In 2021, I taught a postgraduate seminar called Contemporary Psychoanalytic Perspectives on Addiction to staff members and Fellows at the Austen Riggs Center in Stockbridge, Massachusetts. This was an offering I created in my role (from 2021-2023) as the Coordinator of the Substance Use Service at the Austen Riggs Center.
This post makes the syllabus available to anyone interested in reading up on the topic or getting some insight into my expertise with theories of substance use treatment.
Seminar Description: Contemporary Psychoanalytic Perspectives on Addiction
Historically, substance use treatment and psychoanalysis have had an uneasy relationship. In an 1897 letter to Fliess, Sigmund Freud questioned whether “psychoanalysis must stop short” at the treatment of addiction, and classical psychoanalysis developed a poor reputation for helping addicts. On the other side of things, early non-psychoanalytic substance use treatment models influenced by Alcoholics Anonymous relied heavily on structured behavioral interventions and focused on rigid treatment aims (i.e., abstinence) that had little room for the ambiguity, polyvalence, and exploration inherent to psychoanalytic work. Consequently, psychoanalysis has somewhat neglected the study of substance use disorders—frequently seeing them as a symptom of “the real problem” and hence not attending closely to addiction and substance use in and of themselves. Correspondingly, and the treatment culture in the United States writ large does not readily see a role for psychodynamic treatment for substance use disorders.
Arguably, the uneasy relationship between behavioral and psychoanalytic approaches to substance use disorders lives on in psychoanalytic treatment centers, where there can be a tension between managerial and interpretative approaches to these problems (though this is a false dichotomy on its face: patients’ actions can in principle be both managed and interpreted). In this seminar, we will examine some contemporary psychoanalytic thinking (i.e., within the last 20 years) on substance use disorders and addiction with the hope of spurring dialogue about how we conceptualize and treat substance use disorders from our various roles. Thinking together about relational psychoanalytic and object relational models of addiction and applying them to our clinical work may help foster more integrative and collaborative work with our patients with substance use disorders.
Week 1 – Historical Models of Addiction in Psychoanalysis
-
Reading: Morgenstern & Leeds, 1993
-
Supplemental Reading: Dodes, 2003
Week 2 – Addiction and Self-Regulation
-
Reading: Taipale, 2017
-
Supplemental Reading: Khantzian, 2015
Week 3 – Addiction and Object Relations
-
Reading: Director, 2005
-
Supplemental Reading: Miller, 2002
Week 4 – Addiction and Destructiveness
-
Reading: Palacios-Boix & Laliberté, 2017
-
Supplemental Reading: Sweet, 2011 (pp. 38-41)
Week 5 – Addiction and Temporality
-
Reading: Sweet, 2014
-
Supplemental Reading: Goldin, 2014
Week 6 – Addiction and Dissociated Self-States
-
Reading: Burton, 2008
-
Supplemental reading: Rothschild, 2010
Seminar References
Burton, N. (2005). Finding the lost girls: Multiplicity and dissociation in the treatment of addictions. Psychoanalytic Dialogues, 15(4), 587-612.
Director, L. (2005). Encounters with omnipotence in the psychoanalysis of substance users. Psychoanalytic Dialogues, 15(4), 567-586.
Dodes, L. M. (2003). Addiction and psychoanalysis. Canadian Journal of Psychoanalysis, 11(1), 123-134.
Goldin, D. (2014). Addiction and temporal bandwidth. International Journal of Psychoanalytic Self Psychology, 9(3), 246-262.
Khantzian, E. J. (2021). Psychodynamic psychotherapy for the treatment of substance use disorders. In N. el-Guebaly, G. Carra, M. Galanter, A.M. Baldacchino (Eds.), Textbook of addiction treatment (pp. 383-389). Springer.
Miller, J. (2002). Heroin addiction: The needle as transitional object. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 30(2), 293-304.
Morgenstern, J., & Leeds, J. (1993). Contemporary psychoanalytic theories of substance abuse: A disorder in search of a paradigm. Psychotherapy: Theory, Research, Practice, Training, 30(2), 194-206.
Palacios-Boix, J., & Laliberté, V. (2017). Addiction and Destructiveness. Canadian Journal of Psychoanalysis, 25(2), 60-78.
Rothschild, D. (2010). Partners in treatment: Relational psychoanalysis and harm reduction therapy. Journal of Clinical Psychology, 66(2), 136-149.
Sweet, A. D. (2011, March). When therapeutic worlds collide? On Bion’s concept of reversible perspective: A brief review and clinical case illustration. In International Forum of Psychoanalysis (Vol. 20, No. 1, pp. 38-44). Taylor & Francis Group.
Sweet, A. D. (2012, June). Black holes: Some notes on time, symbolization, and perversion in the psychodynamics of addiction. In International Forum of Psychoanalysis (Vol. 21, No. 2, pp. 94-105). Taylor & Francis Group.
Taipale, J. (2017). Controlling the uncontrollable. Self-regulation and the dynamics of addiction. The Scandinavian Psychoanalytic Review, 40(1), 29-42.
Psychodynamic Substance Use Treatment in the Berkshires
If you are interested in working with me as a psychotherapist for substance use issues or any other issue (in-person in Great Barrington, Massachusetts; also available for remote psychotherapy to people anywhere in Massachusetts, New York, North Carolina, and Rhode Island), please feel free to learn more about my psychotherapy practice or get in touch!