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Separation of drug addicts from these substances during treatment has several implications on the general wellbeing of the same. It is because addicts' dependence on the drugs is very high and in most instances, they can hardly function without the influence of drugs. However, in order to function executively, independence from drugs and alcohol is of essence. The separation process is characterized by shame, rage, fear and many other factors that undermine the total recovery of the addicts. Studies conducted show that the process of mourning is fundamental because it enhances the release of the negative feelings that inhibit recovery. Indeed, mourning according to psychoanalysts enables the addicts to let go of the destructive relationships that they have with the drugs and establish constructive and productive viable relationships with human beings. In order to achieve this, it has been identified that spirituality plays a very fundamental role.
This concept means different things to different people but essentially, it has been contended that the influence of the Supreme Being enhances change in character. At this point in time, it is worth noting that change forms the background of the recovery process. Specifically, spirituality helps in the construction and reconstruction of personal narratives in the contexts of the purpose and meaning of the addicts' life. It is n this consideration that this literature review provides an in depth analysis of the role of spirituality in substance abuse and the recovery of drug addicts. To enhance effective coherence of in the review, it is organized in subsections that exhaustively evaluate particularistic aspects of the theoretical construct of the subject under review, psychodynamic perspectives on addiction, psychodynamic perspectives on mourning, p psychodynamic perspectives on rage, the concept of spirituality and its role in the recovery process, how spirituality can be employed in the construction of narratives, the application of the multiple code theory on mourning and the impact of rage and shame on the mourning process and ultimate recovery of the addicts.
General theory of affect
Object relations theory
Over time, the objects relations theory has gained popularity because of the fact that its application plays a fundamental role in psychoanalysis. The theory explicitly explores the active course of mind development as an individual grows and the influence of the different 'real others' that are found in that particular environment (Masterson, 1998). The term 'object' in this regard refers to the physical others as well as the others that are imagined. All these are found in a person's holistic environment and influence growth in different ways. Ogden (1990) indicates that an individual's rapports with the various objects are often initiated during the childhood interactions that an infant has with a care giver, the mother or any other individual that the infant shares a close relation with. Studies conducted in this regard show that these early interactions can be modified and improved through time due to the different experiences that an individual goes through (Grostein (1981). However, despite the modification, Klein (1962) affirms that the early interactions have a permanent effect on a person's psychological wellbeing.
The infant usually interacts with and understands different objects differently in accordance with their functions and implications in its life. These are referred to by Ogden (1990) as part or whole objects. For example, he explains that the breast that provides milk and satisfies the infant when it is hungry is perceived as the good breast by the infant. However, one that does not contain milk and is of little help to the infant when it is hungry assumes a bad breast relationship. During this time, the infant is often subjective and sensitive to the different implications of the objects in its life. Moreover, it is from these relationships that the infant starts to internalize certain objects and develops a sense of imagination. As such it can fantasize about certain objects and develop an image of the same in the mind. According to Stephen (1997), these internal objects may be a direct representation of the real external ones, or may not. The presence of an ideal aiding environment results into the ultimate transformation of the part objects in to whole. To this end, the infant can then be able to accept the ambiguity and complexity of the whole objects (Gunstrip, 1995). For example, the infant will be in position to realize that both the bad and good breasts are part of the mother.
Fairbairn's contributes to this subject and contends that the parents are the first individuals that the infant develops a relationship with because of the personal relationship that the infant shares with them (Fairbairn, 1952). The various interactions with the parents lead to the development of a special bond which further strengthens the attachment between the parents and the infant. According to Fairbairn, the future emotional experiences of the child are highly influenced by the emotional relationship that the child enjoys with the parents during infancy. To this end, he asserts that the libidinal objects that the child develops at infancy determine later relationships with others.
With regard to the relationship with the internal objects, Fairbairn asserts that effective parenting results in to the development of holistic individuals that can maintain a good relationship with real others through interactions. On the other hand, defective parenting produces children whose interactions with real individuals are relatively superficial and therefore defective. In this respect, instead of valuing actual relationships with real people, these children fantasize private relationships with the internal objects and in most instances live in their imagined world. In order to nurture socially acceptable individuals, it is important that parents provide a good environment for holistic growth during infancy.
Fairbairn (1952) also argues that in cases where the parents are missing, the infant's mind internalizes the unresponsive (bad) aspects of its parents and visualizes the aspects as forming part of it due to the fact that the aspects are not actually available. He refers to this as the splitting ego effect. For instance, in cases where the mother of the infant is stressed but renounces this state, the child identifies with this state because s/he may be unable to establish a complete relationship with the mother during this period. As a result, the infant becomes stressed, not because of any external influence, but because of the fact that it can not effectively relate with the mother and the mother has denied the condition.
In his study, Winnicott shows that a child develops from an integrated condition to a distinct status from which s/he can be able to identify and relate with the objective world (Roadman, 2003). He asserts that the early environment, possibly provided by the mother provides an important basement upon which the future of the child is anchored. However, in order to attain a satisfactory level of development that is essential for survival, Winnicot argues that the child should be able to perceive the mother as neither a good nor bad object but rather an independent and complex individual who lives an independent life. This then helps the child to understand and acknowledge the contributions of the mother in his or her life. Generally, the propositions of Winnicott presented through his exploration of the development process create a good enough mother who is characterized by patience and tolerance. Thus in order to understand the patients well during therapy, he suggests that the medical practitioners should assume the ideal qualities of good enough mother and provide the best environment for the patient t recuperate.
The drive theory
This theory is based on the conception that human beings are born with certain structural expectations. Studies show that failure to fulfill these expectations results in to a state of anxiety which is basically destructive. Ogden (2005) explains that it is because anxiety leads to tensions that have adverse effects on the emotional wellbeing of human beings. However, when the expectations are met, the drive is then reduced and the being assumes a stable condition characterized by calm and relaxation. Proponents of this theory assert that drive often increases with time (Grostein, 1981).
With regard to psychoanalysis, the theoretical construct of drives is perceived to encompass different motivations and instincts which have distinct objects. Classic examples in this regard involve the drive in the direction or life (productivity and construction) and death (destruction). To this end, it is increasingly important that the therapists understand and appreciate the drives of their patients in order to derive the best approaches that they can utilize for effective recovery. For instance, by identifying the gaps and weaknesses in the provision of the expectations, timely interventions can be undertaken to avoid adverse effects.
The Inter-subjective theory of affect
This theory presumes than in order to address problems in an effective manner, there is need for an agreement between the differing parties (Carveth, 1994). A state of inter-subjectivity according to this theory is reached when the two or more differing parties agree on the same definition of a given condition even when they have different perceptions of the conflicting issue. Furthermore, the theory shows that inter-subjectivity plays a vital role in influencing our various ideas and relationships. To this end Atwood and Stolorow (1993) indicate that inter-subjectivity promotes peaceful conditions that are fundamental for human co-existence. Of particular importance according to them is the role of language in enhancing the state of inter-subjectivity. They assert that language enhances effective communication that enables the individuals to express themselves with ease and therefore reach a consensus quickly. According to this theory it is perceived public rather than private and is instrumental in initiating social relationships.
In light of modern psycho analysis, a study conducted by Carveth (1994) affirms that in order to attain inter subjectivity and enjoy its implications, it is important to forego the isolation that characterizes certain individuals. The myth of isolation to this end indicates that some individuals virtually exist on their own, independent of the world and other individuals. As such, they become vulnerable to the different forces and challenges that life presents. This vulnerability then culminates in to conditions of anxiety and anguish that in some instances becomes unbearable. It should be acknowledged that the state of anxiety highly inhibits effective emotional functioning of an individual.
To this effect, therapists recommend that patients are required to open up and involve third parties in making important decisions. In addition, when faced with any emotional and psychological problem, the patients should seek early interventions that can be readily provided by the persons that they are close to. This is instrumental in regulating the severity of the effect of mental problems to their wellbeing (Carveth, 1994). Basically, this theory shows that establishment of viable 'real' social relationships go a long way in avoiding psychological problems. It is because they give the patients a chance for relief during the early stages of their psychological anguish and relatively prevent situations of psychological breakdown and the associated mental difficulties.
The affect theory
Theorists in this regard contend that an affect refers to a sentiment or a feeling that is subjectively generated and is independent of any external influence. The affect theory is aimed at an organization of different affects in to distinct classes and provides a connection of each to a typical response. Often, the affect is internally felt but manifested externally through various expressions. Tomkins (1991) shows that all the affects can be easily recognized through different facial expressions that stem from a stimulus. For instance, the affect of pain or discontent can be easily identified through the act of frowning. On the other hand, the affect of happiness is revealed through smiling. The nine affects as identified by this theory include joy, excitement, rage, disgust, fear, distress, dissmell, humiliation and surprise (Tomkins, 1991).
With regard to modern psychoanalysis, the positive affects are always prescribed to the patients as opposed to the negative affects that are discouraged. During therapy, Kelly (1996) asserts that affects should be properly utilized to give the intended effect. Furthermore, it is argued that affects play a vital role in initiating and maintaining intimate relations that are fundamental in psychotherapy and mental health on the whole. It is because they emphasize positive relationships towards a particular goal and discourage the negative relationships. The employment of affects is also fundamental due to the fact that they encourage the members that are seeking mental health and recovery to express affects to each other in order to identify the extent of the progress and make prescriptions accordingly (Tomkins, 1991).
In addition affects can be very important in describing to the mental health patients the goals and objectives that are supposed to be achieved in the course of therapy. These are employed during narrative of different events that aid in therapy. Setting of goals provides an impetus fro the patients to employ individual effort and achieve the expected results within the set timeframe. Tomkins (1991) shows that not only does this help the patients to save time and resources that are used in therapy, but it also improves their productivity.
Furthermore, the affects are also associated with Christianity. To this effect, it can not be disputed that Christianity plays an important role in regulating feelings of violence, anger and suffering. On the contrary, it encourages feelings of love, peace and enjoyment. By optimizing the use of affects, therapists encourage the patients to embrace religion and spirituality. Studies conducted after its inception affirms that the theory plays a vital role in enhancing the process of therapy and positive results have been attained from its usability. Of particular reference is the employment of spiritual values and virtues during recovery. Kelly (1996) indicates that these values provide a framework for sustainable recovery.
Psychodynamic perspective on addiction
This perspective was initiated by Dr, Freud and it has been in use for almost a full century now (Mitchel & Black, 1995). Its contention is based on the presumption that there exist some complexities with regard to the extensive and expansive world of behavior. To this end, it is assumed that the unconscious forces that are found within the human being are key influences of why we behave the way we do and why we involve ourselves in addictive behavior. In this respect, Isaac (1958) shows that through the various modes of interpretation of the traumatic experiences that children often experience and the difficulties that they face during development, in future; they derive different meanings and relations with particular events, specific individuals and certain activities. At this juncture, it should be appreciated that the severe internal conflicts often originate from a persons childhood and if interventions are not made in a timely manner, studies show that this can result into mental illness at later stages of the child's life.
According to Martin and Marcel (2008), this situation can happen because of the fact that these childhood conflicts have the ability to inhibit the effective growth and maturity of three structures which make up the human psyche. In their study, they show that these encompass the ID that initiates the sexual and force related drives, the ego that is found in the brain and provides reference between reality and unconsciousness and the super ego which provides control over the stimuli of the Id and symbolizes ethical ideals. Freud suggests that their recovery from this trap is determined by the extent of their understanding, their disentangling and their exposition of these instinctive forces, convictions and meanings (Priestly et al., 1998). Over time, this perception has undergone various changes that incline the key concepts to special adaptation, efforts to provide self medication for painful and unbearable emotions, a compulsive behavior and need for this self medication and an ultimate reflection of an abnormality in self organization.
The mental psychologists strongly believe that various mental issues result from the psychodynamic conflicts that can not be effectively addressed using the defense mechanism. In their study, Lende and Smith (2002) argue that often, employment of defense mechanisms as a response to the different conflicts provides a temporal internal satisfaction. However, Ornsten (2008) indicates that at the levels of the super ego and the id, this approach is ineffective and it is largely blamed for adoption of maladaptive behavior, which in most instances is addictive.
Likewise, other theorists have made enormous contributions to this field using more specific aspects of addictions. To this end, the psycho analytic contributions made by Glover with regard to drug addiction can be considered very invaluable on this body of knowledge. Other compulsive behaviors explored by this author include the prostitution and sadism. Specifically, he classified the different mental disorders and explored the mind development process and its implications on addiction and other compulsive and persistent behaviors (Martin & Marcel, 2008).
In his study, Sando Rado coined the word compulsion that is presently used to describe addictive behavior. According to him the addicts experienced pleasurable moments by use of specific pleasure centers found in the addicts brain that are sexual in nature (Priestly et al., 1998). From these reviews, the word compulsion has been widely used in the addiction studies. Additionally, he suggested that psychopathology was likely to be a cause of addiction rather than its preconception as a result of addiction.
Simmel in his study made so many contributions to the field of psychoanalysis and addictions. He pointed out that gambling is indeed an addiction because according to him, it is virtually an expression pleasure although it is also characterized by tension and fear (Lende & Smith, 2002). During adulthood, this is used to restrict feelings of guilt and anger. Priestly et al. (1998) argues that it is related to the failure to comprehend the meaning of socialization. According to Simmel, unlike winnings that can be really ecstatic, loosing implies restriction of parental affection.
Leon Wumser is yet another psychoanalytic who made significant contribution to the field of addiction. He particularly explored drug addiction and contented that this is influenced by intense inner conflicts of a being, family diseases and disturbances that are faced in the course of development. He presumes that addiction to drugs occurs because usually, the user adopts them as a defense mechanism against what he terms as undesirable internal and external reality. In his study, he also explores the relationship between addiction and phobia and shows that the two, despite being compulsive, are parallel to each other. He also points out that according to his field research, most of the drug addicts were maltreated when still young (Martin & Marcel, 2008). They then suppressed these feelings at that particular time and find it difficult to face the feelings during later stages of their lives. This makes them to assume addiction as a temporal comfort zone for them, away from the fears of the urge to experience the painful childhood feelings.
Henry Krystal then explored the psychoanalysis of alcohol addiction with regard to the relationship of the addict and the object. To this end, he indicates that often, the drug addict wishes to reconnect with an ideal object and dreads it at the same time (Ornsten, 2008). As a result, he assumes fantasy and drama and can not be separated from the addictive substance. Thus particular functions that are meant for perpetuating nurturance are inhibited and instead reserved in order to act as a representative of the object. This knowledge shows that the role of therapy in this is to enable the patient to expand the conscious of self recognition to his entire self. According to Kystal, this frees him from the urge to use the drug which then enables the patient to have access to the parts and functions that were initially isolated.
Khantzian also explored the concepts of self, ego and opiate addiction and proposed that addictions often occur because the addict fails to asses his or her self and the different situations that s/he experiences. As such, the addict fails to caution and protect the self against the dangers by involving in dangerous activities. It is because of the fact that initially, he or she failed to differentiate between the destructive and constructive activities ad make efforts to putting place measures. To this end, he argues that the therapy should aim at effectively addressing the hidden psychopathology and other behavioral defects. In order to achieve this, Khantian suggests that the addict should gain full control over his or her feelings and destructive behavior. It is because the ability to effectively address this lies in the inner self of the patient. To this end, it can be argued that despite the fact that the therapist's help enhances recovery; the patient is the one to make the ultimate choice regarding the recovery from addiction.
Greenspan then develops a comprehensive model that fuses the developmental process and substance abuse in an effort to understand how each affects the other (Priestly, et al., 1998). In his study, he explores the different patterns of substance abuse and resultant addictions. He further argues that in order for the treatment to yield satisfactory results, it is important to understand the patterns and internalize the relationship between the inner and outer self of the addict and how the same contribute to the state of addiction. According to him, this is essential due to the fact that in most instances, addicts pretend and they may quit treatment before their internal problems are fully addressed.
Bernard Brickman argues that the traditional approaches to psychoanalysis did not effectively affect addictions. He supported this presumption using different studies and researches. He challenged the basic psychoanalysis assumptions with regard to psychoanalytic pathology (Lende & Smith, 2002). It is in this consideration that he proposed a holistic approach that is supported by various studies undertaken in other related disciplines like genetics and physiology amongst others. In general he recommended that abstinence should be the first intervention and should be taken during the early stages of addiction. According to him, this is a requirement for satisfactory analytic therapy. Additionally, he emphasizes that mutual help groups like alcohol anonymous play a critical role in the recovery of addicts.
Finally, Norman Zinberg contributes to this body of knowledge by highlighting that the physical and social environment of the addict also contributes in different ways to these conditions. His theory starts by acknowledging the fact that the attitude and overall personality of the user play primary roles in contributing to the condition. These propositions are very important during therapy in that the conditions in the hospital greatly differ from the home environment. According to him, these have different implications on the process of recovery. Generally, he contends that social factors including the social construct of the addictive practice contributes to different patterns regarding addiction. For instance, he indicates that in most societies, alcohol is associated with feasting and parties. To this end, frequent feasts and parties are likely to contribute to alcohol abuse.
Overall, he points out that therapy should adopt a multidimensional approach in order to realize optimal results (Martin & Marcel, 2008). He argues that despite the fact that behavioral change and drug administration play a vital role in the recovery process, external and independent aspects of the social and physical environment should also be given equal consideration.
The above reviews provide important insights about the psychological perception of addiction. To this effect, it can be ascertained that addiction is a multifaceted aspect and effective psychoanalysis is essential if effective treatment is to be given. Therapeutic efforts should also be complex in order to address all the aspects that impact upon the recovery process. Additionally, it is increasingly important for the psychological therapists to understand and appreciate the differing needs and requirements of their patients in order to provide customized services. Considering the fact that the patient's past has various implications on his or her present, practitioners should start by understanding the patient's past events and experiences. This forms the basement upon which successful psychotherapy is derived.
In addition, it should also be appreciated that the present society and life is characterized by stressful conditions and other forms of depressive events. It is in this consideration that this Ornsten (2008) suggests that the modern psychoanalysis should also put in to consideration the modern factors that lead to addictions. It is important that root causes of these factors that include economic, social and psychological difficulties are addressed in a timely and effective manner. This calls for integrated effort from all major stakeholders.
Psychodynamic perspectives of mourning
Mourning is a mental condition that is characterized by various processes and is triggered by a loss of an object that the individual has a great attachment to (Lerner, 1990). This takes some certain period of time that is depended upon the individual's capability to overcome it. The individual goes through various stages and when the process is over, s/he is completely separated from the lost object. The process is characterized by intense pain and denial of the reality but gradually, the individual attains a level of acceptance. Eventually, Field shows that the person succumbs to the changes, accepts the loss and initiates new relationships with other objects (1999).
The grief that occurs as a result of mourning has various emotional and psychological implications to the person that is mourning. Essentially, the different stages of the mourning process that contribute significantly to the theoretical framework of mourning were discussed in detail by Bowlby. These were based upon the observations made to the infants when the mother's presence was missing. The first phase according to this study includes numbing and is often characterized by painful feelings of distress (Berry, 2008). The feelings if not controlled may result in to psychological or mental breakdown. The individual may engage in certain activities that are physical in nature in an effort to express these feelings. Common activities include screaming, wailing and crying amongst others.
After this, the person that is mourning goes into a stage of yearning and looking for the missing individuals or objects. This happens because of the feelings of denial due to the fact that the loss could have been unexpected. The stage is still characterized by feelings of sadness and refusal of the loss. Usually, Lerner (1990) indicates that the individuals at this stage still hope that the lost object will at some time return to them. During this stage, the person is still susceptible to the external information about the lost object.
The third phase is then characterized by despair and lack of organization. This happens because of the inability of the lost object or person to return. It indicates the beginning of hopelessness and acceptance (Field, 1990). The fact that the lost object is not likely to return to the person makes the person confused and disorganized in various ways. In addition, the individuals' affirmation that he relationship shared with the lost person is also lost contributes to the disorganization.
Finally, the stage of increased or reduced reorganizations follows. This according to Bowlby is depended on the person's ability to appreciate the loss incurred. According to him, if the person fails to fully acknowledge the loss, s/he is unlikely to be organized during this stage. On the contrary, persons that perceive the loss as positive and part of the change process are often organized during this stage.
According to Bowlby, the time taken during the whole process and the sequence of the phases differ considerably from one individual to another. It is because various individuals posses different capabilities to deal with the loss and overcome it accordingly. In addition, the resources available during the mourning process also influence the period of time that an individual takes during mourning. In this respect, Berry (2008) argues that availability of resources such as therapy hastens the mourning process. Generally, the mourners' movement through the process as described by Bowlby is oscillatory- forward and backward movement.
This study was based upon the principles of psychodynamic analysis that highly utilizes the role of emotion in the recovery of mental health. To this end, Freud argued that grief was important because of the fact that it enabled the person mourning to dispel painful feelings and detach from the given loss. This is important because the person then has a chance to realize his or her potential with regard to psychological resources. To this end, it is suggested that longer periods of mourning are relatively beneficial to the emotional wellbeing of the individuals (Lerner, 1990). However, this contention has faced various changes with Field (1999) arguing that the propositions are not backed with empirical data. Field researches conducted by various psychologists in this regard show that the period of mourning has limited influence on the psychological wellbeing of different persons.
However, modern approach to the process of mourning appreciates the role of the child's environment. Additionally, the subjective reaction of the child to the process and the role of the third parties in enabling the child overcome the same are also acknowledged. While addressing the attachment theory, Boylby asserts that attachment as part of behavior mechanism that is fundamental for survival. Furthermore, with regard to grief and mourning, he indicates that these are disruptions that highly compromise the emotional stability of individuals. In addition, Field (1999) agues that disruptions in the relationships always occur due to insecurity as a result of lack of cooperation from parents. These complexities result in to depression and stress because of the feeling of failure experienced by the child. Further, the feelings are attributed to limited support from individuals who are supposed to offer the same.
Freud also did an extensive study regarding the psychodynamic aspects of mourning and ascertained that this state implied a real loss of person. He asserted that the process of mourning is part of melancholia and is pathological in nature. He showed that the feelings of accusations that are experienced during mourning are often directed towards the mourner, despite the fact that they are meant to be directed towards the lost person. To illustrate this, he gives the example of a loyal wife who rebukes herself after the loss of the husband on the pretext that she could have strayed in some way. According to Freud, this feeling should be directed towards the dead husband, who in this case is the cause of this, rather then the wife. At the end of the day, the wife is depressed by an imagined wrong.
Likewise, Klein's contribution to this course of study can also not be disregarded. She did extensive studies about depressive illness and suggested that in an ideal mourning situation, the initial stages are characterized be paranoid and suspicious anxieties. Their reactivation makes the mourner feel as though it is a punishment imposed on him or her. Because of immense pain, the mourner may loose some considerable level of emotional stability and goes in to a state that Klein refers to as depressive position. During this stage the person is not able to make personal decision and experiences extreme emotions that are either good or bad. To this effect, Klein argues that effective therapy usually targets providing a stable emotional condition that enables the mourner to make informed decisions and counter the pain experienced.
In his study, Winnicot takes a different approach by analyzing the implication of mourning to children. His findings were backed up by research carried out on thirty children whose pets died. To this end, the credibility of this study has been challenged by emergent researches that were carried out after Winnicots. The studies argued that the affection to the pets can not be compared by the affection that the children had on their parents. Generally, Winnicot contends that children do experience immense painful emotions when faced with any type of loss. He argues that this knowledge is essential as it shows the severity of the condition and enables the therapists to adopt most suitable and effective ways to address the same. Further, Winnicot asserts that loss leads to aggression of the mourner as a defense mechanism (Winnicot, 1974).
From the above review, the theorists affirm that the mourning process is a practice that individuals experience as a result of loss. It is characterized b various activities that in many ways enable the individuals to cope with the loss. As noted earlier, the ability to effectively overcome the loss is influences by various factors. In his study, Craib (1998) ascertains that various emergent studies have given the process an entirely new conception. Modern psychoanalysis in this regard shows that the mourning process is essential for healing and recovery. Hence psychotherapists should encourage the patients to boldly go through the process as failure to experience it has various adverse effects on the emotional wellbeing f the victims.
Psychodynamic perspectives on rage
Most studies undertaken in psychology affirm that rage can be very destructive and it should be avoided at all costs. It is because of the fact that it inhibits proper functioning of a person by initiating violence. Omstein (1999) indicates that extreme reactions of anger are caused by the numerous types of injuries done to the esteem of a person. It is also contributed to by disappointments from the people that are close to the person during childhood. These people in most cases have a significant degree of influence to the child's self esteem. They include the mothers, care takers and important others that relate with the child during the later stages of life.
In incidences where the injuries are traumatic or massive, Ormstein (1999) points out that the resultant anger is often intense and has destructive implications on the emotional and physical wellbeing of the individual. Psychoanalysis in this regard aims at addressing the root source of the anger. The psychologists adopt empathy as hey explore the enrage word of the patient rather than direct confrontation which in most cases only worsens the problem. These empathic approaches enable the therapists to address the particular causes of the problem as the patient opens up and shares his or her subjective experiences regarding rage.
Specifically, the therapists assume a neutral attitude and avoids being judgmental. Furthermore, in order to attain optimal results, the therapist is required to refrain from criticizing the patient in any way. In his study, Sehl (1994) shows that this makes the patient blame him or her self for the situation and undermine the process of recovery. To this end, psychological studies indicate that the therapist should be patient and explain to the clients the root sources of the anger and how the same can be countered. Ormstein (1999) affirms that this is likely to restore calm in the patients and ameliorate the vulnerabilities of the same.
Spontnitz made various contributions to the present day psychoanalysis of rage. According to him, most of the problems being experienced n the present society are as a result of the people continuously containing the destructive feelings of rage. He argued that the remedy in this lies in these individuals releasing the bottled up feelings that internally hurt the persons. To this end, he asserts that all children deserve comfort, understanding and emotional support in order to grow up in a healthy manner and become productive individuals of the society. He refers to this as a nurturing environment that is fundamental for growth and development. Despite this knowledge he shows that the present society has not taken much effort to address the concerns. To this end, he indicates that the present trends show that children are emotionally and physically abused in various ways. Many people according to statistic conducted in the recent past have in one way or the other undergone some sort of abuse and have been emotionally abandoned when they were young.
He further shows that in instances when a child is denied the basic needs for survival, a feeling and reaction of rage does occur. For instance, he indicates that when a child is frequently scolded for making mistakes, the child slowly withdraws from the social environment. This also makes the child to continuously attack itself and harbors feelings of inadequacy and worthlessness. Sehl (1994) asserts that these greatly inhibit the sustainable emotional development of the children. It is because the child feels that is does not deserve any form of love from any given source. These feelings have various implications on the overall development process and studies show that it even affects the academic performance of the child. It is because the child experiences confusion with thoughts and wastes much of its time n trying to clarify the expected experience instead of concentrating on achieving the goals set. Psychologists show that this pattern is likely to continue and even worsen in future.
In general Kohut (1971) indicates that rage is often meant for revenge. He asserts that it is manifested in so many ways and is attributable to the feelings of shame and failure. In his own perception, the patients and especially addicts often get enraged due to the fear to what would happen to them once their problem is addressed. This rage is usually unjust and is directed at individuals that the patients relate with in their daily lives (Wolf, 2001). This rage inhibits their cognitive capacity and results in to unfair judgments and actions against others. Enraged individuals often shout aimlessly and distort the facts while making various accusations at innocent individuals.
From the review, it is noted that rage is a form of psychological disorder that has negative implications on our thought process. The fact that it inhibits just decisions and encourages false accusations makes it undesirable. The root causes of rage lie within our society and are contributed to by the persons and events that we have conduct with. Hence, it is important that parents are made aware about their role with regard to growth and development of their children. They should assume the responsibility of cushioning their children against the societal ills by providing the bet holistic environment for effective growth.
This is also referred to as matters of ones spirit and is associated with existence of the deity or the Supreme Being. Matters related to spirituality are often beyond a person's physical wellbeing and energy. It is because it encompasses concerns that are well beyond an individual's time, physical senses and the general material world with which human beings interact with during heir existence (Anthony, 1993). To this end, studies conducted affirm that spirituality is characterized by a certain emotional connection to some being that is considered a reality yet it is beyond the physical world. These emotional experiences often entail some feeling of fear and veneration.
Furthermore, Bouma (2006) also contend that internal development and nurturing of spirituality requires an effort through practices that are often religious in nature. Special practices in this regard include prayer, meditation, searching for God, heavenly influence and information regarding life after death. These practices are unique to specific religions and differ considerably. However, they usually aim at upholding good practices and nurturing basic life virtues. Also, Culliford and Powell (2005) show that the perception and comprehension of spirituality differs from one person to the other and is basically subjective in nature.
Spirituality has various implications to the wellbeing of humans. Its practices such as prayer highly influence the individual's thoughts and actions too. To this end, it can be argued that it contributes a great deal in shaping a person's character and influencing the health of the same. To this effect, Chan et al. (2001) shows that spirituality influences a person's health because it dictates what a person eats, how the person dresses, activities that the person engages in and the relationships that the person initiates. It can be contended that all these contribute in various ways to a person's overall wellbeing. Despite the fact that this has not been scientifically proven, behavioral studies affirm that indeed, spirituality highly influences a person's wellbeing in different ways (Culliford and Powell, 2005).
To ascertain this contention, specialists in alcohol anonymous have indicated that the practice has been instrumental in enhancing the wellbeing of alcoholics. However, of particular importance is the presumption that spirituality is a source of true happiness and internal peace. It achieves this by preventing the feelings, emotions and thoughts that may prevent a condition of content and happiness. In his study, Anthony (1993) also shows that it does not necessarily involve religion, supernatural beings or religious beliefs rather it is based on a persons inner thoughts and aspirations. To this end, it can be appreciated that spirituality is pivotal in the recovery process of mental health and/or addictions. It is because of the fact that its central goal is to change the way of thinking of individuals and align the same to the basic virtues that influence healthy living. In this regard, Bouma (2006) indicates that spirituality challenges individuals to change their way of thinking to be in line with the virtues of religion and expectations of the deity.
In their consultative study, Culliford and Powel (2005) indicate that patients of serious mental disorders that include compulsive behavior always find spirituality a very important aspect during their recovery. A study conducted by Bouma (2006) in the US mental institutions affirmed spirituality provided strength for the patients to carry on during conditions of adversity. Furthermore, this study contended that spirituality provided the basic moral practices that helped the patients uphold an acceptable level of ethics and therefore recover steadily. These ethics were derived from the teachings and practices of spirituality that were conducted in the institution.
Also, the participants of the study pointed out that spirituality helped them change their way of thinking from pessimistic perceptions to positive perceptions. Thus they were able to initiate and uphold good behavior in hope that this would enable them to gain a state of health. Mental health practitioners contend that this positive change of attitude is instrumental in enhancing the healing process. Again, participants agreed that spirituality helped them to change their attitude and overall thoughts. As indicated earlier, it can be acknowledged that assimilation of positive attitude forms the core of the recovery process. Additionally, the participants affirmed that the teachings of spirituality gave them the strength that enabled them to face various daily challenges and overcome them accordingly.
According to the findings of this study, the participants also asserted that the teachings of spirituality enabled them to solve the problems that they faced amicably and expeditiously. They did this without anger and fear and promoted forgiveness. As such, they were able to co exist with each other in a peaceful manner and avoid external conflict which in most instances contributed to unnecessary tension. This led to the development of a serene living environment that is characterized by peace and tranquility. The environment then enabled them to engage in productive activities that boost their overall wellbeing and enhance their level of living. For instance, they were able to come up with a gospel musical and they recorded several Christian songs. Afterwards, with the help of the institution's administration, they sold these songs and the proceeds went towards enhancing their living conditions. Additionally, studies show that the tense situations that characterize conflicts only exacerbate the problem and by preventing it, spirituality and religion if very important (Culliford and Powell, 2005).
The participants also confirmed that the teachings of spirituality enabled them to initiate outreach programs and were able to interact in various ways with the communities. By organizing and participating in these programs, the community changed their attitude towards them and assimilation in the community on completion f treatment became faster. This assurance in itself hastened the recovery process of addicts. It is because initially, the community perceived them as a threat to their security and safety.
The inferences made from this study indicate that generally, spirituality enabled the mental health patients to adopt positive lifestyles that in return played a fundamental role in enhancing their recovery. They upheld good grooming and helped their peers to change their behavior ad attitude accordingly. In fact, the institution confirmed that they aided in recovery by encouraging other patients and setting the best examples. To this end, the study recommended that spirituality issues should be given equal priority by the therapists just like medication and other aspects. Without this, this study shows that the recovery process may not yield satisfactory results.
In his study, Anthony (1993) also shows that spirituality is very essential because it plays a pivotal role in avoiding substance abuse that can easily culminate in to addiction. It is because of the fact that most of the spiritual teachings condemn the destructive behavior that culminates from substance abuse. Additionally, the dependence nature that he substance abuse places an individual into is also discouraged by the spiritual teachings. According to them, the Supreme Being should be the sole source of our dependence. In Christian teachings for example, the Supreme Being, also referred to as God is considered the sole provider of all human needs. Dependence on other things according to this religion is considered idolatry, which is shunned within the religion.
A study carried out on fifty participants in a recovery period of twenty eight days in USA affirmed that spiritual practices are of great importance. To this end, the results of the study showed that prayer and self meditation had positive implications on the participants' wellbeing because they enable the patients engage in self discover. Particularly, the participants' abstinence from chemical use and abuse was influenced by these spiritual practices. Hence the findings of the study are important because they portray the positive relationship that exists between the employment of meditation, prayer and other spiritual practices and the recovery of patients that use or and are addicted to chemical substance abuse.
Another study about the relationship between spirituality and was carried out on a population that abused alcohol in south Asia. The inferences from this study also indicated that spirituality to this population meant there is a Supreme Being who has great power and whose directions and teachings were supposed to be upheld by the people. As such, the alcoholics changed their destructive behavior in accordance with the teachings and expectations of the Supreme Being. To this end, they were able to change their behavior and adopted positive mannerisms as prescribed by the teachings. In this regard, it can be ascertained that spirituality has a positive impact on the recovery process of alcoholics.
In general, it can be concluded that spirituality forms the basement upon which the recovery of compulsive behavior, mental health and addiction is based. Studies in this regard indicate that the recovery process is all spiritual due to the fact that it demands a significant degree of honesty, searching, finding and appreciating that there exists a Supreme Being that is more powerful than the human being and acknowledging that the recovery process can not be successful without the intervention of the higher power (Culliford and Powell, 2005; Bouma, 2006). In his study, Anthony (1993) shows that essentially, spirituality addresses the relationships that a being shares with the supreme power, with itself and with other beings. Thus he indicates that it is characterized by three dimensions. Further, it is indicated that all these relationships are intricately connected (Anthony, 1993).
To this effect, it is unlikely that an individual will genuinely treat the Supreme Being with absolute love and a fellow being with hate. It is because the teaching s emphasize that the Supreme Being is a direct representation of the humans with which we share different relationships with. As such, it implies that whatever is done to the fellow humans is actually done to the Supreme Being. This makes the humans review their activities and align them to the provisions of these spiritual teachings.
The therapists affirm that addicts seek treatment with an aim of evading painful repercussions that stem from the practice (Strupp, 1996). Often, the practices that they initially engage in have painful implications. According to the therapeutic measures undertaken, the ultimate role of the recovery process is to encourage the addicts and other diseased individuals to turn away from the destructive practices. In this respect, Bouma (2006) shows that therapy and recovery entails helping the patients to assume desirable social values and virtues that then help them achieve this desired goal. It is worth acknowledged that these virtues are derived from the teachings and practices of spirituality.
In his review, Strupp (1996) points out that some addicts that resort to treatment at certain stages often do not belief in any Supreme Being and lack any conscious relationship with the same. Therapists in this regard affirm that these people often fear establishing any type of relationship with the deity because of the expected changes and because of the assumption that they are already unworthy to share such relationships with the Supreme Being. According to Bouma (2006), the best approach to recovery in such instances is to come down to their level and initiate the recovery by starting with establishing the fundamental relationship with the deity. This can be achieved by the therapist informing the patient that s/he does not believe in a Supreme Being either. At this juncture Strupp (1996) affirms that this enables the patient and the therapists to collectively start by addressing the basics of spirituality. Additionally, this helps the patient to establish some level of confidence in the therapist and reduce the tension and fears that the patient might have prior to the initiation of the recovery process. Chan et al. (2001) shows that these initiations provide the best environment that enables the therapists to derive sustainable methods of effectively getting to the problem that the patient faces.
Another effective approach in this regard has been to help the patients be able to identify the connections and relationships that enhance holistic functionality of their being. This approach was considered because of the fact that the patients insisted on having no relations with nature and the Supreme Being as well. The issues that were important in enabling the patient change this perception were the recognition of for instance how the food they consume reaches their table as well as how the clothes they wear are made. For instance, the therapist would begin by explaining to the patients the interconnectedness that exists between the food consumed and the Supreme Being. To this end, particularistic examples would include telling the client that the weather is entirely controlled by the power of the deity. Thus He provides the rain, heat and other factors that enhance the growth and survival of food crops. To this end, Strupp shows that the patients are encouraged to think being themselves and appreciate the role of other independent and external factors in their wellbeing (1996).
To emphasize the importance and role of spirituality on the overall wellbeing of humans, Safran (1993) likens it to the heat that the sun generates and its role in maintaining life. He illustrates this by indicating that sitting in the sun during summer enables one to feel some warmth even though the source of the warmth can not be physically seen. Further, when a person temporarily moves in to a conditioned room, s/he is assured that the warmth is still there and it did not leave too.
Hence spirituality in the domains of psychological recovery implies that it is extremely important for the patient to let go of the negative and destructive thoughts, beliefs and practices amongst others and appreciate that the higher power and the colleagues are capable of reversing the trend. Chan, et al. (2001) asserts that acceptance of the Supreme control by the patients as a background to sustainable recovery. Ultimately, it enables them to not only stop the addictive practices but also gain intrinsic value of serenity, courage, respect and honesty amongst others that characterizes return to life.
From the above review, it can not be disputed that spirituality plays a vital role in the process of therapy and ultimate recovery of drug addicts and other mental health patients. Of particular importance are the teachings and practices of the same that seek to enhance change in attitude. At this point in time, it is worth acknowledging that positive change is essential in enhancing recovery. Spirituality, through its emphasis on vital values and social virtues plays a critical role in initiating this vital change in the lives of the patients with compulsive disorders that include drug addiction and alcohol abuse.
Spirituality and action
Culliford and Powell (2005) show that the teachings of spirituality often encourage the followers to undertake actions and make the teachings of the same practical. This is because of the need to practice and be able to develop a spiritually acceptable way of living. Without practicing what they are taught, Bouma (2006) shows that grasping the concept and inculcating it in their behavior and character can be very difficult. Safran (1993) affirms that human nature is characterized by a high level of forgetfulness that can only be effectively curbed through practice. Additionally, spiritual activities enable the followers to experiment and appreciate the outcomes of the theoretical teachings. Furthermore, these activities keep them busy and as such they hardly find time to engage in activities that are destructive and unhealthy. Above all, in his study, Strupp (1996) argues that these activities often enhance social cohesion because of the fact that they yield tangible results.
For instance, by reaching out to the community through activities like helping the poor and offering human services, the overall wellbeing of the society is enhanced. The psychological effect that accompanies such activities enhances co-existence through appreciation of each other. Additionally, as indicated earlier, when the drug addicts reach out to the communities, they are likely to alter the communities' perception of them as killers, rapists and violent people to positive perceptions. This also enhances social cohesion and reduces the conflicts that occur as a result of the initial destructive activities that the addicts once engaged in.
In his study, Hilton et al (2002) likens the concept of actions in spirituality to roots and fruits. He points out that true spirituality is represented by the roots which provide critical support for the tree to grow and bear fruits. In this regard, he argues that spirituality can be manifested through actions, just like the bearing of fruit by a tree indicates the strength and dedication of the roots by ensuring that the tree is well nourished. The people who perceive spirituality as to be related to religion often believe that true faith is manifested through actions. These actions are derived from the teachings about the specific religion.
Assuming that the same belief is held by addicts and other health patients, Hilton et al. (2002) indicates that it can be affirmed that the improvement of behavior of these people is highly influenced by the spiritual beliefs. For instance, when they are taught that the supreme demands that they do not kill, drug addicts are likely to refrain from substance abuse because it is the one that influences them to kill. In this respect, it can be contended that spirituality plays an important role in helping persons with compulsive behavior like drug addicts to modify their conduct. It should be appreciated that this forms part of the core goals and objectives of therapy.
Spirituality helping in constructing narrative
Use of narratives in psychotherapy has been employed in therapy since its inception during the onset of 1970s. In her study Mary (2003) affirms that its employment over time has produced relatively satisfactory outcomes. The therapists in this regard believe that the identity of individuals is completely shaped by the accounts of our lifestyles that are brought in to the limelight through their narrations and stories. Moore (1992) indicates that the role of the therapist is to help the patient in providing a detailed description of the comprehensive stories about their types of lives and the possibilities that are related to the same. As the patient gives this description, the therapist is often keen about investigating the person's relationships as well as influences. This enables the therapist to derive viable measures that are directed towards enhancing the recovery of the patients.
Full analysis of the problem is achieved during this process because of the fact that the therapists usually isolate the problem from the individual. This isolation not only enhances the relationships between the patient and the therapist because it enhances inculcation of objectivity in the same. As such, the therapist is able to treat the patient irrespective of the ills that are manifested through the problem. Additionally, the fundamental assumption made during this process is that the individual has the competency and ability to overcome the distanced problems that influence his or her life in various ways (Mary, 2003). To this end, objectivity ensures that the therapist capitalizes on this patient's capability in order to achieve maximum impact. Moore (1992) argues that the externalization of the problems makes the therapist to be able to evaluate them fully and come up with viable ways of how they can be addressed.
With regard to the role of spirituality in narrative construction, therapists can also employ the same procedure (Mary, 2003). This is achieved when the therapists externalize the values that are derived from spiritual practices. These are then evaluated and relationships made about how they can be employed in resistance of problems. Other ideals that can be explored in this regard include the patient's hopes, aspirations and commitments. These can be identified from the events narrated by the patient and then be incorporated in to the narration by the therapist during re-narrations. Moore (1992) affirms that when re-authored to take the position of helping the patient to resist problematic situations and practices, they are very effective in mending way ward behavior.
Further, considering that spiritual values are very influential, they can likewise be entrenched in to re-authoring conversations as a measure towards helping people to reclaim their lives. Also, the therapists can recommend the spiritual virtues to the patient at the end of the therapy and during the process of therapy. According to Hilton et al (2002), this helps the patient to perceive the same as part of their commitments and hopes and thereby steer the recovery process.
Additionally, considering the fact that the therapist has a broad array of questions to choose from during the process of therapy s/he can reframe the questions to address the extent to which the patient values spirituality. This then provides the basement information upon which the therapist can base the narration. To this effect, Bouma (2006) shows that the patients have various perceptions with regard to spirituality. Knowledge about this is important in order for the therapist to provide for the specific spiritual needs. In addition, it should be appreciated that spirituality is a sensitive matter that should be handled with great care and caution. Failure to put in to consideration the specific concerns of the patients according to Anthony (1993) inhibits the whole process and undermines the outcomes. For example, religious beliefs that are associated with spirituality differ from one religion to the other and in some instances, they are conflicting. Acknowledgement of these concerns is important in order to prevent contradicting the views of the patients.
Moore (1992) indicates that by insisting on the importance and role of spirituality during narration and construction of narratives, the desired effect can ultimately be achieved. In addition, before starting and finishing the process of therapy, the therapist can start by undertaking basic spiritual practices that may include prayer. It should be noted that this should be in line with the beliefs of the patient about the same. Additionally, Mary (2003) indicates that initially, the therapist should seek the consent of the patient before engaging in such practices. The practices can then be made more regular as therapy continues. By the end of the treatment, Safran (1993) shows that the patient is likely to attain spiritual fitness if this pattern is employed and enforced accordingly.
Spirituality as identified in the above discussion is very influential in the construction of customized narratives that meet the specific needs of the clients. The therapists can capitalize on this ability and construct their narratives in the sense that they address the specific needs and requirements of the clients. To this end, they should include the current issues that affect the psychological wellbeing of the clients as well as the spiritual beliefs that he patient associates with. It is worth acknowledging that the present world is characterized by complex issues that may contribute in several ways to psychological instability. Strupp (1996) contends that the present day psychological environment has pressurizes humans in several ways. This maximum effect has beneficial outcomes as then the therapy will be able to achieve the set goals and objectives.
From the discussion, it can be asserted that inculcation of spiritual values in the construction of narratives by the therapists during the treatment process is fundamental in enabling them alter their behavior. As indicated earlier, spirituality is a powerful tool of behavior change and narrative construction presents another golden opportunity through which therapists can encourage their patients to embrace the same. It is because of the fact that the patients are often vulnerable during this period and hence they can easily take up the virtues. Most importantly, the therapists can introduce spirituality to the non spiritual patients and ensure that they take up the most desirable values. Ultimately, this will enable them to change their behavior and assume more viable mannerisms.
Spirituality and intensifying group affect necessary for transformation
Psychologists affirm that the impact of a group to an individual's overall wellbeing is relatively significant. To this effect, they argue that personal decisions are in some instances influenced by the perceptions of the group. This is especially common with the vulnerable persons who can not make independent decisions. To this end, it can be noted that the addicts and mentally ill persons are susceptible to the impact of the group because they rely on the same in many ways. Knowledge about this is important and can be utilized in various ways to attain the desired optimal effect. In particular, Lerner (1990) argues that when coupled with spirituality, this presumption can be very helpful in initiating change.
The group notion always implies some level of consistency and homogeneity in various activities. Basically, people form groups in order to collectively achieve certain goals and objectives. Hence they engage in various activities that are geared towards achieving a specific goal. In this regard, it should be appreciated that the members of the group often make individual efforts according to their different capacities. These individual efforts are made possible by the group environment that provides encouragement and persistence.
It is in this consideration that Kelly (1996) ascertains that the change process of persons with compulsive and addictive behavior can equally capitalize on this assumption. To this end, the therapist or the person initiating the change process can group the patients according to their various problems. Patients with similar problems once grouped together can be given specific goals to work towards achieving. Anthony (1993) also argues that the values and virtues of spirituality that aid in the recovery of a given group can be introduced and upheld during the process. The group influence can then be instrumental in enforcing the values and Anthony affirms that the rate of change is then enhanced (1993). At this juncture, it is worth reaffirming that spiritual values and virtues play a critical role in the recovery of the patients. Additionally, considering that these persons are vulnerable in different ways, groups offer the best channel for quick recovery.
The persistence and consistence that characterizes the group environment can also be capitalized upon by therapy. To this end, the therapist can mainstream spirituality in the various teachings as well as practices that the patients engage in. Then the therapist can ensure that consistency is upheld by the group in order to achieve maximum effect. In order to attain this, it is increasingly necessary that the patients are encouraged and provided with the right environment to enforce the spiritual values and virtues that they are introduced to. Particularly, Ornsten (2008) shows that ambiguity should completely eliminated from the teaching process. It is because of the fact that some patients within the group could be embracing spirituality for the first time. To this effect, it is important that the teaching process ensures simplicity and effectiveness.
In general, Mary (2003) indicates that the mainstreaming of spiritual values and practices within the group context during therapy is essential for recovery. Of particular reference is the fact that the group environment hastens and enriches the recovery process. Studies conducted in mental hospitals and other rehabilitation institutions in this regard ascertain that the group provides the best environment for the mental health patients. Nevertheless, Culliford and Powel (2005) also indicate that group conditions may also have negative implication especially when it contains individuals with negative influences. This is because this particular group is fragile because of its vulnerability and susceptibility to change (Safran, 1993).
To this end, caution should be taken to ensure that clear and effective guidelines are provided by the therapists. In cases where a defect is identified, timely interventions should be undertaken in order to avoid significant damage. Additionally, the teaching methods should be clear to ensure that the intended message is conveyed in a timely manner. In this regard, it should be appreciated that the spiritual teachings are very sensitive and therefore precision with regard to interpretations should be ensured. This goes a long way in avoiding distortion of he messages conveyed because this has the capacity to undermine the overall process. These measures are important because as indicated earlier, the vulnerability that characterizes these persons makes them adopt any behavior.
Spirituality as collective fantasy and collective projection
The mental health patients and addicts are often seen as existing in their world. It is because of the fact that in most instances, they resort to addiction and other compulsive behaviors because of their inability to effectively co-exist in the real world. Often their 'real world' is characterized by harsh environments and many difficulties. Thus they prefer staying in their own world as and keep off from the harsh reality that according to them is inhabitable. Kohut (1971) asserts that this is because of the lack of courage and the fear of how they could possibly survive without the drugs.
Therapy is appreciated as a multifaceted and complicated process that requires utmost competencies in order to yield desirable effects. Some studies argue that fantasy plays a role in enhancing the recovery process of patients with compulsive disorders (Priestly et al., 1998). Particularly, in their study, Lende and Smith (2002) point out that fantasy enables the patients to retrieve repressed memories that undermine the ability of the patients to function normally.
Spirituality aids in this process because the practices associate with spirituality are fundamental in triggering the remembrance of these memories. Additionally, spiritual teachings often contain some episodes that act as triggers to the remembrance of past incidents that had adverse effects on the wellbeing of individuals (Hilton et al., 2002). Furthermore, the spiritual teachings lead to fantasies of for instance the period that humans will be reconnected with their creator. According to Moore (1992), all these fantasies aid in the remembrance of specific episodes whose unraveling enhances recovery.
Regression also influences the recovery process of the persons with psychological problems. Winnicott (1980) argues that it is considered normal for the patients to feel psychologically stuck at some point in time. Often, these patients could have sought the help of various traditional approaches in an effort to solve their problems. Hilton et al. (2002) in this regard appreciates that in order to attain a satisfactory condition of healing, special consideration also needs to be put on the spirit. According to him, the spirit is an important part of the whole that also requires healing in order for one to be considered psychologically fit. This is an emergent realization that studies show that in the past, it has been largely ignored (Mary, 2003). This makes the patient to feel disturbed even after the recovery process is perceived to be complete.
According to Culliford and Powell (2005), this can be effectively achieved through the process of past life regression. In their own words, they affirm that this is meant to literally unstick the patient from the condition that inhibits complete recovery. Various methods have been put forward as viable approaches to recover the past memories. These include exposing the patient to sensory stimulus, meditation, and application of hypnosis during therapy and through dreams. Despite Culliford and Powell (2005) indicating that this may be ineffective for the patients that do not believe in the past events, Mary (2003) show that the method has helped many patients to reclaim life and health.
Also, the recovery process in some instances may be undermined by the various myths that the patients hold about the given compulsion or and addictions. For instance, some common myths about alcohol show that its abuse is healthy. For effectiveness, Safran (1993) indicates it is necessary for the therapist to identify the types of myths that inhibit recovery and start by eliminating them. Additionally, the alternative myths that enhance the recovery process should be encouraged. In this regard, Bouma (2006) shows that the patient could have strong beliefs in something and suggest that in order to know and understand the implication of these to the recovery process; the mental specialist should view the same from the patient's point of view. In other words, the therapist needs to appreciate the myth and define it from the patient's perception and understanding.
This enables the patient to believe that his or her perceptions are acknowledged and appreciated by third parties. Strupp (1996) this plays an instrumental role in enabling the patient to open up and in return appreciate the views and recommendations of the therapist. This mutual understanding is essential for the attainment of smart goals in therapy. Furthermore, Decisions made in such incidences need to be well informed to avoid instances of being to intrusive in the patient's lifestyle (Anthony, 2003). This as an independent factor may compromise the recovery process. In addition, being well informed about these myths enables the therapists to employ complex recovery approaches in accordance with the severity of the matter and exhaustively address the various intrinsic aspects of the patient's perception. This according to Moore (1992) the recurrence of the problem and is basically a sustainable approach. Generally, all these measures contribute to sustainability of the recovery process by filling the gaps and addressing the real but hidden causes of the problem. Ultimately, the patient is in position to recover wholly and fit in the society on completion of the process of therapy.
One of the fundamental strategies that can be undertaken in such cases is to encourage and help the patients to differentiate between the conception of myth and reality. This is achieved by use of factual information, illustrations and analysis of different case studies. If undertaken in an effective manner, these go a long way in modifying and changing the perceptions of the patients. Mary (2003) shows that they practically aid in bringing the patient back to reality. The patient is then able to appreciate the role and contribution of reality to his or her wellbeing. To this end, it is worth acknowledging that this measure constitutes one of the fundamental goals of psychotherapy.
Myths according to Winnicott (1980) often perpetuate addictive behaviors and in most instances are deep rooted in a persons thinking process. It is because of the fact that they give the patient the urge to continue engaging in addictive activities that are unhealthy. The patients due to their vulnerabilities highly depend on this internal urge for decision making. Further, the substances that they consume inhibit undermine their ability to make rational decisions. In fact, their capacity to think wisely when under the influence of drugs and other addictive substances is walled off by the influence of the drugs. Despite the fact that modifying them might be an enormous task, therapists perceive this 'a must' step towards recovery.
The modification of the myths is further made difficult by the cultural nature of these beliefs. In his study, Field (1999) shows that some myths encourage involvement in addictive and destructive practices. Often, these practices are valued by the society and hence addressing them is sensitive and has various implications on the process of therapy. To this end, a study conducted in the rural communities of south east Asia indicated that some of the individuals abuse alcohol on he pretext that it makes them courageous and according to them 'man enough'. This is a cultural perception that has been in practice since time in history. At this juncture, breaking such beliefs could prove difficult for the therapists. The patients are bound to feel offended and may not easily give in to the therapeutic requirements to change. This situation just illustrates how the process of therapy may be complex and problematic where myths are involved.
Cohesion is yet another factor that influences the recovery process in different ways. Fundamentally, cohesion enhances peaceful conditions that are characterized by healthy relationships between people and within the society. Additionally, it fosters unity and togetherness that is fundamental for productivity within a given society. This condition according to Tomkins (1991) enhances the recovery of mental health and addiction in different ways. It should be appreciated that these patients often face some form of stigma and are isolated from the society. According to Masterson (1998), they are considered social misfits that do not fit at all within the societal environment. The entire society often makes efforts to get rid of them because their activities compromise the co-existence within its members. It is because they engage in destructive activities that generally undermine the security of the entire society.
To begin with cohesion enhances the initiation and maintenance of healthy and sustainable relationships (Roadman, 2003). As indicated earlier these encourage confidence that makes the process of therapy easier and more productive. As a result they reduce the intensity of stressful feelings as well as psychological distress which contributes a great deal to mental health disorders and compulsive behavior. Indirectly, Klein (1962) shows that they reduce the incidences of addictions that are unhealthy and counterproductive.
Cohesion also maintains peaceful conditions and avoids tensions and conflicts. To this end, it should be appreciated that it is the tension and conflicts that contribute to conditions of distress and anxiety triggers addictive behavior (Carveth, 1994). In a peaceful environment, a person can also be able to solve several problems with ease and in a timely manner. In addition, peaceful conditions and environments also enhance the recovery process. To this end, Mary (2003) notes that such conditions virtually act as part of the prescriptions.
Furthermore, social cohesion aid in the recovery process due to the fact that accessibility to resources is enhanced. In his study Moore (1992) indicates that when people share good relationships, they are likely to help others and work in unity towards achieving societal goals. In such instances, he asserts the society assumes the sole responsibility of ensuring that all its individuals are in perfect health in order to enhance factors such as productivity. As such, in cases where the addicts may lack enough resources to seek medical services, the society is likely to step in (Moore, 1992). Availing of mental health also prevent other social problems that contribute to addiction and compulsive behaviors. For instance, it curbs isolation due to stigmatization and discrimination.
The patients in this regard are socially appreciated and accepted and view themselves as part of the whole (Bouma, 2006). This supportive emotional environment plays a critical role in the growth and development of healthy individuals that value societal productivity. They are encouraged to take up treatment and stop the addiction and other practices that are detrimental to the societal wellbeing. Sehl (1994) contends that all these conditions enhance the recovery of these patients and improve their psychological wellbeing. Since their problems are psychological in nature, it can be asserted that this serves to address the root causes of the problems that they face and provides the best environment for growth and development.
Additionally, Kelly (1996) shows that cohesive societies are often characterized by good governance which in return has various implications on the overall well being of all the individuals. Specifically, He argues that good governance ensures that the society has the vital resources it requires to sustain itself. Additionally, a good government provides jobs for its citizens and thereby empowering the economically. This according to Safran (1993) has the capability to reduce the psychological distress and stress that contributes to addictions and other compulsive behaviors. In this regard, cohesion is considered as a measure used to address the key causes of mental health (Safran, 1993). To this effect, it can be concluded that indeed, for the recovery process to successfully take place, cohesion is of essence. It is because of the fact that cohesion provides coping strategies and viable environments for the patients and this hastens the recovery process.
Psychology of group dynamics
Groups have proven very essential in the recovery process and as such, they have been widely employed by therapists during the treatment of addicts. It is because of the fact that the group environment also provides a unique environment that enhances the recovery process of these patients. To this effect, Chan et al. (2001) assert that the group environment is important in augmenting the process of recovery because of the emotional support that it provides. Various theorists and psychologists have also explored the contribution of group dynamics in psychotherapy and the main contention has been that the aspect is instrumental in recovery. It is in this consideration that the following discussion provides an in-depth analysis of the contribution of the literary works done by two renowned psychoanalysts, Bion and Yalom.
The literary works done by Bion and Yalon about the psychology of groups provide useful insights about the role of group dynamics in the recovery process. Bion agrees with the propositions made by Freud about the family by indicating that the family setting is the mother of all types of groups. It is because of the fact that it is made up of several members that support each other in different ways. Further, Bion highlights that anxiety is the basic cause of the psychological problems that we face in our day to day lives. This anxiety according to him is perpetuated by various psychological problems that characterize the present society. He indicates that psychotherapy and psychoanalysis conducted at the individual and group level aim at identifying the anxiety and providing measures to counter them. This according to him forms the framework upon which psychotherapy derives its goals and objectives. Addressing the psychological problems results it to a state of normalcy that enhances holistic societal development.
However, what differentiates the individual approach from the group approach is that the group contexts brings fourth issues that are alien at he individual level, and especially to the individuals that have had limited experience with groups. Bion further indicates that despite the fact hat groups are essentially set up to address actual and prudent goals, in most instances, they fall in to a condition of basic function, which he calls 'madness'. Such conditions are characterized by pairing, conflicts and lack of autonomy. However, emergent studies counter this argument and show that each group is unique in its own ways and therefore, the proponents of group psychotherapy should not put great emphasis on the type or nature of the group, but rather on the accomplishment of the set goals (Field, 1999). To this end, Lerner (1990) asserts that in order for the psychotherapy to be fruitful, therapists should not put great emphasis on the implication of Bion's propositions. Rather, they should remain focused and work towards achieving their set goals in this regard.
Yalom also made different contributions to the concept of group dynamics from a psychological point of view. He places great emphasis on the interactions that take place within the group as well as the various issues that the group is meant to address. In his approach, he discourages the group members from talking about any issues in their past as they only derail the recovery process. Furthermore, he also discourages the members from talking about any issues or events that could be happening outside the group context because they divert their attention from the basic goals. In incidences where one member of the group presents a problem with interaction, the particular member is advised to find another member within the group that resembles the person that the member would interact with in his or her daily life.
In general, disputes and other problems that arise within the group are also addressed in a similar manner. During the relationship, Yalom requests the patients to make keen observations about them selves. In this regard, he tries to develop what he terms as a self reflective loop. He asserts that in the process of making the observations about what they are engaging in at that particular moment, what they are saying and the feelings they are experiencing then, the members are in the best position to learn about how they would act independent of the group. In other words, they are in the best position to initiate, maintain and sustain viable relationships once they quit the group.
From his perception, Yalom sees the group developed by the patients as the basic of all other social groups that are found within the family as well as within the larger societal context. It is because of the fact that such groups equip the patients with fundamental knowledge with which they can be able to co-exist in other external groups. He further asserts that in order for the group to become effective, there is need to place therapy at the center of the life of the client.
To this end, Martin and Marcel (2008) show that the group therapies conducted by Yalom are characterized by intense interactions, new ideas and experimentation. The members within the group are often encouraged to keep a record and provide a feedback as they experiment new behaviors. Yalom further indicates that change within the group is influenced by catharsis and unity and therefore he urges the therapists to perceive this knowledge as fundamental for desirable effect. To this end, he argues that when the members of the group explore their feelings to the fullest and find relief for the same, they are usually motivated to adopt change and mend unacceptable behaviors that have detrimental effects to their wellbeing. When the individual in this case perceives the group as an important aspect and finds it attractive, s/he changes and conforms in order to suit within the group. In this effect, Yalom indicates that for a group to achieve cohesiveness, it is important that its members find it important to their wellbeing.
From the review, it is noteworthy that the two theorists provided important knowledge through their independent perspectives of the group dynamics. Their propositions are important in the psychoanalysis of the drug addicts due to the fact that they provide the basics of group dynamics. In deed, their exploration of the nature of the group from the psychological point of view is vital for the psychologists that employ the same during recovery. Moreover, by highlighting the ways in which to manage the patients in group contexts in order to attain optimal results, it can be concluded that the psychologists contributed significantly to this body of knowledge.
Psychodynamic perspective on rage
The addiction patients that are at different levels of their various illnesses in some instances experience a feeling of rage that could be directed at different persons. Wolf (2001) indicates that this could be directed at the self, God, the doctor, family and friends amongst others. Usually, this is perpetuated by the feeling of suffering, helplessness, the terror of the unknown and the resultant blame. This condition varies from moderate to extreme levels and is manifested in different ways (Masterson, 1998)
Psychoanalysts perceive extreme rage as a behavioral disorder that has various implications on an individual's actions and feelings. To this end, they argue that rage, if uncontrolled leads to violence and the resultant destruction and other forms of disturbances. In his study, Wolf (2001) shows that the purpose of therapy in this regard is to restore a feeling of calm and integrity in an addict's life. Further, he indicates that in some instances, chronic rage at times is prevented from reaching a level of transference. This situation according to him inhibits proper treatment of the same. Kelly (1996) shows that presently, most patients affected by rage are increasingly reaching these dangerous levels that are characterized by rage. Presently, treatment in this regard is directed at addressing the outcome of this rage (destruction) rather than the real course of the rage.
Results in this regard indicate that when successful, this goes a long way in reducing the physical manifestations of the inner hidden rage. To this end, some patients would assume a calm attitude while others would complain about a feeling of emptiness. Wolf (2001) indicates that in the later situation, these patients would experience the same feelings during their next incident of destruction. It is in this consideration that Wolf (2001) shows that the self attitude plays an important role. It is because this enables the patient to participate fully in his or her own activities and experience the same by feeling the rage. This is considered a fundamental stage towards recovery and with time, Tomkins (1991) indicates that the patient reaches a level that he or she can fully experience and acknowledge the different needs, demands and feelings. As this stage, Mary (2003) shows that the patient fully acknowledges his or her emotional self.
At this juncture, it is appreciated that rage is a destructive feeling that negatively impacts on the recovery of drug addicts. However, acceptable degrees of anger should be allowed to be manifested in order for the patients to completely heal. As indicated earlier, their suppression on serves to exacerbate the problem to the level of rage. This calls for providence of a supporting environment for growth and development and especially during the early stages of life. This exposition challenges the parents and guardians to assume their responsibility and effectively provide viable conditions that are fundamental for healthy growth.
Integration: theory of multiple codes
When attending the narcotic anonymous program, the addicts often use different integrated communication systems in order to initiate the process of mourning. To start with, they arouse feelings of loss through narration of their dreams as well as fantasies about the drug. This could happen through the conversations that they have with each other. The symbolism of their feelings is then explained to them by the psychoanalyst after they have gone through the emotional pain as a result of remembering their past feelings. The patients often respond to this through facial expressions and at times physical expressions like physical body pain. Finally, they experience the emotional phase and this is characterized by negative feelings towards the analysts.
Rage, shame and mourning
Kelly (1996) indicates that rage and shame are intricately connected and they both contribute to the condition of addiction. In particular rage is employed to hide the feelings of shame that the addicts experience different stages of their lives. Shame on the other hand contributes to the feelings of rage and discontent. All these conditions are characteristics of the addicts that enhance the practice of addiction.
Rage and shame have various implications on the mourning process and may inhibit the same in various ways. According to Wolf (2001), this is unhealthy and often undermines the overall recovery process due to the fact that it inhibits expression and release of feelings of distress and inadequacy that the addicts face. This then makes people to dwell in stressful conditions and recovery at this point is usually elusive (Sehl, 1994). Psychologists assert that mourning is a healthy process that an individual should be allowed to experience. According to Wolf (2001), mourning the loss of connections is fundamental for a person because it enables the same to maintain and nurture the feelings of affection and love towards the persons and objects that they are in conflict with. To this effect, the mourning process enables an individual to break down ad release the feelings of anger towards another. If these are not released, Ormstein (1999) indicates that they have the capacity to affect our relationships because of the devaluing thoughts about other people that constitute anger.
Additionally, mourning enables individuals to overcome envious thoughts that Wolf (2001) indicates that they characterize anger too. Release of these destructive feelings then enables the individual to initiate, maintain and sustain the bonds that once existed. To this end, Wolf (2001) asserts that release of these can only occur through the act of grieving or mourning. According to them, disillusionment of thoughts that pertain to ones perception to the other is not enough to counter the destructive internal feelings of anger. Wolf (2001) the feelings of anger that contribute to rage should be effectively countered through mourning. Without this, the feelings continuously build up and results into rage and feelings of shame. Suppression of these feelings also contributes to feelings of bitterness towards one self instead of releasing them.
During mourning, Wolf (2001) argues that individuals tend to internalize these feelings and use them to attack their inner self. This is referred to as anger and it helps clear other feelings that are related to envy and frustrations. Lack of these internal attacks according to Kohut (1971) result in to a feeling of melancholia and reconciliation is unlikely to take place. It should be appreciated that lack of reconciliation makes the addicts strain the relationships that they have with the significant others. The resultant tensions exacerbate the practice of addiction as the patients resort to the drugs for temporal relief.
To this end, it should be noted that anger plays a fundamental role in internal healing but this is usually affected by rage. In this regard, Wolf (2001) shows that whilst anger is essential for healing, rage on the other hand is destructive. In other words, rage implies a destructive form of anger that inhibits complete expression of negative feelings. These feelings are often embedded in the internal self that needs to heal for complete recovery to be experienced. Therefore, an individual should be encouraged to express the feelings of anger and abstain from rage in order to have peace at mind and recover accordingly. Sehl (1994) affirms that failure to this may result in to hatred and other destructive feelings that highly compromise the health of the individual as well as that of the relationships after the loss. It is in this consideration that Wolf (2001) encourages the therapists to help the patients to manage their anger to prevent it in to developing into destructive rage.
Loss also perpetuates some feelings of shame that have various implications on the process of mourning. To this effect, Berry (2008) contends that shame is actually a prime inhibitor of the process of mourning. According to him, it is because shame regulates the experience and expression of the feelings associated with loss and/ or grief. Essentially, loss usually triggers the feelings of vulnerability and individuals in this regard lose the capability to entirely control themselves. This situation then leads to shame because of the anxiety and fear about being unable to control oneself as a result of loss. It should be noted that basically, loss leads into anxieties related to separation, abandonment and susceptibility to helplessness.
According to Wolf (2001), these anxieties generally define the feeling of shame. Shame is also manifested when individuals experience feelings of dread and mortification especially instances of extreme loss. Additionally, these individuals may feel guilty and blame themselves for the loss which results in to a condition of personal disregard. All these feelings make individuals depressed as well as shameful. According to Berry (2008), this greatly undermines the mourning process.
Furthermore, Wolf (2001) ascertains that the mere feeling of loneliness may also make the individual experiencing loss feel shameful. This shows that shame is socially inclined because of the implications that it has on social order and social organization. Also, shame separates an individual from him or herself and in most instances, persons experiencing shame may not be aware of their thoughts and feelings. Berry (2008) asserts that this condition inhibits the mourning process because the feelings that are supposed to be released are not available in the first place leave alone being suppressed. These denied mourning is not healthy for the recovery process because just like rage, it does not allow the person experiencing loss to effectively experience and release the negative feelings.
From the above review, it can be ascertained that the feelings of rage and shame are interconnected as one contributes to the other. In addition, it has been ascertained that these feelings impact negatively on the recovery process. Therefore, it is recommended that viable conditions should be availed by the growth and development process in order to ensure that the feelings are released. In addition, therapy should aim at addressing the root causes of shame and rage.
Shame, rage and addiction
The goal of psycho analysis and psychotherapy is to come up with viable measures that would enable a person to function effectively independent of any form of addiction (Wolf, 2001). Addiction in this context implies lack of personal independence. Priestley (1998) shows that, feelings of shame and rage often arises due to the failure of the addicts to overcome these compulsive feelings and address them accordingly. It is indicated that shame arises due to self depletion while rage is a by product of self fragmentation. Addicts often use these feelings as a coping mechanism from various traumatic conditions and humiliation.
In his study, Berry (2008) shows that feelings of shame provide potential developments of addictions that are purportedly considered defense mechanisms by the addicts. Studies show that the individuals that often withdraw from shame develop certain addictions which act as escape zones for negative behavior that can not be socially tolerated and as substitutes for their interpersonal relationships that are characterized by shame. Usually, these people will resort to the addictive behavior to provide relief from shame or rage. It should be noted that these 'escape zones' only offer temporal relief and the addicts will always experience feelings of shame or/and rage after some time. The bad thing is that persons that go to these perceived escape zones' for temporal relief get trapped in those zones and Wolf (2001) likens them to refugees who escape from their home country and move to other countries and vow never to return to their country of origin. Apparently, they get stuck in those countries and loose their freedom completely.
Berry (2008), shows that instead of addressing the actual causes of problems, the addicts develop attitudes of 'acting at' and 'using at'. Hence they resort to addictive practices in as a way of expressing their revenge against a problem or some form of difficulty. Wolf (2001) shows that addictions only mask the problem rather than solving it and suggest that more sustainable efforts to this should be recommended. Additionally, he indicates that that addiction does occur because of the presence of unexpressed childhood anger or shame. To this end, these individuals take up addictive behaviors of drugs, sex or alcohol in order to 'stuff down' feelings of fear, anger or shame that were not expressed during childhood. To this end, it is imperative that parents provide the best environment or their children to develop wholly. The best environment in this regard refers to encouragement of the release of negative feelings that are characterized by sadness, anger or shame. According to Berry (2008), this goes a long way in curbing adult addictions that supposedly aim at addressing these feelings.
Importance of mourning
At this point in time, it is worth acknowledging that most addicts have a special personal relationship with the substances that they are addicted to. In fact, some authors argue that they actually share a love relationship with these substances (Berry, 2008). To this end, separation from the objects is likely to result in to a painful feeling of loss. It is for this reason that these individuals practically grief for the loss of the substances which they consider dear to them once they start treatment. This mourning is important and should e encouraged for various reasons.
Usually, as indicated earlier, addicts often have unresolved problems from their past and childhood. Wolf (2001) shows that the employment of drugs and alcohol inhibits the mourning process that results in to a suspension of the process of mourning. Hence the problems that the addicts faced in the past can not be solved until the employment of drugs and other addictive substances is stopped. This then enables the addicts to experience and process the feelings that were associated with the problems that they faced in the past. It is after this that the recovery process can then be successful.
The process of mourning is also important because it enables the addicts to grieve for several losses that could have occurred during the time that they were using drugs. Studies in this regard show that a significant number of addicts mourn for the time they lost with the family, the time lost for establishing and building careers as well last the lost opportunities. This happens after they have identified pitfalls in their progress as compared with the progress of their peers that are not addicts (Kelly, 1996).
Mourning the loss of the drugs enables the addicts to break the barriers and release the negative feelings that they often perceive of human beings. As such they can be in position to establish new and healthy relationships with humans rather than with drugs. To this end, Carveth (1994) affirms that the mourning process enables the addicts to appreciate the loss of the drugs with a positive attitude. According to him, this is important because it encourages them to let go of the past practices. The resultant establishment of new alliances with human beings then enhances social cohesion. Through mourning, the addicts find a chance to realign their commitments to more sustainable ways of life. In this respect, the 'death' of the drugs breaks the commitment of the addicts to the same. As indicated earlier, addicts often share very close relationships with the substances that they are addicted to. According to Tomkins (1991), this removal of the substances from their mentality helps them to find something else to be committed to.
Generally, Culliford and Powell (2005) contend that mourning of the addicts is like subjecting them to freedom. It is because it disentangles the addict from the emotional bars that are characteristic of substance abuse. To this end, Wolf (2001) show that addiction is just like imprisonment. The addicts lack the freedom to explore other areas of their lives independent of drugs and alcohol. In other words, the drugs and alcohol virtually control the activities and thoughts f the addict. Addicts should therefore be allowed to mourn their loss of drugs in order to gain confidence to continue with their positive life and establish healthy relationships with humans.
From the review, it is indicated that the mourning process plays a fundamental role in the recovery of addicts by enabling them to achieve their set goals. Psychotherapists often encourage their patients to mourn over their lost objects (drugs) because it is a healthy expression of painful feelings that if suppressed have detrimental impacts on the recovery process. Of particular importance is the fact that mourning enables the addicts to appreciate the loss incurred and carry on with their lives
In conclusion, it can be appreciated that addiction is a condition that is contributed t by various factors that are experienced from childhood. It is also noteworthy that the process of mourning is important because of the central role that it plays in recovery. This process can be inhibited by shame and rage because they discourage the complete release of the painful feelings that develop as an aftermath of loss. In order for the drug addicts to attain a sustainable level of recovery, feelings of rage and shame should be discouraged and an ample environment should be provided for the same to be effectively released. This will go a long way in hastening the process of complete recovery of the addicts and separation from drugs. As a result, they will be able to initiate viable and productive relationships with humans.
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