Clinicians Digest Jan/Feb 2008 - Page 6


The two most severely affected groups--Young Antisocial and Chronic Severe--fit the common perception of people with AD. They're the most likely to have antisocial personality disorder and a history of legal, personal, and financial troubles. The primary difference between these groups is that the Young Antisocials downplay the negative effects of their own drinking, while the Chronic Severe group no longer does.

Moss feels it would be helpful to use these types as a guide to determine which treatment approaches to use. The more severe types require the most intense, multifaceted interventions and complete abstention, he thinks. But it may be counterproductive to automatically approach the less severe types with stern interventions and demands for total abstention. Because they haven't paid a price for drinking and may, in fact, be able to maintain their lifestyle and control their drinking, abstention is less likely to be a goal that engages them in treatment.

Does Therapy Breed Isolation?

Even in the absence of empirical evidence, most therapists assume that the supportive therapeutic relationship enhances clients' abilities to have successful relationships with others. Why, some might argue, waste time researching something so self-evident? Not so fast, says Harvard psychiatrist Richard Schwartz, "The conviction that psychotherapy is good for social adjustment turns out to be largely an act of faith," he says.

To support his claim, Schwartz points to the large Stockholm Outcome of Psychoanalysis and Psychotherapy Project in 2000, which looked at therapy's long-term outcomes. The project found that after therapy concluded, patients who underwent psychoanalysis and psychotherapy engaged significantly less with other people--a decline in social functioning found even among those whose therapy was considered successful.

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