When Behavioural Addiction Arrives in a Generalist Caseload

The referral rarely says addiction. It says anxiety, or low mood, or relationship difficulties. The gambling emerges in session six, usually sideways, and often with an apology attached. What happens in the following ninety seconds tends to shape the rest of the work.

Most therapists I supervise have had no specific training in behavioural addiction, and many describe a particular kind of hesitation when it appears: a sense that this belongs somewhere else, with someone more specialist. Sometimes referral is appropriate. In other cases the work may remain within a practitioner's competence when risk, harm, training, supervision and available specialist support have all been considered.

Two questions can be useful early on. The first is whether focusing on the detail of what was gambled, played or watched would help the formulation or simply increase a client's sense of exposure. The function also matters: what was happening beforehand, what changed during the behaviour, and what arrived afterwards. For some people the behaviour temporarily reduces a difficult internal state; noticing that possibility can support a less judgemental formulation.

The second is to consider the aftermath as part of the formulation rather than assuming self-criticism will motivate change. Shame can reinforce secrecy and may recreate some of the distress the behaviour temporarily alters. Approaches that intensify disgust or self-attack therefore risk making the pattern harder to discuss and change, although each person's maintaining factors need to be assessed rather than assumed.

There is a third thing, less comfortable, which belongs in supervision rather than in session. These cases provoke us. Financial loss can activate our own relationship with money; gaming and pornography can activate positions we did not know we held. A therapist who is quietly appalled will be experienced as appalled, whatever the words say, and the client — already expert at detecting judgement — will edit accordingly. Noticing that response early is more useful than being sure you do not have one.

The absence of a specific accreditation does not remove the usual duty to work within competence. A formulation that includes function, a non-shaming stance and appropriate supervision may support some generalist work. Significant financial harm, safeguarding concerns, diagnostic uncertainty or needs outside the practitioner's skills should prompt early consultation with, or referral to, specialist services.