have an effect-especially within four or five hours of bedtime. People who suffer from insomnia should stop drinking coffee-or at least cut down drastically. Of course, quitting will probably cause drowsiness after lunch because people usually eat some kind of sugar at lunch, and sugar causes drowsiness after delivering a quick shot of energy. The usual antidote to that drowsiness is more coffee. So, sugar needs to be cut back too. The best solution is to eat a light lunch that is high in available protein and low in sugar. For a substitute to the usual mid-afternoon coffee and cigarette, one New Age nutritionist recommends a capsule of cayenne, or a glass of lemon juice with brewer's yeast together with a good stretch or a run around the block. 

In the evening, insomniacs should not have coffee with dinner or after and should not smoke cigarettes for one hour before bed-time. Having eaten a nutritional well-balanced meal, and having some warm milk or herb tea (no black tea, which contains caffeine), just before going to bed will bring sleep in most situation, especially if there has been some physical exercise during the day. 

People can keep themselves awake with worries-especially worries of not being able to sleep. It is especially important for people who have sleeping problems not to lie awake in the dark because that situation is one in which the Enemy tends to have an easy hold of the mind. It is useful to have a good reading light that will not disturb one's sleeping partner and which can be turned on in the middle of the night. It can be effective to pick up some light reading and go back to sleep when drowsy instead of becoming agitated and panicked about losing sleep. Sleeping medication should be avoided as much as possible, but it can sometimes be effectively used to break a string of sleepless nights and ease the anxiety and tension of insomnia. 

Cravings

Cravings for food, cigarettes, and alcohol are all related to each other. Very often people are undernourished even though they may be eating large quantities of food. This will cause them to be constantly hungry and to smoke cigarettes and drink coffee, since they do not want to eat. Cravings for alcohol can have a similar source. People's diets are too heavy in white flour, refined sugar, and fats, all of which have essentially no food value. 

Making sure that a person is eating whole wheat flour products, that she is consuming enough fresh foods (vegetables that have recently been cut) and some form of easily digested low-fat protein, such as farmer's cheese or tofu, can do a great deal to decrease an alcoholic's craving for food, sugar, caffeine, and nicotine. Instead we eat what we are sold processed food all of which-without exception is nutritionally substandard; all packaged or processed foods are adulterated and nutritionally damaged and should be avoided whenever possible. At the very least, people should read the ingredients list that appears on all packages with the understanding that the contents are listed in order of quantity, with the highest amount first. 

Accordingly, it is good to look for the inevitable sugar, also listed as sucrose and dextrose, and note how high on the list it appears. The higher up, the more sugar the package contains. If it appears first, second or third, the package should be avoided at all costs. 

People who must economize should know that it is possible to obtain excellent nutritional food in little-known ways and at low cost. Brown rice combined with beans is a rich source of protein although brown rice or beans alone are mostly a source of starch. It is possible to sprout alfalfa and sunflower seeds, lentils and beans for a source of chemical-free greens rich in minerals, vitamins and other nutrients. 

It is not the intention of this book to provide a complete nutritional guide, but just to point out that these are important issues.  As the science of modern nutrition develops more information on the subject should become available and easily accessible through books and through the Internet. 

Unhappiness and nervousness

As I explained before, I see all negative thoughts and energies as originating in the Enemy, which definitely resides in the mind sector of the person. But it is also important to recognize that irritability and nervousness can have chemical origins. Excessive smoking, coffee, sugar, salt, and certain additives in most processed foods chlorine in water and smog in the air are all a potential source of nervousness and irritability. Any unpleasant bodily feelings are a springboard for the Enemy. Food additives like food colors, MSG, calcium propionate, sulfur dioxide, benzoic acid, BHA/BHT, are known irritants. No one knows what happens when these chemicals are combined with each other and with caffeine and nicotine. 

When a person is experiencing strong feelings of nervousness and irritability, let us not blindly assume that the source of those feelings is strictly psychological, but try to minimize all other possible sources to enhance his chance go through a period of withdrawal from alcohol with a minimum of difficulty. 

Unfortunately, because of the irritability that comes with stopping alcohol use the reaction of someone who stops drinking is often an increased use of all the other harmful chemicals that he is using already. The person who stops drinking will usually drink even more coffee, smoke more, take prescription drugs and eat more snacks which notoriously contain all sorts of dubious chemicals. It is therefore important for the alcoholic to recognize that alcohol is not the only harmful substance that he is consuming. He must remain conscious of all the other things he puts into his mouth and into his system (including prescription drugs especially benzodiazapines and antidepressant SSRIís which can have large and serious side effects) while he is trying to stat sober.  

Because snacks are important as pacifiers, it is a good idea to have good nutritious snacks available. Good snacks are carrot and celery sticks, sunflower seeds, peanuts in the shell, and a favorite of mine, popcorn sprinkled with nutritional yeast. In all of these, it is important to keep salt content low since salt itself can cause irritability. 

Feelings of coldness

Another physical reason that people give for their drinking is being cold. People often drink because they have found drinking an effective way of warming up. Alcohol is known to give a feeling of warmth; less known is the fact that it causes heat loss and eventually more chill.

Here it is important to understand the several factors that could cause the kind of chill that would require one to have a drink. Cigarettes and coffee, which are both stimulants, constrict the blood vessels in the skin and cause feelings of coldness. Drinking is often associated with lack of strokes and literal cravings for human warmth and being touched. Being cold at night in bed is another common occurrence, whose importance is often neglected. It is helpful to teach people how to dress warmly, and how to sleep warmly: to wear a nightshirt, to make sure to have enough warm blankets-preferably down. Hot beverages can produce a feeling of warmth and niacin, which is often lacking in the alcoholic diet, can do the same. It is useful as well, for a person who drinks to learn how to treat the skin to massages, warm comfortable organic clothing that contains cotton or wool, rather than synthetics, and pleasant comforting bedclothes. 

And of course, kicking the smoking habit is a very important and life-giving change to make. Cigarette addiction is a whole subject in its own right. When they are ready to quit, people can get lots of information and help from many available books such as "Kicking It" by David Geisinger as well as from the Internet. 

Some of the changes that are suggested in this chapter require a large modification in life-style. Nevertheless, even if they cannot be followed completely, or all at once, it is useful to be aware of the importance of the issues mentioned here. Ironically chronic drinkers such as Wino players are often more aware of these issue than beginning alcoholics because of the information is often supplied by outreach programs to the chronic drinkers. People need to become conscious of how they may be adding to their emotional difficulties through diet and other factors that are usually not associated with alcoholism. Alcoholics who are trying to stop drinking are fortunate if they have loved ones who are concerned enough to help them with these everyday details. If friends and family are not around, it is usually even more difficult to do what must be done. 

 Nevertheless, it is important to keep all these factors in mind. 

 

 Chapter 23: Favorite Hang-ups 

  In this book, I address myself only to those ideas and methods that I have found specifically useful in dealing with alcoholics. In saying this, however, I want to make clear that outside of the fact that alcoholics drink too much, I have not found them to be particularly different from other people. Once alcoholics stop drinking and have been sober for a few weeks, they are indistinguishable from other people who may need therapy. They are neither more passive, nor more aggressive, nor more passive-aggressive, nor in possession of more personality or thinking disorders than the run-of-the-mill citizen. This assertion is corroborated by Armor who, in Alcoholism and Treatment agrees that "a large number of studies have generally failed to identify and specify personality traits that clearly differentiate alcoholics from other deviant groups or from persons judged to be normal." Often. in fact, ceasing the drinking, an alcoholic feels extremely well and is a well-adjusted individual who seemingly does not even need psychotherapy. 

 In this chapter, I will focus on some of the patterns or hang-ups which tend to appear in the lives of alcoholics. This is not to say that these same factors are not apparent in the lives of other clients, or in the lives of all people; but just to say that they are often found in alcoholics and are therefore worth our consideration. 

 One of the patterns which I have observed with alcoholics and other people who abuse intoxicating substances is that very often, under circumstances of stress, when a problem presents itself, there's a tendency to use the drug to escape the strain. Some people learn that under difficult circumstances, the most effective thing to do is to literally sit down, clear their minds, and think about the problem and its possible solutions. This problem-solving attitude includes seeking out other people who are respected for their capacity to think and solve problems and together to map out a strategy to deal with the situation. 

 Alcoholics and other drug abusers very often deal with problems by drinking instead of thinking. Commonly people who abuse drugs are under the definite impression that the drug helps them think and solve problems. They have observed that when the mind does not function well under conditions of anxiety, their drug of choice acts as a mental lubricant, so that where it was once impossible to think clearly and every thought was painful and difficult the mental machinery now pumps along like a well-tuned engine. 

 But while the subjective experience of easy and brilliant thinking is real enough, it does not necessarily reflect very effective, objective problem-solving. In fact, the type of thinking that occurs under drugs is often riddled with fantasy and wish fulfillment and does not reflect the workings of reality very well at all. Even if good ideas are occasionally generated in this frame of mind, they are ordinarily lost in the fog of intoxication. Consequently, when people drink instead of thinking, nothing is accomplished. The pain that is postponed has to be faced all over again in the future. 

 The ego state that is capable of thinking in a direct and concentrated way is the Adult. The Adult can be exercised like muscles are exercised and it is important for an alcoholic or any other drug abuser to consciously decide to think instead of using. Very often, in group-therapy sessions, I have had the experience of asking the people who use drugs how they feel, or why they did a certain thing and their answer, very often, comes back: "I don't know." My retort when somebody says "I don't know," is "Well, think about it, figure it out, concentrateÖ"

 Sarah reports that she had a huge fight with her husband which started when he came home the other night and dinner was not ready. She felt rather guilty about not having cooked his dinner and eventually got drunk after the meal. 

CS: "Why didn't you have dinner ready when your husband came home?" 

Sarah: "I don't know. I just didn't." 

CS: "Well, think about it. What was going on?"

Sarah: "I told you, l don't know. I just didn't." 

CS: Sarah, I want you to think about it. There must have been a reason, and maybe it was even a good reasons so let's try to figure it out. Why don't you relax and concentrate and try to put yourself back at the time and tell me why you didn't cook that dinner." 

 Sarah: "Well. I was angry, and I didn't feel like cooking-that's all." 

 CS: What were you angry at?" 

 Sarah: "I don't know." 

 CS: "Think about it." 

 Sarah: "Well, I was angry at Jonas because I had been asking him for weeks to have dinner out, and he kept promising that he would as soon as possible. But he never remembers, and we just don't ever go out." 

 CS: "Okay. So you were angry at Jonas. How did that cause you not to cook dinner?" 

 Sarah: "That's obvious. What a ridiculous question." 

 CS: "Well, I'm not so sure it's obvious. Anyway, let's make it real clear. What brought you from being angry at Jonas to not cooking dinner?"

 Sarah: "I was angry at him and I realized that when he comes home he expects to be fed like a king and I wanted to annoy him and so I figured that if I didn't cook dinner he would be plenty annoyed." 

 CS: "Did you also think that if dinner wasn't ready he might also take you out for dinner just because there wasn't any dinner at home?" 

 Sarah: "Yes. Isn't that ridiculous? Instead he started screaming at me, and we didn't go out, and we didn't eat, and instead of that, I got drunk."

 This is a simple example showing that although Sarah was originally unable to explain her behavior, once she thought about it, it became logical and understandable. From her understanding of why she did not cook dinner for Jonas and how that was based on her anger, she also was able to develop a strategy to deal with the problem. She decided that she had to do something about her cooking all the time and to ask Jonas to participate in the house chores. She did, and eventually she took a part-time job so that Jonas did not have to work so hard. They both became more involved in the duties and obligations of cooking, and they also went out to eat more often. 

 Sarah tends to assume that she cannot understand and think through what's going on. Therefore she deals with her confusion by drinking. Yet, if she simply concentrates, she can actually understand and solve some of the difficult situations that she encounters in her daily life. "Think, don't drink" is a relevant alcoholic motto in this situation. 

I'd rather not talk about it

Another pattern in alcoholics and other people who harm themselves is to find themselves powerless in a way that causes them embarrassment and humiliation and to avoid discussing the embarrassing realities of their everyday lives. Things are discussed on a sort of semi-theoretical level that never really touches the actual facts of the situation. 

For instance, Peter an alcoholic, seemed to be quite willing to discuss his private life, to talk about sex, about his drinking bouts, and so on. At east blush, he seemed very unashamed and candid. But it was a characteristic experience when listening to him that one never really understood just exactly what was happening. If there was drinking, one didn't really know much about it. How much did he drink? Did he throw up? Did he fall down? How long did he drink? What were the details of his latest binge? Peter found it extremely difficult to go into details. If pressed, he would blush and become angry and turn on the questioner, saying, "Why are you bugging me?" "Why do you want to get into the gory details?" "This is nobody's business but my own." "I'd rather not talk about it" He was extremely embarrassed about these events and found it very painful to them, so he circumvented them while giving the impression of discussing them. In not talking about the details of his everyday life, he created a mistaken impression and also kept himself aloof from other people who tended not to take a serious and deep concern in his situation. With Peter, it turned out to be extremely important to press him for the details, the specific transactions, the actual happenings of his everyday life. 

 Once Peter was complaining that he recently felt bored in his relationship with his wife, and that this boredom caused him to think about drinking almost all the time. 

"Things aren't the way they used to be; it's a routine that we just can't get out of. We just don't have any fun." 

At this point the members of the group started making suggestions along recreational lines, such ms "Why don't you go to a play (or on a trip) (or play Scrabble?)" But I got the impression that Peter had not really stated what his boredom was all about. I couldn't get a real feeling of what he was talking about, so I questioned him further. 

"I don't really understand what you're talking about. What is it that is different from the way it used to be? You don't go out so much? You don't go dancing? You don't take drives to the country?" 

 "It has nothing to do with that. It's just that she and I together don't have any fun."  

"How do you mean that?" 

"Well you know. In our relationship." 

The word "relationship" set of a bell in my head.

"You mean in your sexual relationship?" 

"Yeah, what else?" 

"Oh I didn't realize that that was what you were talking about. Well, what is it like? Are you not having sex as often as you used to, or is it just not as much fun?" 

"Now you're getting personal." 

"I'll course I'm getting personal. How else are we going to figure out what you're talking about? Are you willing to explain it?" 

"Well, Iíd rather not talk about it; I don't talk about my sex life with people." 

"I think you're going to have to do it. Otherwise we won't have any idea of what you're saying and we'll just beat around the bush, so to speak. What do you think?"

 "Okay, sex is boring. It doesn't feel good like it used to."

 "How do you mean that?" 

(Blushing) "Well, I'm having trouble . . . you know, getting off." 

 "So that's what you were talking about. No wonder you're upset. You know, it's very interesting how unclear this was to begin with. Can you see how everyone thought that you were talking about something completely different? We need to get into your sex life if we're going to talk about this at all." 

"I don't want to do that at all. I feel it's really nobody's business."

"Why not? Are you embarrassed?" 

"Sure." 

"I think it's important that you overcome . . . (haha) this embarrassment and that you learn to be willing to speak about these things with other people. I bet that's one of the reasons why in the past you have gone back to drinking. You aren't able to openly discuss your situation with other people. You tend to speak indirectly. There are probably a lot of Enemy messages in your head which need to be exposed. If you keep them inside and don't discuss them, they will be very hard to stop. What do you think? Would you be willing to do this?"

 "I guess it's probably a good idea. Okay." 

 This is an example of the kind of resistance to frank discussion of the ups and downs of everyday life that alcoholics often exhibit. An excellent solution is a group in which everything is dealt with frankly by everyone. The cooperative contract with its "No Lies or Secrets" clause is very helpful in this respect. In fact, whether or not the cooperative contract is used, a group in which the avoidance of certain embarrassing subjects is allowed can't possibly be fully effective; completely frank discussion must be the rule in a problem-solving meetings in which the Adult ego state has a primary role.  

 

 SUMMARY 

 Alcoholism is not a disease; therefore, the solutions to alcoholism are not medical. Drugs, hospitals, and physician are not of any particular value in healing alcoholism. 

Alcoholism is not incurable. It is an acquired condition different from person to person, based partly on innate biochemical sensitivity to alcohol, partly on social pressure to drink, and partly on the emotional, thinking, and nutritional habits of the alcoholic. Alcoholism can be healed, and a few former alcoholics are evidently able to return to normal drinking though the majority either can't or won't. 

 Alcoholics Anonymous is a valuable source of help in providing very effective, easily available, frequent and free meetings for all alcoholics in need of help. On the other hands AA is also an overbearing organization with a powerful dogma which can prevent different, possibly valuable points of view from being expressed to the detriment of the advance of knowledge in the alcoholism field. 

  The physical factor responsible for alcoholism is the addictive properties of alcohol which for some people are extremely powerful combined with the poor dietary habits (cigarettes, coffee, sugar, adulterated food) which are usually associated with alcohol abuse. The social factors responsible for alcoholism are the intense social pressures to drink coming from the alcoholic's family, social, and work circle, from the media, and from the fact that alcohol is almost universally associated with recreation. 

One powerful psychological factors responsible for alcoholism is the Enemy. The Enemy continually attacks the person's O.K.-ness. The Enemy is a collection of harmful messages that have been adopted by the person and that interfere with thinking, feeling, getting strokes, and being aware of one's body.

 The specific combination of all the physical, social and psychological factors are different for each alcoholic. Alcoholics are not significantly deferent from all other people. They simply represent the most extreme and visible sector of a population that is poisoning itself with a variety of chemicals, drugs, and environmental pollutants. 

 A major factor in alcoholism is the participation of alcoholics and their circle in the Alcoholic game with its three roles: Victim, Rescuer, Persecutor. These roles must be avoided by anyone who wishes to help the alcoholic 

 In order to avoid the role of Rescuer. a helper needs to make sure that a mutually agreed upon contract exists in the relationship with the alcoholic. Avoiding Rescuing is the best way to avoid subsequent inevitable participation in the game as Persecutor or Victim. Staying aloof from the game roles is a prerequisite to helpful interaction with the alcoholic. 0nce game-free the helper works by providing loving confrontation that is: relevant, objective information in a context of warmth and protection. Sobriety, frank discussion of life problems and how to solve them, how to obtain strokes, changing dietary habits emotional release, body work, developing an Ally and Antabuse are some powerful aids in healing alcoholism. 

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