Overview: The purpose of this article is to share some ideas and experience regarding psychotherapy and the Twelve Steps and working with clients in Twelve Step Recovery, offer some guidelines and suggestions for working with recovering clients, and invite dialogue and conversation within our community to better serve this population.
There is a fair amount of ambivalence, if not outright distrust or disdain, in both communities, regarding the value and effectiveness of the other. Many a joke is cracked and a good hearty laugh had at the expense of psychotherapy during the course of Twelve Step meetings around the world, where therapy is often regarded as a total waste of time and money. At the same time, I have noticed an equal ambivalence or doubt, if not ignorance, among therapists, regarding the value and effectiveness of the Twelve Step Recovery experience for those who rely on it.
While there is some truth to both of these points of view – psychotherapy is not useful for all addicts in all situations and some addicts do use the Twelve Step programs as another escape from the deeper and more challenging issues they face - for the most part, my experience has been that psychotherapy and the Twelve Steps, when used together to complement each other and practiced in the spirit of cooperation, are a powerful force for healing and transformation which can mean the difference between true happiness in recovery and continued relapse and suffering. Furthermore I've found that the Twelve Steps and psychotherapy are not only compatible but are, in a sense, merely different approaches to, and contexts for, the same process: discovering and bringing to light that which blocks or obstructs our capacity for joy and aliveness, and cultivating a more balanced, fulfilling and joyful way of life; one that is sustainable over the long haul.
The Twelve Steps invite us to look closely at our thoughts, feelings, motives, beliefs, attitudes, dreams, fantasies, and conduct, and to discuss these with another human being, in the interest of freeing ourselves from the bonds of suffering, and living happy and productive lives.These elements comprise a process of becoming more aware of how we actually live, moment by moment, and finding a fuller and freer way of living; an invitation to deeper awareness and connection. Psychotherapy is, in my view, a similar and, in some instances, nearly identical process. The containers and interventions may differ but, ultimately, the goal and the essence are the same.
Many people in Twelve Step programs arrive at a point in their recovery where therapy becomes an key part of the process. For many, this is a troubling and challenging dilemma. The prospect of trusting someone who may not be in recovery with intimate, shameful, painful feelings and experiences, may feel risky at best and life-threatening at worst; particularly after one establishes trust, sometimes exclusively, with sponsor(s) and friends in recovery.
Many, if not most addicts - and by addicts, I mean all types of addicts: food addicts, sex and love addicts, debt and spending addicts, gambling addicts, drug addicts, alcoholics, relationship addicts, codependents, come into recovery realizing their lives are in serious, even perilous danger. The realization and acceptance of this fact, is, ideally, the foundation of recovery. It's what makes one willing, as the book “Alcoholics Anonymous” (aka “the Big Book”) says, “to go to any length,” (p. 58) to recover. If our life is on the line, we are more likely to try things that our fears, defenses, and habitual patterns would have us resist or outright refuse to try. For many addicts, anything that feels like it may topple the apple cart of recovery, or “sobriety,” in the largest sense of the word, feels life-threatening. Therapy may very well fall into this category.
For many addicts, keeping things simple and routine is extremely valuable in avoiding slips and lapses that can prove Psychotherapy and the Twelve Steps: Addressing Some of the Unique Concerns of Clients in 12-Step Recovery cont'd.
quite dangerous. Entering therapy to work on issues that have long plagued them, even in sobriety, can feel like walking a tight rope with death on either side. “What if my therapist and my sponsor don't agree? What if my therapist suggests I do something that the program would discourage? What if I get triggered by something my therapist says and relapse? How can I trust a therapist anda sponsor and a Higher Power? I don't want to upset the apple cart; I've been sober – or abstinent – too long.” A well-informed, aware therapist can offer a quality of aid and
support that can make this journey less treacherous – both literallyand emotionally – for a client in recovery. A firm knowledge and understanding of the Twelve Steps and the Twelve Step recovery process as it is commonly practiced can provide the therapist with a greater ability to support the client's recovery, while doing the therapeutic work that can foster the growth and development the client so desperately needs.
Some practical suggestions:
Here are some practical suggestions for improving your effectiveness when working with clients in 12-Step Recovery:
Attend open 12-Step meetings, particularly in the fellowships to which your clients belong.
Read AA literature and literature from other fellowships; specifically:
Alcoholics Anonymous ('the Big Book')
The Twelve Steps and Twelve Traditions (AA)
The Twelve Steps of Overeaters Anonymous
Co-Dependents Anonymous (the CODA 'Big Book' )
How Al-Anon Works
Sex and Love Addicts Anonymous (S.L.A.A. 'Basic Text').
Ask how many meetings your client is attending. Ask if that's enough. Ask how long it's been since they spoke with their sponsor and how often they speak. Take an interest in their relationship with their sponsor and the others they attend meetings with.
Take an interest in their recovery and how it's going for them. Ask them what step they are on and how they are progressing. Inquire about their relationship with God or Spirituality or a Higher Power; this is an essential element of the recovery process and one that often poses difficulties along the way.
Familiarize yourself with the Twelve Steps so that you can relate directly to your clients' experience and understand what they are talking about.
In many ways, working with clients in Twelve Step Recovery is like working with any other cultural difference: the more we can learn about it - from our clients, our own research, consultation and immersion - the better equipped we are to help them.
Alcoholics Anonymous. (2002). Alcoholics Anonymous Big Book, 4th Edition. New York, NY: Alcoholics Anonymous World Services.
Al-Anon Family Groups. (2008). How Al-Anon Works. New York, NY: Al-Anon Family Groups.
Alcoholics Anonymous. (1981). The Twelve Steps and Twelve Traditions. New York, NY: Alcoholics Anonymous World Services.
Anonymous. (2012). Co-Dependents Anonymous, 1st Edition. New York, NY: CoDA Resource Publishing.
Anonymous. (1993). The Twelve Steps of Overeaters Anonymous, 1st Edition. Rio Rancho, NM: Overeaters Anonymous, Incorporated.
Augustine Fellowship. (1986). Sex and Love Addicts Anonymous: The Basic Text for the Augustine Fellowship. San Antonio, TX: The Augustine Fellowship.
Peter received his Masters Degree in Counseling Psychology, with a Transpersonal Focus and a Specialization in Child and Adolescent Therapy, from John F. Kennedy University. He is also Certified by the Kripalu Yoga Institute in Lenox, MA as a Holistic Health Counselor / Educator. He was originally trained in the Humanistic Client-Centered and Gestalt methods, gradually incorporating a myriad of other methods and approaches, 25 years of Zen Buddhist practice, and his training in Holistic Health Counseling and Education into his practice as a Psychotherapist. He also completed 12 units of Early Childhood Education at Merritt College and taught preschool for three years. Peter specializes in working with people in 12-Step Recovery, those who have survived the suicide of a loved one, adolescents and their families, and spiritual and existential dilemmas. He lives by the lake in Oakland and has an office in South Central Berkeley.