Substance use and recovery
Substance use work where abstinence is an option, not a precondition.
The fastest way to make somebody lie to their therapist is to make honesty expensive. So here honesty is free, and the goal is the one you actually want rather than the one you are supposed to want.
Harm reduction, in practice rather than as a slogan
Harm reduction means meeting you where you are and reducing damage, whatever your current goal. It does not mean I am indifferent to what is happening or that I will never raise a concern.
In practice it looks like this. You tell me what your use actually is, including the parts you have not told anybody, and nothing bad happens as a result. We look at it together with curiosity rather than alarm. We work out what it is doing for you, because it is doing something, and substances that are doing nothing get dropped easily. Then we decide together what change you want: stopping entirely, cutting back, changing the context, making it safer, or simply understanding it better for now.
If abstinence is your goal, I support it fully and I will help you build the structure around it, including connecting you with recovery communities and, where appropriate, with medical support for withdrawal, which is not something to do unsupervised with alcohol or benzodiazepines.
Why the substance is rarely the whole story
Most heavy use I encounter is doing a job. Managing an anxiety that has no other outlet. Making an unbearable social situation bearable. Producing sleep in a body that has forgotten how. Numbing a grief. Providing the only forty minutes of the day that do not feel like effort.
Which means that removing the substance without addressing the job it was doing tends to produce either relapse or a substitution. This is why willpower approaches so often fail and why the failure gets misread as a character defect. The work here is to build other ways of doing the job, so that stopping stops requiring heroism.
What I will be honest with you about
If your use is at a level where you need medical detox, I will say so directly and I will not attempt to manage it in weekly therapy. If it is escalating, I will name what I am seeing rather than tactfully avoiding it. If a higher level of care is warranted, such as an intensive outpatient programme, I will tell you and I will help you find one and stay involved.
Being non judgmental is not the same as being passive. You can expect me to be entirely without moral judgment and entirely willing to say the uncomfortable true thing.
Relapse
If it happens, it is information rather than a verdict. Something was harder than the current plan could hold. We look at what happened in the twenty four hours beforehand and adjust. What I ask is that you bring it in rather than cancel three weeks of sessions out of shame, which is the far more common and far more costly response.
How the work goes
Honesty costs you nothing here. That is the whole design.
Get the real picture
An honest, unhurried account of what use actually looks like, without minimising and without catastrophising. This alone often shifts something.
Find out what it is doing
Sleep, anxiety, social ease, grief, boredom, pain. Naming the function tells us what has to be replaced before anything can be removed.
Choose your own goal
Stopping, cutting back, changing the setting, or making it safer. The goal can change over time and often does.
Build the alternative first
Other ways to do the job the substance was doing, put in place before the substance goes, which is the difference between change that holds and change that does not.
Questions
What people ask before starting.
Do I have to be sober to start therapy with you?
No. Turning up under the influence is not workable for a session, but you do not need to have stopped, cut down or decided anything before we begin. Many people start therapy precisely because they cannot work out what they want to do about it.
Is this a substitute for rehab or a programme?
No, and I will say clearly when a higher level of care is indicated. Weekly therapy works well alongside intensive outpatient programmes and recovery communities, and it is not a replacement for medical detox where that is needed.
What if I am in a twelve step programme already?
That works alongside this without conflict. I have clients who are deeply involved in twelve step communities and clients for whom that framework does not fit, and I will not push you towards or away from either.
Will you tell anyone?
Confidentiality applies with the standard New York exceptions, which I will explain in full before you disclose anything. Substance use in itself is not one of those exceptions.
Also here
Related work.
Individual Psychotherapy
Weekly one to one work that goes past coping strategies and into the patterns underneath them.
Read moreTrauma Therapy
For single incident trauma and for the long slow kind that came from growing up somewhere unsafe.
Read moreAnxiety & Depression
When the alarm never fully switches off, or when nothing has felt like anything in months.
Read moreReady to bring yourself in the most self loving way
A first conversation costs nothing and commits you to nothing. Fifteen minutes on the phone is usually enough to tell whether we are a fit.