Were decades of psychoanalysis enough to cure Woody Allen’s angst? Long-term psychotherapy seems to be on the decline these days – staying on the couch for more than five or six years is extreme, but many patients have a hard time saying goodbye to their therapist. Often in therapy, the patient feels cared for and safe, and there is anxiety about leaving this nurturing relationship. Many feel a lingering fear that if they were out on their own, they couldn’t hold it together. Their emotional discomfort, relationship struggles and other symptoms would recur, and they’d feel like a failure crawling back to the couch.
A related phenomenon is the occasional “therapy hopper” – patients who jump from doctor to doctor – perhaps enjoying the thrill of the initial meetings and early sessions of psychotherapy. Often such people are afraid to delve deeper into their own emotional life and flee before the feelings get too intense.
In one of the unusual cases I describe in “The Naked Lady Who Stood on Her Head: A Psychiatrist’s Stories of His Most Bizarre Cases,” the patient appeared to have addiction issues – not to alcohol and drugs, but first to food and then to shopping. After what appeared to be successful therapy for her impulsive purchasing, along with the help of a 12-step debtors anonymous program, I by chance discovered that she had begun regular psychotherapy sessions on the sly with a colleague, while continuing to work each week with me. After confronting her, she admitted that her she craved the thrill she felt when she experienced those moments of insight with me, especially when she realized that her addiction had shifted from eating to shopping. As much as she tried, the thrill of therapy was gone so she moved on. I had heard of serial addictions. People who kick one habit have a tendency toward addiction so they take on a new form of addiction. The thrill-seeking patterns are the same, but the objects of desire change.
Whether people are addicted to substances, such as alcohol or drugs, or processes, such as gambling, sex, work or spending, they suffer similar symptoms. They become preoccupied with the experience, develop tolerance and crave higher doses, have difficulty avoiding the experience, and have withdrawal symptoms when they can get what they want. Often they conceal their addictive behaviors and are attempting to escape or avoid uncomfortable feelings. Not all experts agree whether some of these behaviors represent true addictions or just obsessive-compulsive behaviors. For example, work groups for the new Diagnostic and Statistical Manual of Mental Disorders (DSM-V) have argued that there is insufficient evidence to include Internet or as a category.
Whether we call it an obsession or an addiction, overlapping brain circuits that control pleasure-seeking are involved when people give up one addiction only to substitute another, and we know that these behaviors disrupt people’s lives. When patients shift from one form of addiction to another, the problem can elude friends, family members and professionals.
Most specialists are aware of addiction-switching, but can someone really get hooked on therapy or develop a serial therapy addiction? What do you think?
See my new book, “The Naked Lady Who Stood on Her Head: A Psychiatrist’s Stories of His Most Bizarre Cases.”
Copyright Gary Small, M.D.