title: Envelopments: immersion in and emergence from drug misuse.
abstract: Contemporary psychodynamic therapists, as contrasted with early ones, are more active and interactive, less dependent on interpretations, and more focused on affects, self-regulation, and interpersonal relations, with a premium placed on the therapeutic alliance. Evidence supports the utility and effectiveness of the psychodynamic paradigm. Two cases are presented that demonstrate how a well-trained psychodynamic therapist is able to effectively apply such an approach to individuals with substance use disorders, in one instance a client in early treatment still immersed in her addictions, and, in the second case a client in early abstinence emerging from a long standing dependency on alcohol and cocaine. The case material highlights the special sensitivities and practices required to address predisposing factors and resulting consequences associated with addictive disorders. Reflections by the therapist and the clients provide a basis to consider the nature of the clients' addictive involvements, a rationale for the therapist's interventions, and how client vulnerabilities are addressed in their attempts to recover from their addictions.
authors.affiliation: South West London and St George's Mental Health NHS Trust, London, UK. weegmans@aol.com
authors.forename: Martin
authors.initials: M
authors.lastname: Weegmann
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Khantzian
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000523:psychology; D016739:Behavior, Addictive / Q000523:psychology*; D019970:Cocaine-Related Disorders / Q000523:psychology; D055030:Drug Users / Q000523:psychology*; D004630:Emergencies; D005260:Female; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D019966:Substance-Related Disorders / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult