The Empty Chair Tecnique in the treatment of Substance Abuse

• Gestalt Therapy and Mental Health Care: Part 1 by Brian O'Neill, 11/3/96
  • Substance Abuse Therapy in Community Mental Health Centers by J. Richard White, 11/24/96
    • The Gestalt approach in Substance Abuse by Brian O'Neill, 12/5/96
      
      

Frederick S. Perls, the founder of Gestalt Therapy, used what he called the "Empty Chair" technique to integrate fragmented parts of the personality. One of the main difficulties with the disease of addiction is the lack of integrity in the personality do the the denial proccess. It seems generally agreed that much human problem behavior is learned, and that psychotherapy is essntiallly a reeducation or relearning process. But this is not classroom learning; it is active behavioral learning. What is rrequired is doing something different, like practicing a better golf swing at a golf clinic. The addicted personality is a deeply conflicted, fragmented, self deceived, isolated person filled with fear, remorse, guilt, resentment, self pity, and contempt.

For the past ten years I have been facilitating what I have called the "Empty Chair Group" in a residential treatment center. In the group setting two chairs are placed in the center of the room, with the clients sitting in a circle around the chairs. Clients are asked to articulate the part of themselves that wants to recover in one chair and the part of themselves that wants to continue drug or alcohol use in the other. In other words they are asked to present a dialogue between these two conflicting parts of themselves by first sitting is one chair and then moving to the other chair to reply. Frequently, probably because of compliance to the peer pressure in the treatment center, or because of anger over the circumstances of coming to treatment, the part of the client that wants to recover expresses anger at the addict or alcoholic, and tells him to leave him alone, get out of his life, etc. If only it were that simple. The client is allowed to complete this interaction and then is asked how many times he has said this to himself, and if it has done any good. Most clients actually experience just how powerless they have been over drugs at this time, and the experience can be very powerful. In this way clients are given an opportunity to practice the first three principles (Steps) of the twelve steps of recovery while having a dialogue between the two conflicting motives. They are encouraged to actually take the action while in the chairs. For instance, once they have experienced their powerlessness over addiction, they are encouraged to ask the group for help.

Clients are told that recovery is a battle between the part of them that wants to recover and the part of them that wants to contuinue to use, and that the only way that the part of them that wants to recover can win is to surrender and admit complete defeat over the addictive proccess or the alcoholic inside of them (Step 1). This clears the way for them to ask for help (Step 2), since most recovering people will not ask for help until and unless they realize that they can't recover on their own. Thus the clients have an opportunity to experience the paradox of winning by giving up: admitting personal powerlessness (Step 1), and then asking for help (Step2). During this process the self deception that has locked the addictive behavior in place is exposed, and the escape-avoidance behavior that has kept the person isolated is broken through.

It seems generally agreed now that didactic information from educational classes has very low retention, and very little impact on behavioral change. This is the reason I am so excited about a treatment plan that includes the actual practice of recovery principles in it. Clients who practice this giving up and getting help process many times before they leave treatment have a much better chance of maintaining their recovery because they will have practiced the first 2 Step many times before leaving treatment.

For more information contact me at: ab0ge@train.missouri.org

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