Working with addictions and compulsions

Carol A. Butler

It is challenging to modify compulsive or addictive behavior on your own or even with the help of a therapist or a program, and it may be useful to think about the differences between compulsive and addictive behavior in order to work towards change.  

People who engage in compulsive behavior usually recognize it as absurd and irrational, and they feel bad about it before, during, and after engaging in the behavior. Examples of compulsive behavior are feeling you must repeatedly check to see if you locked the door or turned off the stove or wash your hands, or identifying as a “neat freak”.  They are aware they are out of control in this aspect of their life.

Active addictive behavior, in contrast, usually occurs in an altered, less-than-rational state (sometimes described as a trance state or a delusional state), where a person feels they aren’t out of control, they can handle it, won’t overdo it, are just trying to get relief or escape discomfort. Once the addictive behavior is triggered the person is on a slippery slope, and turning back is unlikely without the tools of recovery. After a binge there may be feelings of remorse, shame, guilt, and anxiety, but those feelings fade when the person is triggered again.

Recovery from addiction begins with learning to recognize your triggers and having ways to help yourself avoid that slippery slope.  Compulsive behavior can be modified but addictive behavior usually needs to stop. Harm reduction programs try to modify addictive behavior but in my experience they are usually not effective after the initial excitement about the notion of being able to keep your addition but not letting it get out of control.  

There is a reason the 12-step programs’ focus on sobriety and community has proved to be effective for many people.  My goal is to be part of the community around the addict who is trying to live a healthy life.

My job as a therapist

I am always learning from people who come to me for help.  I feel my job as a therapist has two components. I want to help people analyze and understand the reasons they feel and act the way they do, but I also want to work with them to change behaviors that they cannot modify by insight alone. Patients sometimes remark that I am “practical”, and I feel OK about that; I understand they aren’t expecting it from a psychodynamic therapist.  

I realized early on that my psychoanalytic psychotherapy training had not addressed sexual issues other than the Oedipal complex, and I felt frustrated and unprepared when patients expected me to help them overcome their inability to have an orgasm or to sustain an erection. When I heard about the groundbreaking work Masters and Johnson were doing in understanding and treating people with erectile and orgasmic dysfunctions I arranged to join them in St. Louis for advanced training. Similarly, I realized I didn’t know how to help people overcome addictions, and that led to advanced training and work in rehabs, teaching, and clinical supervision with a focus on sex addiction and survivors of sexual abuse.  

I am committed to helping people make changes and learn to feel good about themselves so they can enjoy life and make every effort to attain their goals.