Denial, the topic for this week’s discussion, is unfortunately not a river in
Jordan. While not a river, it is a characteristic that at times seems to be as
resistant to change as the most torrent watercourse. Denial has been described
as many things in many ways by many people and still I find the Webster’s
Dictionary definition of denial to be the most meaningful and accurate:
“an assertion that an allegation is false…disbelief in the existence or reality
of a thing…self-denial…[and] the reduction of anxiety by the unconscious
exclusion from the mind of intolerable thoughts, feelings, or facts” (1977).
The readings and following class discussion illuminated just how varied and
vast denial can manifest itself, especially with alcoholics and addicts. The
discussion concluded that denial may be noticeable in the form of 1) an
individual not being able to accept what is in front of him; 2) a coping
mechanism to deal with facts as presented; or 3) the inability to see
consequences of one’s behavior. Also based on the class discussion, things a
counselor can look for to discern if a person is in denial are 1) if they
consistently miss or avoid scheduled sessions, or while in sessions they
continually change the subject; 2) if clients appear to reject logic or reason;
3) clients demonstrate incongruence, that is their non-verbal expression and
actions are inconsistent with what they say; and 4) clients demonstrate the
various defense mechanisms associated with alcoholism, addiction, and denial.
These defense mechanisms can be in the form of projection, (“I don’t have a
problem –you have a problem.”) rationalization, (“It helps me
relax/concentrate/forget” or “I’ll stop as soon as the pressure lets up”)
justification, (“Everyone I know does it”) suppression or repression, (forcing
down memories of using behavior and negative consequences as a result of that
use and behavior) and one that sometimes gets overlooked, geographic escapes
(my life is unmanageable – but it’ll get better if I move to another place.)
The text also offered some useful information in understanding the phenomenon
of denial. On page 30 of the text Assessment of Addictive Behavior, Tarter,
Alterman, & Edwards (1985); Tarter & Edwards (1986); Tarter, Hegedus,
Goldstein Shelly, & Alterman (1984) suggest that “…neuropsychological
deficits among alcoholics, particularly deficits in accurately perceiving
internal cues of physiological arousal and emotion and in appraising the
significance of environmental events, may underlie what has been described as
‘alcoholic denial’ ” (cited in Donovan & Marlatt 1998). In other words
people may be so impaired from the damage heavy drinking causes on the brain
they may not have the capacity to comprehend beyond their “denial reality.” In
addition, on page 223 of Psychotherapy in Chemical Dependence Treatment, Rugel
and Barry (1990) state, “denial is a way to defend against loss of self-esteem
occasioned by negative public and self-valuation.” They go on to say, “Denial,
therefore, may be a necessary step in the recovery process, required in order
to defend the ego.” Interestingly, Rugel and Barry found that in groups where
clients felt safe and supported enough early on in the treatment process to do
self-exploration, a reduction in the need for the clients to erect denial
defenses resulted. However, in groups where there was a big emphasis on the
venting of powerful emotions of remorse and shame, via cathartic exercises,
denial and defense mechanisms were reinforced (cited in Buelow & Buelow
1998). This is important information for those of us who may be providing
substance abuse counseling to know, because we may need to be more sensitive to
the techniques we introduce so as not to impede the counseling process for
clients but rather enhance it.
As far as my thoughts are concerned, I agree with the class, in that, I believe
denial is both a conscious and an unconscious characteristic of alcoholics and
addicts. People may be consciously aware they have a problem but due to shame
or guilt are unable or unwilling to admit it. While on the other hand fear may
unconsciously push addicts into denial. Based on my four years of personal
recovery and two years of providing substance abuse counseling, I have found
that people who are afraid to face their problems often start practicing denial
even before they are addicted but then as the addiction progresses, it causes
its own problems. At which point the idea of facing reality can be so
frightening and overwhelming people are unaware that underneath it all they
have become addicts. This personal observation is congruent with Professor
Charles-Heathers’ assertion that denial is most probable a cyclical dynamic
whereby people may move through stages from low level denial, which may not
have much in the way of consequences, to high level denial, which may affect a
persons ability to function from day to day and lead to loss of relationships,
children, jobs, freedom or worse…
Lastly, there are many strategies for addressing denial. Some of the suggested
strategies by the class were life stories, family groups, self-assessments
exercises, significant other interventions, building and establishing rapport
and trust with the client, journaling, education, and self-disclosure. My final
thoughts are this; denial is a defense mechanism that enables people to survive
situations and abuses that they would not be able to otherwise tolerate. It
also allows clients to be where they need to be until they are ready to face
what it is that was previously pushed away or avoided. Facing a problem is the
first step to solving it. I personally know that addiction is difficult to
overcome alone. So, as counselors we are there to help clients face their
problems not with judgment but with nurturing, respect, education, support, and
encouragement. I have seen first hand the phenomenon of people moving from the
paralysis of denial to the miracle of recovery by the simple act of someone
believing in them.
References
Buelow, G. D., & Buelow, S. A. (1998). Psychotherapy in chemical dependence
treatment: A practical and integrative approach. Pacific Grove, CA:
Brooks/Cole.
Donovan, D. M., & Marlatt, G. A. (1998). Assessment of Addictive Behaviors.
New Your, NY: Guilford Publications.
Steinmetz, S. (Ed.). (1997). Webster’s college dictionary (2nd ed.).
New York: Random House.