A Bit of a Big Book Bibliotherapy

                                                         By George M. DuWors

This article describes a practical technique for showing clients, from their own experience, how relapse may be set up in the first days or weeks of abstinence. The counselor requests them to read and reflect on two separate passages from Alcoholics Anonymous, the “Big Book.”  If clients identify with these two experiences and the connection between them, one task for lasting recovery becomes clear. As does the need for Steps Four through Nine of the 12 steps, or something very much the like. 

So this procedure starts with client experience.   Not just relapse and/or a painful spree, but the painful aftermath often described as “beating myself up.”   You may catch this live during detoxification or early abstinence, when you will have to carefully gauge what the client can absorb or tolerate.  Otherwise, you may have to elicit the experience through directed questions and/or role-play. “How would you describe what you go through the first few days after you get clean and sober again?” “Do you beat yourself up during those first few days or weeks?” Even, “Be yourself after you got clean and sober again – see if you can play out loud the sort of thoughts you were having about yourself.” If they have never tasted dismay at their own loss of control, the exercise may have to wait!

If you can bring this experience (back) to their attention (or they share it spontaneously), enough that they are feeling it, you can offer them Page 73 of the AA Big Book. Highlight the two paragraphs in the middle of the page, starting with, “More than most people…” and ending with “that makes for more drinking.”  Of course, while they are reading, you are going to be at your most attentive, watching and

 

 

 

listening for reactions to the text. And noting their eyes and whole physical being when they look up from it. You may well get a chance to encourage them to verbalize their nonverbal responses. “What was it that made you chuckle?” “What made you nod your head up and down?” At a minimum, you will want to know how much they identify with the experience of leading a “double life.” Most important, you want to know if they experience their own post-binge memories as “nightmares” and have felt the grim determination of the Big Book alcoholic/addict as “he pushes these memories far inside himself.”

Open-ended questions might help the transition to the second passage. “What do you make of this?” “Any thoughts on where this fits with your own relapse experience, or how to prevent it from happening again?”

After reflecting and validating their thoughts as much as possible, you might ask them if they have a name for the feeling when facing those “nightmare” memories.  If they do not recognize “shame,” you can offer it as a possibility, see if they think it fits their own experience.  The next question sets up the second selection for them to read, regardless of how they answer. “What do you think happens to those memories when you successfully push them inside?”  Even if they answer quite correctly, ask if they would like to look at another passage in the Big Book, one which seems to be talking about the resulting problem.

Assuming the answer is “yes,”  hand them page twenty-four, asking them to read the already italicized paragraph which begins, “The fact is…” and ends with, “the first drink.”  The key sentence laments being “unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or month ago.”  Once again, you track and elicit the nonverbal responses. Have they, too, been unable to remember “with sufficient force” at the moment of picking up the first drink/drug of physical relapse?  This should be particularly clear to those who began their relapse with the classic self-assurance that “One won’t hurt” or any other variation of wishful thinking. Those who picked up the first drink/drug with a more emotional expletive – “Dammit” or the less polite variations – may have had better memories, but they can hardly argue their recall had “sufficient force.”

Having established their personal experience with the italicized description in the Big Book, you can ask if they see any connection between pushing shameful memories “far inside” after drinking/drugging and being unable to remember those very same memories before picking up the first drink/drug and creating still more shame. Some will. Some won’t. One way or another, lead them to the conclusion:

   The alcoholic/addict, tormented by shame from the latest episode and “beating him/herself up,” is using a mental hammer to drive the shameful memories so far inside the mind they will lose almost all “force.”  If remembered at all, they will have no deterrent power. They will not seem real.

You may have to repeat and explain this more than once. It is, at the same time, both abstract and concrete. “You seem to see that the shame after your relapse was intolerable and you drove those

 

 

 

nightmare memories deep inside? When you decided to pick up the first drink/drug again sometime later, those memories just weren’t there to stop you – yes?”  Still, it seems counterintuitive that a person so unhappy with themselves for drinking/drugging again is, at that very moment, setting up the next relapse by suppressing their “mental defense.”  Maybe that is one reason they seem to have to repeat the cycle, again and again.  The Big Book itself never spells out the connection between these two pivotal points in the relapse cycle – the hours and days after the last “spree” and the moment immediately before the first drink of the next one – it is the steps themselves which address it. And maybe that is why it took 40 years from the time this clinician first read the Big Book until he connected the two descriptions, in spite of routinely working with shame.

At any rate, we are not quite done.

Ask your clients if they see the dilemma. Perhaps, you may summarize, “If you do not push those memories deep inside, you live in constant shame. If you do push them inside, you seem doomed to constant relapse.”  Again, watch for their reactions. Check if this makes sense to them as a personal dilemma. Raise the question of any ideas they may have about how to remember their painful experience enough to not repeat it, without having to endure perpetual shame. 

When you perceive they are ready, you might ask if they can see an alternative to pushing “these memories far inside.” What would that look like? What would one do? If a person wants an opposite result, what is the opposite action?” You might even be literal and ask what it would look like to “push these memories far outside oneself.”

Clients will vary in their ability to spell this out. Letting them be the first to suggest alternatives, you can develop a list together for pushing memories outside instead of inside. It just might look like this:

• ·        Allowing the memories to be and tolerating the shame for the moment. (Accept vs reject)
• ·        Presenting memories to (or holding them in) the light of any sort of loving, higher consciousness, whether mindful compassion or a theistic “Higher Power.” (Bringing to light vs hiding in darkness)
• ·        Writing memories down on paper, which puts them outside your body. (Objectify and externalize vs suppress)
• ·        Reading or sharing them out loud to another human being, which puts them in someone else’s mind, also outside your body. (Share vs. hide)
• ·        With that other person, looking for any patterns or motivations that made you do the things you are ashamed of, even things you did while sober. (Understand vs hide)
• ·        Making a list of the “victims” of your shameful actions, the people you find hardest to face. (Objectify and externalize vs hide)
• ·        Looking these victims in the eye, taking personal responsibility and performing any action that will undo or repair the shameful action or its consequences, pushing it into still more people, and into the past. (Repair vs deny/defend/avoid)

 

 

The above list would be reasonable results for a (group?) brainstorm on the subject of doing something that is the direct opposite of pushing shameful memories inside.  It is also a reasonable synopsis of the most cognitive-behavioral of the 12 steps, Four through Nine. These steps include two lists, one of the memories themselves and one of people harmed. They include active self-disclosure and direct, behavioral amends.  As a result, Steps Four through Nine directly address the psychodynamic of shame-suppress-forget-relapse-shame, replacing it with shame-face-repair-remember-recover. This process “detoxifies” the memories of shame, guilt, and resentment.

Some clinicians will go straight to the 12 steps, without brainstorming. Others may offer a “decisional balance” exercise for the “pushing inside” behavior. However you do it, the point is to give the client a clear picture, from their own experience, of how shame and suppression set up the next relapse. And a clear alternative, a task that is as concrete as it is active – to clean up the mess that shames you instead of burying it. However you came by the knowledge, you need to convey the power of those middle six steps to transform the deepest shame into powerful gifts. Gifts your clients already have for their fellow alcoholic/addict, the one who is still floundering on the dark side of shame and relapse. And every time  alcoholic/addicts share their detoxified experience they are “pushing it far outside” yet again.  Not to mention, refreshing memory that stands in the way of the first drink or drug with the full force of reality. And virtually none of the shame.

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George DuWors is an addictions specialist in private practice near Seattle, Washington. He is the author of the new workbook, “Getting It: Building Motivation from Relapse” and has developed the corresponding workshop for counselors, “Motivation for Maintenance: Developing Discrepancy From Moments of Addictive Relapse.”  See motivationformaintenance.com or gettingitworkbook.com.