CHEMICAL DEPENDENCE AND THE TRANSFORMATION INTO A PERSEPHONE WOMAN by SYNDE LYNNE ACKS-STEWART A clinical case study submitted in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY IN CLINICAL PSYCHOLOGY MERIDIAN UNIVERSITY 2011 Copyright by SYNDE LYNNE ACKS-STEWART 2011 CHEMICAL DEPENDENCE AND THE TRANSFORMATION INTO A PERSEPHONE WOMAN by SYNDE LYNNE ACKS-STEWART A clinical case study submitted in partial fulfillment of the requirements for degree of DOCTOR OF PSYCHOLOGY IN CLINICAL PSYCHOLOGY MERIDIAN UNIVERSITY 2011 This clinical case study has been accepted for the faculty of Meridian University by: __________________________________ Lisa Herman, Ph.D. Clinical Case Study Advisor __________________________________ Melissa Schwartz, Ph.D. Academic Dean iv ABSTRACT CHEMICAL DEPENDENCE AND THE TRANSFORMATION INTO A PERSEPHONE WOMAN by SSyynnddee LLyynnnnee AAcckksss---SSttteewwaarrrttt It is thought by many that chemical dependence can develop in response to specific unmet emotional needs, and can be an intergeneration family dysfunction. This Clinical Case Study describes the psychotherapy journey of a young adult woman struggling with chemical dependence. Although attention was largely focused on her drug use, by the end of the six months of psychotherapy, she was well on her way to changing her identity from a lonely, self-conscious girl into an empowered young woman. The Literature Review chapter includes biological, cognitive-behavioral, psychodynamic, and socio-cultural perspectives on chemical dependence, as well as imaginal approaches to chemical dependence. Key concepts and major principles from these perspectives help identify the ways chemical dependence can be experienced psychologically. The Progression of the Treatment chapter depicts this woman’s struggle with cocaine dependence and its resolution. This section highlights themes, significant interventions, and turning points during the course of therapy. Imaginal Psychology’s v contributions to treatment interventions helped contain the client’s exploration of her vulnerabilities with acceptance and understanding. The Learnings chapter addresses the mythic lens through which the client viewed her world and the chemical dependence that she suffered as a result. There were five significant learnings this study can contribute to the field of psychology. The first learning is that chemical dependence is highly correlated with a false self: the mask that problematically entrenches its captives in the pervasive, all-consuming experience of isolation, shame, and alienation. The second is that intoxication is sought for the mystery, magic, beauty, and interpersonal connection inherent in the experience. The third is that chemical dependence is experienced as a form of enslavement rooted in the bastardization of the feminine principle through the mind-body-spirit split. The fourth is that it is problematic to either be codependent, distanced, or adherent to rigid boundaries while treating a patient with chemical dependence. The fifth learning is that after the development of chemical dependence, the remaining benefit of the pattern lies in the transformative potential of sobriety. The Reflections chapter presents the Demeter and Persephone myth as the backdrop to the client’s life. The client began suffering from a mind-body split early in her youth. Once she managed to process how the implications of this myth played out in her life, she was able to significantly improve her connection to her body, to develop soulful connections, and to minimize cravings for intoxication. Demeter and Persephone is a myth worthy of close attention when working with women who have undergone early trauma in their lives particularly relating to their interpersonal familial relationships. vi ACKNOWLEDGEMENTS There have been some heart-felt, generous people who helped me complete this Clinical Case Study. I graciously and deeply appreciate the loving, practical, and emotional support provided to me by the following: Kate Acks, Craig Stewart, Zeth Stewart, Bob Acks, Chris Acks, Billie Green Greenhalgh, Chrissy Smedberg, Betty & Barry Smedberg, Cohort Six from Meridian University, Pamela Culver, Paula Solomon, my co-soul-workers at TLC Child and Family Services, the mentors and educators who taught coursework during 1998-2002 at Meridian University, Professor Barry Dank from California State University, Long Beach, and the courageous youth I have been blessed to work with who have put up with me who graciously allowed me to witness them. I am also in debt to Nicole Doherty and other friends at UCHS who endured struggles with me during our youth. These people were invaluable during challenging and exciting moments when I needed to share what I was going through. Thank you for loving me, giving me a swift kick when I needed it, and for reminding me what really matters. I especially want to thank my son, Zeth Rowland Stewart, for his contagious belly laughs and his brilliant honesty. I also need to thank my husband, Craig Stewart, for keeping Zeth thriving while I completed this work. You both inspired me. I am grateful to my parents for believing in my ability to complete this initiatory process. Aside from the love and pride they have shown that I am their daughter, their belief in me helped me live up to my potential. My mother provided countless hours of childcare, emailed articles, encouragement, praise, and suggestions to help me along the way. My father repeatedly told me I would be a doctor from a very young age and he inspired, vii encouraged, bribed, and pestered me to complete this work until it was done. I only wish my grandparents, Rowland and Alice Rudser, were still alive to see this work come to its completion. I believe that they are still watching over me, and they would be proud that I followed through with this substantial goal. Thanks to Pamela, a kindred spirit, who offered encouragement, compassion, and practical guidance when I did not know how to live my life and finish a Clinical Case Study. Similarly, Cohort Six has been my guild, my family, and my sohbets. I am blessed to have so many brilliant, amazing women in my world. Paula Solomon was a tremendous blessing as a supervisor. Aside from her wisdom, she was a role model, who showed me ways to be kind, accepting, warm, funny, practical, and she mentored me with integrity. My coworkers along the way have reminded me that psychology is valuable insofar as it helps us to live life, not hide from it. TLC has the best employees possible for a residential treatment facility because of their soulfulness, heart, willingness to think outside of the box, and pure intentions. Of course, this case study would not have been complete without the courageous client who was the focus of this study. She was truly inspiring. Lastly, I extend great thanks for the educators at Meridian University as well as what I think of as my intellectual mentors: Sheila Powell, Marion Woodman, Tanya Wilkinson, Sylvia Brinton Perera, Sigmund Freud, Dominick Streatfield, Timmen Cermak, Erik Erikson, Lisa Herman, Melissa Schwartz, Aftab Omer, and others who laid the theoretical groundwork for me to integrate the concepts inherent in chemical dependence. viii CONTENTS ABSTRACT .......................................................................................................................... iv ACKNOWLEDGEMENTS ................................................................................................... v LIST OF ILLUSTRATIONS ................................................................................................. LIST OF TABLES ................................................................................................................. Chapter 1. INTRODUCTION ............................................................................................... 1 Clinical Topic Exploration of The Topic Confidentiality and Ethical Concerns Framework of Treatment Client History and Life Circumstances Progression of Treatment Learnings Personal and Professional Challenges 2. CLINICAL LITERATURE REVIEW .................................................................. 32 Biological Perspective on Chemical Dependency Cognitive-Behavioral Perspective on Chemical Dependency Psychodynamic Perspective on Chemical Dependency Sociocultural Perspective on Chemical Dependency Imaginal Approach to Chemical Dependency ix Conclusion 3. PROGRESSION OF TREATMENT .................................................................... 95 Treatment Planning The Story of Treatment Legal and Ethical Issues Outcomes 4. LEARNINGS ........................................................................................................ 126 Key Concepts and Principles What Happened Imaginal Structures Primary Myth Personal and Professional Development Applying an Imaginal Approach to Psychotherapy 5. REFLECTIONS .................................................................................................... 158 Personal Development and Transformation Impact of the Learnings on My Understanding of the Topic Mythic Implications of the Learnings Significance of the Learnings The Application of Imaginal Psychology to Psychotherapy Bridging Imaginal Psychology Areas for Future Research Appendix 1. INFORMED CONSENT .......................................................................... 180 x 2. CHERYL’S DIAGNOSES ....................................................................... 182 3. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL