Joanne Steinwachs has practiced psychotherapy as a clinical social worker since 1985 and runs a private practice in Denver. She works primarily with adults, addressing a wide range of issues, including chronic mental illness, addictions, eating disorders, and bipolar disorder. Joanne is a friend of Friends, and she spoke with Western Friend by phone on March 14, 2013.
Western Friend: Could you start out by talking a little about your professional experience, especially in working with people with substance abuse issues?
Joan Steinwachs: The primary model that I work from is called Acceptance and Commitment Therapy. Basically what we think is that most struggles people have are from their trying to get rid of stuff that humans can’t get rid of – normal, everyday parts of being human, like shame, hurt and sadness. People find different ways of trying to escape from this basic sense of human vulnerability. Some people are born with physiologies that just react really strongly, that make it really compelling to try to escape. Some people are born into families that teach them that if they have feelings, there’s something wrong with them.
So for me, addiction is just one way that people try to escape from the stuff that’s inescapable. So the work really is to help people learn how to stay compassionately with themselves when painful stuff shows up.
Our culture tells us that we’re supposed to be like machines or something – bulletproof, immortal, perfect, omniscient. People can get so caught up in this unrelenting screaming at themselves, that anything that makes that screaming stop seems good. And it does stop for a moment when you get high or you get drunk. But then it starts right back up again.
WF: Where does the word “commitment” fit into the equation?
JS: So the acceptance piece is: you’re not going to spend your life trying to get rid of things that can’t be gotten rid of. The commitment piece is, OK, what do you want your life to be about? What’s important for you to do in your short time on this planet? What do you care about?
And here’s where it gets really interesting – whenever somebody really shows up whole-heartedly to what they care about, all kinds of other stuff also shows up – fear, shame, doubt, anxiety, you name it. If you show up for your children or your family or anything you really care about, you make yourself vulnerable to pain. So commitment means that when pain shows up, you let that be there.
A lot of therapies imply that after you stop feeling bad feelings, then you can live your life. After you work out your issues, then you can contribute to the world. And it just never happens.
WF: So when you’re working on commitment, you’re looking outside yourself towards something out there in the world you’re committing to?
JS: Yes, that’s part of it, but it’s a little sloppier than that. You don’t actually look outside of the pain for what you care about, you look right at the pain. Things don’t hurt unless they matter. I care deeply about my friends, my colleagues, my family, and if they’re struggling and suffering, it’s hugely painful for me. So the pain is a signal.
And this is where the how-to-get-better narrative in our culture doesn’t work, the idea that, “When I don’t feel this shame or sorrow or grief or regret, then I will change my behavior.” That doesn’t work.
WF: What’s your – if you have one – what’s the way you conceptualize Sprit in the mix here?
JS: I’m very open to however people see that. When people are talking about something they care about, you see this kind of light show up for them. It might be embedded in a lot of shame and a lot of pain. But I’ll say, “What is it about this that matters?” And they’ll say, “It just does.” And I think that, that sense of “it just matters,” if you want, you can call it God or Spirit or whatever is a kind of light that shows up for people, usually with some sense of love and caring. And how people look for that light or that connection, I think that you can do it a million different ways – Judaism, Christianity, nude interpretive dance. I don’t think it matters.
WF: So how do you see that awareness interacting with addiction and recovery?
JS: A lot of times people will say, “My god, my spirituality, my ground – is my addiction.” People will say that. People drink spirits, right? This is a very old conversation in addiction literature. The founders of AA talked to Jung about this, about how the alcoholic is looking for this transcendence.
So I think finding a different kind of transcendence . . . I’m not Christian, but I talk to people a lot about the story of Gethsemane, Jesus in the garden. In that moment and in that place of absolute terror and despair, he said, “Yes.”
I mean, he’s a god, right? So he knows what’s coming. And you can hear him in this incredible humanness, bargaining, “Could we just take this cup from my lips?” But eventually, he just says, “Yes.” And I think there’s something profound in that he didn’t say “Yes, if,” or “Yes, if not,” but “Yes.” Will you show up for your life?
WF: And in this case, showing up for life means showing up for death.
JS: Exactly. And none of us gets to escape that. So if that’s the case, then how do we want to live? It’s like, death is not the enemy. Not living is the enemy.
One of the other things that I think people get really confused about is the difference between “intense” and “alive.” Smoking crack is intense, but it’s not alive. Sometimes things can be very alive, but not intense, like watching your children sleep – it’s not super intense, but it’s extraordinarily alive. People who have been running away from their pain their whole lives, it’s hard for them to feel “alive,” and they get confused between “alive” and “intense.” Does that make sense?
WF: Yes, there are all sorts of conceptualizations that Quakers have drawn from different parts of the Bible, and the concept of the “still small voice” relates to what you’re saying, I think.
JS: Yes. And you can’t run away from your pain and listen for the still small voice. You have to stop. You have to sit still. And you have to listen. And when we stop, sit still, and listen, the first thing that tends to show up for people is not the still small voice, it’s the loud, screaming, shrieking voices.
WF: I’m interested also in the more social dimension of all this, especially interested to be talking with somebody in Colorado, which has just legalized marijuana. So what do you think about the role society ought to be taking in regulating drug use?
JS: So, whenever we say “society,” that’s us, that’s me and you. So how do we interact with people who are struggling? What is the role that I take as a human being? I try to be open. I try to be honest. I try to be respectful. I ask, “What happens when you smoke pot, or drink alcohol?” And pretty much to a person, people say things like, “Well, I feel better.” OK, so then I ask, “And then what happens?” “I feel worse.” And I think really, it’s being respectful to recognize that for a lot of people, they don’t know anything else. They don’t. This attitude of, “Don’t use alcohol and don’t use drugs because you’re weak or bad or stupid,” I think it’s just so inhumane.
WF: Quakers have this long-standing history of opposing alcohol. I’ll read you this quote from William Penn in 1678, “Drunkenness or excess in drinking is not only a violation of God’s law, but of our own natures. . . . It renders men unfit for trust or business, it tells secrets, betrays friendships, disposes men to be tricked and cheated, finally, it spoils health, [and] weakens the human race, . . . .” So there’s been this history, and I’m curious about your reactions . . .
JS: Well, here’s my thought. What I hear Penn saying is, “Getting wasted does not make a life that’s really grand for most people.” No argument there for me. What I object to is shaming people. If that worked, the conversation would have ended with Penn. But we’ve got a large swath of the people in our culture who are doing everything they can to escape feeling, so we have to address that. The issue is that we’ve told people that normal human responses must be gotten rid of, that for you to be a good person, you have to feel good all the time. There’s no room in that narrative for ordinary suffering. So, what can we as a society do? We can show up and say, “It’s OK. It’s OK that you’re mad. It’s OK that you’re hurt and angry and ashamed and feel guilty. It’s all right.”
We can get so focused on “get rid of alcohol” or “get rid of marijuana,” and you know, we’ve done that. Now what?
WF: Right. So taking that red herring off the table might help.
JS: Yes, and here’s the other thing. When I’m seeing someone with behaviors that are very costly to them in some way, I always think – that person, with their history, they’re avoiding something that for them is much worse. You know, humans don’t choose pain because we prefer pain. We choose pain because we are avoiding something worse.
As creatures, one of the things that we try to avoid the most is uncertainty. And as human creatures, we’re constantly surrounded by ambiguity and uncertainty. “I don’t know what happens next!” And if we have such a deep aversion to something as ubiquitous as uncertainty, and if we have no skills for dealing with it, and we’ve never learned that it’s normal to be scared when you’re trying something new – then why wouldn’t we try to get rid of it?
And this is the other chunk that I think about a lot – we’re at the top of the food chain not just because we have language and a way to pass on our information and communicate and plan, but we are also the children of the incredibly pessimistic and paranoid. Those of us who were not pessimistic and paranoid, back when we were little monkey people, died. There’s a saying, “It’s better to miss lunch than be lunch.” So our brains and bodies are really designed to go to the dark side, to move to a hostile, threatened, state – all of us.
I think that contemplative religious traditions speak to that – that we have to teach ourselves something that’s not natural. We really have to train ourselves to pause, to be silent, because our first response is usually going to be one of threat and violence. It’s just how we’re built. And in responding to that part of ourselves, of our creaturehood, that sort of war in our heads, we have to respond to ourselves with kindness.
One of the things that I teach my clients, I call it the “Oh, Honey” move. When I was younger, I had this woman in my life who was so deeply kind to me, and I’d go to her and I’d be all spun out, and she would just look at me and say, “Oh, Honey, you’re a mess!” And then she’d just pat me really kindly, you know? So when you find yourself really spun up and grinding and in that very escalated place, just put your hand on your chest, or some part of your body, and pat yourself gently, and say really kindly, “Oh, Honey, you’re a mess!” ♦
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