Therapeutic technique gives voice to patients` conflicts

Some addiction professionals' preference for experiential techniques in treatment is leading them to embrace a therapy that experienced its heyday a couple of generations ago.

New York-based Scott Kellogg, PhD, is a leading practitioner and trainer in “Chairwork,” usually conducting a couple of training sessions each month for clinicians in various disciplines. Founded by the creator of psychodrama and then made more accessible to professionals through the efforts of Fritz Perls, Chairwork offers patients an opportunity to give voice to conflicting energies within themselves, something that Kellogg says is often not considered acceptable in traditional treatment settings.

Kellogg says interest in the therapy among professionals has been significant of late, although he adds that he mainly trains individuals who have some background in mental health therapy, as opposed to addiction counseling alone (for more information on Kellogg's work, click here).

The “chair” element of the therapy refers to a process in which the therapist may have the patient sit in one chair and imagine another person sitting in an adjacent empty chair, engaging the patient in a dialogue to address a conflict. In the context of addiction, the chairs could be occupied by two different parts of the patient—for instance, the part that wants to continue using substances, and the part that seeks something different in life.

“The whole notion of someone saying, 'I want to continue using,' it is usually forbidden in traditional treatment to speak in this way,” says Kellogg.

Catalyst for change

Kellogg says Chairwork is built around a couple of core concepts: that it is therapeutically healing to work with the patient to give voice to the various energies within them, and that it is also healing to enact or re-enact scenes from the individual's past, present and future. For the patient with an addiction, for example, the past might focus on an experience of trauma, the present might address assertiveness skills, and the future might envision the person whom the patient could become.

The most easily understood conflict that an addiction patient might be experiencing involves the desire to continue using vs. the desire for something different, says Kellogg. In Chairwork, a patient would have the ability to express thoughts such as, “Drugs give me pleasure,” or “Drugs help my depression,” as well as the opposite thoughts of, “Drugs are destroying my life,” or “I want something better,” he explains.

“These two parts speak strongly,” he says. “That's profoundly catalytic for people. Rarely do people have both parts engage and encounter with each other.”

In this scenario, the patient might participate in such a dialogue for 10 to 15 minutes and then be debriefed on what the experience was like. A plan for addressing both parts of the individual in a productive manner would then be articulated over time, over multiple sessions.

Kellogg says that Chairwork can be integrated into therapists' other clinical constructs—it is not limited to use with only one or two other modalities.

Perls, the creator of Gestalt therapy, popularized Chairwork in the 1960s. His philosophy was that he did not want patients to talk “about” an issue they had with someone, but to place that person figuratively in the chair and to speak directly to that person. He believed that people lose access to parts of their personality, but that those can be reintegrated through dialogue that reverses damage. Giving voice to these disparate sides of oneself can give rise to creative solutions, Kellogg explains.