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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: INDIVIDUAL COUNSELINGEarlier we defined treatment as all the interventions intended to short-circuit the alcoholism process and to introduce the alcoholic to effective sobriety. This could be put in equation form as follows: Treatment = individual counseling + family therapy + family education + client education + group therapy + medical care +AA +Al-Anon + Antabuse + vocational counseling + activities therapy + spiritual counseling +….As you can see, individual counseling is only a small part of the many things that comprise treatment. So what is it? A very simple way to think of individual counseling is simply the time and place and space in which the rest of the treatment is organized and planned. One-to-one counseling is a series of interviews. During the interviews the counselor and client work together to define problems, explore possible solutions, and identify resources, with the counselor providing support, encouragement, and feedback to the client as he takes action. Before proceeding to a discussion of how the counselor does this, we would like to digress for a moment.One of the difficulties in thinking about, discussing, or writing about counseling is knowing where to begin. It all seems more than a little overwhelming. One of the problems is that most of us have never seen a real counselor at work. We have all seen police officers, telephone lineworkers, carpenters, or teachers busily at work. So we have some sense of what is involved and can imagine what it would be like. The counselor’s job is different. It is private and not readily observable. Unfortunately, most of our ideas about counselors come from books or television. Now it doesn’t take too much television viewing to get some notion that a good counselor is almost a magician, relying on uncanny instincts to divine the darkest, deepest recesses of the client’s mind. You can’t help thinking the counselor must have a T-shirt with a big letter S underneath the button-down collar. Television does an excellent job of teaching us that things are not always as they seem. Yet, remember, in real life they often— indeed usually—are. Everyone is quite adept at figuring out what is going on.*115\331\2*

STRESS AND MARRIAGE BREAKDOWN: BLAMING MARRIAGE ITSELF FOR MARRIAGE BREAKDOWN
I think our society these days is inclined to see marriage itself as a cause of problems in marriage. For example, it is not uncommon to hear people blame their marriage for the deterioration in their sexual relationship: ‘I think I just got bored with the same old routine, Doctor!’ Likewise, people may blame their communication problems on ‘becoming bored with the same person’, or ‘We just grew apart.’Therefore, people who blame the marriage for some of their relationship difficulties tend to see trial separation as an answer. Similarly, some people see divorce as an answer to problems of personal self-acceptance and personal worth. The tendency to think this way reflects primarily the philosophy of our post-war Western democracies, described ably by Paul Vitz as ‘selfism’.Vitz contends that what our culture has done in relation to its views on the rights and responsibilities of the individual self, is to take the Christian concept of the self – each person intimately loved by God, unique, with specific gifts and talents to be used for God’s service – and then take God out of the picture. Thus we are left with the concept of each individual as unique and important, each with a specific destiny to fulfill, but there is no God, and there is no evil. Therefore our society, once it did away with the concept of sin, was left without anything to explain why we, who begin life as beautiful, innocent children, can grow up to be selfish, greedy, power-hungry, dissatisfied adults.The response of our society was predictable. We discovered new devils and new bad influences to explain why we human beings always seem to create problems in getting along with one another. I find that people now tend to blame marriage, commitment to love relationships in general, family influences and society, as prime causes of their own unhappiness.I believe if I stood on the street, asking all the people who walked past, whether society has a good or a bad influence on the individual person, that a lot of the people answering would say it had a bad influence. Many of these people answering my question would be healthy and fit, protected by this same society against catching all sorts of diseases, fed, clothed and entertained by the very system which they think is the basis of a lot of our interpersonal difficulties.Similarly, marriage as a concept has come in for a great deal of criticism in recent years, particularly from younger people, who tend to see the solution to their fears of rejection in not signing up for life in marriage, but instead negotiating limited contractual agreements, mainly for the sake of the orderly disposal of shared property once the relationship breaks down.Therefore people experiencing stress breakdown symptoms and relationship problems, if they are to save their marriages, need to resist a general society tendency to drift into divorce. In this climate of peer-group pressure in favour of splitting up, it almost seems as if it takes more psychic energy to stay together and face problems than split up and start again.However, the people who have opted for divorce often find that divorce hasn’t solved their problems, but in fact, magnified them. Ex-husbands don’t become ex-fathers, nor do ex-wives become ex-mothers of children whose big problems begin when parents become divorced. Often people, who find themselves divorced as the result of stress breakdown affecting the marriage, find that when they lose their ex-partner, they lose their best friend.It might sound an unexpected thing to say, but I believe from my experience in psychiatry, that divorce solves the problems of very few people. Easy divorce is associated with an increasing number of people being raised in one-parent families, in real poverty. I believe that stress breakdown is a major reason for divorce in this country, and the majority of those divorces are unnecessary.
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This state of mind, which is not altogether uncommon, may increase our feeling of pain, but at the same time it helps us to endure it.

But remember that this is a pathological sequence of thought which is engendered by the psychological mechanisms which we have already discussed. If you find yourself thinking along these lines, concentrate on this. Yes, you have done wrong. We all have. And now you are suffering from pain. The pain has a real cause whether it be organic or psychological, and is in no way punishment for past misdeeds.

The Masochistic Embellishment of Pain.-Just as pain can become associated with the idea of punishment, it can also become associated with the feeling of pleasure. This rather complicated psychological reaction has its origin in sexual experience. The man is active. He is vigorous. His movements are forceful and may cause pain. Thus the ideas of sexual pleasure and causing pain may become associated. This is known as sadism. On the other hand, woman is passive. He does it to her, perhaps forcefully; and feelings of sexual pleasure are intermingled with pain. In these circumstances the pain itself may become tinged with pleasure. This is known as masochism. By various complex psychological reactions either man or woman may become sadistic or

masochistic, and the feeling of pleasure in giving or receiving pain may be transferred from sexual experience to the ordinary affairs of everyday life.

However, it is masochism, or the feeling of pleasure involved in experiencing pain, which concerns us in our present discussion. We could find many simple examples of this. When we scratch ourselves perhaps we get a strange feeling of pleasure as we actually injure the skin. There is often a great temptation to pick at the scab on a healing wound. As we pick it, there is a feeling of it hurting, but at the same time there is a pleasurable sensation. People often toy with a little piece of loose skin at the base of a fingernail in much the same way. Many people who discipline themselves very sternly are masochistic. This sometimes applies to those who swim every morning in winter, finding pleasure in the extreme cold. These examples merely serve to show that minor degrees of masochism are accepted as ‘normal behaviour.

Under some circumstances this same psychological mechanism of masochism can become stimulated and applied to pain of either functional or organic origin. In a perverse way the pain becomes tinged with a pleasurable feeling. This helps the sufferer to tolerate his pain, or if the condition is more fully developed he may really grow to enjoy the pain. However much this may help the individual to cope with his pain, we must remember that such a process is a gross perversion of the normal senses, and if allowed to develop to meet some particularly painful situation it is likely to lead to complications in other aspects of life.

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The multifactoral causation of illness applies even in psychoneurotic conditions. In these disorders there is often a clear-cut causal relationship between some past event and the present disability. This is the cause. But whether or not the cause actually produces symptoms may depend on the individual’s general level of stress. Furthermore, understanding the psychological causation of the illness may not be enough in itself to relieve the symptoms without some reduction of the general level of stress.

Claustrophobia

«This all happened a few years back, but I remember the story vividly.

‘It’s damn silly. Get the jitters if I go to the toilet and shut the door. The jitters, and can’t do what I came for. All right if I leave the door open. Can’t always do that. Know all about it. Tail gunner with the Lancasters. Thirty missions over Germany. It was at the bad time. They said ten per cent chance of coming through a tour of duty. I know all about that. Get caught in the search lights. God! How did it feel! All the ack-ack in the world firing. Terrible crash. But the old bus kept going. It’s the blast that makes the crash. Fighters on our tail. Gave them what I could. I know all that. Bombs away. Then home at last. Our ‘drome bombed out. Craters miles deep in the runway. Flying around in the dark, trying to find somewhere to get down. I know all about that. Off again in a couple of nights. Up the steps into that little box on the tail of the plane. Chap on the ground slams the door. How did it feel! I know all about that, but I still get the jitters if I close the door of the toilet. »

The psychopathology is painfully obvious to everyone including the patient. This demonstrates a very important point. There is a widespread delusion among people in general, and not a few psychiatrists and psychologists that a knowledge of the cause of nervous symptoms will make them go away. This is simply not true. The relief of the symptoms requires some other factor as well. This may sometimes be provided by the relief of stress in the profound experience of intensive meditation.

«Can’t stand being shut in. Terrible panic. Sweat. Heart thumps. Feel I’m going to faint. If I go anywhere, have to sit by the door. Better if it’s open. Have to sit by the door in church, and on an aisle at the cinema. »

Unlike the tail gunner, she had no idea as to the cause of her claustrophobia. However, when under deep hypnosis, she became very disturbed, crying out, ‘Let me out of here. Let me out.’ It transpired that she had regressed to an incident in childhood when her mother had locked her in the broom cupboard for being naughty.

The interesting point is that this dramatic insight did not give immediate relief to her claustrophobia. Her relief came only slowly over a period of some weeks as the level of her stress was gradually reduced.

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Skin troubles

“It comes and goes. Has done so for years. Just now I am in a bad phase. Skin bad. Inflamed, itchy. And I’m bad too. Irritable, edgy. Not my usual self as when my skin is all right.”

His skin is bad, and he is bad. His brain is receiving a continuous in-put of disturbing impulses, making a background for the development of stress.

In these recurring skin troubles we are often faced with a complicated array of causes. Of course there is the genetic factor. Some people are born with sensitive skins. Then there is the allergic factor. Some are sensitive to different brands of soap or a detergent used in washing underclothes. Or the allergy may be a result of something eaten, and manifested in the skin. And stress. Of course, stress plays a part. In fact many of these recurring skin troubles are precipitated by stress. It often happens that the effects of allergy and stress combine to produce the rash.

Now we come to the main problem. The rash, and particularly the itching, by their disturbing impulses to the brain produce stress. Then the stress further aggravates the skin condition. In this situation some serious meditation will reduce the stress and so help the healing of the skin condition.

Fatigue

“I’m tired. Just tired. Little things are getting on top of me. I can usually cope. Cope well. But now I can’t. Everything is a muddle. Feel at my wits’ end.”

The message of this little book is that we should help our brain through act of mind and by what we do, so that we can cope with adverse circumstances. But of course we all have our limits. And some people have not fully learned the principles of the self-management of stress. So there may come the time when the individual is in fact overwhelmed, and becomes over-fatigued. This may arise through a number of circumstances – a smouldering chronic infection, sleeplessness, conflicts of conscience, or simply the ageing process and, of course, a greater load of mental or physical work than the individual can manage. Fatigue has a direct effect on our brain cells. Disturbing impulses are not so well integrated and the individual comes under stress.

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