Psychodynamic psychotherapy of the intravenous cocaine abuser

Using the psychodynamic psychotherapeutic treatment of a 23 year old female cocaine-addicted client as an example, the author describes the theoretical concepts and clinical methods he has found useful in this context. Using an approach that draws on the work of Winnicott (1971, 1986, 1992) and Malan (1979), the author describes how psychodynamic psychotherapy can be effective in facilitating change in an addiction in an outpatient setting. Winnicott's work provides the context for the treatment while Malan's model provides a structure for the therapeutic process. Within the context of a holding environment, links between past trauma and current drug use as a defence are explored. Also discussed are the use of dream material, the facilitation of the corrective emotional experience, and the complementary use of 12-step programs in the therapeutic process.