Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

Individual PsychodynamicPsychotherapyCHAPTER 21LANCE M. DODESEDWARD J. KHANTZIANIndividual psychotherapy is widely used in treatment of addicts, though it isperhaps still underappreciated in comparison with group modalities, includingself-help groups. Many addicts benefit from a combination of simultaneousindividual and group treatments, and some require the individual psychotherapyto be able to remain with other treatments (Khantzian, 1986). Furthermore,a significant number cannot, or choose not to, make use of other treatment andcan only be treated successfully with individual psychotherapy. This chapterrearticulates and extends ideas that we and others have developed previously,based on our understanding and treatment experience with addicted individualsover many years (Dodes, 1984, 1988, 1990, 1996, 2002, 2003; Dodes &Khantzian, 1991; Flores, 2004; Kaufman, 1994; Khantzian, 1980, 1986, 1995,1999a, 1999b, 2001, 2003; Khantzian, Dodes, & Brehm, 2005; Walant, 1995).The rationale for individual psychotherapy with addicts arises from anunderstanding of the psychological factors that contribute to addiction. Contemporarypsychodynamic formulations stress the role of conflict, the objectmeaning of alcohol or drugs, deficits and dysfunctions in ego functioning, andnarcissistic deficits as important factors in reliance on substances (Dodes &Khantzian, 1991). These deficits and dysfunctions result in self-regulationdisturbances involving affects, self-esteem maintenance, and the capacity forself-care and self–other relations. These areas of psychological vulnerability ordysfunction contribute significantly to addictions and are targeted in psychotherapy(Khantzian, 1986, 1995, 1999b, 2001).457