God seems to transform and bring healing to us in at least two distinct ways;  an instantaneous miracle, or through a process of peeling back multiple layers of spiritual, emotional, and psychological walls, often compared to “peeling an onion.”  This latter process usually occurs over extended periods of time often requiring years or even a lifetime to accomplish.

In my experience with counseling those struggling with sexual addictions and sexual sins, transforming healing and freedom occurs during a process over time.  I’ve also observed this “healing process” with drug addictions as well. During the process there are often “slip-ups” where the person who has resolved never to go back, never to “use” again, returns to use the drug or view the pornography once more.

While we know that God has the power to instantly heal and bring recovery, I believe he uses this restorative process over time to vividly demonstrate the destructive, deadly, consequences that sin brings not only to the individual but to family and friends surrounding the person.  It helps one to realize the “awfulness” of the sin which drives us to our knees in daily submission and supplication to our Father for help.  The process also reveals to us the magnificence and depth of His grace when we are  totally and completely dependent on God for deliverance.  Remember God spoke to Paul about his struggles and said “my grace is sufficient.” God did not instantly bring healing or restoration to Paul regarding the “thorn in the flesh.”  I believe he wanted to use this opportunity to demonstrate his grace and power in Paul’s life.

The story of Joseph in Genesis perfectly describes a healing process.  God could have instantly taken revenge on the brothers who tried to kill Joseph.  He could have made Joseph ruler in Egypt at any time.  But he didn’t.  We’re provided a narrative that tells of how Joseph was left for dead, slandered, accused of rape, and  imprisoned before being placed in authority to save his family.  It was a process.  All the evil that was hoisted upon Joseph, God turned it around and made something beautiful and good that saved his entire family from death.

Genesis 50:20 You intended to harm me, but God intended it for good to accomplish what is now being done, the saving of many lives.

Look at the process that God took Abraham and Sara through.  Why didn’t God just give them a son during their youthful years?  Why did he wait 100 years before giving them a child?  It was through this extended period of time that Abraham proved his faith and God demonstrated his powerful hand to accomplish what he promised he would.

I believe God can take the evil that haunts and seeks to destroy our lives and make something good from it.  Addictive behaviors are always the tip of the iceberg.  It’s what we observe from the outside. God wants to uncover the often hidden root causes, the emotional and psychological wounds, unforgiveness, anger, self reliance and pride, that support and give way to the addictive behaviors.  True restoration, freedom and healing from these types of wounds will take time to explore and allow the Holy Spirit to reveal new insights within our hearts which will bring lasting transformation.

This leads to instant gratification of impulsive cravings.  These “pleasure” chemicals mimic the cocaine “high.”  Many addictions (especially sexual addictions) stem from the fear of abandonment.  These individuals do not trust themselves or others.  They find comfort in their addictive, compulsive, and fantasy which is a false substitute for the true intimacy they are searching for.  In the past heard others and I myself have mistakenly made the statement about addicts, “why don’t they just stop?”  or “they could stop is they wanted to.”  Well, it’s more complicated than that.  The addictive behavior is only the symptom.  The behavior will continue until the root cause (eg fear of abandonment) is healed by God and/or through counseling and therapy.

For more information contact www.thepeacemakercenter.org or rwcreasy@gmail.com

I am not worthy of love.  I am not capable of getting the love I need without being angry and clingy.  Others are capabale of loving me but might not do so because of my flaws.  They might abandon me.  I am poor at getting the love I need and I must please my loved ones or I will be worthless and unlovable. 

The ambivalent attachment style often leads to unhealthy dependent relationships on others.  The framework of thinking that leads to dependency goes something like this;

I am incompetent. I struggle to handle things on my own.  I need strong protection.  The world is cold and dangerous.  I am flawed and on one could like me.   Every failure verifies I am flawed.  When someone rejects me, it proves I am flawed. 

Know someone like this?  It’s important to re-frame our thinking and realize that we are competent and we everyone has flaws.  Failures do not confirm a flaw.  It simply means that we have to try again.  It also means that this is not something inherently wrong with us but rather signals that we may have had one or more parents that were inconsistent in “being there” when we cried out for a safe harbor.  That’s not your fault.  It was something you needed as a child and didn’t receive.

Many people who have developed a framework of thinking since early childhood hold onto beliefs,  feelings, and ways of thinking regardless of the evidence to the contrary.  This faulty framework of thinking is also reinforced at times when events and appearances (standing on the shore and looking out at the horizon) seem to validate our “self-talk.”  I recently talked with a client who had been physically abused by his father beginning at around age 3.  It’s a long familiar story, and  you’ve probably heard it all before.  Years of abuse, neglect, and rejection led him to develop a survival personality marked by emotional distance, addictions, mistrust and suspicion of  ALL people.  No one should be trusted, everyone is out to get me,  I’m a loser, I’m stupid, I’m a failure and I’m never going to accomplish anything.  The paradox is, even in light of his extreme negative self talk, this client has a masters degree and has several attributes and gifts to be proud of.  Yes he is clinically depressed, displays some paranoia,and  has trouble establishing emotional intimacy and relationships.  If he can practice telling himself  “the earth is round” even though all of his life he’s been taught and believed “the earth is flat”  he’s going to experience emotional and spiritiual healing.  His own personal history provides  evidence that says he can establish intimacy, he can set a goal and reach it, he’s not stupid but actually has a very high IQ.  I’m currently working with him to re-frame his thinking and tell himself the truth.  The truth is, it feels like the earth is flat sometimes, but the fact is, its round.

I won’t belabor Jack’s story.  It’s a familiar one for those who struggle with substance abuse.  He was in and out of therapy, attempting to maintain sobriety through a number of support groups and therapists.  I was struck by how remorseful and sorry he was for causing others pain.  And like most people suffering from addictions,  Jack had suffered tremendous pain himself, abandonment, abuse, low self esteem, depression.  Yet he loved deeply.  He loved his family and he loved God.  He wanted to be reconciled with those he loved.  He wanted to get his life in order and he was a man of strong faith in God. Yet, as true with those who struggle with addictions of any kind, there were two Jacks.  There was the Jack who was in deep emotional ache reaching out to numb the pangs of darkness that would at times flood his soul.  This was the angry, depressed Jack full of rage and discontent who was looking, searching for some way to wall off  and block the awful pain.  This was the Jack that could hurt those around him with his harsh words and his violent behavior.  But, there was also the remorseful Jack, full of guilt, shame, and yes love. Always trying to improve himself, find his way back, and live a productive and fulfilling life. Jack was earnestly searching for restoration.

Recently Jack passed away and I was fortunate to attend his memorial service which was held in a beautiful, secluded wooded campground.  The outdoor pavilion was filled with his friends and relatives. Amazing? Had he been forgotten? Did he die after living a meaningless life?   Not at all.  Remember, he loved deeply.  His children are well educated, and very well adjusted and balanced from what I can tell.  Somewhere in all this murky emotional pain and rage, he conveyed a strong sense of love, right, and wrong to those he loved.  He passed those values and ethics on to friends and relatives.  It was duly noted during the brief service.  The speaker pointed out so clearly that there were two Jacks.

This was a sun drenched summer day that I will always remember. In the quiet solitude of the woods that Jack loved so well, sitting there on a rustic picnic bench, so much seemed to make sense to me.  Not only did I come to understand more clearly who Jack was, but I also learned more about myself.  I saw so much of Jack in myself.  Jack is in all of us.  You know, the other side of us that is sometimes panicked by fear, anger, rage, the walls we build, and various addictions that take hold of our life.  Don’t be tempted to judge Jack. Addictions and seeking relief from emotional and spiritual pain come in many forms.  But, I realized perhaps for the first time, that grace covers it all. Yes, sometimes there are “two of me” struggling within just as there were two Jacks.  We continually bathe in his grace to cover our  sins. Grace made the way where flesh failed time and time again.  Jack’s final testimony was that he was ready to go home. He knew that he was forgiven and ready to accept the wide arms and embrace of his heavenly Father.  There was a real spirit of peace that fell on the mourners that day.  And I know that Jack is experiencing that peace at this moment; the ultimate peace that Jack had been searching for all of his life is now an eternal reality.  And once again, Jack had touched lives by living his.

And don’t forget Heath Ledger and Anna Nicole Smith, Mama Cass, Janis Joplin, J. Henrix, and many others.   What is so strikingly  familiar is the host of enablers that surrounded the Hollywood media stars, including  the “king” of rock and roll and the “king” of pop.  Doctors, friends, family, nurses, personal attorneys all knew the dire situation with both  the troubled EP and MJ. Amazingly, all seemingly paralyzed,  unable or unwilling to try and stop the death spiral. Crash.  Gifted, talented, performers tragically and suddenly expunged  from life as we know it.  Who will be next? It’s only a matter of time.  Hopefully, the Hollywood, Music, Stage, star idols who have friends, family who struggle with addictions will be bold enough and loving enough to stage an intervention and perhaps prevent other tragedies from happening before the irreparable crash occurs.  What about you?   Know anyone struggling with deadly addictions?

This video is the trailer for a great documentary on the US’s addiction to debt. There’s also a great 30 minute preview on youtube.

Once the faulty cognitions have been identified, the therapist may coach the client on implementing effective reframing techniques, which can assist the patient to substitute more reality, oriented interpretations for overly negative thoughts. The goal is to help the client learn to identify and alter dysfunctional beliefs which predispose him/her to distort life experiences. Cognitive Therapy, in contrast to psychoanalytic therapy, focuses on the here and now problems. However, childhood experiences may have relevance when used to clarify present observations. According to Beck, the general assumptions on which cognitive therapy is based, include the following:

• Perception and experiencing in general are active processes, which involve both inspective and introspective data
• The client’s cognitions represent a synthesis of internal and external stimuli
• How a person appraises a situation is generally evident within their cognitions (thoughts and visual images)
• These cognitions constitute the person’s “stream of consciousness” or phenomenal field, which reflects the person’s configuration of individual self, his work his past and future
• Alterations in the content of the person’s underlying cognitive structures affect his or her affective state and behavioral pattern
• Through psychological therapy a patient can become aware of their cognitive distortions
• Correction of these faulty dysfunctional constructs can lead to clinical improvement

Schemas

Beck refers to cognitive structures that organize and process incoming information as schemas. They represent thought patterns usually acquired early in an individual’s development. Relatively stable cognitive patterns form the basis for the regularity of interpretations of a particular set of situations. The term schema is used to designate these stable cognitive patterns. The schema is the basis from which the client or individual molds data into thoughts. Schema forms the basis for screening out, differentiating, filtering, and coding stimuli that confront the client. Individuals use schemas to categorize, organize, and evaluate their life experiences. According to Beck’s experience with substance abusers, schemas generally fall into two categories: (1) “I am unlovable” or (2) “I am helpless.” Offshoots of these two schema could be described as “I am trapped,” “I am inferior,” “I am ineffective,” “I am powerless,” “I am unwanted.” These types of schema are often associated with individuals suffering from substance abuse primarily because the individual believes the drug(s) will in some way provide solutions to their negative schema through faulty information processing.

Faulty Information Processing (Cognitive Errors)

Beck believes that individuals suffering from substance abuse make “systematic errors” in their cognitions, which actually serve to perpetuate negative ideas and thoughts regardless of the contradictory evidence available to the contrary. Beck has identified the following as common systematic errors:

• Arbitrary inference—basing a conclusion in the absence of evidence to support the conclusion or when the evidence actually contradicts the conclusion.
• Selective abstraction—focusing on a detail taken out of context, ignoring other important features of the situation.
• Overgeneralization—construction of a general rule on the basis of isolated incidents and then applying that rule across the board to related and unrelated situations.
• Magnification and minimization—placing an inordinate amount of significance to an event that is clearly distorted.
• Personalization—refers to the client’s proclivity to relate external events to himself when there is no basis for making such a connection.
• Absolutistic, dichotomous thinking—is the tendency to place all experiences in one of two opposite categories; for example, perfect or defective, clean or filthy, saint or sinner. Basically this is an either/or cognition.

Addictive beliefs include the following:

• I need the substance (drug) if I am to maintain my psychological and emotional balance
• When I use, I can function better in social settings as well as increase intellectual capacity
• I expect that when I use, I will derive pleasure and excitement from the drug that I cannot find anywhere else
• The drug will provide me with energy and increased power
• The drug will sooth and calm me down
• The drug will relieve my boredom, anxiety, tension, and depression
• Unless something is done to satisfy my craving, it will continue indefinitely and possibly get worse.

In addition to addictive beliefs, the user may also exhibit a variety of permission-giving-beliefs and entitlement thinking which minimizes risks in the patient’s mind. Examples of these beliefs include, “Since I’m feeling bad, it’s OK to use,” “I’ve been having a hard time so I deserve to use and get relief,” “The satisfaction I get is worth the risk of relapsing.”

Core addictive beliefs activate emotions that may eventually lead to the addictive behavior.

Core Beliefs

I am trapped / alone.

Addictive Behavior

Visits Crack House

CBT is aimed at modifying each of the categories of beliefs: anticipatory, permissive, as well as the underlying core beliefs that potentiate these drug related beliefs. When the addicted person’s core beliefs interact with life stressors, they produce anxiety, worry, dysphoria or anger. These stressful or stimulus situations activate drug related beliefs that lead to craving. Beck asserts that basic faulty, incorrect beliefs and automatic thoughts about drugs, their perceived benefits and uses, may account for increased substance abuse.

Case Formulation

It’s important to obtain a thorough case history which examines all relevant childhood information and family dynamics. The essential components of case conceptualization include relevant childhood data, current life problems, core beliefs or schemas, conditional assumptions, compensatory strategies (survival techniques), vulnerable situations, automatic thoughts and beliefs (specifically related to drug use), emotions, behaviors. This helps the therapist to conceptualize the basis for the client’s core belief system and assumptions. By understanding the client’s conditional assumptions and belief system, it helps the therapist to understand and identify the compensatory strategies the client may have developed as a result of childhood experiences. For example, if the father of the client was an alcoholic, verbally abusive and humiliated the client as a child, the client may have developed a core belief system that says, “I’m unloved, unwanted.” This leads to the conditional assumptions, beliefs and rules that say, “If I do everything perfectly, then people will like me and I’ll feel comfortable,” or if I show others how I really feel, they will abandon me.” The compensatory strategies or “survival personality” that flows out of this type of thinking could be “I’ll use drugs when I am uncomfortable because they will make the pain go away,” or engage in isolation and withdrawal or “Don’t do anything unless you are 100% sure you can succeed,” or “Don’t show others how you really feel.” Establishing a complete case formulation helps set direction for therapy sessions and provides the specifics necessary to develop meaningful assignments and goals for the client.

Homework

Homework or assignments for the client to complete outside of the therapy session is a valuable component of CBT for the substance abuser. As in all other applications of cognitive therapy, homework assignments allow the client to apply and practice the skills learned during sessions. Homework assignments can be useful to reinforce and embed the self-guided techniques of Socratic questioning, (e.g. “What evidence do I have for this thought or belief?”) within their everyday lives. The authors provide several examples of homework assignments that can assist the therapist and patient with recognizing faulty thoughts and how to substitute rational cognitions. The Advantages/Disadvantages Analysis Chart allows the client to document in a chart the advantages and disadvantages of using and abstaining. This can help the client identify, review, and recall in very specific terms what the pros and cons are of using or abstaining.

The Daily Thought Record (DTR) is an effective tool, which serves as a standardized form for listing and modifying maladaptive thoughts. In the case of cocaine addiction, it is useful for modifying addictive beliefs that lead to urges and craving. Specifically, the DTR has five columns labeled, situation, emotions, automatic thoughts, rational response and outcome. The patient is instructed to document their experiences of urge and craving using the chart. They are asked to describe their situation and the actual event leading to the unpleasant emotion or stream of thoughts. Based on the situation, they are then asked to record their automatic thoughts that preceded their emotions. They are asked to document their emotions such as hate, anger, rage, frustration, depression, or sadness. Recording rational responses reinforces positive reframing. Reframing is a salient goal of CBT because of the negative, often untrue and unrealistic cognitions that arise automatically.