Psychodynamic Treatment with the Addicted Person

Psychodynamically trained clinicians have much to offer patients with substance use disorders, but lack a coherent model of treatment for addictions. This paper proposes a bipartite model for approaching addictive illness, separating the addicted person from their illness. Within this framework, the psychodynamic treatment approach seeks to discover and cultivate each person's unique humanity through the therapeutic relationship. Addiction and recovery are conceptualized not as states but as opposing dynamic forces within the individual, each requiring its own therapeutic approach. The seeds of psychodynamic work are planted from the onset of treatment through a therapeutic position of curiosity, nonjudgmental acceptance, empathy, kindness, honesty, and evolving trust. Unlike other treatment approaches, the therapeutic relationship takes center stage in driving the healing process. Countertransference challenges signal crucial opportunities to “flip the script” from dynamics of addiction to those of recovery. The author draws upon several models to illuminate this work. Khantzian's ego-deficit model describes areas of self-regulation vulnerability associated with addiction and conversely pathways to growth in treatment. Winnicott's concept of false self is translatable to the addictive self, while psychotherapy allows true self to emerge. Krystal's description of psychic trauma relates directly to the fragmentation and dissociation of experience in addictive illness. Clinical vignettes illustrate the themes discussed. Psychodynamic therapy offers the opportunity for healing of the deep psychic wounds afflicting many who suffer from addictive illness.