Psychodynamic Theory and Gambling

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Psychodynamic Theory and Gambling

• Todays Agenda
• Psychoanalytical Theory PPT / Discussion
• Break
• Inquiry 2

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Basic Assumptions of Psychoanalytical Theory

• A great deal of human behavior happens at an
  unconscious level.
• Humans are driven by instinctual drive states
• Human development unravels through a predictable
  series of stages, hence a trauma or block of such
  maturation can affect the development of a viable
  ego / sense of self.
• The self is first and foremost and energy system.

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Basic Assumptions of Psychodynamic Theory

• 5) A fifth assumption of psychodynamic theory
  speaks to the process of sublimation, whereby an
  individual substitutes a desired behavior for a
  more socially acceptable behavior.
• Ultimately, pathological gambling in one form or
  another can be looked upon as a regression of
  sorts whereby the gambler essentially returns to
  a former developmental stage so as to complete
  its development.
• Such gratifications are considered to reflect
  past impingements of ego development and may be
  viewed as escapes, affect regulators, ego
  inflators, self love actions, etc.

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Hans Von Hattingberg

• Tenets
• Gambling is pleasurable, but also fraught with
  tension, anxiety, and fear.
• Gambling in adulthood becomes a means to control
  anger and guilt associated with the failure to
  understand parental socialization (which was not
  worked through in childhood).

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Hans Von Hattingberg Earliest Known
Psychoanalytical Gambling Theorist

• 3) Thus, gambling can be understood as return of
  the repressed, because as an adult one uses
  gambling to control their inner and outer world.
  
• And yet, this act of gaining control through
  gambling also brings about states of guilt
  especially when losing, as the gambler
  re-experiences such guilt as being delivered by
  parental imago's.

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Ernst Simmel

• A controversial character, held that gambling was
  a sublimated expression of an unresolved
  fixations.
• Whereby money is symbolic, in the sense that
  winning is orgasmic, and losing represents
  castration (withdrawing of parental love).
• Essentially the gambler has a developmental block
  (age 2 3 years), and through gambling the
  individual seeks to work through his attachments
  to his parents and gain independence.
• An independence that he was not afforded as a
  toddler.

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William Stekel

• In comparison to other psychoanalytic theorists,
  Stekels ideas on gambling were applicable to
  treatment and helped to better understand the
  gamblers mind.
• For instance, he distinguished the real gambler
  from the from the professional.
• The professional gambler plays because gambling
  is his livelihood, whereas the real gambler plays
  because he wants to escape from his current
  world.
• For Stekel, gambling was a regression in time (to
  childhood) where their were no worries or cares.

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Stekels contributions to theory

• First to suggest that gambling produced alternate
  states. Thus, at the heart of gambling was a
  need for tension and release.
• He also was the first clinician to point out that
  gambling was highly tied to superstition and
  ritual.
• Stekel also saw the symbolism behind gambling and
  held that winning enabled the gambler to seize
  and hold onto to love.
• Hence, one could say that such love may have not
  been introjected into the psyche at an early age
  or in the gamblers current life, the energy
  brought about by gambling helped to sooth inner
  demons.

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Otto Fenichel

• One of the first theoreticians to point out the
  narcissistic qualities of the gambler.
• For instance, the gambler who continues to think
  they are going to win, does so because he/she
  holds that their omnipotence is greater than fate
  or for that matter, more powerful than the odds
  themselves.

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Edmund Bergler

• Bergler (1958), like Freud, invested much
  interest into the unconscious mind of the
  gambler, yet, he, unlike Freud, differentiated
  the non- clinical from the pathological
  gambler.
• Hence, Bergler was the forerunner of diagnostics
  in consideration to delineating the specific
  qualities held by the pathological gambler.

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Berglers contributions

• Systematically identified
• The gamblers habitual risk-taking.
• Preoccupation with gambling.
• The irrational persistence to quit despite
  reoccurring defeat.
• The inability to stop when losing or winning.
• The wagering of too much money.
• The intoxicating and euphoric effects that
  gambling has on the gambler and,
• The pleasure-painful tension that a gambler
  experiences between the time a bet is placed and
  its outcome.

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Edmund Bergler (contd).

• Clinically Bergler, was also the first real
  treatment specialist and created a practice
  around treating problem / pathological gamblers.
• His main tenet was that the gambler had an
  unconscious wish to lose.
• This was based on the fact that because the
  infant/child lost their omnipotent power (between
  0 -2) they tried to reinstate or seize it through
  gambling.

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Bergler (contd).

• And yet, gambling too, is a withholding and
  essentially a losing game.
• Thus, at an unconscious level (gambling) offers a
  return to the omnipotent state that was taken
  away during infancy/childhood.
• However, as an adult, the game despite it
  bringing frustration, the gambler at least
  controls their frustration.
• Essentially, allowing them to deriving pleasure
  from pain (masochism).

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Breaking With Tradition Later Psychoanalytic
Theorists

• Bolen and Boyd
• Although holding allegiance to some early
  theories on gambling Bolen and Boyd set
  themselves apart from their predecessors
  distinctively. . .

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Bolen and Boyds Theoretical Contributions

• Found gambling to function socially, religiously,
  and spiritually.
• Were the first to suggest that a great deal of
  problem gamblers had parents that gambled and
  held that this may provide a propensity to gamble
  in the future.
• Found that gambling served to counteract feelings
  of nothingness or emptiness replacing these
  emotions with a euphoric sense of importance,
  power (power seeking), and control.
• Thus, laying the earlier foundation which holds
  that addiction is a self-medicating habit to deal
  with hidden psychiatric problems.

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Bolen and Boyds Breaking With Tradition

• Eventually, Bolen and Boyd challenged earlier
  psychoanalytical thought, claiming that their
  experience with gamblers led to claim that
  sexuality, masturbation, anality, had nothing to
  with gambling pathology.
• For them, gambling was a defensive psychodynamic
  function, but both intrapsychic and interpsychic.
  
• Having in roots in childhood, but also throughout
  the lifespan, more object related psychodynamics.

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Richard Rosenthal

• Modern day psychoanalyst, psychiatrist, has been
  treating gamblers for twenty-years.
• Greatly responsible for the DSM criteria of the
  pathological gambler.
• Although trained in psychoanalysis, largely
  studies the process by which gambling continues
  and how to go about treating it.

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Rosenthal and the Gamblers Defenses

• For Rosenthal, treatment of the pathological
  gambler lies in the understanding, of how these
  five defense mechanisms
• Omnipotence
• Splitting
• Idealization/devaluation
• Projection, and
• Denial
• Interact and help the gambler control his/her
  inner and outerworld(s), although eventually
  leading to their demise.

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Omnipotence

• Refers to feeling of being all powerful, which is
  a direct defense against feelings of
  helplessness.
• This is a quality found in a great deal of
  gamblers and is exempflied in their wishful
  thinking.
• I will win because I have to win or I can will
  myself to win (despite the house odds).

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Splitting

• Is a defense mechanism whereby the gambler thinks
  himself/herself to be two separate people.
• One is all good the winner, and the other, all
  bad the loser. Hence, the gambler oscillates
  between these two personalities types.
• One hand, they can act all powerful whereby they
  seek to try to control others, thus, repressing
  the loser into the background.

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Idealization and Devaluing

• Essentially, the idea of controlling others is
  seen in either, I idealize you, or I devalue you.
  
• Thus, as much research points out, we see why
  gamblers appear to have problems with intimacy,
  because the relationship is based on. . .

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Projection

• Process of casting your feelings, thoughts,
  judgments onto somebody else.
• Hence, the gambler routinely goes about
  controlling his inner world by devaluing/idealizin
  g others.
• He or she can then deal with the division with
  themselves (splitting, good or bad), but never
  really perceiving that it is them who are bad and
  good. DENIAL
• Or that people themselves can be bad or good, a
  milestone that the self usually negotiates
  between the age of 0 6.

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Rosenthal and Treatment

• Ultimately, Rosenthal suggest that successful
  therapy hinges on helping the client realize that
  they are employing the latter defense mechanisms.
  
• Not to mention how they are related to current
  gambling binges, and possibly how and why such
  defenses originated in the first place.

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Rosenthal and Treatment

• The question maybe asked then, How does the
  therapist go about bringing these defenses to the
  clients awareness . . .
• The answer is simple, the patient will try to
  deceive the therapist, idealize him or her, or
  devalue him/ her, thus projecting their good and
  bad onto to him or her.
• Hence, learning to hold such projections, while
  equally learning when to help the client peel
  away their defenses, is key to assessing the role
  that gambling plays in the clients life, and why
  there is a need to feel omnipotent in the first
  place.

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Rosenthal and Further Insights Staying in the
Action

• Most recently, Rosenthal has brought attention to
  the issue of dry drunk syndrome and this operates
  in the gambler a terms he calls staying in the
  action.
• While it is know that most substance abusers have
  to remain abstinent, it is a near impossibility
  for gamblers to not indulge in the use of
  money, similar to eating disorders.
• Thus, this poses a risk for the gambler as they
  are somewhat still involved in the action (at
  least when it comes to money).

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Staying in the Action Im Not Talking about
Money.

• And yet, using money is not the only way in which
  the gambler stays in the action.
• As Rosenthals clinical research makes clear, and
  suggests, that there are many ways for the
  gambler to take risks, or remain in a gambling
  mind-set, without making a bet.
• Examples of staying in the action
• Mind Bets
• Success
• Playing with Reality
• Covert gambling
• Lying, cheating and stealing, and
• Switching addictions

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Staying in the Action Through the Guise of
Switching to another Addiction.

• The concept of dual addiction is not knew, but
  Rosenthal suggests that a new addiction might not
  be so new for the gambler.
• Essentially, their new addiction, may actually
  represent gambling phenomena or an unconscious or
  covert way of staying in the action.

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Switching Addictions One gambler stated,

• After a period of individual therapy and regular
  attendance at Gamblers Anonymous, Mr. A appeared
  to have turned his life around. He abstained from
  gambling, which no longer seemed attractive, and
  his old debts were being paid off. He had
  remarried (his first wife divorced him because of
  his gambling), and claimed he and his wife were
  happy. His career had gone in a new direction and
  he was doing even better than before. He worked
  hard, but got satisfaction from his work. His
  employer and clients praised his accomplishments,
  and he was rewarded with frequent bonuses. By all
  accounts he would be considered successful.
• What was wrong? With a great deal of
  embarrassment, he confided that he had begun
  frequenting prostitutes. He attempted to
  rationalize his behavior by telling the therapist
  that his sex drive was stronger than his wife's,
  and that she had been less available for him
  recently because of their different work
  schedules, and because of her involvement with
  her ailing mother. His turning to prostitutes, he
  said, was "quick and easy."

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• As he continued talking, the self-deception
  became obvious. If all he wanted was sexual
  gratification, he knew a number of women willing
  to accommodate him. He was a good looking, rather
  charming and outwardly confident young man, and
  women were sometimes quite forward in indicating
  interest. They did not even seem to mind that he
  was married. However, he rejected any and all
  such opportunities, preferring instead to seek
  out prostitutes on the street.
• Such assignations were anything but "quick and
  easy." He experienced enormous anxiety that the
  prostitute would give him AIDS or some other
  disease which he would then pass on to his wife,
  or that the prostitute would turn out to be a
  policewoman and he would be arrested. In
  addition, he was certain that if his behavior
  became known, his wife would leave him and his
  career would be ruined. It dawned on him that he
  was gambling, and that the more he engaged in
  this behavior, the more certain he was to lose.
• Why, he then asked, when he found a prostitute
  who appeared "safe," would he not go back to her,
  but would insist on trying someone different each
  time?

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• Obviously he either wanted to lose, or was
  excited by the risk of jeopardizing everything
  and escaping unharmed.
• Mr. A then recognized that the feelings he had
  while looking for prostitutes were identical to
  the feelings previously experienced gambling. He
  not only had the same "rush," but the compulsive
  aspects were the same. He would find himself
  preoccupied by it while at work, inventing
  excuses for driving home through neighborhoods
  where there were streetwalkers. The anticipation,
  and the guilt afterwards, and the need to lie
  about where he spent his time and money, all
  reminded him of his previous gambling.

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Opinions Please?

• What do folks think about this case?
• Is it gambling or is it a sex addiction?

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Switching Addiction and Treatment

• For Rosenthal, gambling and his sexual compulsion
  were fused, which is not an uncommon occurrence.
  
• However, when looking at addiction this way, the
  therapist needs to be sure that the phenomena
  he/she is hearing is actually what is happening.
• Thus, making treatment easier, despite the
  complexity in treating an addiction switcher.

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Switching Addiction and Treatment

• Essentially, at the core of the behavior was
  risk-taking, and more pertinently, past gambling
  behaviors.
• As such, these behaviors needed to be pointed
  out, investigated, and brought to light, whereby
  staying in the action is understood fully by both
  client and therapist alike.

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Lying, Cheating, Stealing

• A second way gamblers stay in the action is
  through, lying, cheating, and stealing.
• For some pathological gambles, lying, cheating,
  and stealing are the heart of their addictive
  behavior.
• Even after maintaining abstinence, LCS, may still
  frequent the gamblers mindset.

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Confronting Lying, Cheating, Stealing

• Hence, sometimes the slightest transgressions on
  part of the clients need to be investigated.
• Because part of the pathological gambler game is
  to have the therapist collude with them.
• And in this collusion, the gambler wants them to
  accept their dishonesty, as something that cannot
  be changed. (At least I dont gamble, right?)
• Rosenthal suggests, that by not confronting the
  gambler on such matters, the client is
  unconsciously devaluing the therapist,
  themselves, and the work they have done together.
  

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Case of Magazine theft. . .

• Mr. D took a magazine from the waiting room and
  brought it into the session with him, and then,
  afterwards, while driving home, realized he still
  had it with him. Actually he had wanted to finish
  reading an article, so his forgetting, although
  not conscious, nevertheless served a purpose. He
  had not thought of asking if he could borrow it,
  because the therapist might say no, and besides
  it would have made him aware of his dependency on
  another person, something he went to great
  lengths to avoid. He did have a momentary thought
  that he should go back and return the magazine,
  but "put it out of (his) mind.
• The following week he forgot to bring the
  magazine with him for his appointment. He
  intended to mention it but started talking about
  something else, and it was again forgotten. He
  was shocked when the therapist brought it up
  halfway through the session, and referred to it
  as a kind of stealing. Mr. D became very
  defensive, and argued that everybody did things
  like that, but then realized that he had been
  feeling particularly uncomfortable about coming
  for the session, and had not known why.

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• Nevertheless, he persisted in trying to
  trivialize the incident, and could not accept the
  therapist's contention that it was something for
  them to examine in the session. It was only later
  that he could admit to other "omissions"obligatio
  ns that were forgotten, bills he ignored,
  promises he failed to keepa pattern of lying and
  cheating that he had not consciously recognized.
  By stealing the magazine, the patient was
  gambling that he could get away with it.
• He was also protecting, and trying to keep out of
  the therapy, a part of his personality that
  believed these kinds of activities were all
  right. This included his secrecy and sense of
  entitlement. Only when this was acknowledged and
  dealt with was there any chance of recovery.

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Primitive Avoidance and Case of the Magazine
Theft.

• According to Rosenthal, this example illustrates
  not only how one little lie or omission can lead
  to another, but the kind of "primitive avoidance"
  so common among pathological gamblers.
• Hence, uncomfortable realities can be just put
  out of mind, or "shoved under the rug. But, the
  therapist cannot let little things like this go,
  because if they do, they actually are enabling
  covert behaviors to continue possible leading to
  full blown relapse.
• Thus, Rosenthal suggests that the pathological
  gambler must develop, or reestablish, an
  internalized value system based on honesty and
  integrity.

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Guilt and Staying in the Action

• And the only way to help the gambler deal with
  their staying in the action behaviors, is to
  have the gambler take responsibility for their
  dishonesty.
• Hence, as evidenced in a great deal of
  psychoanalytic theories presented, the gambler
  needs to dispel their guilt.
• Which is done by not decreasing their discomfort
  over their guilty actions and allowing them to
  get away with it, but to actively challenge it
  and get to the bottom of why the guilt is their
  in the first place.

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Guilt and Staying in the Action

• One of the major reasons for intractable or
  unrelenting guilt is the continuation of some
  harmful behavior, however covert, subtle, or
  rationalized.
• The first step toward self-forgiveness is an
  acknowledgment of change. In other words, being
  able to say I used to do such-and-such. I don't
  do that any more.

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Critique of Psychoanalytic Theory Con

• Hard to research unobservable tenets.
• A great deal of its tenets are based on case
  study phenomena.
• A great deal of its theoretical tenets have no
  concrete proof of their existence.
• To highly concerned with developmental arrest and
  sexual libindal theory.
• Male centered thinking.
• Ignores social and other environmental factors
  that may influence gambling behaviors.

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Opinions on this case please?

• Is Rosenthal way over the top here?
• Does this case represent staying in the action?
• Do you think the therapist was too judgmental in
  the last case?