Most of us know someone that is struggling with addiction or perhaps you yourself are struggling.

In my practice, I work with people who have both come to therapy to address their drug and alcohol use and those whose addictions are slowly uncovered in the course of treatment.

Early in my training I was told, if not explicitly, that working with people in active addiction was really no use. A picture of futility was painted, the idea that I would just be spinning my wheels and ultimately wasting my time. Until the use stopped, therapy would just stall.

Our society as a whole has trouble with contradictions, shades of gray and in betweens.

When we talk about addiction we tend to use terms like clean and dirty, terms that by their very nature indicate a kind of moral judgement.

I recently spoke to a colleague in which I presented a case of a woman that I’m working with that, in the early phases of our work together, was smoking methamphetamine twice a day. My colleague was shocked and wondered how we could possibly get anywhere.

I will admit that at times during my work with this patient, I struggled to understand where we were going and where we would end up. It’s hard as a therapist when the path seems unclear and out of desperation we can cling to roadmaps in the form of manualized treatments. We understand there is a desired outcome, in this case sobriety. At times we start to focus so much on a goal that we lose our patients. We leave them behind in our quest to be “successful”.

In this particular case, when I was able to stop focusing on outcome, I was able to actually experience my patient and understand where she was coming from. Drug use was certainly a manifestation of poor coping skills and ultimately a way to deal with disappointment in her own life. For months we sat, at times in silence, while she continued to use outside of our sessions together. I carefully listened to her and fully tried to understand what had led her to use in a way that no longer felt good. At the end of our sessions, she ended with the line, “thanks for listening.”

At first, I didn’t think too much about this line.

Wasn’t that what therapy was all about anyway? Listening. What I came to realize is that everyone had indeed stopped listening. She had become and addict, someone who was “failing” at life, someone that couldn’t be trusted.

While her world had become small, I was always willing to go there with her and explore. Overtime, I was able to stop striving and just be present with her. There is something so powerful about just listening. Not trying to fix or guide or shape the outcome. So much of what all of us need is the full presence of another.

One of the biggest problems with addiction is not always the drug itself, but the isolation that many people with addiction face. In my work, I try to help people move into more connection with themselves and then the larger world. I listen to what they are wanting for themselves. How they want their lives to turn out. This is by no means the only ingredient in my work with substance misuse but I must say, a loving and whole presence can be the most powerful medicine.

Set up a 20-minute consult call so I can answer any questions you may have.

Michelle Cilia
Psychotherapy San Francisco
415-710-6731
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