"If he does not play to win, he does not play to systematically lose either, rather for those breathtaking moments at which everything - absolute gain, ultimate loss - becomes possible" Marc Valleur


I recently attended a 2 day training event in Brighton entitled "Working with Problem Gambling" with GamCare Clinical Training Officer Trevor David.

My training was funded by GamCare as I have recently become an Associate Counsellor for Steven James Counselling, a counselling agency in Poole, Dorset, who are in turn, a partnership agency of GamCare. [please note that I have taken a break from working via GamCare with effect from June 2015 although am still seeing people with gambling issues privately]

Gamcare was founded in 1997 and is a charity that provides information, advice, support and free counselling for the prevention and treatment of problem gambling. They also engage in ongoing research around the issue of problem gambling and work with gambling companies to develop responsible policies.

So, some facts and statistics we learned were:

• 73% of adults in Great Britain gamble each year
• Over 1 billion pounds is staked each week
• After the National Lottery, scratchcards are the most popular gambling activity
• 14% of the population used the internet to gamble in the past year

Training focused on problem gambling and pathological gambling. In 2010 approximately 0.9% of the GB population met the DSM IV Pathological Gambling criteria up to around 450,000 people. In the USA the proportion is 3.5% and in Hong Kong it's 5.3%. Canada and New Zealand are at 0.5%.

So with the focus on problem gamblers we learned that:

• Gambling can be used as emotion management - to dispel difficult or threatening feelings and emotions
• Problem gamblers often believe that they are an expert in what they do
• They have distorted beliefs about the likelihood of winning money back
• There is persistence even when losing, and a tendency to "chase losses"
• There is  toleration of associated costs (financial, personal, social)

There is a risk of suicide with problem gamblers - 13% reported an attempt, and 26% of pathological gamblers had attempted, so this is an important part of the assessment process and shows the necessity of support.

I was relieved that we weren't told exactly how to run the sessions but given background information about gambling and tools to incorporate in our existing practice, including existing models of problem gambling, tips on how to work with inevitable ambivalence and an introduction to Motivational Interviewing which fits in very well with my person-centred/existential leanings. MI is "a collaborative, person-centred form of guiding to elicit and strengthen motivation for change".

The 2 day course was jam-packed with information - there was so much to learn delivered in a variety of teaching methods. What helped enormously was Trevor David's teaching style which, whilst professional and informative, had a distinct edge of sharp humour, self-disclosure and humanity. Since learning that latest neurology states that when we learn, “the recall of new facts is enhanced by the presence of certain degrees of emotion during learning” (Antonio Damasio 2000), I have appreciated being taught in a vivacious way that doesn't reply only upon academic fact being imparted.

I see gambling as a form of addiction, not dissimilar to addiction to substances. In the case of gambling, the person is addicted to the neuropeptides and neurotransmitters (the body's natural chemicals) that are released when gambling, whether they win or lose (see quote at the start of this blog post!). The person suffers withdrawal symptoms when they try to stop this behaviour. The cells of their body are used to receiving certain levels of these chemicals and when they stop, their body's homeostatis is sent out of kilter. The unconscious, survivalist part of the brain sends messages to say "get those chemicals" and highjacks the thinking part of the brain (the frontal lobe) into making decisions that will restore the homeostatis - i.e. we will engage in behaviour to ensure we get those certain chemicals we're used to by partaking in gambling. This model of addiction to our own chemicals can help explain why people may struggle with anger, stay in abusive relationships, or not be able to stop worrying.

I also share some of the ideas of the psychodynamic approach to gambling which says that gambling behaviour is a reenactment of an unresolved conflict. This may make sense to you when you consider that there is often a cycle of low self-worth, followed by gambling until one has nothing left, followed by a further dip in self-worth. Why would somebody carry on doing the very thing they are ashamed of, that is getting them into financial and relationship trouble, if there wasn't some pay off in the wretchedness they suffer after the event? The same applies to people with problems with substances.


The GamCare helpline is open daily from 8am 'til midnight:

0808 8020 133

•  51 people chose A (42.9%)
• 60 people chose B ( 50.4%)
•  1 person declined to answer (0.8%)
•   1 person said that they had no preference (0.8%)
•    2 people said that it would depend on the situation (1.7%)
•    4 people said they would like a mixture of the two i.e. be given the option of structure but given the choice of whether to adhere to it or not, or to start with A and progress to B (3.4%)

• 6 chose B
• 1 chose A (but reckoned that clients would choose B)
• 2 chose a mixture of the two

1. As a client I would want the commitment (T)
2. I trust their (the therapist’s) judgment
3. I wish I had had more guidance. Therapy can open you up and leave you raw and without the agreement it could leave people floundering. You can’t sort your head out in one hour.
4. I would go by what they said
5. I can’t be trusted
6. Better being disciplined – it suits my personality
7. It would be structure and I’m not structured
8. If you’re going to go on a journey you need to stick to it
9. I’d like a bit of order
10. I would have thought that if you needed therapy you would need A
11. If it wasn’t A I probably wouldn’t bother
12. Commitment is important – it gives the incentive to keep going even when the going gets tough
13. If you were told that you had to do it weekly you would be more likely to go
14. It would be easier for me, I like routine
15. I would know that that time with the therapist was safe
16. I would want it weekly, but not for a particular length of time
17. Would need A to be effective
18. We assume the therapist knows better than we do.
19. My judgment may be impaired
20. A – otherwise I wouldn’t go
21. I need structure
22. People need structure, particularly those with addictions

1. It would feel restrictive going weekly
2. Some clients only want one session (T)
3. Definitely B – you can’t tell how long it’s going to take somebody to clear (T)
4. B, but with organised contact e.g. weekly telephone call
5. I can’t tell what mood I’m going to be in
6. People are busy, and you might get better
7. B, but endings are important (T)

It was over a week ago that I attended a super workshop entitled "Working with Self-Destructiveness" with Andy White. I wish I had got around to blogging about it the next day but I had work, and have only just got around to it. The regret is that some of the content was esoteric and quite abstract and hard to define in writing, and possibly even more so 9 days on.


The workshop was described as being for practicing counsellors who would like to strengthen their ability to work with issues of self-destructiveness in their client group. Andy White, who has stacks of initials after his name (Dip Adv Ex Psych, Dip RF, Dip Adv HIPS, Dip Psychosynthesis), is a very charismatic and creative individual and was a great teacher. 


First of all we went into groups of three to discuss self-destructiveness, then to thrash out a definition. My group came up with;


"Engaging in thoughts, actions or patterns of behaviour, which can be outside of conscious awareness, and are against our self-interest or authentic long-term goals and/or ideals."


Most groups came up with something roughly similar and there were philosophical and semantically-based challenges to each definition. It certainly got us thinking anyway. There were some pertinent quotes banded about by Andy, such as; 


"We are destroyed by anything with which we are unconsciously identified." Jung


There was a loose Venn diagram sketched alluding to the origins of inferiority and superiority; the inferiority being based upon the parts of ourselves that were not melded with Mummikins, and superiority where we had a sense of omnipotence and oneness with mother. Andy told us that inferiority and superiority are two sides of the same coins, that they exist in all of us and that there is a dialogue between them. 


I didn't take much in the way of notes, but I did jot down some names and quotes as they seemed very valuable. Andy explored self-destructiveness versus creativity and it edged into the realm of existentialism, with a great Viktor Frankl quote;


"Some refuse the loan of life to avoid the debt of death."


...and someone referred to as Hillman, who I can't for the life of me find reference to on the 'net;


"To create is to have a brush with death."


Spiraling well and truly into the vortex of existentialism, I am going to repeat this quote in it's entirety, lifted from a book Dionysus: Myth & Cult, by Walter Otto:


"He who begets something which is alive must dive down into the primeval depths in which the forces of life dwell. And when he rises to the surface, there is a gleam of madness in his eyes because in those depths death lives cheek by jowl with life. The primal mystery is itself mad–the matrix of the duality, the unity of the disunity, ..The more alive this life becomes, the nearer death draws, until the supreme moment when something new is created–when death and life meet in an embrace of mad ecstasy. The rapture and terror of life are so profound because they are intoxicated with death. As often as life engenders itself anew the wall which separates it from death is momentarily destroyed...Life which has become sterile totters to meet its end, but love and death have welcomed and clung to one another passionately from the beginning."


There was also a great Navajo story of the jumping mouse. I had goosebumps at the end of the story on the day, and his ending was way better. It entered the realm of psychosynthesis, as did the next part of the workshop, which was about our self-saboteurs.


The best learning, for me at least, is experiential and I very much enjoyed taking part in a visualisation exercise which involved being in a forest glade then taking a path through the trees to meet our internal saboteur (we all have one you know!). I found mine straightaway, but it morphed a few times, before settling down. We asked our saboteurs questions such as "What do you need" and "How can you help me". I quite like visualisations and the images came easily. It was fairly emotional for me, then we were invited to go back to the glade, then resurface to the room, and the everyday reality. Then we had to draw what we saw, with some crayons.


Off in pairs, we shared details of our self-saboteurs then in the larger group compared notes. What struck me, is that it seems that the self-saboteurs, an aspect of our subconscious, knows us better than we know them, which I found intriguing. People's images were very varied although many were archetypes in the Jungian sense. Here's a picture of mine (remember, crayons make for tricky drawing!); 

Exciting things are happening in the world of recovery in Devon. I was delighted to be able to attend the Devon Drugs and Alcohol Team's (DAAT) Exploring Recovery Event which was held on Monday 21st May, at St James's Park.

The morning kicked off with an introduction to the day by Kristian Tomblin, manager of DAAT. We were encouraged from the start to think about our own definitions of recovery and try and identify which part of the recovery continuum our work belongs to. The continuum starts at one end with harm reduction and at the other end with a dependence free lifestyle.

During a further talk by Francis de Aguilar of Addictions Solutions UK. We were told that the various definitions of recovery agree that:

• The individual's acceptance of the problem is key
• Recovery flourishes best with abstinence
• Partcipation in self-help groups is very helpful  and
• Recovery often means big life style changes

Then there were some words from Ian Sherwood, from the National Treatment Agency, on offshoot of the Department of Health. My ears really pricked up when I heard him share these ideals for the recovery process:

• Recovery is an individual, person-centred journey
• Service users lead their treatment

He also stressed the importance of developing a therapeutic relationship and said that we require a "whole systems approach" i.e. all those involved in the recovery process are united in their approach. Whilst I really enjoyed hearing these things I was also wondering how these ideals would fit into the bureaucracy that I notice is an inevitable aspect of any public sector entity.

Next we split off to go to various workshops. My first selection, on Mental Health, was very much worth going to. It was run by John Lilley from Devon Partnership NHS Trust. There was a talk by a service user - a man who had been addicted to alcohol but, it was discovered, had underlying mental health problems. This helped to get the recovery issue into context. There was then a talk from somebody who worked for the trust but also had children who are or who had been service users - a very useful perspective. She listed 3 things that she said were helpful about the current system, and 3 things that weren't:

What doesn't help

• Lots of differing opinions from professionals
• Labelling e.g addictive personality. She believed that this gave her son an excuse to not strive for recovery
• The lack of a personalised approach

What does help

• The relationship one of her sons had over 2 years with a CPN (Community Psychiatric Nurse)
• Simple advice at times of crisis - "support not rescue"
• The 12-Step programme

John Lilley got us to examine the correlation between mental health and recovery - "the mental health and recovery interface" and we were asked in teams to pictorially represent currents problems with this and how we would like it to look ("Rich Pictures"). Cue lots of interesting, metaphorical and frankly bizarre illustrations involving lots of bags of cash and shiny happy people.

The second workshop I attended was the Devon Drug Service talk for which I was a teeny bit late having got lost in the maze of corridors. This was a straightforward chat about the recent changes they have made and challenges faced. The way drug addiction was handled in the past was to put users onto methadone, a "holding bay" - parking users and hoping things will change. However, switching to methadone does not deal with the problem of "me". Now there is more emphasis on psychosocial intervention and there are workshops in place to educate users. DDS are attempting to bridge the gap between treatment for addiction and reintegration into society.

A couple of interesting points that came up in this talk was the importance of out of hours support for users who may need support at times of crisis. Also,  DDS expressed that although the recent financial cuts have been unfortunate, it has prompted creative thinking in their approach.

There were other workshops available - SMART Recovery, Soberlink, Alcoholics Anonymous, Howell Road Recovery Community and Narcotics Anonymous.

Lunch was a total carbfest, and a very enjoyable one at that (pasta, quiche, sandwiches, cake).

After lunch we were treated to an incredibly powerful poetry recital by Steve Duncan which brought tears to my eyes, such was it's powerful and poignant message. I think it was called "Welcome to My Judgment Room" and it was empathy, horror and shame inducing all at once. You can find a different poem recited on a youtube performance here.

We all split off into groups of 10 for roundtable discussions asking 4 questions about recovery - what is the most important stage? What is going well? What are the gaps? And what proposal would we make to improve recovery?

These were all fedback to the wider group and there was a lot of overlap in the proposals. People wanted greater collaboration between agencies and an improvement in access to the service users ("multi-agency case conferencing", "professional networking site", "service mapping", "central communications hub").

There was more poetry and some feedback about what delegates had written on the "What Recovery Means to Me" wall (legitimate graffiti!). Unfortunately, the event was running a bit behind and I had to slip out early due to a childcare catastrophe.

What did I get out of it? Well, I did my fair share of SMART Recovery promotion, seeing as I wholeheartedly believe in it and there were some there, working in the addictions industry who knew nothing about it. In fact, I think that SMART Recovery deals with the integration into society aspect of recovery very well, which was a theme that arose more than once that day.

There was also the promise of a shift in perspectives and approaches to addiction; more peer-led mentoring and educating, a client-led recovery system and the bringing together of the various agencies involved in recovery. I also heard mooting of the importance of therapeutic alliance and the relational aspect. Music to my humanistic ears.

I did put my feelers out with regards to one-one therapeutic work as previous readers will know, I have a particular interest in the field of addictions, but there doesn't seem to be much in the way of funds for that purpose.