Call
Dr. Geffner at:
310-446-3887
GENERAL INFORMATION ABOUT MY OUTPATIENT TREATMENT FOR GAMBLING PROBLEMS:
Psychological treatment depends on what
the therapist brings to the treatment, what the patient brings, and the
interaction between the patient and therapist. The following are some
aspects of the initial phase of treatment.
Assessment of
the problem.
A detailed
life history of the person and their gambling behavior.
Basic
education about the nature of the disorder.
Relapse
Prevention discussions.
Motivation
issues.
Brief
supportive phone contact as needed between sessions.
The following are some perspectives I use to understand the person's gambling:
- Behavioral: Breaking down the habitual
behavioral pattern and building road blocks when possible.
- Psychological: An attempt to answer the "why do I
keep doing this over and over again" question; understanding the deeper meaning of the gambling
behavior. Some common examples are: inability to cope with boredom,
difficulty with delay of gratification, hyper-focus on money as an indication
of self worth, excessive need for escape, poorly developed coping skills with
difficult emotional states, maladaptive self-reward, exaggerated fantasies of wealth, struggles with accepting status in life,
difficulty accepting loss or failure, meaninglessness in life, lack of
interests in non-gambling activities, relationship problems.
- Cognitive: (thinking about gambling): Gamblers
often exhibit thinking patterns that maintain
the behavior, here are some common examples: I need to pay debt caused by
gambling (true) and can I win the money by gambling more
(usually false); I will only bet __ dollars or stay for __
hours and then leave (illusion of control combined with what I call a
permissive lie); I will make a quick win and leave; I will pay the money back
(if borrowed) after I win; I am not hurting anyone but myself; I deserve to
gamble; it is so fun, I love it; (this is disconnected from the consequences,
like the emotional crash when leaving the casino, and the problems that the
gambling creates), and I can afford it...
- Social: Some aspects of the gambling
may seem to fill a social need, some people feel like they are at home at
the card club or race track. Some gamblers are very introverted
and do not allow for intimacy with themselves or others. Even married
gamblers are often very introverted and avoid real intimacy. Gambling
establishments provide an illusion of being with people and friendships but
the experience is really empty. Many male
gamblers have huge intimacy issues with their wives and families. Others, more
often women, have been badly hurt in
relationships and find the limited interactions of the casino crowds
decrease the loneliness they feel. For sports betters, talking about sports is a way to connect with others but with limited intimacy.
On the other side are the majority of gamblers that prefer to gamble alone, gambling becomes a way to avoid having
to interact with people. According to Dr. Tim Fong, gambling alone
rather than with friends is often a sign of a deepening addictive
process.
- The Self: Many, but not all gamblers have a damaged
"self." Either the problem is one of very poor self-esteem,
or what I often find with the "action" gamblers is what psychologists call
narcissism. The word narcissism has a clinical meaning that
is somewhat different from that found in popular literature, but it
basically is reflected in characteristics like grandiosity,
omnipotence, and excessive self-focus. Treatment often is able
to address these issues if they are present.
- Biological: Recent research has shown that the
neurological make-up of pathological gamblers is substantially different
then that of "normal" gamblers. Briefly stated here, there
are clear difference in the utilization of dopamine, which is a
neurotransmitter (brain chemical) that is associated with pleasure and
serotonin which is involved with impulse control.
There also appears to be differences in the frontal lobe activity of
gamblers.
Treatment sessions are held once or twice a week depending on degree of
addiction. Session frequency can be reduced once the person is not
gambling and emotionally stable (typically 3-6 months, but sometimes longer).
Therapy sessions are scheduled at a consistent time each week. Less
frequent sessions may be available, but this is determined on a case by case
basis.
In some situations telephone sessions are available, but this
depends on the patient's stability and ability to sustain abstinence. Phone
sessions for active gamblers are usually not appropriate.
Family members are encouraged to be involved whenever possible.
Attendance at Gambler's Anonymous meetings is strongly encouraged and some of
the concepts are used in my treatment program.
Supplemental reading material and video materials are available.
If a patient continues to struggle to maintain abstinence from gambling, a brief
daily phone call is often required for a limited period of time.
If medications are needed, a referral to a psychiatrist is made.
Long term follow-up after treatment is available.
If you are interested in learning more specific information about my
office location please click here Office information
For a brief biographical sketch of my background and training click here: biography
"If I have to change something, I change it. if you're
on a path and there's a fork, and you know which way you have to go and you know
that something's stopping you... that means making some changes when it's not
really very easy to do, but ultimately that keeps you alive." Neil Young
