Private DetectiveMany therapists operate on what may be characterized as the root cause hypothesis. That’s the notion that inside every addict or alcoholic there exists an emotional root cause for that person’s addiction– something in their experience, however remote, that’s driving their substance use. The therapist assumes that if the root cause can be identified, it can then be ‘dealt with’ in therapy, to the point where the patient’s desire for substances is reduced or goes away entirely.

It’s the foundation of many psychodynamic approaches. Sometimes the root cause is believed to be trauma, or something about the ‘family of origin’. The therapist presumes it exists and sets out, through therapy, to uncover it– much like Sherlock Holmes on a case.

On one occasion, I observed a therapist working with a patient who’d come for treatment of PTSD. The patient, an alcoholic, had been successfully sober for two years. “Yes, but have you understood why you drank?” the therapist wanted to know. The patient shrugged. “I’m an alcoholic– and I don’t drink anymore. I’m OK with that,” she explained.

But the therapist wasn’t. “You must understand the root cause of your drinking,” she insisted.

Translation: Patient’s experience doesn’t fit therapist’s belief system, so therapist rejects it.

We’re all attracted on some level to the idea of exploring our own personal mystery. For some of us, the pot of gold is the possibility of a single explanation for who we are. But maybe there isn’t one. Complex behaviors often require complex explanations. And it’s not like there’s a CCTV camera in our heads that recorded our existence so we can go back and check it for evidence.

Maybe some of us will come away feeling that we’ve identified a root cause for our problems — but most of us won’t.

To me, it’s more a deep-sea treasure hunt than a detective novel. Sometimes the map is wrong, and the treasure just wasn’t there.

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