Many recovering addicts choose to seek help in therapy as well as twelve step rooms. Sometimes this begins with a stay at an inpatient rehab followed by standard outpatient therapy. Other times addicts skip rehab and seek standard outpatient treatment right away. Either way, therapists who specialize in addiction treatment (and even those who don’t) nearly always steer their addicted clients toward twelve step meetings, encouraging them to get a sponsor and to work the twelve steps as originated by the founders of Alcoholics Anonymous and adapted for use by other recovery programs.
Generally, the twelve steps are worked with guidance from a sponsor—a fellow recovering addict who has worked the steps already as part of his or her own recovery. Therapists, even those who are in recovery themselves, should NOT serve as a client’s sponsor. The therapeutic alliance is unique, and it should not be conflated with sponsorship. A sponsor’s primary function is to walk an addict through the twelve steps of recovery, occasionally providing in-the-moment guidance and suggestions. The role of a therapist is very different, though complementary.
Generally speaking, therapists focus on breaking through the addicted client’s denial, helping that individual to see and understand the nature and consequences of his or her addiction. As such, addiction-focused therapy looks more at current behaviors than the past. Later in the recovery process, after sobriety is firmly established, childhood trauma and other early-life issues can be uncovered and dealt with. In the beginning, however, in-the-moment behavior change is the primary emphasis.
Typically, psychotherapeutic tasks include psychoeducation (learning about the addiction), behavioral contracting (agreeing to abstain from problematic behaviors) coupled with various forms of accountability, and resolution of the addict’s immediate crises (the situations and consequences that drove the addict into treatment).
Additionally, as stated above, addiction-focused clinicians nearly always encourage clients to participate in twelve step recovery. To this end, the therapist might:
- Explain the nature of twelve step programs and what addicts should expect at meetings
- Suggest specific meetings that the addict might find comfortable and beneficial
- Monitor the client’s twelve step meeting attendance and participation, encouraging, when necessary, a greater involvement
- Explain the role of a sponsor, helping the client decide who might be a good choice
- Assign therapeutic tasks that mesh with the client’s twelve step work, so that therapy and twelve step recovery are mutually reinforcing
This last bit, assigning therapeutic tasks that mesh with twelve step work, is incredibly important. Though therapists typically do not walk their addicted clients through the actual steps, they often ask them to perform related work. This is most likely to occur early in the recovery process, when addicted clients are asked to create lists detailing their preoccupation/obsession with their substance/behavior of choice, attempts they’ve made to control their use of that substance/behavior (and their lack of success in this regard), and consequences they’ve experienced as a result of their addiction.
This early therapeutic work is meant to educate the client about the nature of his or her addiction, and to help break through any remaining denial. Those goals also happen to be the primary goals of step one: We admitted we were powerless over our addiction, and that our lives had become unmanageable. Thus, the work of therapy and twelve step recovery may mesh in ways that are mutually reinforcing.
As addicts move forward in their recovery, especially if they have a knowledgeable, twelve step oriented therapist, the work of therapy may continue to parallel the work of twelve step recovery. Over time, however, as sobriety becomes well established, therapeutic work will tend to move more toward traditional therapeutic issues like resolution of childhood trauma, addressing underlying issues like depression and/or anxiety, developing healthier interpersonal relationships, etc. Meanwhile, twelve step work continues to focus primarily on the addiction and maintaining sobriety.
In future postings to this site, I will present suggestions for how to effectively work each of the twelve steps.