In supervision the other day I was asked about aversion therapy as the supervisee was required by her clinic to apply aversion therapeutic techniques to cocaine users.
Aversion therapy was popularised by the movie A Clockwork Orange
In this scene Alex has been given a drug which makes him feel very sick and nauseous. He is then shown violent films. He is being conditioned such that in the future should he ever seek to be violent to others then he will feel profoundly uncomfortable and stop.
The same has been used with alcohol and drug users. Indeed Claude Steiner discusses the use of antabuse for alcoholics. If you take the drug antabuse and then drink alcohol one feels very sick and uncomfortable. His position is for the use of antabuse if it is administered correctly.
These aversion techniques are controversial with some being quite opposed to them. Of course there is no answer, only opinions and one is left with the question of does the end justify the means. If antabuse works does that make it OK to use it. If Alex stops being violent does that justify treating him as he is being treated with the use of pain.
My response to the supervisee was a little different as I looked at what we are communicating to the client. In therapy there is often an ulterior transaction based on the nature of therapy. If one suggests a client use antabuse what we are saying to the client is indicated in the transaction below shows
When the person is being conditioned the therapist is giving to the client permission to hurt self. The therapist is encouraging and at times is directly involved in a piece of behaviour where the client is hurt by feeling very sick and uncomfortable. The therapist’s actions give that permission. Of course this is counter therapeutic and indeed corroding the client’s self esteem.
In the therapy I do at times I encourage clients to feel painful emotions. I encourage them to experience pain and discomfort with the final goal that this allows for script change. Does the end justify the means with my therapy? Obviously I think so. Whilst I am not doing aversion therapy I am communicating the same as the aversion therapy transaction.
I am saying to the client
Adult to Adult: This technique will allow you to change your life script.
Parent to Child: It’s Ok to hurt yourself
With the resulting damage to the Child ego state as a result of that permission. I am undermining the therapy by applying the therapy. It has an inherent contradiction in it.
To avoid this one could do a therapy like Rogerian therapy. In this therapy the therapist simply provides the client with unconditional positive regard. At no point does the therapist suggest the client do any thing which he would find painful. By the action of the therapy the client is being told you are worthwhile and as a result should not be hurt. The goals of the therapy and the practice of the therapy do not have the contradiction in them that the therapy I use does.
Another example of the need to be aware of what we are communicating to our clients is in the use of pharmacotherapies for the treatment of alcohol and drug use. For example the use of methadone in the treatment of heroin addiction or the use of naltrexone for the treatment of opiate abuse. Same for the use of antabuse and alcohol treatment. The following transaction is being communicated to the client.
The goal is to stop the drug use but in the very nature of the treatment one is giving permission to take drugs. Same in the Redecision therapy I use. In applying the therapy one is automatically undermining it at the same time.