Attachment Theory, DBT and the Importance of Community in Recovery: a Q & A with Mark Sturgeon, LCSW, DBT Therapist

Mark  Sturgeon joined Freedom Institute in 2013, bringing to the team more than 20 years of experience working with individuals and families struggling with the disease of substance abuse and addiction.  Trained in Psychoanalysis, DBT and the field of attachment theory, he understands that chemical dependency is a disease of isolation and that recovery happens within the context of relationship and community.

How did you get started as a therapist?
I was involved in acting from a very young age. As I got older, the training as an actor became more and more intense. I was forced to examine what I loved about it. The answer was that in addition to my love of live theatre and the craft of acting, I became aware of a deep fascination with and I in fact gained sustenance from, the relationships one creates and sustains as an actor.  As an actor I was studying the circumstances and layers of relationships of the actor to other actors, the actor to director, the actor to their character, the actor to the audience. Ultimately, I realized it was more fascinating to work directly with relationships in real life and I made the transition to return to school and the decision to study relational psychoanalysis. This led to a career that feeds both my head and my heart.

How did you decide to focus on the specific area of substance abuse and addiction treatment and recovery?
I found my way into the field of addiction treatment through my own recovery, now 30 plus years.  I have training relational psychoanalysis, attachment theory, trauma treatment, and DBT.  In my own recovery, I come from a 12-step background, and this has taught me that an authentic experience of community is essential for recovery.  However, it is not necessary for recovery that this community comes in the form of a 12-step program. Community is all about relationships. Substance abuse and addiction amount to profound isolation from self and others. What group therapy, and what 12-step programs offer for people in recovery are regular interactions with people practicing coming together absent coercion, control, judgment or hierarchy.  It is simply a group of people who are coming together solely for the purpose of mutual support and giving each person the opportunity to be genuinely seen and heard.

Can you tell me a bit more about Attachment Theory?
Attachment Theory focuses on the importance of our earliest relationships and examines how we form a style of attachment to others from the earliest days of our lives and how this attachment style affects and informs the attachments and relationships throughout our later young adult and adult lives. The renowned British psychoanalyst D. W. Winnicott (who started as a pediatrician)said, “There is no such thing as a baby” meaning that we cannot form a sense of ourselves in a void. I can learn to self soothe, for example, but I cannot learn to self soothe without having learned how to within the context of a relationship.

Human beings co-regulate emotion. Co-regulation refers to the social relationships and the way we adjust ourselves within interactions with others, in order to maintain a regulated self.  One cannot engage in self-examination or self-love if we have not been taught it. The good news is you can learn healthy attachments.

And how does this relate to substance abuse and addiction?
Chemically dependent people talk about “filling a void.” In repeatedly attempting to fill the void with substances, their primary relationship becomes the substance.  Alcohol and other drugs cut us off from our emotions, and our emotions are how we connect with self and others.  This is how addiction is a disease of isolation. With addiction, we are separating ourselves from our true feelings and emotions, and therefore cutting ourselves off from genuine relationships. There is a human need, a fundamental need, to be recognized, to be seen and understood by another. Human connections and relationships are learned from birth.  In recovery from addiction, learning to connect with others, within a community is essential.

What are you most passionate about in the work you do?
My passion is using the foundation of Attachment Theory combined with principles of evidence-based recovery, DBT and 12-step practices when applicable.  I work primarily with adults and young adults, and in individual and group therapy and I see all human interaction through an attachment lens and supporting recovery through relationships within a community.

There is a treatment protocol called the Circle of Security. It is probably the best description of the essential importance of relationships to the process of recovery.  Imagine a diagram of an oval. On one end is pair of hands that represents the secure base and safe haven. The secure base must be bigger, stronger, kind and wise.  Around the oval ventures a child, or any individual, who explores. In a secure, healthy relationship, those hands support, help, delight in, protect and welcome them back when the need for safe haven arises. Those hands need to comfort and delight in the child and protect and help them organize feelings.

How is this Circle of Security protocol used in your work?
The safety and nurturing of a healthy relationship is essential in recovery.  It is easiest to talk about it in terms of group work.  In the recovery work I do the group becomes the secure base. The collective is bigger, stronger, kind and wise.  In the DBT groups of Freedom Institute’s Intensive Outpatient Program, the members of the IOP come to group three times a week for three hours. Our clients are working to develop their use of DBT skills and generalize them in their life circumstances and relationships. If group therapy is done well, the whole becomes greater than the sum of its parts. The group is essentially the secure base or safe haven represented by the hands of the Circle of Security and we practice DBT skills with respective members moving out, into their lives and then returning to review the experience, learn more skills and, again going out into the world.  Going out from and returning to the secure base is going around the Circle of Security where eventually the secure base becomes internalized.  This is the role of community and relationship within the process of recovery from addiction.

DBT seeks synthesis between seemingly opposing truth such as “everyone is doing the best they can on the one hand, and on the other hand that we need to do better.” DBT skills help us develop acceptance of ourselves as we are now and, when practiced and supported, help us to make changes in habit patterns of thought and behavior. Clients go from the group experience to their own lives with the encouragement of the group to effect change in the direction they want. The group is way more powerful than the individual members of the group.  I really believe there is no recovery without community, and our recovery goal is to free ourselves to live more fully and authentically.

Can you talk about the importance of DBT in recovery?
When we are using substances, we are living in a state of isolation or a state of reflexive compulsive reaction, chasing after some kind of high. I am in reaction to a painful emotion, driven by that instead of living, feeling, and being comfortable with uncomfortable feelings. If I am ruled by emotions and ruled by substances, it is very hard to develop and maintain meaningful relationships.

DBT comes out of Buddhist principles and is basically a set of skills to enable us to accept and better understand our emotions, thrive in life without substances, and learn to grow and develop in the context of healthy relationships.  DBT teaches the skills of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, and puts individuals in a better position to enter in to relationships and communities such as family, work or socially with friends.

Do they or how can DBT and 12-step work together?
DBT is a behavioral form of therapy.  12-step recovery programs (AA/NA etc.) are communities of mutual support.   In my way of thinking, DBT skills are learned within a particular treatment and communities of mutual support are an excellent environment within which to practice and develop DBT skills in the service of living more fully and freely.  In a nutshell, DBT teaches behavioral skills and communities of mutual support offer environments where skills can be generalized and practiced within an individual’s day to day life.

What is one piece of advice you would give to people who are struggling with substance use or abuse?
Give voice to your struggle. In other words, find someone in or around your life and tell them what is happening.  In my personal experience and in watching countless others, when we human beings get to the place where we can say out loud: “What I’m doing isn’t working, please help me,”  that is when recovery begins

What is one piece of advice you would give to people in recovery?
Understand that your recovery offers you a way of living life more fully and more freely than you otherwise might.  What you might think of as a liability becomes a powerful asset that, in fact, enriches your life and the lives of everyone you are connected to… which, of course, is everyone.