Changing Self-Destructive Habits

Pathways to Solutions with Couples and Families

Matthew D. Selekman, Mark Beyebach

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415820769
• eBook ISBN: 9781315722399
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

For the first time in one volume self-harm, substance abuse, eating-disordered behavior, gambling, and Internet and cyber sex abuse—five crippling, self-destructive behaviors—are given a common conceptual framework to help with therapeutic intervention. Matthew Selekman and Mark Beyebach, two internationally-recognized therapists, know first-hand that therapists see clients who have problems with several of these habits in varying contexts. They maintain an optimistic, positive, solution-focused approach while carefully addressing problems and risks. The difficulties of change, the risk of slips and relapses, and the ups-and-downs of therapeutic processes are widely acknowledged and addressed. Readers will find useful, hands-on therapeutic strategies and techniques that they can use in both individual and conjoint sessions during couple, family, and one-on-one therapy. Detailed case examples provide windows to therapeutic processes and the complexities in these cases. Clinical interventions are put in a wider research context, while research is reviewed and used to extract key implications of empirical findings. This allows for a flexible and open therapeutic approach that therapists can use to integrate techniques and procedures from a variety of approaches and intervention programs.

1

SELF-DESTRUCTIVE HABITS

A Collaborative Strengths-Based Brief Family Therapy Approach

I count him braver who overcomes his desires then he who conquers his enemies, for the hardest victory is the victory over self.

Aristotle

Introduction

This book presents a brief family therapy approach for five different, broad categories of self-destructive habits, each of which would surely merit a text on its own: self-harm (self-injury), substance abuse, eating-distress, gambling, and Internet and cyber-sex abuse difficulties. Why have we chosen to include the treatment of these five different self-destructive habits in the same book?

First, all five self-destructive habits share a number of important features that create similar therapeutic dilemmas. These shared elements include the role that brain functioning and neurochemistry play in all of them, the major impact they have on the couple and family relationships of our clients, and the therapeutic challenges they are likely to present even to the most seasoned clinician.

Second, in our clinical experience clients are very likely to present with not only one, but probably two or even three different self-destructive habits at the same time. Therefore, it makes sense to cover all five self-destructive habits in one text.

A third reason is that, as couple and family therapists, we may not only work with a client presenting with various self-destructive habits, but also encounter different members of the same family engaging in some of them as well. In these not so uncommon cases, co-morbidity will interact with multi-problem families increasing complexity and creating entirely new challenges.

Our fourth and final reason for writing a book for clinical problems for which a number of well-researched treatments exist, many of which have been deemed “empirically supported,” is a clinical one. There are indeed a number of “empirically supported treatments” for the kinds of problems we cover in this book, but the truth is that, although the majority have been demonstrated to be effective to a certain extent, they are not entirely satisfactory; many of the clients who undergo these treatments do not improve, many of those who improve are still symptomatic at termination, and many of those who are not symptomatic at termination relapse shortly after completing treatment or less than a year down-the-road (Dennis et al., 2004; Gutiérrez, 2011; Westphal, 2007). If on top of this we take into account that the average attrition rate for all these treatments (before, during, and after treatment) is in the 30–50% range (Roth & Fonagy, 2005), the hard fact is that less than one-third of clients who were meant to receive treatment end up completely recovered. This is not to say that these treatments should be dismissed, but it is a reminder of how much ground there is still to be covered.

Orford (2008) contends that researchers may have been asking the wrong questions, by pitting competing treatments against each other instead of recognizing the basic equivalence of outcomes between bona fide treatments and refocusing on what are likely to be more relevant therapeutic processes than the theory-driven differences: the therapeutic alliance, the unaided self-change processes, the social support and broader provider systems, and therapists’ and clients’ views of change. This also is the reason why, in this book, we do not wish to propose yet another therapy model, to create another therapeutic approach by emphasizing all that is different or supposedly better in our way of intervening. On the contrary, we would like to bring to the fore the similarities, the common change processes that seem to be at work in the successful treatments for a variety of self-destructive habits. Furthermore, we certainly have no problem in bringing aboard the most promising elements of different therapeutic approaches, like for instance cognitive interventions with gamblers (Ladouceur & Lachance, 2007; Marceaux & Melville, 2011), biological heat interventions with eating-disordered clients (Birmingham, Gutiérrez, Jonat, & Beumont, 2004), or the strategic engagement of the families of young drug addicts (Szapocznik, Hervis, & Schwartz, 2003; Szapocznik & Kurtines, 1989). However, we do that with an acute awareness that these elements will only contribute to therapeutic change in the context of other powerful factors: the therapeutic alliance (Diamond et al., 2006; Friedlander, Escudero, & Heatherington, 2006); the ongoing feedback processes between therapist and clients (Lambert, 2010); and the skill and competence of each individual therapist (Anderson, Ogles, Patterson, Lambert, & Vermeersch, 2009); all of them in interaction with the strengths and limitations of each individual client and the broader systemic forces of family, cultural, peer, and larger systems influences. In other words, collaborative strengths-based brief family therapy is a way to take common therapeutic factors and accumulated psychotherapeutic practice evidence-based wisdom seriously, and to do so by both offering therapists ideas and tools to better serve their clients, and emphasizing the important role of therapists’ creativity and risk-taking in therapy (Selekman, 2009; Selekman, Wilson, & Beyebach, 2005).

Understanding the Territory of Self-Destructive Habits

We provide here a comprehensive overview of how self-destructive habits can develop, are maintained, and can be transformed into virtuous habits by harnessing clients’ self-change processes and unique quitting styles, and by using a collaborative strengths-based brief family therapy approach. We begin by discussing four major societal aggravating factors that can fuel self-destructive habits; present our Buddhist and wellness perspective on self-destructive habits; compare and contrast self-destructive habits with other behavioral and mental health difficulties; present the pathways model as a useful framework for understanding how self-destructive habits develop and are maintained (Blaszczynski & Nower, 2002); and discuss the key brain systems and neurochemistry involved in maintaining self-destructive habits. We cover how, for many clients, self-destructive habits have served as gifts and resources for coping with life difficulties; and we present important self-change research that can inform our clinical practices in the treatment of the five self-destructive habits featured in this book.

Self-Destructive Habits in the Age of Dysregulation

It has been our clinical experience that the five self-destructive habits featured in this book are fueled by a wider consumerist cultural and media-driven societal climate that primes us for getting and overspending, and overrides our capacities for self-control and self-regulation by bombarding us with multiple temptations that can rapidly and temporarily elevate our moods or “numb out” any emotional distress or external stressors. We can quickly anesthetize ourselves with the help of a razor blade, pick up fast food, get drunk or “stoned,” play video-games, and thanks to the advancements in digital technology, we can shop, gamble, and have cyber-sex 24 hours a day! Unfortunately, the more we consume and engage in these risky habits for temporary rewards of pleasure and to obliterate stress, the more physical health, psychological, social, and financial consequences we will incur over time. It becomes a vicious cycle that we become ensnared in and takes on a life of its own.

There are four major aggravating factors that we believe are playing a central role in the development and maintenance of self-destructive habits today: economic upheaval and nihilistic fear about the future; high levels of anxiety and stress; the increasing popularity of quick fix solutions; and the primacy of the virtual world over human contact.

Economic Upheaval and Nihilistic Fear about the Future

The devastating economic aftermath of the Wall Street and home loan crisis in 2008 has wreaked havoc around the world. In both of our countries, the United States and Spain, unemployment rates, personal indebtedness, loss of savings, and home foreclosures have skyrocketed. For many, the freedom to make choices has been replaced with restraint, and happiness has been replaced with gloom and pessimism about our governments being able to resolve the economic crisis (Salecl, 2010). In response to financial stress and worry, many of the young people and adults we work with have increasingly turned to unhealthy and inexpensive fast-food consumption, excessive use of cigarettes, heavy drinking, abusing cheaper and readily available substances, and long hours surfing the Internet in search of pleasurable activities to escape into as attempted solutions to quell their anxieties and fears.

High Levels of Anxiety and Stress

In our clinical practice settings and at our workshops, therapists are reporting that they have been seeing an increase in clients presenting with severe anxiety and stress-related difficulties. College-bound adolescents and young adults already in college are highly stressed about being able to fund their education. Adults are fearful of losing their jobs and pensions (or have already lost them), and are reporting having panic attacks; couples are presenting with multiple habit and serious financial difficulties.

Some high-achievement oriented parents believe that by over-scheduling their children in multiple college level classes and in several extracurricular activities they will become highly marketable to top colleges and universities and possibly secure them scholarships. What these parents are totally oblivious to is that their children are stressed and struggling to stay afloat. Many of these young people are leading the “vampire” lifestyle to stay ahead of the game: pumping themselves up with heavily-caffeinated drinks and abusing attention-deficit disorder (ADD) medications and other stimulants to keep them going. A recent study found that 25–40% of college students across the country abuse the ADD medication Adderol for late night studying and to improve their academic performances (Razzano & Pashka, 2012). Both college students and adolescents have reported also relying on cutting, substance abuse, binge-eating and purging to soothe them and get quick relief from their emotional distress (Levine, 2006; Selekman, 2009; Selekman & Schulem, 2007; Whitlock, Muehlenkamp, & Eckenrode, 2008).

Quick Fix Solutions: Obliterate Stress and Discomfort at all Costs

Television and the Internet are full of advertisements for medications for just about every physical health and psychological ailment, presented as the ultimate quick fix solution for all human troubles. The underlying message from major pharmaceutical companies about their popular money-making products is: “Take this and it will quickly obliterate your physical and psychological discomfort.” Unfortunately, the wider public are not being exposed to alternative healing methods, like mindfulness meditation and yoga, that in the long run will likely produce many more positive physical and psychological health benefits. Instead, young people are exposed to advertisements on the Internet, television, and in magazines about how a particular medication will enhance their sexual performance, help them rapidly lose weight, or cure their psychological ills. In addition, they also may be observing their stressed parents relying on prescription medications, alcohol, illicit substances, and nicotine just to cope. They soon discover that cutting oneself, binge-eating, abusing certain substances, video-games, and cyber-porn can function as fast-acting sedatives for their stress or as mood elevators to make themselves quickly feel better.

Alone Together: The Virtual World Has Become More Valued and Meaningful than Human Contact

Thanks to significant advances in digital technology, the popularity of social networking sites like Facebook and Twitter, and highly successful marketing strategies by the leaders behind these companies, having the next popular digital device and interacting in the virtual world has become more highly cherished than having human contact in the offline world. Interestingly enough, recent research on Facebook has found that rather than bringing us closer to others, it is isolating and distancing us from the very people we care the most about. This is increasing feelings of loneliness, and in some cases psychologically contributing to our being more depressed and anxious (Burke & Kraut, 2011; Cacioppo & Patrick, 2008; Marche, 2012; Ryan & Xenos, 2011). Chellappan and Kotikalapudi (2012) found that excessive users of the Internet exhibited high levels of anxiety and the depressive symptom of “flow duration entropy,” which occurs when there is frequent switching among Internet applications like excessively checking one’s e-mails, downloading files (movies and music), spending lots of time in chat-rooms, and engaged in online games. Turkle (2011) has written extensively on and researched the addictive quality of digital technology and how, once hooked, craving for “the next new thing” (digital device) and spending excessive amounts of time in the virtual world not only psychologically entraps users but promotes emotional distance in offline intimate relationships. Recently, when one of us (MB) went to the waiting room to invite a family in for their first session, all four members were connected to a different digital device and disconnected from one another: the father was having a work conversation from his mobile phone, with headphones and speaker; the mother was texting on her Blackberry; the 10-year-old daughter was writing on her iPad, and the 8-year-old was absorbed by his Nintendo—“alone together.”

In many families today, parents are not providing any firm boundaries or guidelines for screen usage time nor do they know what websites their children and adolescents are regularly visiting (Selekman, 2009; Taffel, 2009). Excessive screen usage can drive emotional wedges in parent–child relationships. As far as we are concerned, nothing replaces parental presence and spending regular high-quality time together as a parental couple or family group, even in this age overloaded daily agendas and highly stressed parents. In fact, research has indicated that not only is spending time together as a family one of the six characteristics of strong families but simply having dinner together has been found to serve a preventative function for the initiation of adolescent drug experimentation and preventing substance dependency with young people already experimenting, and for helping prevent obesity with young people (Califano, 2007; DeFrain & Stinnett, 1992; Fulkerson et al., 2006; Stinnett & O’Donnell, 1996).

Why “Self-Destructive Habits” rather than “Addictions”?

Our choice of the words “self-destructive habits” over the more traditional term “addictions” grows out of our basic therapeutic assumptions regarding how we view self-destructive behavior and the treatment for these difficulties. We have adopted the Buddhist perspective in our clinical practices that self-destructive habits, like all life difficulties, are impermanent and in a consta...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Authors
• Acknowledgments
• 1 Self-Destructive Habits: A Collaborative Strengths-Based Brief Family Therapy Approach
• 2 Key Elements for Co-creating a Therapeutic Climate Ripe for Change
• 3 Major Therapeutic Experiments and Rituals
• 4 Self-Harming Habits
• 5 Eating-Distressed Habits
• 6 Substance-Abusing Habits
• 7 Problematic Gambling Habits
• 8 Internet and Cyber-Sex Dependency Habits
• 9 Working with Reluctant and Complicated Multi-Habit-Dependent Clients and Couple and Family Systems
• 10 Couple and Family Relapse Prevention Tools and Strategies
• 11 Self-Destructive Habits: Future Directions with Treatment , Training, and Research
• References
• Index