Tag Archives: 12-step programs

On Circularity and Tautology

 

Just before Covid broke out and thereafter shut us in, I’d started going to Peets to prepare notes for this blog. I’d already had in mind to write a few overdue thoughts on the matter of tautology when I saw an anecdotal cue in the corner of my eye. Over the shoulder of a diligent girl with a winning, sympathetic smile who served me coffee was a poster proclaiming that the house brew from Colombia was a hundred percent grown by women—that is, men were not involved, presumably. For a fleeting, half-witted moment I wondered why this was necessary to advertise before thoughts of obligation intruded. Was there a tradition of female exclusion in the Colombian coffee industry? I wondered. Amid the progressively flavored ambience the question seemed foolish, and not because I ought to have known something, anything, about Colombian culture. The poster’s claim/boast will have been deemed acceptable by marketers; been green-lighted by franchise execs, nodded to by employees and duly patronized by a genteel, civic-minded customer base. Why? Because its premise will have been deemed unfalsifiable. No evidence necessary. Circular reasoning, in philosophical and critical thinking circles—not so much the office spaces of advertisers, I’ll venture. Was research into the history of the Colombian coffee trade really necessary? That women had been hitherto excluded was a given, wasn’t it? Would it even matter if the implication wasn’t true?
Unfalsifiable ideas (ideas immune to rebuke) designed for professional and thereafter public consumption are nothing new in modern psychology. An acknowledgement of this dates back to the 1930s at least, when Freud wrote in “Constructions in Analysis” that psychoanalysis employs circular reasoning when considering the accuracy of interpretations. If a patient were to reject an interpretation, it is only a sign of resistance, many analysts thought. Those of the Kleinian school took it a step further, suggesting that a resistant, interpretation-rebuffing patient was one exhibiting a “negative therapeutic reaction”: meaning, an act of aggression, denying the nurturing goodness of the attending analyst. Even those who write with tongue-in-cheek satire of this stance confess guilt when asked if they have ever resisted the resistance of a patient—even claiming that the correctness of an insight was or is confirmed by the denial of the patient. Indeed, the more intense the denial, the more deeply embedded is the truism, was or is often the belief. The matter of real interest becomes the correspondence between the intensity of denial and the level of unconsciousness: the deeper the idea is buried, the more intense the denial of the analyst’s interpretation.

Circular thinking is habitual; that is, it happens unconsciously and repeatedly, so they lodge in the mind. I recall one example from an academic setting, during a somewhat delicate discussion about touch in therapy, as in the prospect or practice of physical touching between clinicians and patients. The sensitivity in the air concerned the matter of sexuality, of course, and more specifically, the legacy of sexual abuse by male practitioners upon female patients. Amid this background, however, the view remains that some manner or degree of touch between patient and provider may be appropriate. Hugging, for example, or shaking hands. Fair enough? Not so fast, complained one student—a woman—who pointed out that most of the literature on the subject of touch between patient and analysts/therapists has been written by men. She needn’t have substantiated her point, it seemed. Still, what she then pointed out, without comment on the contradiction, was that an analyst named Judith Butler has “written more on the subject of touch in the clinical setting than anyone”.
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As in more than anyone since men stopped writing on the subject, assuming that’s still allowed? The data point supplied had not perturbed the previously declared premise. My not-quite-as-provocative-as-that query didn’t yield an answer on this occasion. My fellow student didn’t identify the men of yesteryear who had previously dominated the topic. Neither did the instructor. They simply thought it a refreshing change, not an irony, that the most prominent commentator upon touch in therapy was a woman. By the way, I’m sure there has been plenty of “research” into this question, utilizing hidden cameras no doubt, to determine how often, and by what proportions of each gender, that physical touch is occurring in therapists’ offices. I know. I’m not taking this seriously, am I? Well, not quite. It’s more that I don’t take seriously the thinking or methodology that’s being applied to this subject. I can’t be bothered to review beyond what I already have what’s being written on this subject, as if it could be studied objectively. And it hasn’t. I imagine (borderline assume) that the fewer male therapists that remain in this field are as conservative as I am. I shake hands. I will give a hug to a male patient, usually without concern. I will give a hug to a female patient at the end of an intermediate-to-long-term therapy, assuming she initiates. I will never initiate. Never. The day that changes is the day it becomes acceptable to have hidden cameras in my office. And that’s the day I retire, frankly. Actually, that’s bravado. I’d check my bank account first. So, who knows about what’s under the surface, or behind closed doors upon which “In session” still interdict? Should we know?

Circling back to my main topic: circularity. In the crossover realm of addictions and addiction treatment, which I attempt to describe in the forthcoming book, Getting Real About Sex Addiction, there are analogous tautologies, which are redundant expressions indicating unfalsifiable logic. The term “male sex addict” may be one example; the phrase “objectification of women” may be another: terms that may seem redundant because of prejudicial beliefs. Do we assign the term sex addiction to women in an era sensitive to “slut shaming”? Would the term “objectification of men” be deemed a thing by an average observer not prone to ontological (nature of being) insight? There are chestnut beliefs taken for granted by many, professionals as well as consumers of psychotherapy.

One that exists on the periphery of mental health care emanates from Alcoholics Anonymous, still the most prominent sobriety movement in the United States after a near century of existence. Absent a painstaking assessment of a drinking history, and sometimes even in spite of said data collection, a person who presents for help, either within a 12-step milieu or within a 12-step-based treatment program, is often thought to be in denial of a problem simply if he or she denies a problem. The presentation for assessment, for care—whether at the behest of others or not—signifies the conclusion a priori. Hence a circularity: if an individual presenting for care admits that he is an addict/alcoholic, then he is an addict/alcoholic. If he equivocates or else denies that he is an addict/alcoholic, he is still an addict/alcoholic. It’s just that friends, family and professional helpers will all now have some work to do upon the resistant mind.

No surprise that similar phenomena contaminates the sub-field of sex addiction treatment, which is otherwise largely preoccupied with medical, ontological, and phenomenological (study of experience) questions regarding diagnoses and criteria: questions like, what is this thing we call addiction? Or, for those still debating the details, what are the events or behaviors that actually happened? Hence, the field ignores its other assumptions. But tautologies and circular reasoning are apparent, and not just amongst practitioners and patients, but especially amongst the non-acting out, “betrayed” partners of designated sex addicts who, in the aftermath of a discovered acting out pattern, are hypervigilant to clues of wayward behavior, including instances of denials or argumentativeness. I’ve known more than one partner of an addict declare with studied conviction that she knew that her partner had slipped or relapsed in his behavior, not so much because of some undeniable evidence pointing to this conclusion, but rather because the intensity of his denials implied the unconscious defense of negation—negation of that which is necessarily deemed true. So, don’t tell me that analytic ideas have no place in the modern conversation of addictions just because people don’t know the theoretical derivatives of their assumptions. Next, this issue of whether an addict is an addict based upon whether he self-identifies or else because he’s in denial is just the tip of the iceberg on this matter of tautology and sex addiction. As my opening anecdote suggests, the muddying of water (or coffee) extends to gender biases intersecting with notions of what is trauma, or what constitutes objectification as these concepts pertain to an already loaded subject—sex. Okay, I got called out recently (you might have read) for using words like ‘trauma’ without explaining what it means. As if I know what it means! That doesn’t mean that I don’t have ideas, or even experiences that would inform, but I think the term’s meaning has become diluted in our culture. For once, I’ll be brief and orienting, for I think the debate congeals around a triangular phenomenon: firstly, there is the notion that trauma is the crazy-making event. Second and third, the question (broadly) is whether the crazy began in the self or within some un-locateable pre-verbal memory, or further, whether crazy stems from a later (even contemporary) crazy-making event. Platitudinous wisdom suggests that some combination of each phenomena is true.
Thanks
If the subject of trauma across contexts has been contaminated, can you imagine what I think has happened when the context is sex? Well, without the background specter of sex and gender politics, it’s hard to imagine that sex addiction would have gathered steam as a concept, displacing as it has (almost) in recent years the relatively benign if not old-fashioned construct of infidelity.
In Getting Real, I argue that sex addiction treatment is a subsidiary front in a zeitgeist war against male sexuality. The evidence for systemic tautological fallacies lie in the far higher rates of men being admitted to sex addiction treatment versus women, coupled with the absurdist view that such admission rates constitute a privileging of care for men instead of the neo-Scarlet lettering that it obviously is. Now, I know there are some who would reject my appropriation. Cue again the concern with matters of moral equivalence, or asymmetry. So, once again, I accept that the plight of modern sex addicts doesn’t match the experience of ostracized women in 17th century New England, but also (once again), metaphors and allegory don’t imply equivalence or symmetry. They serve as reference points, and are inherently imprecise, as all meaningful things are. Incidentally, few would argue that the trauma of sex addicts’ partners matches that of combat veterans, but does that render the term sex addiction induced trauma invalid? I don’t know if the people who promulgate this hegemonic opinion also believe that sex addiction is an unnecessarily pathologizing label, but it wouldn’t surprise me if such concurrences of semi-thought, which compound absurdity, exist in our professional field. Beyond the statistical surfaces, the ethical complaints that accompany the sex addiction concept—that pornography and prostitution exploits and objectifies, or that extramarital affairs betray partners—largely target a heterosexual male population whilst shielding would-be female sex addicts from a similar excoriation. In my view, a now dominantly female proletariat in mental health care is wary of attaching pathologizing labels to female sexuality, which results in circular, apologist formulations. Therefore, a woman who acts out sexually with pornography or prostitution or serial affairs does not exploit or objectify others, especially men, but rather internalizes a demeaning state of mind such that what she does she invariably does to herself.
Uh-huh. Again, note the Cliff Notes co-opting of a psychoanalytic concept, which is common within frameworks that comprise the sex addiction field. More importantly, note the assertion of ideas across mental health/sociological spectrum that are presented credulously; that is, immune to falsification.

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What To Look For In Drug Rehab

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If you go to a 12-step meeting one of the slogans you’re likely to hear is “keep coming back”. It’s meant to welcome you, and be encouraging. And it is. But with respect to rehab, you don’t want to “keep coming back”. As a therapist of 20 years, I can’t tell you how many times I’ve heard something like the phrase “I’ve been going to rehabs for years,” from weary drug addicts who are still suffering, wanting to get clean. They are not so much unmotivated as stuck with something that is more than an attitude, and something closer to an embedded way of being: I want to feel better, not get better.

            Find a program that does not collude with this misguided goal. Here are a few tips and explanations:

1.)    First of all, size matters: the size (as in number of beds, # of patients participating in activities); the size of a case manager/therapist caseload. If a program has more than six beds, or offers groups with more than 8 participants, the tendency is for treatment to become unwieldy, possibly unsafe. If a therapist has more than half dozen patients on their caseload, it is unlikely they will have sufficient time to devote to one individual or family. I’ve observed these phenomena over many years, and depict numerous examples in Working Through Rehab.

2.)    Secondly, ask questions about the influence of patients’ rights groups, community licensing bodies. Some programs are more answerable to external regulators than others, which isn’t necessarily a good thing. In my book, I chronicle several instances wherein outside agencies influenced program procedures, often based upon societal norms, and not for the better. Often, accommodations served to enable problem-behaviors of substance abusers, not protect individual’s rights. This is a similar view to that offered in Dr. Drew Pinsky’s 2004 book, Cracked: Life on the Edge in a Rehab Clinic.

3.)    Thirdly, observe the proscription of depth therapy in rehab settings. Note the tendency of programs to sell short-term models that address behavior and cognition, but not underlying feeling states, maladaptive patterns of relating to others—attachment difficulties, and trauma. For example, anger management skills and mindfulness training are well and good, but they don’t address pervasive distortions of self and others. Furthermore, dovetailing with item #1, if a therapist is too preoccupied with multiple staff meetings, producing rote documentation, communicating with collaborators on largely pragmatic matters, in-depth focus with any one individual or family is more or less squeezed out.

4.)    Finally, hear with some distrust the phrase “fun in recovery”. This language is pitched to teens in order to get a buy-in, but while teen programs should include recreational activities, make no mistake: recovery, or meaningful change, is not fun. If you are a parent looking to place your child in rehab, I suggest the requirement of “fun” has not worked, and reinforcing this idea may have you or your child coming back, again and again.

 

 

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