Woody Allen was in psychoanalysis for decades. Was that enough to cure his angst? Long-term psychotherapy seems to be on the decline these days - staying on the couch for more than five or six years is extreme, but many patients have a hard time saying goodbye to their therapist. Often the patient feels cared for and safe, and has anxiety about leaving this nurturing relationship. Many feel a lingering fear that if they were to face the world on their own, they couldn't hold it together. Their emotional discomfort, relationship struggles and other symptoms would take over, and they'd just come crawling back to the couch.
A related phenomenon is the occasional "therapy hopper" - patients who jump from doctor to doctor - perhaps enjoying the thrill of the initial meetings and early sessions of psychotherapy. They get to tell the stories of their early childhood and current problems over and over, never having to delve deeper into their emotional life. Then they flee the therapy before the feelings get too intense.
In one of the unusual cases I describe in "The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases," the patient appeared to have addiction issues - not to alcohol and drugs, however, but first to food and then to shopping. After what appeared to be successful therapy for her impulsive purchasing, along with the help of a 12-step Debtors Anonymous program, I discovered that she had secretly begun regular psychotherapy sessions with a colleague of mine, while continuing to work each week with me. After confronting her, she admitted that she craved the thrill she felt from the early insights experienced in therapy with me - for example, when she realized that her addiction had shifted from eating to shopping. As much as she tried, the thrill of therapy with me was waning, and seeing another therapist was her way of moving on. Now, I had heard of serial addicts - people who kick one habit only to move on to another. The thrill-seeking pattern is the same, but the object of desire changes. However, at that point I had not experienced a patient who was addicted to changing therapists.
Whether people are addicted to substances, such as alcohol or drugs, or processes, such as gambling, sex, work or spending, they suffer similar symptoms. They become preoccupied with the experience, develop tolerance and crave higher doses, have difficulty avoiding the experience, and have withdrawal symptoms when they cannot get what they want. Often they conceal their addictive behaviors and attempt to escape or avoid uncomfortable feelings by replacing one addiction with another. Not all experts agree whether some of these behaviors represent true addictions or just obsessive-compulsive behaviors. For example, work groups for the new Diagnostic and Statistical Manual of Mental Disorders (DSM-V) have argued that there is insufficient evidence to include the Internet as an addiction category.
Whether we call it an obsession or an addiction, overlapping brain circuits that control pleasure-seeking are involved when people give up one addiction only to substitute another, and we know that these behaviors disrupt people's lives. When patients shift between forms of addiction, the problem can elude friends, family members and professionals.
Most specialists are aware of addiction-switching, but can someone really get hooked on therapy or develop a serial therapy addiction? What do you think?
Copyright Gary Small, M.D.
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See my new book, "The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases."