Autism expert can help those who struggle with addiction
In the late 1990s I begin attending workshops on trauma therapy because I realized many of those who struggle with addiction also wrestled with untreated underlying trauma – sexual, physical, and emotional. It was at one of the workshops that I first heard the name Stanley Greenspan. Today he is known as one of the foremost experts on autism having published over 35 books and many scientific publications since graduating from medical school in 1966. But for me, he has become an instrumental figure in understanding the foundation of long-term successful addiction management - which in a nutshell is healthy relationships.
In an earlier post I described how addictions are about relationships, and that long-term success in dealing with addiction necessitates replacing unhealthy relationships with objects with healthy relationships with people. The key to doing this is realizing that to initiate, develop, and maintain healthy relationships requires developmental skills that become constricted, or in some cases, never develop due to trauma or time spent in addictions. These skills are critical to relating to others in many contexts: intimate relationships, child rearing, work environments, marriage. Yet most treatment programs and self-help groups are unaware of the critical need to assess and treat emotional developmental problems. When they go unaddressed, many continue to relapse and struggle in life without the benefit of knowing what is missing in recovery.
Based on his extensive clinical and research experience, Stanley Greenspan created a developmental framework that I believe is among the very best at helping us understand the essence of what it takes to succeed in relationships, but even more, how to optimize our mental health. The framework, in brief, suggests that emotional development occurs in six sequential steps. This overview paper focuses on infants and toddlers, but in the book The Growth of the Mind, Greenspan details how many adults become stuck at early developmental levels and require developmentally based therapy to catch-up. Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root. In all fairness, I spent plenty of time hacking at the leaves with patients because assessing emotional development and knowing how to do developmentally based therapy is not so easy. In fact, it requires a therapist to be attuned to their own emotional development and have some fairly advanced therapuetic skills. But therapy is not the only way to increase developmental capacities. By doing things out of your comfort zone, joining diverse types of groups, engaging with people in many contexts, and journaling about your emotional world can help. In future posts I will be more explicit about specific things that lead to developmental growth.
To get a flavor of the genius of Dr. Greenspan, here is a very short clip from the documentary film “Autistic-Like: Graham’s Story.” Although he is talking about the early development of his DIR model of intervention for autism, such insights are very appliable to those who struggle with addiction. Because “emotions serve as the orchestra leader for getting the mind and brain working together” it is absolutely critical to long-term successful addiction management that significant energy is invested in understanding, managing, expressing, and acting on the vast array of emotions we experience every day.
The following statement struck me: “Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root.” Getting to the root of addiction rests in working with the underlying trauma and problematic relationship patterns that clients have experienced throughout their lives. Getting to the root of these deeply rooted problems inside clients with addictions seems like an extremely difficult task that requires many therapeutic skills and techniques. Using DBT is very complex and takes extensive training, and I imagine that many addictions counselors are not trained in DBT, because many do not a have a graduate-level education. If professionals are not thoroughly trained and educated to treat people struggling with addictions, then how do clients receive the most effective therapy from these professionals?
I also think we must be constantly thinking back to prevention and education. We can’t expect to exclusively treat addictions effectively after the roots have sprouted into dysfunctional and diseased branches and leaves, especially if we do not have the training to do so effectively. We already know that the acute based treatment system is ineffective in many ways. Therefore, we have to prevent the unealthy roots from growing unhealthily to begin with. The very first and most crucial step is to ensure that the “soil” is healthy. Child development is very much dependent upon their environment. As teachers, counselors, community members, and parents, we must ensure that we identify children in these unhealthy environments and do everything we can to help them when they are young. Children must also have the proper prevention services available so that they can learn how to be healthy before their problems get too deeply rooted. It is much easier to uproot a sapling than it is an old-growth tree.
I appreciate the importance being placed on emotional development. This is often the root of the problem. I think that counselors spend too much time “hacking at the leaves” because they don’t know any better. Real change necessitates going deeper and helping clients increase their emotional development. At this stage in my education I do not know much about how to do this, but I know that I will be looking to learn more as it is so important; not just for addiction treatment, but for the treatment for all clients.
I think I’m a Greenspan fan, this guy is great! Hearing him in this interview (albeit brief) really makes me want to see him in action. I understand that he values “meeting the client where he’s at” but honestly I’m not sure what that looks like. For example, I would love to see Greenspan do a session with a typical 10 year-old, and then do a session with an adult who possessed developmental constraints and restrictions that would make him similar to a 10 year-old. I wonder what differences and similarities there would be in his tone and technique?
What I hear in this blog is the importance of replacing unhealthy objects with healthy behaviors. I really appreciated what you had to say about the various ways that this can be achieved, such as doing new behaviors, joining groups, or participating in things previously uncharted. In a class I have on interpersonal neurobiology, we talk about creating new “pathways” by trudging through this uncharted territory. Research shows that the plasticity in the brain is high, and that there are many ways that growth can occur for individuals not only struggling with addiction, but struggling with social relationships of any kind. Trauma can stunt areas of the brain, causing development to halt for a period of time or in some areas of relational functioning. This post brought to mind the importance not only of psychotherapy, but also of relating openly and honestly in social relationships in new, uncharted ways.