An Interview with Stefanie Goldstein, Ph.D. on Mindfulness-Based Treatment of Addiction
David Van Nuys, Ph.D. Updated: May 16th 2008
Dr. Van Nuys interviews Stefanie Goldstein, Ph.D., a Los Angeles, CA based Clinical Psychologist specializing in providing mindfulness-based forms of psychotherapy to people dealing with substance abuse and addiction. Dr. Goldstein's interest in using mindfulness approaches to help patients grew out of her long-standing interest in the relationship between spirituality and coping, shaped as a teenager by the death of a friend, and by experiences with meditation while traveling in Asia. When seeking to become a psychologist, she sought out training programs which would approach psychology from a spiritual angle, and ultimately attended the Institute for Transpersonal Psychology, in Palo Alto, CA, one of a very few training programs in the United States emphasizing integrative and holistic models of psychotherapy care. Her interest in addictions grew out of experiences she had while working in Kaiser Permanente's chemical dependency program where she was encouraged by the emphasis on spirituality found in the dominant models of addiction recovery, and by the profound patient transformations she witnessed while doing that work.
Dr. Van Nuys and Dr. Goldstein talk some about the way mindfulness techniques are entering into many forms of psychotherapy today. Dr. Goldstein relates her experience with Jon Cabot Zinn, Ph.D.'s Mindfulness Based Stress Reduction (MBSR) protocol which was developed for assisting chronic pain patients and which has proven a helpful treatment when other treatments are less helpful. MBSR practice involves daily mindfulness meditation and yoga practice, combined with psychoeducation, and runs for approximately 8 weeks duration. The success of MBSR has caused other researchers to integrate MBSR components into other forms of treatment. Presently, the influential substance abuse psychotherapy researcher Alan Marlatt, Ph.D. is working on a mindfulness based version of relapse prevention with grant support from NIDA, and other researchers are incorporating mindfulness into cognitive behavioral psychotherapy.
Dr. Van Nuys asks Dr. Goldstein to talk about Psychosynthesis, an older but relatively little known holistic and transpersonal approach to psychotherapy, emphasizing the development and integration of all aspects of a person's personality and spirituality, originally developed by Roberto Assagioli about 1910. Apparently, techniques in wide use today for purposes of stress reduction and relaxation such as guided imagery and visualization were originally contributed to the psychotherapy canon by Psychosynthesis. Dr. Goldstein studied Psychosynthesis at the Institute for Transpersonal Psychology, and incorporates its insights in her practice. Simple techniques drawn from Psychosynthesis, like scanning the body for signs of tension, can help people to become more aware of hidden or unconscious concerns.
Dr. Goldstein talks about her practical work helping addicted clients and the "broken pleasure system" that maintains their habits. In a simplified form, she reviews briefly the role of the neurotransmitter dopamine and its role in creating the experience of pleasure. Drugs like heroin and other opioids and methamphetamine hijack the dopamine system and offer people experiences of pleasure which are far out of proportion for what the brain is designed to experience itself. People who are born with fewer dopamine receptors become more vulnerable to craving this heightened pleasure experience than people born with more receptors as they have never previously experienced such extreme pleasure before. Recent imaging studies are showing that addiction is dominantly a sub-cortical problem. The subcortical areas of the brain are the oldest areas of the brain from an evolutionary standpoint; they are concerned with instinct and survival, and less with judgment or thought. This is part of why it is so difficult to kick an addiction once it takes hold.
Mindfulness and psychosynthesis techniques are helpful to addicted people because they help them to become more conscious and thus more capable of understanding when they are most vulnerable and of choosing to not continue drug use. Many actions in life are done on "autopilot"; in a semi- or unconscious state where people act but aren't really paying attention. Addictive behaviors get acted out without thought when they are triggered by unconscious impulses and feelings, and by mistaken interpretations of events. By learning to be more aware and conscious, it becomes easier for people to pay attention on a more consistent basis, and thus become more free to choose what they will do, rather than be led around by impulses and cravings
For those who are interested, the Institute for Transpersonal Psychology has a detailed website describing their programs
Dr. Goldstein recommends the book Mindful Recovery to anyone suffering with addictions.
For therapists interested in learning more about the use of mindfulness with respect to addiction, Dr. Goldstein recommends reading anything by G. Alan Marlatt, Ph.D.
About Stefanie Goldstein, Ph.D.
Stefanie Goldstein, Ph.D. is a Clinical Psychologist who integrates traditional psychodynamic psychotherapy with progressive psychotherapeutic interventions such as mindfulness, Psychosynthesis, and Somatic Psychology. Dr. Goldstein is also an Addiction Medicine Specialist and a trained practioner in Psychosynthesis, an integrative form of psychology that focuses on the synthesis, healing, and growth of the self. She has worked individually with adolescents, adults, couples, and families and has facilitated many process and education groups. She has also had a rich and varied training experience working in multiple community mental health and health care organizations in the Bay Area. A few of the places she has or will be speaking at include: USC, UCLA, Kansas University, Institute of Transpersonal Psychology, and University of Washington.
Dr. Goldstein's passion is working with individuals, couples, and families struggling with daily life to help to support them on their path toward healing and growth. She believes therapy involves all aspects of the self, including the emotional, psychological, physical, and spiritual.
Today Dr. Goldstein lives with her husband in Los Angeles, California, where she works as a Psychologist and co-author of the Audio CD Mindful Solutions for Addiction and Relapse Prevention.
Important Work - John K - Jun 10th 2008
I really appreciated this interview with Dr. Goldstein, it made me think. Especially about how in my own life my uncomfortable emotions can act as triggers for me to act in a behavior I'm less than proud of. I've had a meditation practice before and am going to start applying it to this. Thank you Dr. Dave and Dr. Goldstein for this stimulating interview! Keep them coming.
Articles by Alan Marlatt - Douglas Eby - Jun 9th 2008 There are two articles that might be of interest, on the AddictionInfo site: Understanding and Preventing Relapse, and Harm Reduction Works - by G. Alan Marlatt.
The example she likes to use - zoom - Jun 4th 2008
I'm sure she's doing a lot of good work, but if in the end her agenda is to spread war propaganda by suddenly talking about a suicide bomber in a pizzeria when simply talking about the weather would have made the point, then the standards of who gets licensed to become a psychologist has surely dropped to new level. Dr Dave tried to balance things out by noting that she has a quote from Rumi on her website, but this is also confusing since Rumi is Persian, not Arab. Psychololgy is a tool to heal and understand each other, not the other way around. I hope she will look her projections on this one.
"Beyond ideas of right and wrong, there's a field" (Rumi), let's meet there.
Editor's Note: Dr. Goldstein's response to this comment:
I would like to respond to the listener's interpretation about the example I gave in the interview. I intentionally gave an extreme example to illustrate how people can interpret the same event in vastly different ways. This example is not judging either interpretation as "right" or "wrong" - it is simply bringing awareness to the fact that our interpretations give events meaning. This example is not war propaganda and it is certainly not the focus of the interview. The focus of the interview is the application of mindfulness to addiction and relapse prevention.
Additionally, I was surprised to see that someone had misunderstood this example of a basic Cognitive Behavioral Therapy and Mindfulness technique and turned it into a personal attack on me and even more surprising, a global statement calling the standards of licensing for Psychologists into question.
I feel very passionate about this therapeutic work and I encourage you to listen to the interview to see if using mindfulness as an approach to addictive behaviors and relapse prevention fits for you. I also welcome any other comments or feedback posted on this website or you can contact me directly through my website: www.drsgoldstein.com .
Stefanie Goldstein, Ph.D.
I (Mark Dombeck, Ph.D.) also wondered about this comment when it came through and thought it an inappropriate interpretation of Dr. Goldstein's point (e.g., that different people can see the same event through very different filters). Not every mention of Israel is a statement against Palestine. Sometimes a cigar is just a cigar, etc.
Spamming website. - JR - May 31st 2008
Sorry, Editor - the post was there when I wrote the comment!
Tired and Emotional in Iowa (again) - JR - May 30th 2008
Seem to have come across this site before. A rather confusing animal, that tends to lead one on a rather confusing trail through the badlands of institutionally-based addiction treatment centers across the US. Its main aim seems to be to promote treatment centers with a strong residential and formal out-patient element, and with a discernable (if not strongly overt)12-Step bias. Possibly useful if that is what is required - but I would hesitate to call it comprehensive (or balanced) as a presentation of recovery options available.
Editor's Note: JR is likely refering to an addictions listing webpage which has been aggressively spaming these comments. Every few days they manage to post their link, and every few days, I go through the database and remove them.