February 28, 2013 by Dr. Bob Weathers
I recently had the opportunity to watch the video “Integrating Therapy with 12-Step Programs” (published in 2000 by Allyn & Bacon). The presenters, three Ph.D. therapists, begin by touting the value of a comprehensive bio-psycho-social approach to treatment; one which addresses and takes seriously the undeniable biochemical and medical aspects of addiction, as well as the psychological (individual and family) and social (socioeconomic, ethnic, gender) factors underlying addictive behavior.
The presenters stress that therapy and 12-Step programs are ideally complementary, including considerable overlap between their respective functions. With this premise in mind, the presenters extol the value of 12-Step programs’ focus on stopping the addictive behavior (abstinence), as well as their providing a connecting, supportive subculture which is clearly committed to the individual’s recovery. To this last point: the presenters argue convincingly for our all being basically “tribal” by nature; hence in need of communities like the 12-Step programs, and never more so than when in major life transitions like recovery from addiction.
Yet there are plenty of times, over the course of an addict’s healing and recovery process, where therapy makes sound sense as collateral treatment. The presenters repeatedly assert: stopping substance abuse may be only the beginning. The question arises as to how to sustain that abstinence (or, relapse prevention). For example, an individual coming to recovery with a history of severe trauma (childhood abuse, or PTSD, as in the case of the war veteran with whom therapy is recorded live, by one of the presenters) may need first to be clear of substance (detoxified). But then individual, trauma-focused therapy may be indicated in order to clear future obstacles (anxiety, depression, obsessive-compulsive behaviors) to sobriety.
It makes good sense when the presenters clarify that abstinence provides “containment” to pave the way for therapy. In essence: no sobriety, no truly effective treatment. In this spirit, we learn that getting clean and sober is the first priority, before examining other emotional and relationship issues in therapy; hence, the value of 12-Step programs’ bedrock in abstinence.
The presenters observe: once you remove the “anesthetic,” then the psychological work may at last commence. And if there is relapse, a therapist’s response is primarily to thoroughly examine emotional and relational precursors to that relapse. In actual fact, recovery is, as the presenters articulate, “spelled W-O-R-K.” It may be something closer to two steps forward, one step backward. The crucial element is the direction in which the recovering addict is headed.
Once the addict has moved from prior ambivalence (about his/her entering wholeheartedly into recovery) toward a decisive commitment (Step 3: “Made a decision to turn our will and our lives over to the care of God as we understood Him.”), then the hard work, or action, truly begins. Therapy may be of adjunctive service here both in mobilizing clients to embark in earnest on their own recovery paths, but also to aid their examining closely any possible blockages, or resistance, to 12-Step meeting attendance and step-work (under the close supervision of a sponsor; seen here as functioning hand-in-hand with good therapy).
One final note: I really appreciate the presenters’ closing emphasis on therapists, who would work collaboratively with 12-Step programs, themselves attending 12-Step meetings as a matter of course. (The presenters suggest a minimum of 6-12 meetings/year.) This hands-on involvement goes a long ways in ensuring a genuine spirit of working together; where the right hand truly knows what the left hand is doing, and vice versa!