Sometimes, especially in difficult times like we are experiencing right now, one looks outside of oneself for answers and assistance coping with one’s feelings. For many, psychotherapy is the answer. However, for those already participating in a 12-step program there may be some resistance to this idea based on misinformation regarding the compatibility of therapy with the core beliefs as sober members in a program. While they serve crucial but different purposes, the individual benefits cannot be addressed by the other. However, by combining a 12-step program with psychotherapy, one is able to reap a better benefit from both.
It is important to acknowledge that 12-Step models embrace the idea that one is allowed to be as miserable as one is willing to tolerate. It’s true that through elements like the 4th step it is possible to achieve relief from narcissism, anxiety, and the like. However, as stated in the Big Book, “There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.” The key is not only being honest with others, but with yourself as well. In the 3rd step it recommends turning oneself over to something higher than yourself. Recognizing one’s limitations and need for greater assistance is paramount to continued recovery. Think of the therapist as a kind of sponsor like figure. However, unlike a sponsor, your therapist will not tell you what to do. Rather, they will help you better understand your experience and develop your own strength and hope. Like a sponsor however, many therapists have learned much about the practice of psychotherapy as a function of having been patients themselves.
In comparing the components of psychotherapy and the 12-Steps there are many commonalities. Firstly, there is a trained socially sanctioned healer. Second the individual is immersed in the therapist/sponsors model of therapy/steps. Thirdly there is a formal change process. Fourthly, the understanding of both the problem and of the cure is achieved. Fifthly, the individual is re-moralized. And lastly, there is an expectation of improvement and consequently the experience of hope. It is important to note that although the goal of successful participation in the 12-Step programs is abstinence, abstinence without a corresponding change in character or personality is viewed as unstable. Addiction is conceptualized as a problem that is 90% thinking and 10% using. The idea that one cannot remain clean “without undergoing a profound personality change” is certainly consistent with psychotherapeutic approaches to alcoholism.
Let’s look at the first three steps. Step 1 (powerlessness) could be associated with the acknowledgment of a loss of agency. Step 2 (the belief that something greater than oneself can help) can be viewed as compensating for a lack of internal structure. Step 3 (turning it over) may be associated with relief from the effort of carrying the weight of strong feelings without assistance and the presumption of agency. These first three steps have been critical for patients’ effectiveness in psychotherapy as well.
Further evidence of the two modalities’ compatibility include psychoanalytic (the modality we use here at the clinic) treatment’s ability to improve one’s sense of self (an important facet in 12-Steps as well). In the programs people share their experience, strength, and hope by telling the group “what it was like, what happened, and what it is like now.” These life stories often begin at birth and describe early childhood experiences in the family of origin that shaped the feelings, attitudes, and beliefs that precipitated and maintained drinking behavior. The role that these attitudes, beliefs, and feelings played in the development of alcoholic drinking and behavioral problems is discussed in these shares. There is usually an emphasis on how these attitudes, beliefs, and feelings changed as a function of abstinence and recovery. Similarly, psychoanalytic theory consists of looking in our past to find the unconscious beliefs that plague us today. By discovering where they came from and understanding them on a deeper level one is able to achieve relief and better personal understanding. For those struggling in the 12-Step programs (perhaps someone who suffers from PTSD or other trauma) to address these past events, psychoanalytic theory may help them better integrate these experiences in a productive way.
Similarly, introspection and the consolidation of the self are further enhanced in the process of completing the fourth step, which requires that a searching and fearless moral inventory is completed. This requires self-examination of positive and negative traits and behaviors or actions. When this step is done honestly and thoroughly, the self-view is rather complete and the self-representation is quite real. In sharing with another person “the exact nature of our wrongs” in the 5th step as they exist alongside positive traits and attributes, an honest presentation of the self is offered to another human being. If the person to whom the self-disclosure is made is chosen correctly, the response is not punishment or condemnation. What is communicated is unconditional acceptance and the reality that one does not have to continue on as before. This encapsulates the therapeutic relationship perfectly. Ideally, from your therapist you can receive a steady stream of empathy, as well as a safe container in which you can express your deepest fears and feelings. Thus, the therapeutic relationship is supported by ultimate trust, acceptance, and confidentiality.
From a clinician’s point of view, I have seen how 12-step and other addiction programs have saved countless lives. To those that depend so avidly on their recovery community, it is understandable how outside sources of help might be viewed with suspicion, especially if it is perceived that the principles are in conflict. Please remember that these are the opinions of a fellow addict, whose opinions are most likely shaped from fear and misinformation. As emphasized in this blog post, although 12-step programs and the professional treatment approach of psychotherapy grew out of different traditions, the two approaches share a common goal, target similar issues, and work toward similar outcomes. I hope you find this blog post helpful in your journey of recovery and mental wellness.
- by Courtney Dietler