ChemSex - Therapeutic Approaches. Neil Dickens Counselling Psychologist (in training)

Transcription

1 ChemSex - Therapeutic Approaches Neil Dickens Counselling Psychologist (in training)

2 Overview Training background (addictions, predominantly MSM using Club Drugs) Research background (dependency, attachment, men, marginalised populations) MSM Club Drug Taking Men s Perception of Their Fathers: An Interpretative Phenomenological Analysis CNWL s Club Drug Clinic Essential Points To Consider Importance of Connection Case Studies

3 CNWL s Club Drug Clinic Keyworker Family Therapist / Counselling Psychologist (M.I) (in training) Modality Duration Presentation CBT 16 Sessions chaotic/using Systemic Collaborative abstinent Person Centred Patient Decides abstinent Assimilative Varies stuck!

4 Essential Points To Consider Minority Stress Cultural Competency (understand my world!) Non-pathologising Culturally Affirming (validate my world!) Different familial, societal and cultural attachment considerations Heterosexism, Racial Prejudice, Sexism Implications for artificial dependency Trauma impact Splitting; intersectionality; internalised homophobia; ChemSex Micro-aggressions; gender binary; not telling (Milton, 2015) Identity (who am I if I don t take drugs?); coming out; HIV status Hear me! Formulate or hypothesize collaboratively (locate problem distress) Strong emphasis on therapeutic alliance - modeling healthy relationships

5 Essential Points To Consider Facilitate self-direction CBT collaborative Systemtic re-populate the genogram Person C. reinforce and affirm HEALTHY RELATIONAL DEPENDENCY INCLUSION

6 It s about thinking how we re socially connected to one another Professor Kevin Fenton, Public Health England On ChemSex Maybe there s a sense of connection that people are getting? Dominic Davies, Pink Therapy European ChemSex Forum, 6-8 th April 2016

7 Let s Get Psychologically Mindful

8 Connected How? Relational Intimacy intra-psychic and inter-psychic Shame (as distinct from guilt) Perfectionism (drugs regulate the dance between this and shame) Self-Esteem Building Social Networks Addressing neuro-psychological impacts Parasympathetic arousal (anxiety reduction) Safe, sane and consensual sex dopamine fix; arousal (sexual abuse) Nomophobia Attachment phenomena avoidant / anxious Regulating inner-chaos without drugs

9 Case Study Assessment complex or non-complex? Heterosexual or LGBT? Empathogens? Stimulants? Dissociatives? Depressives? How does this inform attachment phenomena? How do they connect? What are their unmet relational dependency needs? Physical and/or Mental Health Problems (psycho-pharmacology); ETE ; Mindfulness Risk: drug combinations (e.g. g and alcohol) Safeguarding critical to rebuilding self-esteem and relational intimacy e.g. sexual abuse. Supervision TOPS, GAD-7, PHQ-9, Patient Satisfaction

10 Case Study 1 Mark is a 43 year old White British gay male, former high class sex worker and ChemSex user. Adopted, he was physically and emotionally abused by his adoptive father. Rejected by his family of origin; estranged from adopted siblings. Former crystal meth, mephedrone and GBL user (sexual context). Abstinent on presentation (had worked with a CDC keyworker). Psychologically minded. Fearful-avoidant (particularly around men). A history of physical violence; sexually seductive on initial presentation (relational over compensation). Worked systemically with sessions focused on relationships (to help, family, men and friends). Thirteen sessions so far hypothesizing, staying curious, creating relational breathing space.

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12 Therapeutic Outcomes - 1 Repopulation of genogram friendships, balance of male and female. Focused generation of mutually respectful male friendships (deemed as key). Abstinence from all sexual activity. Management of reciprocal boundaries around overbearing women (relational breathing space). Awareness of implications of familial patterns in here and now. Appropriate regulation of affect. Raised self-esteem. A new blueprint for relating. Focus on connection and getting emotional needs met (relational intimacy). Understood on an interpersonal level (inter-psychic and intra-psychic).

13 Case Study 2 Augustina is a twenty-three year old heterosexual Polish female and (sexual) performance artist, abusing amphetamines daily. She was raised by a dictatorial mother and passive father who became ill when Augustina was 8. She nursed him, would give him his medication. She also took his medication aged 14 and developed a dependency to codeine. She came to the UK five years ago and has felt isolated particularly in the context of building intimate relationships. She has had a platonic relationship and wished it had been so much more. As a performance artist, she allows herself to be cut. Of late this performance has translated to Berlin as well as London. She is in the process of extrapolating herself from the techno-scene (inclusion) and has limited her use of amphetamines to the weekend. She also smokes marijuana 3-4 times a week. Working using CBT, but from an assimilative integrationist perspective, therefore systemically but with CBT as the focus and at the core. Eight sessions thus far.

14 Therapeutic Outcomes 2 Controlled drug use (weekends only). Question remains around chems in the context of sexual performance work. Greater awareness of critical incidents and effects on thinking therefore drug taking behaviour. Regulation of affect through commitment to thought records. Greater intra-psychic awareness through use of downward arrowing and Socratic questioning. Awareness of how father used codeine to physically and arguably emotionally numb relational pain with Augustina s mother. (Bowen Theory). Systemic shift in relationship to perceived authority as well as the drug (triangulation). Pursuit of appropriate pleasurable activities, exercising of personal agency. Healing of shame; greater relational intimacy (therapeutic alliance).

15 References Available On Request Under the supervision of Dr. Susan Strauss