Damián Ruiz
When a patient contacts me with the intention of individual, face-to-face or online therapy, the first factor to take into account is the level of consumption of a certain substance because, honestly, if it is excessively high, I do not consider it appropriate to treat him or her. For these cases it is much better to be admitted to private or public centres for detoxification and, subsequently, once the therapeutic programme established by these clinics has been carried out, it is then possible to carry out a more personalised and individual type of therapy.
If we are talking about consumption of a maximum of once or twice a week, then we can consider starting therapy.
My procedure is not cognitive-behavioural, so I mainly focus on two aspects: why he/she uses and the level of addiction, i.e. the reasons for the beginning of the use and the present ones, and to what extent the patient is more psychically chained to the substance than he/she thinks he/she is.
I would add that in the first therapeutic sessions, being a novelty and a new stimulus, the patient feels a certain degree of satisfaction, firstly because “he/she has put him/herself in treatment” and secondly because “he/she is convinced that this time he/she will overcome it”.
Well, it doesn’t have to be that way, or it does, but it certainly cannot be perceived in a trivial way.
Overcoming an addiction is hard work, persevering, constant, with ups and downs, sometimes accepting relapses and moving on. In most cases it is a permanent struggle until it is achieved, and then it is much more credible and reliable than if you have given up easily, although it may be that in some cases, very few, it is also achieved.
During the process it will be necessary to take into account all those elements that go hand in hand with the addiction, I give some examples: success, seduction, frustration, low self-esteem, work performance, hidden dissatisfaction, etc.
And it may be necessary to make substantial changes in one’s life, and some will involve renunciations and others new opportunities, but all will have a meaning.
It will be essential to get to the essence of the person, to their most significant emotions, those that they express and those that they do not, and to overcome or integrate traumas or situations that make it difficult to stop using.
An important note: I do not usually pursue patients, that is, I leave the continuity of the therapy to their will beyond contacting them if they do not show up for a session and I am available, mainly during working hours, to talk if some kind of crisis appears, but I understand that it is the person who must have the maturity and sufficient will to continue in treatment beyond what happens in their life.
On the other hand, I do not trust therapeutic success to the patient’s will but, as I explain in my book on this subject, to the fact of getting them to not need to use, to feel an absolute rejection of the substance and to understand the need to get rid of it completely.
It is a long road and a lot of work on both sides, the patient’s and mine, but it can be done.