Harm Reduction Psychotherapy

This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies that vividly illustrate this approach with a wide variety of clients, treated individually and in groups by different therapists. The stories are framed by commentary from Dr. Tatarsky, who draws out their therapeutic features and builds a powerful argument for harm reduction as an approach that meets clients where they live.

Research has found that it is easier for some people to begin counseling when specific goals are not required to enter treatment. In harm reduction therapy, any treatment goal that helps reduce harm to an individual is valid. Total abstinence, which may be an outcome of treatment, is one goal among several alternatives. Both abstinence and moderate drug and alcohol use fall under the umbrella of harm reduction.

This approach tailors the treatment to fit the individual, rather than forcing the individual into a treatment model. It employs the methods of psychoanalysis, in addition to cognitive-behavioral strategies, to engage the whole person, not just the addictive behavior. Key to this is helping the client, who is viewed as unique, not part of a problem population, to unlock the hidden meanings that his or her behavior expresses. Once identified, these meanings (or coping mechanisms) can be altered through a combination of psychoanalytic, cognitive, and behavioral techniques.

Though written primarily for clinicians, Dr. Tatarsky's book provides valuable perspectives for laypersons who are considering moderating their drinking or abstaining from alcohol altogether. Many will identify with one or more of the individuals portrayed in the case studies: Tom, a gay museum curator who expresses his anger and depression in drunken behavior toward his coworkers; Gary, a physician whose bravado masks deep personal pain and who self-medicates rather than betray his vulnerability by asking for help; Diana, a single woman who uses wine to free herself from the critical inner voice of her mother. About half of the individuals portrayed choose moderation over abstinence.

Those in search of professional guidance will be encouraged to learn that there are clinicians out there who will help them to set and meet realistic and healthy goals, and do so with understanding and compassion. And although lay-led support groups like Moderation Management are outside the scope of the book, MM members will benefit from Dr. Tatarsky's wise observations about the interconnection of emotions and behavior, and the incremental nature of personal change.