Reflection

From Junky to Doctor

After twenty-five years of clinical work, most of it in addiction, eating disorders and trauma, what I offer patients is more or less what was offered to me when I stopped using.

I remember sitting in front of a therapist for the first time meaning to stop. I was a junky, which is the word that was available then and the one I would have used about myself. I remember the state of mind precisely, because it was not ambivalence and it was not refusal. I had tried. Substitution, methadone, therapy, groups, my GP, a psychiatrist. I had tried everything there was to try.

And I was completely convinced that stopping was not possible.

People outside addiction tend to hear that as an excuse, or as denial, or as not wanting it enough. I don’t think it is any of those. It was a conclusion, and I had reached it the way anyone reaches a conclusion — on the evidence. Every previous attempt had failed. Believing the thing cannot be done, after it has repeatedly not been done, is not stupidity.

You cannot argue somebody out of a conclusion they arrived at that way. I have never seen it work. It certainly would not have worked on me.

What happened instead was that the person sitting opposite me was an addict.

Nobody announced it. I knew from the way he spoke — from what he chose to say, from how he took what I said, from the fact that he put words on my experience that I had not been able to find myself. That is not something you can produce out of reading. It has a particular quality. Anyone who has been there recognises it.

And that did something no argument could have done. It didn’t persuade me that I could stop. It took away my proof that I couldn’t. Because sitting in front of me was a man doing, on an ordinary weekday, the thing I had concluded was impossible.

That is what I can offer a patient that my training could never have given me. Not a promise that it is possible for them — I don’t know that, and I won’t pretend to. Something narrower. After they have sat in a room with me, they can’t quite say it’s impossible any more.

Hazelden was the first place I trained that named this as a method rather than an accident: one addict helping another has therapeutic value in itself, and it can be taught, supervised, used on purpose. Analytical psychology has its own version — the wounded healer, the physician whose capacity comes from the injury rather than despite it. That idea is what let me turn what had happened to me into something usable by somebody else.

The using taught me something too, and it isn’t the thing people expect.

It taught me to observe.

On the street you survive by reading people quickly and accurately. What someone says is the smallest part of it. You work from what they leave out, what they steer around, where their attention goes, what shifts in them when a subject comes up. You watch, you build a picture out of not very much, and you act on it. Being wrong is expensive, so you get good at it.

Years later, at the start of analytic training, I was taught infant observation. It was developed by Esther Bick at the Tavistock in the late 1940s and it is still a foundation of psychoanalytic and Jungian formation. You sit with a baby and its family for an hour a week over a long period. You take no notes while you are there. You don’t intervene, you don’t ask questions, you don’t help. Afterwards you write down what you saw, and you bring it to a seminar where it is gone through in detail.

The whole discipline is two things: observing, and imagining what is happening inside someone who cannot tell you.

I recognised it immediately. It was the same faculty. The street had been training me in it for years, under conditions where misreading somebody carried rather more consequence than an inaccurate seminar paper.

Both of those — the recognition, and the reading — have the same fault. They arrive too fast.

Recognition feels like knowledge. Somebody sits down and within minutes you have the shape of it. You know this. You have been here. You can see where it goes. That feeling is often accurate, which is exactly what makes it dangerous, because it is memory arriving in the costume of assessment.

The failure it produces is specific and I have watched it happen. A man comes in and says he drinks a bit more than he would like, and he isn’t sure whether it’s a problem. A therapist in recovery who hasn’t done enough work on himself hears his own history in that sentence, because that is how his own began. So he says: you’re in denial.

Sometimes that is right. But he didn’t get there by assessing this man. He got there by remembering himself, and he was either lucky or he was wrong. Either way the patient has just been handed somebody else’s story and told it is his.

It is one of the reasons I kept training long after I could have stopped — psychotherapist, then analyst, then the doctorate — and why I have been in my own therapy throughout, at one period five times a week in analysis. That is not accumulation. It is one question, asked over and over: what here is mine, and what belongs to the person in front of me?

Do that work and lived experience becomes an asset. Not a conclusion — a database of what could be. It gives you hypotheses faster than training alone would, and then you test them like any other hypothesis, and you stay willing to be wrong.

Skip it and the same experience becomes a hindrance, and a confident one.

The profession has some measure of this. Of 1,333 certified addiction professionals surveyed, fewer than half described themselves as in recovery — common, then, but not the norm, whatever the folklore says. And among counsellors who are in recovery, relapse has been recorded at around 38%. The authors argued that number obliges the field to examine itself rather than only its patients. I would agree, and I would add that the same missing self-examination is what produces the projection.

I don’t think this risk belongs only to people who came in through their own addiction. It is more general, and I would say it is the main occupational hazard of the work.

At some point a professional gets the impression that he knows what is happening to the person in front of him.

And when that happens, something stops. He isn’t exploring an inner world any more. He isn’t asking what actually happened to this person. He is using the material in front of him to validate what he already thinks.

The session carries on. The patient goes on talking. But everything is being sorted rather than heard — this confirms it, that doesn’t fit and can be filed as resistance, this is denial, that is progress. He is collecting evidence for a thesis he settled on some time ago, and the person opposite has become the material for it.

I don’t think this happens to careless clinicians. I think it happens more easily to experienced ones, because experience supplies the impression of knowing much faster. Twenty-five years hands you a great many patterns, and a pattern that fits is very hard to tell apart from an understanding that is true.

Which is why I keep saying a database of what could be. The moment it becomes a database of what is, it has stopped being useful and started being an obstacle, and the patient is the one who pays.

I don’t have a solution to this. Supervision helps. My own analysis helps. Noticing that I have become comfortable is usually the first sign that I have stopped looking.

Georges Brassens made the point that a gift without technique doesn’t amount to much.

That is the honest description of the last twenty-five years: acquiring technique around what the using had already taught me. The lived experience is not the qualification. On its own it is closer to a liability. Everything since — the training, the years working inside residential treatment, the supervision, the doctorate — is the technique that makes it worth anything to anybody other than me.

I remember my first one-to-one. My supervisor had a good sense of humour, and what he said before I went in was: there is one unwell person in that room, and it isn’t you.

I found it very funny, and for a beginner it was exactly the right instruction. It is everything above, compressed into a joke.

What I have come to think since is that it isn’t quite true.

What is in the room is two people who have had difficult lives. That doesn’t dissolve the boundary — the boundary is what makes the work possible, and one of us is responsible for holding it. But the idea that only one person in the room is affected by what happens there does not survive doing it for twenty-five years.

My view of people has changed enormously through this work. Things I had closed down have been opened by it, and not by choice. I didn’t decide to be changed by patients. It happened while I was attending to them.

I suppose, as a Jungian, I would say the alchemists had the image before psychology did. Two substances sealed in the same vessel: if anything happens at all, neither comes out as it went in, and a third thing appears that was not there before. The analytic relationship works on that principle. The patient is transformed. So is the analyst. It isn’t a risk to be managed. It is the mechanism.

A word about passion, because it runs underneath all of this.

Where there is passion there tends to be less addiction. I think it is the same energy. Jung said the gods have become diseases; what he meant is that the force does not go away, it only looks for somewhere to go. Passion gives it a vehicle that doesn’t destroy the person carrying it.

But passion is never far from pain, and the word says so — passio, in Latin, is suffering. If the thing you are passionate about takes too much space, it costs you. If you lose it, it costs you more.

I am passionate about this work, and it is often painful.

It is painful to sit with people who are suffering. It is painful to be confronted with my own powerlessness — to see plainly that a person’s past is shaping the journey of their soul, and to have no authority over that at all. And it is painful to think I can see another road available to somebody, and to stay where they are instead of pulling them toward it.

That last part is the discipline, and it took me a long time. Accepting that they have to find their own way, and that my job is to be there while they do.

Because being told is worth almost nothing.

Which is where I came in. Nobody told me it was possible to stop. If they had, I wouldn’t have believed them — I had been told before, by people who meant well. What changed it was sitting opposite a man who was doing it, saying nothing about it, and leaving me to draw my own conclusion.

Something has kept me from arriving at I know, and I think it is passion.

Every time I have had the impression of reaching a conclusion — about a psychic state, about the soul, about a pathology, about anything in this profession — a patient has arrived and shown me I was wrong.

Those patients are a gift, though they rarely feel like one at the time. They are the ones who send you back to your supervision, your reading, your own analysis. They make you see the work differently than you did the week before.

So my biggest teacher is, and will always be, my patient.

Dr Philippe Jacquet is a UKCP registered psychotherapist and Jungian analyst, Hazelden-trained, with a Doctorate of Professional Practice from the University of Essex. He practises at Harley Street and in central London, and supervises the clinical team of a private residential addiction clinic and of a private psychiatric hospital. He works with addiction.

Photograph by Zoshua Colah.