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Every psychotherapist working in the challenging field of the addictions is familiar with patients who yo-yo between extended periods of abstinence from substances, or other compulsive and non-substance-based addictive behaviours, and who then lapse or relapse to compressed periods of excessive substance misuse, the so-called binge episode. In this paper we reverse the lens of theoretical focus somewhat, from its more traditional position within the clinical field of addiction. We suggest that periods of abstinence from substance misuse, or other compulsive behaviours, may also represent a type of binge-like behaviour which satisfies, for a time, core needs though which may also invariably be non-sustainable if the underlying psychodynamic processes underscoring such repetitive abstinence binges are not explored and translated, in work with the patient. Linkage will also be made between poles of experience that addicted and substance abusing patients evince, which are here termed black holes (Sweet, ) and white holes (Miller, personal communication, 2015). These proposed intra-psychic structures are, it is asserted, intimately related to the ability, or not, of the individual to bear psychological pain and distress, tolerate separation from objects at both an inter-personal and intra-psychic level and to delay gratification of instinctually grounded desires and wishes. The authors reference Hopper's () previous description of both black holes and white holes in the addictions, and Glasser's () conception of the black hole in relation to perversion and his description of the 'core complex', drawing out both similarities and differences in the viewpoints presented. Key ideas in the paper are illuminated and contextualized through the presentation of a number of illustrative clinical examples. [ABSTRACT FROM AUTHOR]

In clinical theory and practice we rarely find an isomorphic fit between early patterns of attachment and discrete clinical disorders or syndromes. Although a linear equivalence is not implied here the author draws out parallels between early disorganized attachment patterns, the internal world of the substance abuser and the ways in which such psychodynamic processes invariably shape and influence the therapeutic encounter. Exploring further Main and Hesse's (1990) assertion that the essence of disorganized attachment can be summed up as fright without solution, the author develops the idea that active and repeated drug use represents attempts to anaesthetically freeze the self, and in so doing to disable and paralyse internal object imagos that induce feelings of panic, terror and dread. In addition the ingestion of drugs, as other writers on the subject have observed ( Rosenfeld, 1965), often provides a type of internal inflation of the fragile self, leading to a sense of omnipotent and omniscient superiority on behalf of the substance abusing patient. [ABSTRACT FROM AUTHOR]

abstract This paper explores some aspects of psychotherapeutic technique in work with a range of presenting individuals who appeared to evidence various levels of personality integration. Consideration is given to a continuum of personality organization, based on psychotic, borderline and neurotic self-structures. The central contention advanced in the paper is that a very careful and detailed analysis of the presenting patient's level of structuralization is required before a decision on the suitability of psychotherapeutic intervention can be made. I have suggested that prospective diagnosis, by recourse to symptomatology or subset symptomatology, is an inadequate means by which to gain an accurate understanding of an individual's particular needs. Recognition of the predominant mode of personality structure, whether this is psychotic, borderline/narcissistic or neurotic, is of the utmost importance. Experience shows that the ability of individuals to 'adjust' to the parameters of the therapeutic frame will be contingent upon the level of personality structure that has been attained. In turn, the particular forms of psychotherapy appropriate to the developmental level of individuals should be carefully considered. Generally, under-structured patients require a greater degree of supportive work, before movement towards a psychodynamically interpretative approach can be utilized. [ABSTRACT FROM AUTHOR]