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Heroin Addiction and Related Clinical Problems: 2009, 11, 1 (pages: 35 - 40)

Psychotherapeutic Experiences with Methadone Maintained Patients in the Framework of Multidisciplinary Clinical Institution

Todorov O.

Summary: This communication presents a number of theoretical and clinical formulations that belong to a psychodynamic framework specifically constructed to foster the understanding and treatment of drug addiction. I find this framework useful not merely for the purpose of conceptualizing drug addiction as a clinical category, but also in explaining the complex experiences involved in the therapeutic process to people suffering from that condition. Contemporary psychoanalytic tradition sees drug addiction as an unsuccessful attempt to ward off the unbearable and unmanageable effects through self-medication, but also, more importantly, as a massive disorder originating in early interactions with significant others, resulting in a fragmentation of the self that prompts the individual to self-injury, constant traumatic experiences and a paradoxical fear/pain/pleasure relationship with the drug via addictive fantasies. All of this, enacted in everyday life and in therapeutic sessions, evokes complex emotional experiences on the part of patients, therapists and whole institutions. Relieving, bearing, getting to understand and, crucially, modifying these experiences is seen to be the task at stake in the therapeutic encounter. The final part of the article reflects on some of the advantages for the psychotherapeutic work that derive from methadone maintenance treatment and well-organized team work within a specialized clinic.