Ask the Dramatherapist… “Addiction”

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I recently had the privilege and pleasure of being a visiting guest lecturer at the Dramatherapy programme in Anglia Ruskin University, Cambridge. I presented and delivered two different sessions, related to my clinical specialisms: addiction, and sexuality in the LGBTQI+ community.

During the Q&A section of the lecture on addiction, one of the first-year students asked me whether I believed addiction is something people can truly overcome, or not. This is a great, and yet complex, question.

Prior to my work in addiction, I had no experience in this field. I had a very strong personal motivation and curiosity, and general knowledge of reading different research sources on drugs, and treatment approaches. I also had personal experience of addiction, as a family member and friend, and of substance misuse in my personal life.

I don’t share this very often, but I spent a big part of my early 20s drinking irresponsibly and dangerously, and dealing with the consequences of such behaviour. I felt very confused at times, because at one point, I recognised that I had stopped being able to do certain things without alcohol. Things like dealing with overwhelming emotions. Or going for a meal. Or a party. Having sex. Sometimes, even, going to sleep. At the time, I didn’t have anyone that I could confide in with these doubts, and so I kept avoiding the question of whether I had a problem.

And then, on the night of 22nd July 2011 someone spiked my drink in a club and I lost consciousness for most of that night. I woke up feeling completely ashamed and confused at a dear friend’s house, and made my way to my small flat in Camden. As I lay in bed that morning, wondering what had happened to me and feeling completely lost, I received a text which said: “Have you heard what happened to Amy Winehouse?” This was a big life-changing moment, for as I lay in my bed wondering whether I needed to stop drinking, I received news that Amy Winehouse – who lived literally around the corner from me – had died from alcohol poisoning.

I took it this a sign, and decided there and then to stop drinking completely. And I did – for two whole years. And what happened in those two years was that something shifted, and I was able to understand my escapism for what it was, including the understanding that it wasn’t about alcohol at all. And so, I have been able to go back to drinking, without abusing it, or without escaping into it. How? I’m not sure. If I knew, I would package it and help make millions of people feel better.

Why am I sharing this with you? Because, ultimately, this is what drives me. The experience of this shift, from feeling helpless to feeling in control. The experience of managing my self-destructive part. Because I don’t exactly know how this happened to me, I remain completely open to everything when it comes to addiction treatment and approaches. I am open to the medical/disease model, the 12 steps model, the harm reduction model, the relapse prevention model, to name just a few. I am open to everything because I have also learned that different clients will need and connect to different things, or a mix of things. Some clients actually find it helpful to think that they have a disease, and others don’t. I go with what is helpful for each client. Who am I to say anything, anyway?

I am driven to finding the answers that will enable people to stop the suffering in their lives. I never assume that I know something. Sometimes, I think that I do, and a client proves me wrong. And I never feel defeated about it. Not even when a client dies. It makes me more determined. One thing I always mention when referring to addiction, and which people tend to forget or dismiss, is that addiction truly is a matter of life or death. When a client tells me that if they pick up a bottle again, they will die, I believe them unconditionally, because it is the truth. To me, this work is not textbook. It is real life, about real lives. When a client goes to sessions for weeks and then they stop going, there is always a feeling of dread. And this feeling is very real.

Another thing that I notice in my addiction work is the weight of the consequences. I would argue that shame, guilt, and regret, kill more people than the drugs themselves. Of all the things that I believe that I know and learned through the years is this: we need to be more mindful of the language that we use in treatment. The idea of lapsing or relapsing may carry with it such overwhelming weight for clients, that when they lapse or relapse, they end up feeling worthless, like failures, and a waste of space.

I don’t claim to possess answers to anything at the moment. I feel that I spend most of my time listening and following what is needed. The weight of a lapse or relapse is absolutely unnecessary. It carries with it the illusion that someone needs to start again from the beginning. I would always argue that we never fully go back to the beginning, because making a mistake does not imply that we have lost our skills or knowledge. We will always be slightly more ahead than we think. This goes for me, and my clients.

I work from the position that yes; addiction can be overcome. Always. This is my hope and my guiding light through the darkness of active addiction and its aftermath. How is this achieved? I am still figuring that out, but I know that it starts with the following:

  • Looking into, listening to, and treating each person, as a person.
  • Caring deeply, and unconditionally, because they are living beings and for no other reason, and many people don’t even know what this feels like.
  • Being open to dark and light, death and life, and everything else in between.
  • Practising, and encouraging, meaningful and authentic connections.

I am a firm believer that the opposite of addiction is authentic human connection.

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Reflexions…On Butterflies

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It may be a strange analogy within the context of therapy, but do you ever experience being in a clinical session with an individual client, or a group, and the dynamics of that session give you some kind of butterflies? That feeling of excitement because you want to know more, of hope that the unknown will turn out okay, of belonging because you feel you are in the right place, of achievement because you have found something special, and of awe because you have witnessed someone’s spark?

I recently saw my first clients with pronounced clinical depression, and the bleakness of those presentations stopped me in my tracks. Every day, I work with chaos, anger, sadness, ups and downs, glimmers of hope and joy, life and death, shame, guilt, anxiety, to name just a few. But bleakness to the point where there is no alternative, no hope, no light, no movement… well, I was not ready for that.

And this got me thinking about a lecture in my first year of Dramatherapy training, where a lecturer said – and I’m paraphrasing here: “Just because you’re becoming therapists, it doesn’t mean that you can, or should, work with everyone and every kind of condition. You actually have a choice on that.”

I remember how deeply that resonated with me, because I recognised that a part of me did think that I would be somehow responsible to respond to all the problems of the world. I remember mumbling that to myself for days… “I have a choice. I have a choice. I have choice.”

Sometimes there is nothing scarier than having choice. It means that a decision must be made. That something must be left. That something must be taken. And that we are responsible for the consequences of whatever that decision is.

I also remember thinking “How selfish!”. How selfish that I, a therapist, could refuse to help someone, when I’ve been given all these tools to do just that. And yet, there was also a relief: I didn’t have to help everyone.

And through the years, I have been not only actively and consciously making this choice, but I have also been noticing something else. That, perhaps, whatever butterflies a therapist experiences towards a specific client group or clinical context, may be in alignment with some kind of inner talent, skill…an aptitude. Allow me to expand on this.

In my first year of training, I also remember having a chat with one of the lecturers about which client groups I wanted to work with, both practically in terms of my clinical placements, but also generally, in terms of profession and career. It was always very clear to me that I wanted to work within addiction, and with gay men. These were clearly aligned and influenced by my own lived experience and by wanting to know more about myself, by helping others through similar experiences.

It sounds selfish, I know. But I believe that this is something mostly unconscious at first, rather than conscious – this idea that we might want to know more about ourselves, by working with others who share similar life experiences. This became more conscious to me, the more clients I met and worked with. And also, sometimes it’s not even about the condition or context, but about the effects, the aftermath of an experience. For instance, a great friend of mine has never spent time in prison, and yet, she has great affinity and aptitude to work and empathise within that field. Even in my work within addiction, I notice it every day, that I have much greater empathy and affinity towards clients who have overcome active addiction and are now in active recovery. I tend to find the aftermath of active addiction much more fascinating.

Why has this come about now? I have been noticing through the years, and particularly in the past few weeks, that there are certain clinical presentations to which I’m really drawn to and am greatly curious about, and others to which I’m not. And when this occurs in a session, when I’m not drawn towards something or feel no curiosity at all, I notice it immediately, because I always feel like I have to “work at it”.

I felt this particularly during the sessions where I was presented with complete bleakness. I was taken aback, not simply because I couldn’t get through, but also because there was a part of me which, frankly, didn’t necessarily want to get through. This got me thinking about the why of this occurrence, and also why I literally feel so alive in certain clinical contexts, and so indifferent in others. As I’m writing this, my inner therapist just said: “There’s probably a reason in your lived experience for why this is, and if you give it enough time and space, you’ll know exactly why.”

He’s right. My inner therapist tends to be right. And as I think about it further, without getting into much detail, I can connect why I tend to distance myself from both intense bleakness and active chaos – such as psychosis, or drugs withdrawal. I’ve learned and witnessed how well I can create deeply profound connections with individuals who, whilst still experiencing chaos and distress, are also willing and stable enough to want to create some kind of change in their lives.

I feel this may be related with my 7 years of active spiritual practice. If there’s a willingness and an awareness that change is required, no matter how faint this is, and no matter how many difficulties that individual has experienced in the past, or is experiencing in the present, then my curiosity, my drive, my empathy, are fully there. But if I can’t feel that from the client, then those traits don’t seem to make an appearance.

I have been very aware of my choices recently, both in relation to what I feel curious about, and to how much chaos I am willing to engage with on a daily basis. I have been noticing that my aptitudes, and my butterflies, may lie in clinical contexts and presentations where someone has already decided to change, no matter how determined or faint that decision is. And then I look at and talk to some of my colleagues and realise that their butterflies lie elsewhere.

This is the beauty of healthcare professions, and where we can find relief from the potential pressure of wanting to help everyone: there is always someone who is interested, driven to help, experiencing butterflies, in every single clinical presentation that exists. I don’t have to worry about helping everyone, because there are other professionals who are helping people at every single stage of their recovery. I don’t need to feel guilty about not feeling more curious at the earlier stages of someone’s treatment, because someone else is, and I feel that the combination of my knowledge, skills, and talents, is better served when there is a certain level of, or potential for, stability and balance.

Reflexions… On Human Connection and Touch

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Today, was my first day back at work after almost three weeks. I had missed it so much! And even though it was a long day, it was a great one. And then, on my way home, I bumped into a fellow Dramatherapist I hadn’t seen in a long time.

We were catching up on how our lives have been, personally and professionally, and I ended up talking about a meeting I had had with other Dramatherapists many months ago, in my role as member of the Equality & Diversity Subcommittee of The British Association of Dramatherapists.

I was telling my friend that during that meeting we were discussing boundaries in clinical practice, and it occurred to me: we are a clinical practice based on the art form of drama – which will include physical touch at some point during a clinical intervention – so why are we so attached to the boundaries laid down by psychiatry and the medical model of psychology? We don’t even follow the medical model!

And whenever this comes up, I always tell this story. During my third and final year of my Dramatherapy MA training, we were doing the final facilitations in one of the modules when something beautiful happened. By the way, in Dramatherapy training, we actually practice therapy on each other. We take turns being clients and therapists for each other, so by the end of three years, the connection you feel with peers is beyond profound.

So, during one of these facilitations where I was being a witness, and observing a peer being a therapist for another peer, there was a moment of breakthrough and revelation on the part of the client-peer, and a moment of freezing on the part of the therapist-peer.

In that moment, I related to the experience my therapist-peer, as I felt that the question in her mind at that moment was: “Do I hug her? Do I hug my client?”

And I felt my peer in that moment, because I have found myself in that place before. As a trainee and as a qualified therapist. That place where my professional mind is telling me something and my human heart is telling me something else. And my observation is that whenever someone freezes in relation to someone who is in need or distress in front of them, is because they are probably listening to the mind voice, rather than the heart voice. The heart voice always knows what to do, because its essence is to connect. The mind voice’s essence is to justify. There is no comparison.

But back to my peers. There they were, in that very short moment, which probably felt longer than it actually was for all of us. And then our lecturer/examiner stands up, and silently mouths to the therapist-peer: HUG HER!!! I wrote that in capitals and three exclamation points, because that is what her body language and gestures were expressing. HUG HER!!! And my peer did just that. And it was beautiful. We all cried.

Afterwards, whilst reflecting on the situation, my lecturer simply said: “Sometimes, a person just needs to be hugged.”

SOMETIMES A PERSON JUST NEEDS TO BE HUGGED. Writing this, I can still feel what I felt in that moment. Is there anything more human, more simple, than that? I mean, sometimes, theory means absolutely nothing. In the face of guttural, primal, life-changing/saving situations, who cares about what person wrote what, when, why, or how? Who cares? Sometimes, a person just needs to be hugged. And the rest is commentary. Simple.

Why am I writing about this today? Well, one of clients. It was our first session together, and in Dramatherapy, we usually do an exercise called 6-Part Story. The invitation is for the client to create a story in a simple format, but which actually allows their unconscious to reveal what they think of themselves, their goals, their support systems, their obstacles, their problem-solving, and their hopes. It’s so simple, yet so profound! It’s amazing. But anyway, my client today really struggled with the support system bit. And as we were talking about that, it dawned on me how much we all have internalised this story of “I have to do it all on my own”.

This whole Independent Woman/Man thing, which most of us have subscribed to without questioning it for one second. This idea that we don’t need anyone, or anything. We can do it all alone! We should do it all alone! Where has that gotten us, you and me?

I realised today, that I have actually unsubscribed from this story. I mean, one of the three core principles of my practice, Integrative Dramatherapy, is Relationships. I had put these principles together, but until today, I hadn’t actually realised how much I value the principle of Relationships – of connecting to others. Of touching others. Of intimacy.

Why do we subscribe to this idea of being on our own, if our DNA – spiritual, psychological, and physical – is undeniably and vitally, social and relational?

Sometimes, a person just needs to be hugged.

Reflexions… On Not Knowing.

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“Maybe you just need to be honest about it and say:

 ‘I don’t know what I’m doing here. I don’t have all the answers.’

My dear friend, and fellow Dramatherapist, was absolutely right. I don’t have all the answers. No one does. But it’s difficult to admit to that sometimes.

We were talking about my personal life, relationship experiences in particular, and how I tend to struggle so much sometimes with expressing myself clearly and openly. More importantly, how I tend to struggle so much with saying “I don’t know”. With taking time to breathe, pause, and say “I don’t know what the answer is”.

And, as it is usual in a therapist’s life, matters which are calling for a personal healing or cleansing, will often show up in the therapy room through clients’ own life experiences.

A few weeks ago, this showed up through the often difficult life experiences of mothers, who are also recovering addicts. With both clients I worked with, the main struggle related to the notion and belief of being a bad mother, of having ruined or negatively influenced their children’s lives, of not being good enough. Even if you have never had children, I believe anyone can relate to the feelings attached to not being good enough.

I needed a moment in both cases, for this is my inner dialogue in situations where my instinct doesn’t seem to be flowing:

– Say something!

– What? I don’t know what to say! What could I possibly say?

– You’re the therapist! You should say something! You should know what to say!

– I know! How can I make her feel better?

In terms of silence, the first thing to be aware of is that they always feel longer than what they actually are. In any situation, but particularly during a therapy session.

The second thing to be aware of is that the voice inside my head uttering those words is the voice of my ego: doubtful, insecure, scared, reactive, needy, etc.

The third thing to be aware of is that if you want someone to feel something, you need to give them the time and space for that. Often, giving people a tissue, hugging them, telling them ‘it will all be okay’ too soon, it will actually hinder the expression and exploration of a feeling. This is a delicate balance.

The fourth thing to be aware of is that the function of the therapist is not really to make the client feel better, when something uncomfortable appears. If sadness appears, it is important to acknowledge it, to honour it, even. To do anything less than that, is to dismiss the feeling, and by extension, the person or situation which caused it.

Lastly, it is important to be aware of the fact, that maybe, just maybe, I might not know something in that moment. I might not know what to say, what to do, or even what’s best. I mean, what to say to a recovering addict mother who is considering throwing her son out of the house, because he is in active addiction? Somehow, “It will all be okay”, seems reductive and patronising.

The first step to dealing with something, is to become aware of it, to acknowledge it.

Once I admit it to myself, that I don’t know, the pressure disappears. My inner monologue begins to change:

– It’s okay. Breathe. Relax. It’s okay not to know. You’re not here to give them answers, anyway. Remember that! Your job is to help them find their own answers, not to give them the answers. It’s okay. Let go. Whatever you do, it is good enough. You are good enough. Now, what do they need? What do they need, in this moment?

Note the change from inner dialogue to monologue. Whenever I hear a clear monologue inner voice, I know that I’m on the right path. This is my personal sign that I’m beginning to allow instinct to come through.

I can feel the difference straight away. As soon as I’m able to integrate two or more inner voices, into a clear one, and to switch my focus from myself, to the client, I know something helpful will come, whether it’s a question, a gesture, a word, an idea.

And if it’s not great, or what the client might want to hear, it is still good enough.

 

 

Reflexions…On Being Human

Humanity in the therapy space

I have been wondering for months on what the topic of my first ever blog should be about. And after one of the most intense weeks of therapeutic interactions I have experienced so far, I knew what I needed to write about: on being Human.

I mean, what’s better than that as a starting point?

The topic became apparent in different ways throughout the week, but it was fully felt this past Friday. In a group therapy session exploring clients’ inner aspects of Light and Shadow, I was asked to play God twice, a Victim, a Beggar, and a Bully. Beyond the fact that this can be really demanding – to take on and play aspects of a client’s inner and unconscious psyche, in order to reflect this back to them – what I was really left with at the end of that session, was a sense of humanity.

When I mentioned this to the group, there was a collective nod and sound of resonance. They knew what I meant. I had played characters under their direction, which allowed them to not only see aspects of themselves, outside of themselves, but also to have an awakening or awareness of the changes they would like to make.

I expressed that the most prevalent feeling and common thread between those characters, had been a sense of confusion. I explained that I felt confused by their directions, that I didn’t feel like I had enough knowledge about these characters to know their motivation. That they didn’t give me enough knowledge about them. And, in fact, they didn’t have enough knowledge themselves. It’s easier to be aware of one’s actions, but one’s motivations? Not so easy, or simple!

I suspect what these motivations might be, but I also feel that it’s important for them to figure them out. To peel off the many superficial layers of motivation, and find the core driving force behind their emotions and behaviours. This is no easy task, and it’s rarely a smooth experience. But it’s what makes us all human, and it’s what helps us relate to one another in the therapy room. It’s the human relationship between us which facilitates the catharsis, and healing.

I learned a very important lesson when I first started working with adults in substance misuse services: that the most profound and effective way to work through their addiction, was actually to remove the label of addiction. To not treat them as addicts (whatever that actually means!). And to treat them as humans, fellow human beings, in fact – beings of shadow and light, destruction and healing, doubt and hope, fear and love. And in the process of accepting that they were just like me, I had to own, show, and reflect my humanity back to them. My very own perfectly imperfect humanity. That is how my clients started sharing aspects of their lives with me, that they had never shared with anyone, not even their 1:1 support workers or counsellors.

Slowly, I learned that I couldn’t just be Ryan, the Dramatherapist. I had to be Ryan, the person. I had to learn to accept my limitations, my challenges, my own darkness, and to let that transpire in the sessions, in appropriate and healthy boundaried ways.

I understand the need to see and perceive certain professionals as perfect, or well put together, or having it all figured out. But the truth is, no one has it all figured out. We only stop learning, evolving, and changing when we die.

People may also think that they want someone to tell them what to do and how to live their lives when they meet with a therapist, but ultimately, transformation and long-lasting change can only occur when each individual figures it out for themselves. I always tell my clients: “I can show you the way out of your own prison, take you to the gate, be with you at every step of that search and journey, but eventually, you need to cross that gate on your own.”

To me, connection, transformation, and evolution can only truly occur through authentic human relationships. If I’m just being a therapist, and you’re just being client, there’s only so far we can take that dynamic and relationship. If I look at you as a condition, a diagnosis, a clinical presentation, and you see me as someone who imparts knowledge, advice, and tells you what’s best, we will only be able to work on the superficial. There is no depth or resonance in that interaction.

So, this is what I use to keep my therapeutic high horse in check, and to allow my humanity to flow and be present:

  • Every feeling is valid. I believe that we cannot prevent or stop feelings. We can only do that to actions and, to some extent, thoughts. If you feel something, then you feel something. That’s it. No rocket science. I encourage you to feel it, whatever it is. We can then figure out the next step together.
  • There is no good or bad, right or wrong. This is about being mindful of judgment. Please note that I didn’t say removal of judgment. I don’t think we can truly do that in our human interactions. But we can be mindful of it. And we can accept people, places and things as they are. Not good or bad. Not right or wrong. Just as they are. Just as you are. Just as I am.
  • Transformation and balance are possible. People make, create, and maintain long-lasting transformation and balance in their lives, all over the world. Is it easy? Not at all. Is it possible? Absolutely!
  • We are all human. Behind every human interaction there is a variation of one or all of these needs: to be seen, heard, validated and loved.

This isn’t always easy to maintain, and it often involves a very delicate balancing act between professional and personal values. When I feel off balance, I do the following:

  • I take a few deep breaths. I focus on the rhythm of my breath, the simplest, yet most important function of the human body. Without breath, there is no life.
  • I ask: “What do they need?” This usually shifts the focus away from my own anxieties and insecurities, towards the needs of those that I am supporting.

This two-step process has never failed me. It connects me to my own humanity first, so I can then connect to others. Once those connections take place, the therapy begins.