The therapeutic process aims at the transformation of the addict, the extremely estranged individual to a social subject. This process takes place in the therapeutic context, with the aid of psychotherapy and Art. The text stresses the poetic function of psychotherapy and the role of Art, as a dynamic factor of change.
**Key Words: ** treatment of addiction, subjectivation, psychotherapy, Art, emancipation
Dependency on an object (drugs, gambling, internet, etc) has a psychic dimension in that it alleviates a painful tension which stems from psychic instability and deficient psychological functions. Underlying the use of a substance is the search for intense sensations to face the internal void whose experience is unbearably painful. This void stems from the absence of internal objects and the difficulty to meet with the “Other”. Difficulty in communication, extreme estrangement, the terror of absolute loneliness drive this highly vulnerable person to seek an escape from this unbearable reality as he/she experiences it, to find refuge in drugs as a “Paradoxical Coping Strategy”.
The individual plays with death in order to tolerate life. By using drugs, the person often loses his life in a desperate attempt not to die but to survive.
From this perspective, meeting the demand of life intertwines with the metamorphosis of this extremely alienated and miserable person to a “Social Subject”, because in drug addiction the “Nostalgia of the lost subject” is depicted in a most tragic way. Hence drug rehabilitation can only become a process of subjectivation for regaining the lost subjectivity by opening up to the “Other”.
Subjectivity builds upon the symbolic, its verbal and non-verbal expression, which mediates in all human relations. “The coherence of human subjectivity is inscribed in the triple paradox of “physicality”, “chronicity” and the existence in the world, of intersubjectivity”. The term “physicality” refers to keeping a balance between being-your-body (body-subject), like an animal, and owning-a-body (body-carrier), which you use as a tool without merging yourself with it.
“Chronicity” refers to the reconciliation between duration and change one of the self, which allows you to be at all times something more than what you were before and something less than what you are going to be later, therefore to have a a biography and a personal story, something which neither things nor animals possess.
Finally, the term “to live in the world”, to experience the paradox of relations with the “Other” in a system of culture, means a partial mutual exchange of intersubjectivity that allows you to be the other, to put yourself in the position of the other but without merging with the other.
Subjectivity cannot be taken for granted — it has to be conquered. As F. Guattari says, the rise of subjectivity relates to personal and collective factors. The latter include the social, language, symbolisms, emotions and the individual.
The process of subjectivation, i.e. of conquering subjectivity, allows the processing of the psychic traumas of this prematurely and repeatedly injured person, who was later marginalized as an addict and was socially excluded.
When a person joins in a therapeutic framework, it is the first act of joining a peer group. In this group relations based on communication will develop among the members. Everybody who is involved and is part of the therapeutic process and framework belongs to the “peer’ group. Within this framework, one-on-one psychotherapy and group therapy takes place. The foundation of therapy is group psychotherapy, art therapy and psycho-educational groups.
Psychotherapy is the tool for the mediation of the social with the personal and vice–versa, tracking down the reasons that affected on many levels, the relationship of the person with his environment — the nuclear, or that of family, and the more extended one of society. These reasons shaped the psychic deficit of the person and established the substance as the “connective material” in her internal voids. This exploration of the psyche must follow the dialectic path as a process which includes the before and after, viewing the past as history and the future as possibilities, while looking also into the interrelation of the before and after of their life stories on many levels. It is on this “before” stage, before the onset of the addiction, that the psychotherapist of addiction must focus his/her therapeutic interventions. These interventions, because of their aim to change the way of relating and comprehending, can only be of a psychotherapeutic nature. And this is where the necessity of psychotherapy arises in rehabilitation treatment.
The term “rehabilitation treatment” does not mean to prolong the addiction through administering substitutes. The latter is a coping method based on the principle of “harm reduction”. Harm Reduction doesn’t constitute “therapy” in the strict sense of the term, for all the relevant claims by a number of scientists and policy-makers.
Rehabilitation Treatment is a process of constant change of the dependent person, her psychological functions and her overall attitude toward life. Therapy becomes a life experience which includes the element of creativity at all times.
In essence, therapy is the dependent person’s commitment to embark on a radical life-changing adventure.
It is of great importance for the dependent person, who has a very delicate substrate and major narcissistic deficits, to establish those terms that will allow him to face his internal insecurity without finding refuge to his ordinary mechanisms of possession and control of his external object, his substance, and without developing those familiar negative behaviors that sabotage his potential.
Within a therapeutic framework, in this new field of relationships with people with whom he “shares his life”, the person has the chance to reexamine the internal field of his relationships in the light of today and establish external and internal relations on new grounds and in the form of a dialectic spiral.
Through the psychotherapeutic process, which plays an essential part in rehabilitation treatment, the indivisual will be able to function not only through speech, in the context of conventional psychotherapy, but also through art, drama, music, dance-movement, etc. in the context of mediated forms of therapy.
What is important is the analysis of the psychic functions that are jeopardized in this specific person because these functions can be easily “forgotten” behind a behavioristic aspect. Addicts embody fixation on feelings, emotions, shock, the memory of insult (hybris) but also on the abolition of all of them in a dimension where language becomes limited to a few words; what dominates is possession and control of the other, the substance. Addiction as an act, the repetitive nature of usage doesn’t require anything more than words of need, the poor vocabulary of a user’s transaction; indeed, drug addiction could be described as the “algebra of need”. In the words of Jean Oury, an important psychiatrist of the famous La Borde Clinic, “in addiction it seems to be an avoidance of language”.[5A]
The process of rehabilitation treatment aims to introduce this person to the field of language and the desire of making him capable of expressing himself with words; to come out from the realm of need where his addiction keeps him bound. To make him capable to articulate his psychic affliction that remained unspoken until now. Through the process of therapy he will attain the psychic means that can give meaning to his experiences. Verbal communication is now expressed in the context of a psychotherapeutic dialogue where the poetic function of psychotherapy meets the poetic function of language. This verbal communication, at first fragmented, maybe without syntax, full of gaps and repetitiveness which later becomes more coherent, the psychotherapist has to analyze so she can get to know her person in treatment better and help him reconstruct his personality. Through the therapeutic relation which develops between the two, all psychotherapeutic interventions acquire a meaning. The relationship itself, which has an essential importance for psychotherapy, always contains some meanings that the therapist must grasp and interpret in order to determine the next steps of the therapeutic process, with respect to the person in treatment. Rehabilitation treatment should stand out for its originality. “The particularity of rehabilitation treatment lies upon the element of improvisation, i.e. originality”. If therapy becomes a routine it can have devastating consequences, because it reintroduces to the addict the routine of the old way of life in substances and the deadly repetition of the old way of life.
The Poetic Function of Psychotherapy
Psychotherapy should motivate the person, pose questions and seek answers. This is the reason why the psychotherapist must listen carefully to the words of the person in treatment and intervene with flexibility, discretion, inspiration and an open mind.
As the great Catalonian psychiatrist Tosquelles says: “In the psychotherapeutic process, we listen attentively to the verbal communication of the other following, mainly, the paths which the poetic function of language never omits to track…The psychotherapeutic dialogue seems very different from the ordinary and common life dialogue, it is a dialogue that resembles the one the poet tends to share with his audience (to recite the poem)…We can, of course decide to intervene or not in this open form dialogue. Interventions that are handled with modesty and with exact techniques facilitate the speaker to override the obstacles that he meets and among which he sometimes loses himself”.
When psychotherapy is used as a tool, the forces of change get in motion. Change relates to the person’s psychic functions, to the defense mechanisms that he utilizes, the way he thinks, speaks, expresses his feelings, acts, relates and organizes his life.
Psychotherapy and Art
Through the process of rehabilitation, where the basic pillars are psychotherapy (one-on-one or in groups), art and psycho-education (in different kinds of groups) as well as the participation in social life (during the last phase of therapy) the person in treatment becomes able to accept herself and the other, create relations of communication and t function collectively, express her feelings, develop her creativity, reinforce her self-esteem, fill her internal voids, discover new ways of satisfaction, expand her spiritual horizons; finally, to rebuild a new psycho-social identity and redefine a new way of life, without substances, no escape-exits, with values and goals, in other words to discover the poetic side of life.
What's more, all the work accomplished within the therapeutic context of rehabilitation treatment via psychotherapy, art-therapy, psycho-education and all kinds of events contributes to the actualization of the basic target of therapy which Foucaultdefines as “custody of self”. This context contributes to the metamorphosis of the person in treatment through enrolment in two fields in which it was impossible for the addict to function before. These are the fields of intersubjectivity, i.e. the field of sociability, the relation with the other, and the field of chronicity — that of boundaries of time and place in a framework, in the here and now. The work produced in the framework refers always to the internal psychic space of the person and at the same time to the interpsychic space of the group. This dialectic relationship of the intrapsychic-interpsychic provides valuable material that can be processed by the group, giving extra boost to the psychotherapeutic process.
Within the therapeutic framework, art therapy groups function as a complement to classic psychotherapy. In art therapy groups the person can be introduced to the process of symbolism, necessary for his enrollment in the world of culture. In the art therapy group the person can express himself artistically and create his piece of art. With this piece of art he can express his feelings in a picture, with a sculpture, through photography, dance/movement, and drama, because creativity is innate in all human beings, as Winnicot suggests. “It is a way of comprehension that gives the individual the feeling that life is worth living”.
Art constitutes a calling for the new, the higher, the universal. Through this calling the person in treatment gets acquainted with the continuity of human history and conquers the feeling of continuation, identity and overall existence, overcoming in a dialectic way the feeling of discontinuity and fragmentation that define the identity of the dependent.
From this point of view Art is not simply a tool with therapeutic properties but a dynamic factor of change, of conflict with the old, the mundane, the status quo; it becomes a factor of emancipation, finally, a revolutionary one. It is a voyage in a world of emotion, knowledge where the ephemeral becomes timeless and individuality becomes collectivity and universality. Art therapy, along with psychotherapy in a dialectic relation, makes a valuable instrument for rebuilding a new identity, transforming the individual to a social being, capable of living without substances and running away, capable of seizing his destiny, capable of planning a life with a future, able to utilize with inspiration the poetry of creativity at all levels.
-  G. Pirlot “Psychanalyse des Addiction”, ed. Armand Colin, 2009, p. 30-34.
-  A. Ehrenberg “The Fatigue of being yourself. Depression and Society” Editions of the Twenty First, 2013 p.257
-  T. Bottai, L. Cotton “Création artistique, pathologie mentale et traitements psychotropes. Antinomies?” Revue supplement à Nervure, Journal de Psychiatrie. Tome XVII, No 5, Juin 2004.
-  F. Guattari “Three Ecologies” Greek ed. Alexandria, 1991, p. 53.
- ,[5A] Jean – Louis Chassaing “Drogue et langage” ed. érès, 2011, p. 278-279.
-  Michelle Kunz “Les toxicomanes” ed. L’ Harmattan, 1998, p. 206-207.
-  François Tosquelles “Fonction poétique et psychothérapie” ed. Érès, 2003, p. 15. F. Tosquelles was the Director of St. Alban Clinic. He sought refuge in France during the Spanish Civil War. He was a close colleague of Jean Oury, Director of the La Borde Clinic, whom he considered as the most important representative of “Institutional Psychotherapy”, which is based on Freud and Marxism. For more details, see the very interesting tribute at the “Synapsis” journal, no 34. 2014, vol 10, “Institutional Psychotherapy”
-  See no 5, p. 281
-  D. Winnicot “Jeu et réalité” Folio essays, 1975.