|Men in Therapy Gender Issues Ethics Attachment Theory Couples Challenging Cases Symposium 2012 Mindfulness William Doherty Narcissistic Clients Couples Therapy Etienne Wenger Future of Psychotherapy Attachment Community of Excellence Clinical Mastery The Future of Psychotherapy Mind/Body Diets David Schnarch Anxiety Linda Bacon CE Comments Trauma Great Attachment Debate Brain Science Mary Jo Barrett Alan Sroufe Clinical Excellence Wendy Behary|
|In Consultation Mar/Apr - Page 3|
Once a client is attending AA meetings, clinicians may best view themselves as coaches, letting the program do the work of supporting sobriety. Clarifying misunderstandings about the program and defusing resistance to its precepts are important clinical tasks, especially in the early stages of involvement. The process may raise countertransference issues, in that therapists must surrender their pride in their roles as helpers. We're used to viewing psychotherapy as the center of the change process; in recovery from alcoholism, it's critical to see AA's program as the primary agent of change. Our role complements the work on honesty, humility, and spiritual surrender that clients experience in AA.
Many members of AA cite psychotherapy as an important complement to the work they're doing, but a therapist who doesn't fully understand the program may inadvertently sabotage its good work. I recall one well-intentioned therapist who, pursuing the reasonable agenda of helping her client feel more empowered, discouraged her from attending meetings, fearing that acknowledging powerlessness over alcoholism would undermine the larger goal. Without adequate group support for sobriety, this patient's efforts at self-empowerment were severely compromised. Alternately, some of my clients have expressed their comfort in being able to discuss dilemmas rising in the fellowship with someone who understands both the AA program and their own individual dynamics.
The best "training" in AA can be obtained by attending a few meetings; nonalcoholics may go to any meeting listed as an "open" meeting, which will admit anyone who has an interest in alcoholism. Those who do attend are often surprised by the warmth of the reception they get as they walk through the door. Clinicians, in particular, are usually impressed by the degree of honesty and self-disclosure they encounter in a meeting, and by the feeling of hope, community, and good humor they experience there.
The issues of responsibility, acceptance, and prioritization are illustrated in a clinical example. Recently, I treated an alcoholic wife and a critical but overprotective husband. To her, his overbearingness was the stressor that needed to change if she were to attain secure sobriety. He defended his behavior by pointing to her pattern of relapses. Recognizing the AA aphorism "First things first," I saw that this couple's debate missed the central issue: that she must assume responsibility for her own recovery. I refocused the discussion on her actions in support of her sobriety: had she attended any AA meetings in the last week? had she taken her Naltrexone (a medicine that often cuts cravings)? had she called her sponsor? These questions, not the marital issues, were the pressing ones. The interpersonal dynamics were quite real, but they'd come later.