Harm reduction and self psychology in tandem: A case of crystal meth addiction

ABSTRACT

This paper shows the theoretical similarities between Harm Reduction Psychotherapy and Heinz Kohut’s Self Psychology, and delineates how each of these clinical perspectives complement and enhance one another. Using these two theories in tandem provides further opportunities for clinicians to treat a larger proportion of the substance using population not yet ready for cessation or abstinence. A case involving crystal meth addiction is presented, and aspects of the treatment are explicated including identifying the self-regulatory and symbolic functionality of substance use, and working with the patient’s own ambivalence about his behavior. A self- object “twinship” is also highlighted as having an important mutative impact on the treatment.

KEYWORDS:

• Addiction
• crystal methamphetamine
• Harm Reduction
• self psychology
• substance use

Acknowledgments

The author would like to acknowledge the gracious and scholarly editorial assistance of Heidi Mastrogiovanni, Peter Kaufmann, George Hagman, and Heather Ferguson.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ Harm Reduction training requires therapists to become aware of their biases around what substances create more alarm for them than others. In order for the therapist to be able to provide the requisite self-object experience for their substance using patients, they must become assiduously aware of any strong countertransference they might be experiencing around which substance and self-harming behaviors are most evocative for them.

² What visions did I have in my mind’s eye about meth users? Were they all wizened, toothless people with open sores on their faces? Did they all live in drug dens? The images I harbored were nothing resembling the way Ted presented. Ted was well dressed, intelligent, relatively healthy, and ran a successful business.

Additional information

Notes on contributors

D. Bradley Jones

D. Bradley Jones, Psy.D., LCSW is a graduate of two psychoanalytic institutes: The Institute for the Psychoanalytic Study of Subjectivity (IPSS) in NYC, and The Institute for Contemporary Psychoanalysis (ICP/LA) in Los Angeles, CA. He is a Supervising Training Analyst and faculty at both institutes, and enjoys promoting the IPSS Explorations Lecture Series. In private practice for over 25 years now, Bradley has a special interest in working with substance use and mis-use, people in the performing arts, and polyamory. He has published articles found in the journal Psychoanalysis, Self, Context and Psychoanalytic Inquiry.