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Integrated Treatment Approach for Emotional and Behavioural Problems

by George Andruszkiewicz(more info)

listed in clinical practice, originally published in issue 71 - December 2001

Emotional problems are part of life. We are all likely to experience disappointment, depression or the loss of someone that we care about. If we have enough personal resilience and resourcefulness then we are able to deal with such problems and cope with feelings of disappointment or pain before putting the experience behind us and regaining a more positive outlook.

However, sometimes our resources are depleted, or numerous emotional problems occur simultaneously, which in turn lead some of us to take up behaviours such as using excessive alcohol, or other inappropriate coping mechanisms. These ways of coping provide fast and temporary respite but may ultimately create even greater problems through addiction.

There are an increasing number of integrated treatments for physical problems. For example, the London Multiple Sclerosis Society has a therapy centre offering conventional and complementary therapies and some hospital cancer services now offer complementary therapies alongside conventional treatment. However, there are far fewer examples of organizations that offer integrated complementary therapies specifically for behavioural and emotional problems.

The Crossroads Centre Services

The Crossroads Centre, part of the City of London and Hackney Alcohol Service, is one such service. It offers short focus and longer-term counselling, auricular and body acupuncture, herbs, homeopathy, Qi Gong, bodywork, and nutritional advice to its client group.

Many clients using the Crossroads Centre are referred by their GP; others are channelled through the probation service, and a large proportion self-refer. The complementary health service is confidential and free at the point of delivery, being funded by charitable donations from the Pilgrims Trust.

The complementary health service at the Crossroads Centre provides its clients with extra resources to cope with a difficult period of their lives. In many cases alcohol addiction is the tip of an iceberg; some clients have mental health problems and in some cases a history of violence and aggression that is triggered by excess alcohol. For some the road back to 'health and wellness' is easier than for others, particularly if chaos and bad health have become that person's norm. However, the range of treatments on offer at Crossroads helps to ensure that many can be helped to begin to progress and find hope.

The Crossroads Centre is a walk-in service; an initial appointment is not necessary. The only stipulation is that the person has an alcohol problem. Clients are expected to continue taking their prescribed medication and not to reduce the dosage or stop their medication unless they have the permission of their GP or other medical specialist.

Acupuncture

Most clients commence their visits to Crossroads by attending a group session of auricular acupuncture. This type of acupuncture has been specifically developed for addictive behaviours and involves five small needles in each ear. A number of the centre staff have trained in this protocol and attend to the clients who sit in a quiet, peaceful room where detox and herbal relaxing teas are on offer as part of the treatment. When placed in specific points, the acupuncture needles stimulate major organs of the body to cleanse and heal themselves.

The immediate benefits reported by most clients following this treatment is an increased ability to relax and lessened anxiety. The fact that this is a non-verbal treatment means that clients that are nervous about discussing personal matters, or who do not feel like talking, can be easily accommodated until they feel more confident. The fact that the treatment is carried out in a group setting also helps put some nervous clients at ease. These sessions last from 30 minutes to one hour and some clients are able to attend during their lunch break from work.

Alongside auricular acupuncture clients can receive full body acupuncture which can last for up to one hour and deals with more specific health problems.

Homeopathy

The Crossroads Homeopathic service helps clients deal with the emotional problems unique to that individual. In some cases there is a clear aetiology. For example, some clients recount that they started abusing alcohol after the death of a loved one or after their partner walked out on them. Homeopathic remedies such as Aurum metallicum, with symptoms of profound depression, excessive guilt and possibly suicidal thoughts, or Natrum muriaticum when the person is reclusive and feels worse for consolation, may help deal with long-standing negative feelings that date back to a loss. Where a person has suppressed their painful feelings associated with the loss by using alcohol or other substances, sometimes a homeopathic remedy may bring these feeling into consciousness and the client will benefit from talking these through during counselling as described below. Depression is also an emotional feature of premenstrual syndrome (PMS); other PMS symptoms can be behavioural such as aggression, and there are cases of women binge-drinking because they suffer from PMS. One such case at the Crossroads Centre was resolved with a homeopathic remedy Sepia, made from the inky juice of the cuttlefish (see case histories below).

Where there is not a clear aetiology, homeopathy can offer help by determining the person's constitutional remedy. This will be based on studying many aspects of the person such as the symptoms of the illness, fears, preferences and responses to general factors such as the weather and food preferences.

A third strand for homeopathic treatment is prescribing on the basis of functional remedies.[1] For example, the a tincture of Avena sativa is useful where there is nervous weakness, insomnia, trembling and the inability to concentrate; the homeopathic remedy Kalium phosphoricum helps where there is long-standing depression accompanied by irritability, anxiety, loss of memory and nocturnal fears and anguish.

Qi Gong

Clients who have attended Crossroads for several weeks are encouraged to try a Qi Gong session. This is a series of gentle self-healing movements and is based on a style known as Hua Gong.[2] Hua means transformation, integration and simple body movements. Relaxation, visualization, breathing techniques and sounds are the various techniques used in this system.

The Qi Gong class is led by a teacher and is open to all clients on a drop-in basis. There are several classes a week and each class is an hour in duration. The practice involves some movement but it is not an exercise class, so no special clothing or ability are necessary. During the summer months the Qi Gong sessions are held outside at a nearby park. Clients have reported that after the Qi Gong sessions they feel a range of experiences including a gentle release of feelings, recalling beneficial childhood experiences, increased motivation and creativity and a feeling of re-connectedness to their own natural energy.

Nutrition

The role of nutrition in the treatment of emotional and behavioural problems is an ever-growing area of research. Patrick Holford, in his book, The Optimum Nutrition Bible, states that, in treating mental health problems such as depression, often the best results are achieved not by a 'magic bullet' such as for example, folic acid, but by assessment of a person's biochemical status and a tailor-made diet to bring them back into balance.[3] Nutritional intervention may initially present a problem as emotionally depressed people are unlikely to be looking after their diet and alcoholics may substitute drinking for eating. Research has found that drinking more than moderate amounts of alcohol damages the intestinal tract, increasing permeability and possibly resulting in a leaky gut, which exposes the liver to even more toxins from the bowel, and this further aggravates alcohol-induced liver disease.[4] Clients who have been attending the Crossroads Centre for a while are encouraged to attend a series of nutrition seminars, which discuss factors such as the foods that lead to increased craving, the importance of controlling blood sugar levels and how this will affect mood, and methods of increasing the body's ability to manufacture 'feel good' neurotransmitters, such as serotonin, using timed protein meals and complex carbohydrate snacks.

Counselling

Counselling at the Centre is multifaceted. Unlike the other therapies, it is funded through local government and the health service. The counselling model is an integrated one and is based on behavioural, cognitive, person-centred and psychodynamic approaches. It is goal focused, based on the client's own desires around their drinking. There are a number of full-time and volunteer counsellors and the organization runs Continuing Professional Training Programmes and a nationally recognized volunteer scheme. Unlike the Alcoholics Anonymous approach, the Crossroads Centre does not demand total abstinence. Instead there is an emphasis on stabilizing and helping the client to formulate an accurate view of their drinking in terms of triggers, amounts and patterns, thus supporting them in making choices in order to bring about change. The service helps clients to work towards their chosen goal, be that abstinence, controlled drinking or reduction to within safe levels.

Following a detailed assessment, clients are offered six weeks of behavioural counselling based on motivational interview techniques. This can be followed by a referral to the specialist counselling part of the organization, based at separate premises away from the drop-in for longer-term counselling, lasting up to two years. Whilst the short-term six-week model will help some clients to become motivated and to take some action around making changes to their drinking behaviour, for those clients with perhaps a less chaotic lifestyle and higher levels of self-awareness, long-term counselling will help to uncover and resolve deeper-seated reasons for drinking behaviour. For example, many clients are depressed, even suicidal; others suffer from anxiety and use alcohol to self-medicate; others have experienced loss and bereavement. Counselling addresses all of the above and helps people to explore and express themselves in less destructive ways. Throughout the period of counselling, clients continue to receive other complementary therapies.

Case Histories

Case History 1

Jane is in her late twenties. She self-detoxified from alcohol three weeks prior to seeking help. After detoxifying, Jane found herself feeling fearful and very apprehensive. She was unable to sleep at night, found it difficult not to break down and cry at the slightest upset, and felt unsupported. Following her first auricular acupuncture treatment, Jane said that she felt more relaxed and that she slept well that night. She continued treatment twice weekly for a month and felt more in control of her feelings and better able to express and make sense of some of them. She continued using the acupuncture service once or twice a week for the following two months and decided to make use of the homeopathic service. She realized that she had been using alcohol to cope with her feelings of worthlessness. She spent her first appointments almost entirely in tears. She was alone and felt utterly dejected, which arose from a background of prolonged childhood sexual abuse.

She reported that the prescribed homeopathic remedy helped her to deal with very painful issues until these could be explored in more depth with ongoing counselling. In the past, her usual reaction would have been self-harm, for example she had attempted to slash her arms on two past occasions and had been admitted to hospital. This time self-harm did not occur. Another homeopathic remedy helped to reduce the recurring nightmares that she had been experiencing, which had featured pursuit by the abuser. A later remedy helped to reduce the duration of painful menses from an average of three weeks per month, down to seven days. In addition to acupuncture and homeopathy, Jane also made use of long-term counselling at the Centre.

After several months, Jane reported that her self-worth had increased immeasurably. She is now in a relationship, and there is the prospect of fulfilling and interesting paid work within reach. She turned down a poorly paid job that in the past she would have gratefully accepted. She looks obviously brighter and happier than she did a year ago.

Case History 2

Elizabeth used alcohol to cope with her emotional state during menses. Her condition had been steadily getting worse over the years. During her periods she became withdrawn, angry and completely antisocial. She would swear at people and be very short tempered with everyone that she met. She would be unwittingly angry and rude to customers and staff at the charity shop where she worked as a volunteer. Given the choice, she would spend the four to five days of her period at home and only went out to buy alcohol and food at the corner shop.

The homeopathic remedy Sepia was chosen for Elizabeth based on her particular set of symptoms. At her second appointment, Elizabeth said that she had not expected the remedy to work as there was no apparent change. However, after several weeks she noticed that her period was ten days late. This had never happened to her before and she knew she was not pregnant. When her menses did occur she did not experience any of the negative emotional symptoms that had been causing her such problems.

Conclusion

By utilizing different sources of funding in order to offer a wide range of different treatments, the Centre provides easy access in a caring and accepting environment. The Crossroads Centre has established itself among the cutting edge of integrated complementary therapies for treating the emotional problems and behavioural problems associated with substance abuse.

References

1. Bernoville F. Therapeutics of Intoxication. B Jain Publishers. New Delhi. p18. ISBN 81-7021-378-9. 1994.
2. Agutter J and O'Neill L ed. The Natural Health Directory. Kingsley Media Ltd. Plymouth. p310. ISBN 19-0336-100-1. 2000.
3. Holford Patrick. The Optimum Nutrition Bible. Piatkus. London. p194. ISBN 0-7499-1855-1. 2000.
4. Pizzorno Joseph. Total Wellness. Prima Health. Rocklin, CA. p119. ISBN 0-7615-043308. 1998.

Further Information

The Crossroads Centre (part of City and Hackney Alcohol Service) is based at 2 Westgate Street, Hackney, London E8 3RN; tel: 0208 525 1313. The Centre is open from 11am to 4pm Monday to Thursday and 11am to 12.30pm on Fridays.

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